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Foster HM, Polz P, Gill JM, Celis-Morales C, Mair FS, O'Donnell CA. The influence of socioeconomic status on the association between unhealthy lifestyle factors and adverse health outcomes: a systematic review. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18708.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Combinations of lifestyle factors (LFs) and socioeconomic status (SES) are independently associated with cardiovascular disease (CVD), cancer, and mortality. Less advantaged SES groups may be disproportionately vulnerable to unhealthy LFs but interactions between LFs and SES remain poorly understood. This review aimed to synthesise the available evidence for whether and how SES modifies associations between combinations of LFs and adverse health outcomes. Methods: Systematic review of studies that examine associations between combinations of >3 LFs and health outcomes and report data on SES influences on associations. Databases (PubMed/EMBASE/CINAHL), references, forward citations, and grey-literature were searched from inception to December 2021. Eligibility criteria were analyses of prospective adult cohorts that examined all-cause mortality or CVD or cancer mortality/incidence. Results: Six studies (n=42,467–399,537; 46.5–56.8 years old; 54.6–59.3% women) of five cohorts were included. All examined all-cause mortality; three assessed CVD/cancer outcomes. Four studies observed multiplicative interactions between LFs and SES, but in opposing directions. Two studies tested for additive interactions; interactions were observed in one cohort (UK Biobank) and not in another (NHANES). All-cause mortality HRs (95% CIs) for unhealthy LFs (versus healthy LFs) from the most advantaged SES groups ranged from 0.68 (0.32–1.45) to 4.17 (2.27–7.69). Equivalent estimates from the least advantaged ranged from 1.30 (1.13–1.50) to 4.00 (2.22–7.14). In 19 analyses (including sensitivity analyses) of joint associations between LFs, SES, and all-cause mortality, highest all-cause mortality was observed in the unhealthiest LF-least advantaged suggesting an additive effect. Conclusions: Limited and heterogenous literature suggests that the influence of SES on associations between combinations of unhealthy LFs and adverse health could be additive but remains unclear. Additional prospective analyses would help clarify whether SES modifies associations between combinations of unhealthy LFs and health outcomes. Registration: Protocol is registered with PROSPERO (CRD42020172588; 25 June 2020).
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Oude Groeniger J, Houweling TAJ, Jansen PW, Horoz N, Buil JM, van Lier PAC, van Lenthe FJ. Social inequalities in child development: the role of differential exposure and susceptibility to stressful family conditions. J Epidemiol Community Health 2023; 77:74-80. [PMID: 36428086 PMCID: PMC9872228 DOI: 10.1136/jech-2022-219548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stressful family conditions may contribute to inequalities in child development because they are more common among disadvantaged groups (ie, differential exposure) and/or because their negative effects are stronger among disadvantaged groups (ie, differential impact/susceptibility). We used counterfactual mediation analysis to investigate to what extent stressful family conditions contribute to inequalities in child development via differential exposure and susceptibility. METHODS We used data from the Generation R Study, a population-based birth cohort in the Netherlands (n=6842). Mother's education was used as the exposure. Developmental outcomes, measured at age 13 years, were emotional and behavioural problems (Youth Self-Report), cognitive development (Wechsler Intelligence Scale for Children) and secondary education entry level. Financial and social stress at age 9 years were the putative mediators. RESULTS Differential exposure to financial stress caused a 0.07 (95% CI -0.12 to -0.01) SD worse emotional and behavioural problem -score, a 0.05 (95% CI -0.08 to -0.02) SD lower intelligence score and a 0.05 (95% CI -0.05 to -0.01) SD lower secondary educational level, respectively, among children of less-educated mothers compared with children of more-educated mothers. This corresponds to a relative contribution of 54%, 9% and 6% of the total effect of mother's education on these outcomes, respectively. Estimates for differential exposure to social stress, and differential susceptibility to financial or social stress, were much less pronounced. CONCLUSION Among children of less-educated mothers, higher exposure to financial stress in the family substantially contributes to inequalities in socioemotional development, but less so for cognitive development and educational attainment.
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Affiliation(s)
- Joost Oude Groeniger
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands .,Department of Public Administration and Sociology, Erasmus University, Rotterdam, Netherlands
| | - Tanja AJ Houweling
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Pauline W Jansen
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Nil Horoz
- Dept of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - J. Marieke Buil
- Dept of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Amsterdam, Netherlands,Research Centre Urban Talent, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | - Pol AC van Lier
- Dept of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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Poulsen VR, Fischer LK, Aadahl M, Mortensen OS, Skou ST, Jørgensen LB, Jepsen R, Møller A, Petersen TL, Brønd JC, Tang L, Korshøj M. The association between physical activity, low-grade inflammation, and labour market attachment among people with multimorbidity: A cross-sectional study from the Lolland-Falster Health Study, Denmark. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231195510. [PMID: 37621316 PMCID: PMC10447179 DOI: 10.1177/26335565231195510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023]
Abstract
Aim Evidence suggests low-grade inflammation (LGI) to be associated with multimorbidity. Furthermore, there are links between inflammation markers, physical activity (PA), and labour market participation. The aims of this study were to examine the association between PA and LGI in people with multimorbidity and if this association was moderated by self-reported labour market attachment. Methods Cross-sectional data were collected in the Lolland-Falster Health Study (LOFUS) from 2016-2020. We included 1,106 participants with multimorbidity and valid accelerometer data. PA was measured as the average counts per minute (CPM) per day during wake time and split in time spent in moderate to vigorous intensity (MVPA) and light intensity (LPA). Degree of inflammation was determined by high sensitive C-reactive protein (hsCRP) level. Associations were investigated using multiple logistic regression analyses, stratified by labour market attachment. Results The odds of having LGI was higher with lower amount of daily LPA. The highest odds of LGI was observed for CPM < 200 per day (odds ratio (OR) 2.55; 95% confidence interval (CI) 1.46-4.43), MVPA < 15 minutes per day (OR 2.97; 95 % CI 1.56-5.62), and LPA < 90 (OR 2.89; 95 % CI 1.43-5.81) with the reference groups being CPM ≥ 400 per day, MVPA ≥ 30, and LPA ≥ 180 min per day, respectively. We could not preclude an interaction between LPA and labour market attachment (p = 0.109). Conclusion PA recommendations should be developed with attention to people with chronic diseases, who may experience barriers to reach PA at high intensities. People with no labour market attachment may benefit from primary and secondary prevention of multimorbidity.
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Affiliation(s)
- Vivian Rueskov Poulsen
- Department of Occupational and Social Medicine, Holbæk Hospital, a part of Copenhagen University Hospital, Holbæk, Denmark
| | - Linda Kjær Fischer
- Department of Strategy and Plan, Zealand University Hospital, Køge, Denmark
| | - Mette Aadahl
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole Steen Mortensen
- Department of Occupational and Social Medicine, Holbæk Hospital, a part of Copenhagen University Hospital, Holbæk, Denmark
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Lars Bo Jørgensen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
- Department of Physiotherapy and Occupational Therapy, Zealand University Hospital, Roskilde, Denmark
| | - Randi Jepsen
- Lolland-Falster Health Study, Centre for Epidemiological Research, Nykøbing F. Hospital, Nykøbing Falster, Denmark
| | - Anne Møller
- Centre of Research and Education in General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Primary Health Care Research Unit, Region Zealand, Denmark
| | - Therese Lockenwitz Petersen
- Lolland-Falster Health Study, Centre for Epidemiological Research, Nykøbing F. Hospital, Nykøbing Falster, Denmark
| | - Jan Christian Brønd
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars Tang
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
- The Department of Regional Health Research, University of Southern, Odense, Denmark
| | - Mette Korshøj
- Department of Occupational and Social Medicine, Holbæk Hospital, a part of Copenhagen University Hospital, Holbæk, Denmark
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Bruinsma J, Heger I, Loukas VS, Kassiotis T, Karanasiou G, Fotiadis DI, Hanke S, Crutzen R. Public Perspectives on Lifestyle-Related Behavior Change for Dementia Risk Reduction: An Exploratory Qualitative Study in The Netherlands. J Alzheimers Dis 2023; 95:1635-1642. [PMID: 37718799 PMCID: PMC10578282 DOI: 10.3233/jad-230217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND There is accumulating evidence that addressing modifiable risk and protective factors has an impact on dementia rates. Insight into the public's perspectives on dementia risk reduction is needed to inform future individual-level interventions and public health approaches. OBJECTIVE This study explores the publics' openness towards dementia risk reduction and willingness towards changing lifestyle behavior to reduce the future risk for dementia. METHODS Using a screening questionnaire, participants were purposively selected based on lifestyle behaviors that are associated with dementia risk. One-on-one interviews were used to explore their openness towards dementia risk reduction and willingness towards behavior change. Independently, two researchers performed an inductive content analysis. RESULTS Interviews were conducted with 23 participants aged from 40 to 79 years. Main themes that were identified from the data were: 1) abstractness of dementia risk reduction, 2) ambivalence towards changing behavior, 3) negative self-image and low behavioral control, and 4) all-or-nothing thinking about lifestyle change. CONCLUSIONS The concept of dementia risk reduction seems difficult to translate to the personal context, particularly if individuals perceive that dementia would occur decades in the future. This is problematic because a large proportion of the public needs a healthier lifestyle to reduce the incidence of dementia. Translating healthy intentions into behavior is complex and involves overcoming a variety of barriers that complicate dementia risk reduction initiatives. Support is needed for individuals who experience additional obstacles that obstruct commencing to a healthier lifestyle (e.g., negative self-image, engaging in multiple unhealthy behaviors, unrealistic perceptions about lifestyle change).
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Affiliation(s)
- Jeroen Bruinsma
- Department of Health Promotion of the Care and Public Health Research Institute at Maastricht University, Maastricht, The Netherlands
| | - Irene Heger
- Department of Psychiatry and Neuropsychology of the School for Mental Health and Neuroscience at Maastricht University, Maastricht, The Netherlands
| | - Vasileios S. Loukas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
- Biomedical Research Institute, Foundation for Research and Technology - Hellas, FORTH-BRI, Ioannina, Greece
| | - Thomas Kassiotis
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology – Hellas, FORTH-ICS-CBML, Heraklion, Crete, Greece
| | - Georgia Karanasiou
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
- Biomedical Research Institute, Foundation for Research and Technology - Hellas, FORTH-BRI, Ioannina, Greece
| | - Dimitrios I. Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
- Biomedical Research Institute, Foundation for Research and Technology - Hellas, FORTH-BRI, Ioannina, Greece
| | - Sten Hanke
- Institute of eHealth at University of Applied Science at FH Joanneum, Graz, Austria
| | - Rik Crutzen
- Department of Health Promotion of the Care and Public Health Research Institute at Maastricht University, Maastricht, The Netherlands
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Kim K, Tsai AC, Sumner JA, Jung SJ. Posttraumatic stress disorder, cardiovascular disease outcomes and the modifying role of socioeconomic status. J Affect Disord 2022; 319:555-561. [PMID: 36174781 DOI: 10.1016/j.jad.2022.09.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Substantial evidence indicates that post-traumatic stress disorder (PTSD) is associated with an increased incidence of cardiovascular disease (CVD), and differential PTSD-CVD association by socioeconomic status had been suggested. However, there are inadequate evidence on differential association. This study investigated sociodemographic heterogeneity in the association between PTSD and CVD. METHODS A total of 53,749 patients diagnosed with PTSD in 2004-2018 were recruited from Korean National Health Insurance Database. Date of first diagnosis of PTSD was set as an index date. We recruited 3 controls per each patient, matched by age and sex (N = 161,247). Monthly insurance premiums were used as a surrogate variable for socioeconomic status. Cox proportional hazard model was used to estimate the hazard of incident coronary artery disease, incident stroke, and cardiovascular mortality. We stratified participants by age, sex, and insurance premium to test heterogeneities in the association. RESULTS PTSD was associated with increased risk for coronary artery disease, hemorrhagic stroke, and cardiovascular mortality. Elevation in risk of cardiovascular disease was more prominent in younger individuals. PTSD increased the risk of coronary artery disease and ischemic stroke more in individuals with lower SES, especially in men. LIMITATIONS Insurance premium might not fully represent socioeconomic status of individual. Misclassification or misdiagnosis of PTSD by might have introduced biases. CONCLUSIONS PTSD was associated with increased incidence of CVD, particularly in male patients with low SES. For PTSD patients with lower SES, preventive measures against cardiovascular disease would be able to decrease the disease burden of cardiovascular comorbidity in PTSD.
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Affiliation(s)
- Kwanghyun Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | - Jennifer A Sumner
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sun Jae Jung
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Harvard Center for Population and Development Studies, Cambridge, MA, USA.
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Löbel LM, Kröger H, Tibubos AN. How Migration Status Shapes Susceptibility of Individuals' Loneliness to Social Isolation. Int J Public Health 2022; 67:1604576. [PMID: 36561278 PMCID: PMC9763294 DOI: 10.3389/ijph.2022.1604576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives: Our research provides competing hypotheses and empirical evidence how associations between objectively social isolation and subjective loneliness differ between host populations, migrants, and refugees. Methods: The analysis uses data of 25,171 participants from a random sample of the German population (SOEP v.35). We estimate regression models for the host population, migrants, and refugees and test five hypotheses on the association between social isolation and loneliness using a Bayesian approach in a multiverse framework. Results: We find the strongest relative support for an increased need for social inclusion among refugees, indicated by a higher Bayes factor compared to the hosts and migrants. However, all theoretically developed hypotheses perform poorly in explaining the major pattern in our data: The association of social isolation and loneliness is persistently lower for migrants (0.15 SD-0.29 SD), with similar sizes of associations for refugees and the host population (0.38 SD-0.67 SD). Conclusion: The migration history must be actively considered in health service provision and support programs to better cater to the needs of the different groups.
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Affiliation(s)
- Lea-Maria Löbel
- German Institute for Economic Research (DIW), Berlin, Germany,Berlin Graduate School of Social Sciences, Humboldt University of Berlin, Berlin, Germany,*Correspondence: Lea-Maria Löbel,
| | - Hannes Kröger
- German Institute for Economic Research (DIW), Berlin, Germany
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Olsen MH, Frederiksen K, Lassen P, Rotbøl C, Kjaer TK, Johansen J, Primdahl H, Andersen E, Kristensen CA, Andersen M, Farhadi M, Overgaard J, Dalton SO. Association of Smoking, Comorbidity, Clinical Stage, and Treatment Intent With Socioeconomic Differences in Survival After Oropharyngeal Squamous Cell Carcinoma in Denmark. JAMA Netw Open 2022; 5:e2245510. [PMID: 36477477 PMCID: PMC9856247 DOI: 10.1001/jamanetworkopen.2022.45510] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE The socioeconomic gap in survival after cancer is pronounced among patients with head and neck cancer. Understanding the mechanisms of this gap is crucial to target intervention strategies. OBJECTIVE To investigate socioeconomic differences in survival after oropharyngeal squamous cell carcinoma (OPSCC) according to human papillomavirus (HPV) status and the extent to which smoking, comorbidity, clinical stage, and treatment intent explain the survival gap. DESIGN, SETTING, AND PARTICIPANTS This nationwide, population-based cohort study was based on prospectively collected information on all patients with a diagnosis of OPSCC from the Danish Head and Neck Cancer Group database and administrative registries. The study included 4600 patients born in 1921 or later, aged 30 years or older, and residing in Denmark 1 year prior to OPSCC diagnosis. Patients with missing information (547 [12%]) were excluded. Patients were diagnosed between January 1, 2008, and December 31, 2019, and followed up until December 31, 2021. Data were analyzed from June 6 to October 4, 2022. EXPOSURE Socioeconomic position (educational level, disposable income, or cohabiting status). MAIN OUTCOMES AND MEASURES Socioeconomic differences in 5-year overall survival were estimated in Cox proportional hazards regression models by HPV status. The indirect effect and proportion mediated by smoking, comorbidity, clinical stage, and treatment intent were estimated based on a counterfactual approach. RESULTS The analyzed cohort comprised 4053 patients (1045 women [26%] and 3008 men [74%]). The median age was 61 years (IQR, 55-68 years), and 2563 patients (63%) had HPV-positive OPSCC while 1490 patients (37%) had HPV-negative OPSCC. The 5-year standardized overall survival was 10% to 15% lower among patients with a lower educational level, with low disposable income, or who were living alone (patients with HPV-positive OPSCC, 68%-71%; patients with HPV-negative OPSCC, 31%-34%) than patients with a higher educational level, high disposable income, or a cohabiting partner (patients with HPV-positive OPSCC, 81%-86%; patients with HPV-negative OPSCC, 43%-46%). Among patients with HPV-positive OPSCC, a considerable part of this survival gap was estimated to be associated with differences in smoking (27%-48%), comorbidity (10%-19%), clinical stage (8%-19%), and treatment intent (16%-28%). Among those with HPV-negative OPSCC, comorbidity (12%-22%) and treatment intent (16%-42%) were the primary potential mediators. CONCLUSIONS AND RELEVANCE This cohort study suggests that, regardless of HPV status, patients with low socioeconomic position had 10% to 15% lower 5-year overall survival than patients with high socioeconomic position. A substantial part of this survival gap was associated with differences in smoking, comorbidity, clinical stage, or treatment intent at diagnosis.
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Affiliation(s)
- Maja Halgren Olsen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Pernille Lassen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Rotbøl
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Trille Kristina Kjaer
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jørgen Johansen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Elo Andersen
- Department of Oncology, Herlev University Hospital, Herlev, Denmark
| | | | - Maria Andersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Mohammad Farhadi
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
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Östergren PO, Bodin T, Canivet C, Moghaddassi M, Vilhelmsson A. Selling one's future: over-indebtedness and the risk of poor mental health and the role of precarious employment - results from the Scania Public Health Cohort, Sweden. BMJ Open 2022; 12:e061797. [PMID: 36414307 PMCID: PMC9685259 DOI: 10.1136/bmjopen-2022-061797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The credit market has expanded rapidly, increasing the risk of over-indebtedness among those who lack secure employment or adequate income, an issue of concern in the COVID-19 aftermath. We investigated the role of over-indebtedness for developing poor mental health, and whether this impact is modified by age, gender, educational level or being in precarious employment. METHODS This is a cohort study using data from the Swedish Scania Public Health Cohort, based on individuals randomly selected from the general adult population in Scania, southern Sweden, initiated in 1999/2000 (response rate 58%) with follow-ups in 2005 and 2010. Over-indebtedness was assessed by combining information on cash margin and difficulty in paying household bills. Mental health was assessed by General Health Questionnaire-12. Those with poor mental health at baseline were excluded, and the analyses were further restricted to vocationally active individuals with complete data on main variables, resulting in 1256 men and 1539 women. RESULTS Over-indebtedness was more common among women, among persons with a low educational level, born abroad and with a precarious employment at baseline. The age-adjusted incidence rate ratio (IRR) for poor mental health in 2010 among individuals exposed to over-indebtedness in 1999/2000 or 2005 was 2.2 (95% CI 1.7 to 2.8). Adjusting for educational level, country of origin and precarious employment in 1999/2000 or 2005, yielded an IRR of 2.0 (95% CI 1.6 to 2.6). An interaction analysis indicated that a high level of education may act synergistically with over-indebtedness, regarding poor mental health among men. CONCLUSIONS Over-indebtedness was related to unfavourable societal power relations, regarding social class, gender and foreign birth. Precarious employment was independently linked to poor mental health and may also mediate the effect by over-indebtedness. The COVID-19 pandemic might entail increased over-indebtedness, which should be acknowledged in policies aiming at buffering social effects of the pandemic.
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Affiliation(s)
| | - Theo Bodin
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Region Stockholm, Center for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Catarina Canivet
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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Ross S, Armas Rojas N, Sawatzky J, Varona-Pérez P, Burrett JA, Calderón Martínez M, Lorenzo-Vázquez E, Bess Constantén S, Sherliker P, Morales Rigau JM, Hernández López OJ, Martínez Morales MÁ, Alonso Alomá I, Achiong Estupiñan F, Díaz González M, Rosquete Muñoz N, Cendra Asencio M, Emberson J, Peto R, Lewington S, Lacey B. Educational inequalities and premature mortality: the Cuba Prospective Study. Lancet Public Health 2022; 7:e923-e931. [PMID: 36334608 DOI: 10.1016/s2468-2667(22)00237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/26/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although socioeconomic status is a major determinant of premature mortality in many populations, the impact of social inequalities on premature mortality in Cuba, a country with universal education and health care, remains unclear. We aimed to assess the association between educational level and premature adult mortality in Cuba. METHODS The Cuba Prospective Study (a cohort study) enrolled 146 556 adults aged 30 years and older from the general population in five provinces from Jan 1, 1996, to Nov 24, 2002. Participants were followed up until Jan 1, 2017, for cause-specific mortality. Deaths were identified through linkage to the Cuban Public Health Ministry's national mortality records. Cox regression models yielded rate ratios (RRs) for the effect of educational level (a commonly used measure for social status) on mortality at ages 35-74 years, with assessment for the mediating effects of smoking, alcohol consumption, and BMI. FINDINGS A total of 127 273 participants aged 35-74 years were included in the analyses. There was a strong inverse association between educational level and premature mortality. Compared with a university education, men who did not complete primary education had an approximately 60% higher risk of premature mortality (RR 1·55, 95% CI 1·40-1·72), while the risk was approximately doubled in women (1·96, 1·81-2·13). Overall, 28% of premature deaths could be attributed to lower education levels. Excess mortality in women was primarily due to vascular disease, while vascular disease and cancer were equally important in men. 31% of the association with education in men and 18% in women could be explained by common modifiable risk factors, with smoking having the largest effect. INTERPRETATION This study highlights the value of understanding the determinants of health inequalities in different populations. Although many major determinants lie outside the health system in Cuba, this study has identified the diseases and risk factors that require targeted public health interventions, particularly smoking. FUNDING UK Medical Research Council, British Heart Foundation, Cancer Research UK, CDC Foundation (with support from Amgen).
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Affiliation(s)
- Stephanie Ross
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Nurys Armas Rojas
- National Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
| | - Julia Sawatzky
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Patricia Varona-Pérez
- Institute of Hygiene, Epidemiology and Microbiology, Ministry of Public Health, Havana, Cuba
| | - Julie Ann Burrett
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Marcy Calderón Martínez
- Institute of Hygiene, Epidemiology and Microbiology, Ministry of Public Health, Havana, Cuba
| | | | - Sonia Bess Constantén
- Directorate of Medical Records and Health Statistics, Ministry of Public Health, Havana, Cuba
| | - Paul Sherliker
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK; MRC Population Health Research Unit, NDPH, University of Oxford, Oxford, UK
| | | | | | | | - Ismell Alonso Alomá
- Directorate of Medical Records and Health Statistics, Ministry of Public Health, Havana, Cuba
| | | | - Mayda Díaz González
- Municipal Center of Hygiene, Epidemiology and Microbiology, Colón, Matanzas, Cuba
| | | | | | - Jonathan Emberson
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK; MRC Population Health Research Unit, NDPH, University of Oxford, Oxford, UK
| | - Richard Peto
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Sarah Lewington
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK; MRC Population Health Research Unit, NDPH, University of Oxford, Oxford, UK.
| | - Ben Lacey
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
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Nygaard SS, Høj Jørgensen TS, Srivarathan A, Brønnum-Hansen H, Kivikoski C, Kristiansen M, Lund R. Association Between Urban Regeneration and Healthcare-Seeking Behavior of Affected Residents: A Natural Experiment in two Multi-Ethnic Deprived Housing Areas in Denmark. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2022:207314221126283. [PMID: 36121903 DOI: 10.1177/00207314221126283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Area regeneration of deprived neighborhoods is being used to reduce health inequality, socioeconomic deprivation and ethnic segregation. This quasi-experimental study examines if long-term graded exposure to urban regeneration is associated with primary healthcare-seeking behavior among residents. We compared general practitioner (GP) contacts from 2015-2020 in two adjacent, deprived social housing areas, one exposed to area regeneration. Populations were into Western and non-Western males and females aged 15 years and older (N = 3,960). Mean annual GP contact frequency for each group were estimated and a difference-in-difference (DiD) analysis was conducted with adjustments for propensity scores based on baseline characteristics. GP contact frequency increased for all groups across time with a systematically higher level and faster increase in the control groups. In particular, the mean difference between the exposed and control area for non-Western women more than doubled from -0.61 to -1.47 annual contacts across the period. The mean differences in contact frequency increased for all groups but results of the DiD analyses were insignificant. In conclusion, an emerging gap in GP contact frequency, with the highest levels in the control area, was observed for all comparisons across time. More long-term research is needed to understand how the emerging gaps evolve.
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Affiliation(s)
- Siv Steffen Nygaard
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Terese Sara Høj Jørgensen
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Abirami Srivarathan
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Brønnum-Hansen
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie Kivikoski
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Lund
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Webb EK, Cardenas-Iniguez C, Douglas R. Radically reframing studies on neurobiology and socioeconomic circumstances: A call for social justice-oriented neuroscience. Front Integr Neurosci 2022; 16:958545. [PMID: 36118113 PMCID: PMC9479322 DOI: 10.3389/fnint.2022.958545] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/27/2022] [Indexed: 01/29/2023] Open
Abstract
Socioeconomic circumstances are associated with symptoms and diagnostic status of nearly all mental health conditions. Given these robust relationships, neuroscientists have attempted to elucidate how socioeconomic-based adversity "gets under the skin." Historically, this work emphasized individual proxies of socioeconomic position (e.g., income, education), ignoring the effects of broader socioeconomic contexts (e.g., neighborhood socioeconomic disadvantage) which may uniquely contribute to chronic stress. This omission represented a disconnect between neuroscience and other allied fields that have recognized health is undeniably linked to interactions between systems of power and individual characteristics. More recently, neuroscience work has considered how sociopolitical context affects brain structure and function; however, the products of this exciting line of research have lacked critical sociological and historical perspectives. While empirical evidence on this topic is burgeoning, the cultural, ethical, societal, and legal implications of this work have been elusive. Although the mechanisms by which socioeconomic circumstances impact brain structure and function may be similar across people, not everyone is exposed to these factors at similar rates. Individuals from ethnoracially minoritized groups are disproportionally exposed to neighborhood disadvantage. Thus, socioeconomic inequities examined in neuroscience research are undergirding with other forms of oppression, namely structural racism. We utilize a holistic, interdisciplinary approach to interpret findings from neuroscience research and interweave relevant theories from the fields of public health, social sciences, and Black feminist thought. In this perspective piece, we discuss the complex relationship that continues to exist between academic institutions and underserved surrounding communities, acknowledging the areas in which neuroscience research has historically harmed and/or excluded structurally disadvantaged communities. We conclude by envisioning how this work can be used; not just to inform policymakers, but also to engage and partner with communities and shape the future direction of human neuroscience research.
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Affiliation(s)
- E. Kate Webb
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, WI, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, United States
| | - Carlos Cardenas-Iniguez
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Robyn Douglas
- Department of Psychological and Behavioral Sciences, Texas A&M University, College Station, TX, United States
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D’Evelyn SM, Jung J, Alvarado E, Baumgartner J, Caligiuri P, Hagmann RK, Henderson SB, Hessburg PF, Hopkins S, Kasner EJ, Krawchuk MA, Krenz JE, Lydersen JM, Marlier ME, Masuda YJ, Metlen K, Mittelstaedt G, Prichard SJ, Schollaert CL, Smith EB, Stevens JT, Tessum CW, Reeb-Whitaker C, Wilkins JL, Wolff NH, Wood LM, Haugo RD, Spector JT. Wildfire, Smoke Exposure, Human Health, and Environmental Justice Need to be Integrated into Forest Restoration and Management. Curr Environ Health Rep 2022; 9:366-385. [PMID: 35524066 PMCID: PMC9076366 DOI: 10.1007/s40572-022-00355-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Increasing wildfire size and severity across the western United States has created an environmental and social crisis that must be approached from a transdisciplinary perspective. Climate change and more than a century of fire exclusion and wildfire suppression have led to contemporary wildfires with more severe environmental impacts and human smoke exposure. Wildfires increase smoke exposure for broad swaths of the US population, though outdoor workers and socially disadvantaged groups with limited adaptive capacity can be disproportionally exposed. Exposure to wildfire smoke is associated with a range of health impacts in children and adults, including exacerbation of existing respiratory diseases such as asthma and chronic obstructive pulmonary disease, worse birth outcomes, and cardiovascular events. Seasonally dry forests in Washington, Oregon, and California can benefit from ecological restoration as a way to adapt forests to climate change and reduce smoke impacts on affected communities. RECENT FINDINGS Each wildfire season, large smoke events, and their adverse impacts on human health receive considerable attention from both the public and policymakers. The severity of recent wildfire seasons has state and federal governments outlining budgets and prioritizing policies to combat the worsening crisis. This surging attention provides an opportunity to outline the actions needed now to advance research and practice on conservation, economic, environmental justice, and public health interests, as well as the trade-offs that must be considered. Scientists, planners, foresters and fire managers, fire safety, air quality, and public health practitioners must collaboratively work together. This article is the result of a series of transdisciplinary conversations to find common ground and subsequently provide a holistic view of how forest and fire management intersect with human health through the impacts of smoke and articulate the need for an integrated approach to both planning and practice.
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Affiliation(s)
- Savannah M. D’Evelyn
- Dept. of Environmental & Occupational Health Sciences, University of Washington, 3980 15th Ave NE, Seattle, WA 98105 USA
| | - Jihoon Jung
- Dept. of Environmental & Occupational Health Sciences, University of Washington, 3980 15th Ave NE, Seattle, WA 98105 USA
| | - Ernesto Alvarado
- School of Environmental and Forest Sciences, University of Washington, Seattle, USA
| | - Jill Baumgartner
- Dept of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada
| | | | - R. Keala Hagmann
- School of Environmental and Forest Sciences, University of Washington, Seattle, USA
- Applegate Forestry, LLC, Corvallis, USA
| | | | - Paul F. Hessburg
- School of Environmental and Forest Sciences, University of Washington, Seattle, USA
- USDA Forest Service, Pacific Northwest Research Station, Wenatchee, WA USA
| | - Sean Hopkins
- Washington State Department of Ecology, Lacey, USA
| | - Edward J. Kasner
- Dept. of Environmental & Occupational Health Sciences, University of Washington, 3980 15th Ave NE, Seattle, WA 98105 USA
| | - Meg A. Krawchuk
- Dept. of Forest Ecosystems and Society, Oregon State University, Corvallis, USA
| | - Jennifer E. Krenz
- Dept. of Environmental & Occupational Health Sciences, University of Washington, 3980 15th Ave NE, Seattle, WA 98105 USA
| | - Jamie M. Lydersen
- California Department of Forestry and Fire Protection, Sacramento, USA
| | - Miriam E. Marlier
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA
| | | | | | | | - Susan J. Prichard
- School of Environmental and Forest Sciences, University of Washington, Seattle, USA
| | - Claire L. Schollaert
- Dept. of Environmental & Occupational Health Sciences, University of Washington, 3980 15th Ave NE, Seattle, WA 98105 USA
| | | | - Jens T. Stevens
- Department of Biology, University of New Mexico, Albuquerque, NM USA
| | - Christopher W. Tessum
- Dept. of Civil & Environmental Engineering, University of Illinois at Urbana-Champaign, Champaign, USA
| | - Carolyn Reeb-Whitaker
- Safety & Health Assessment & Research for Prevention Program, Washington State Department of Labor and Industries, Tumwater, USA
| | - Joseph L. Wilkins
- School of Environmental and Forest Sciences, University of Washington, Seattle, USA
- Interdisciplinary Studies Department, Howard University, Washington, DC USA
| | | | - Leah M. Wood
- Evan’s School of Public Policy and Governance and The Department of Global Health, University of Washington, 3980 15th Ave NE, Seattle, WA 98105 USA
| | | | - June T. Spector
- Dept. of Environmental & Occupational Health Sciences, University of Washington, 3980 15th Ave NE, Seattle, WA 98105 USA
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Balaj M, Eikemo TA. Sick of social status: A Bourdieusian perspective on morbidity and health inequalities. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:1214-1250. [PMID: 35779001 PMCID: PMC9540620 DOI: 10.1111/1467-9566.13512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
Self-reported health (SRH) is one of the most frequently used measures for examining socioeconomic inequalities in health. Studies find that when faced with 'identical objective health', individuals in lower socioeconomic groups consistently report worse SRH than those in higher socioeconomic groups. Such findings are often dismissed as being the result of reporting bias, and existing literature dominated by the biomedical conception of SRH has not investigated the underlying social mechanisms at work. To address this limitation, drawing on the work of Bourdieu we employ a relational thinking between health and social position. By way of multiple correspondence analysis, we construct social space of health determinants for three European countries from different welfare states and map the trajectories of educational groups experiencing similar levels of morbidity and their relation to SRH. Differences in SRH observed among social groups for the same level of morbidity are understood in relation to the position and the relative power of individuals in different educational groups to maintain or improve their social conditions, especially with increasing levels of health loss. Our analysis indicates that reporting differences in SRH among educational groups emerges from objectively healthy individuals and follows differences in accumulation of social advantages and disadvantages.
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Affiliation(s)
- Mirza Balaj
- Centre for Global Health Inequalities Research (CHAIN)Department of Sociology and Political ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Terje A. Eikemo
- Centre for Global Health Inequalities Research (CHAIN)Department of Sociology and Political ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
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De Ramos IP, Auchincloss AH, Bilal U. Exploring inequalities in life expectancy and lifespan variation by race/ethnicity and urbanicity in the United States: 1990 to 2019. SSM Popul Health 2022; 19:101230. [PMID: 36148325 PMCID: PMC9485214 DOI: 10.1016/j.ssmph.2022.101230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background/Objective Investigating trends in life expectancy and lifespan variation can highlight disproportionate mortality burdens among population subgroups. We examined inequalities in life expectancy and lifespan variation by race/ethnicity and by urbanicity in the US from 1990 to 2019. Methods Using vital registration data for 322.0 million people in 3,141 counties from the National Center for Health Statistics, we obtained life expectancy at birth and lifespan variation for 16 race/ethnicity-gender-urbanicity combinations in six 5-year periods (1990-1994 to 2015-2019). Race/ethnicity was categorized as Hispanic, and non-Hispanic White, Black, and Asian/Pacific Islander. Urbanicity was categorized as metropolitan vs nonmetropolitan areas, or in six further detailed categorizations. Life expectancy and lifespan variation (coefficient of variation) were computed using life tables. Results In 2015-2019, residents in metropolitan areas had higher life expectancies than their nonmetropolitan counterparts (79.6 years compared to 77.0 years). The widest inequality in life expectancy occurred between Asian/Pacific Islander women and Black men, with a 17.7-year gap for residents in metropolitan areas and a 16.9-year gap for residents in nonmetropolitan areas. Nonmetropolitan areas had greater dispersion around average age at death. Black individuals had the highest lifespan variations in both metropolitan and nonmetropolitan areas. Until the mid-2010s, life expectancy increased while lifespan variation decreased; however, recent trends show stagnation in life expectancy and increases in lifespan variation. Metropolitan-nonmetropolitan inequalities in both life expectancy and lifespan variation widened over time. Conclusion Despite previous improvements in longevity, life expectancy is now stagnating while lifespan variation is increasing. Our results highlight that early-life deaths (i.e., young- and middle-age mortality) disproportionately affect Black individuals, who not only live the shortest lifespans but also have the most variability with respect to age at death.
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Affiliation(s)
- Isabel P. De Ramos
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Amy H. Auchincloss
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
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Brønnum-Hansen H, Davidsen M. Social differentials in the impact of risk factor exposures on life expectancy and health expectancy. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01724-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Totsika V, Liew A, Absoud M, Adnams C, Emerson E. Mental health problems in children with intellectual disability. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:432-444. [PMID: 35421380 DOI: 10.1016/s2352-4642(22)00067-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 12/16/2022]
Abstract
Intellectual disability ranks in the top ten causes of disease burden globally and is the top cause in children younger than 5 years. 2-3% of children have an intellectual disability, and about 15% of children present with differences consistent with an intellectual disability (ie, global developmental delay and borderline intellectual functioning). In this Review, we discuss the prevalence of mental health problems, interventions to address these, and issues of access to treatment and services. Where possible, we take a global perspective, given most children with intellectual disability live in low-income and middle-income countries. Approximately 40% of children with intellectual disability present with a diagnosable mental disorder, a rate that is at least double that in children without intellectual disability. Most risk factors for poor mental health and barriers to accessing support are not unique to people with intellectual disability. With proportionate universalism as the guiding principle for reducing poor mental health at scale, we discuss four directions for addressing the mental health inequity in intellectual disability.
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Affiliation(s)
- Vasiliki Totsika
- Division of Psychiatry, University College London, London, UK; Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, VIC, Australia; Centre for Educational Development Appraisal and Research (CEDAR), University of Warwick, Coventry, UK; Tavistock & Portman NHS Foundation Trust, London, UK.
| | - Ashley Liew
- Centre for Educational Development Appraisal and Research (CEDAR), University of Warwick, Coventry, UK; National & Specialist CAMHS, South London and Maudsley NHS Foundation Trust, London, UK; Department of Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK; Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Michael Absoud
- Department of Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK; Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Colleen Adnams
- Division of Intellectual Disability, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Eric Emerson
- Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK; Centre for Disability Research & Policy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Anderson LR, Monden CW, Bukodi E. Stressful Life Events, Differential Vulnerability, and Depressive Symptoms: Critique and New Evidence. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:283-300. [PMID: 34809472 PMCID: PMC9136473 DOI: 10.1177/00221465211055993] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Depressive symptoms are disproportionately high among women and less educated individuals. One mechanism proposed to explain this is the differential vulnerability hypothesis-that these groups experience particularly strong increases in symptoms in response to stressful life events. We identify limitations to prior work and present evidence from a new approach to life stress research using the UK Household Longitudinal Study. Preliminarily, we replicate prior findings of differential vulnerability in between-individual models. Harnessing repeated measures, however, we show that apparent findings of differential vulnerability by both sex and education are artifacts of confounding. Men and women experience similar average increases in depressive symptoms after stressful life events. One exception is tentative evidence for a stronger association among women for events occurring to others in the household. We term this the "female vulnerability to network events" hypothesis and discuss with reference to Kessler and McLeod's related "cost of caring" hypothesis.
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Ethnic differences in cardiovascular risk: examining differential exposure and susceptibility to risk factors. BMC Med 2022; 20:149. [PMID: 35473626 PMCID: PMC9042646 DOI: 10.1186/s12916-022-02337-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethnic differences in cardiovascular disease (CVD) risk have been known for decades, but a systematic exploration of how exposure and susceptibility to risk factors may contribute is lacking. This study aimed to investigate the potential impact of differential exposure and susceptibility between South Asian, Black, and White individuals. METHODS This is a population-based prospective cohort study of UK Biobank participants with a median follow-up of 11.3 years. The association between ethnic group and CVD risk was studied. Additional risk factors were then adjusted to examine mediations. Moderation analysis was conducted to identify whether risk factors had a stronger association in the ethnic minority groups. Population attributable fractions were also calculated to quantify the relative contributions of risk factors for each ethnic group. RESULTS When adjusted for only age and sex, there was a higher risk of CVD among South Asian (n=8815; HR [95% CI] 1.69 [1.59-1.79]) and Black (n=7526; HR [95% CI] 1.12 [1.03-1.22]) compared with White participants (n=434,809). The excess risk of Black participants was completely attenuated following adjustment for deprivation. Compared with White participants, the associations of BMI, triglycerides, and HbA1c with CVD were stronger in South Asians. Adiposity was attributable to the highest proportion of CVD regardless of ethnicity. Smoking had the second largest contribution to CVD among White and Black participants, and HbA1c among South Asian participants. CONCLUSIONS Adiposity is an important risk factor for CVD regardless of ethnicity. Ethnic inequalities in CVD incidence may be best tackled by targeting interventions according to ethnic differences in risk profiles.
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Puka K, Buckley C, Mulia N, Lasserre AM, Rehm J, Probst C. Educational Attainment and Lifestyle Risk Factors Associated With All-Cause Mortality in the US. JAMA HEALTH FORUM 2022; 3. [PMID: 35445213 PMCID: PMC8994133 DOI: 10.1001/jamahealthforum.2022.0401] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Question To what extent can the association between socioeconomic status (SES) and mortality be explained by differential exposure to lifestyle factors (such that unhealthy lifestyle factors are more prevalent in groups with lower SES) and differential vulnerability to lifestyle factors (such that the same exposure to unhealthy lifestyle factors is associated with more deleterious outcomes in groups with lower SES)? Findings In this nationwide cohort study of 415 764 US adults, a mediation analysis showed that lifestyle factors explained 66% (men) and 80% (women) of the association between educational attainment and all-cause mortality. Inequalities in mortality were primarily a result of greater exposure and clustering of unhealthy lifestyle factors among groups with lower educational attainment; with some exception, there was little evidence for differential vulnerability to lifestyle factors. Meaning Public health interventions to create equality in the socioenvironmental contexts that shape lifestyle factors and to reduce exposure to lifestyle risk factors among groups with low SES have the potential to significantly increase life expectancy and reduce socioeconomic inequalities in mortality. Importance The US has experienced increasing socioeconomic inequalities and stagnating life expectancy. Past studies have not disentangled 2 mechanisms thought to underlie socioeconomic inequalities in health, differential exposure and differential vulnerability, that have different policy implications. Objective To evaluate the extent to which the association between socioeconomic status (SES) and all-cause mortality can be decomposed into a direct effect of SES, indirect effects through lifestyle factors (differential exposure), and joint effects of SES with lifestyle factors (differential vulnerability). Design, Setting, and Participants This nationwide, population-based cohort study used the cross-sectional US National Health Interview Survey linked to the National Death Index. Civilian, noninstitutionalized US adults aged 25 to 84 years were included from the 1997 to 2014 National Health Interview Survey and were followed up until December 31, 2015. Data were analyzed from May 1 to October 31, 2021. A causal mediation model using an additive hazard and marginal structural approach was used. Exposures Both SES (operationalized as educational attainment) and lifestyle risk factors (smoking, alcohol use, obesity, and physical inactivity) were assessed using self-reported questionnaires. Main Outcomes and Measures Time to all-cause mortality. Results Participants included 415 764 adults (mean [SD] age, 49.4 [15.8] years; 55% women; 64% non-Hispanic White), of whom 45% had low educational attainment and 27% had high educational attainment. Participants were followed up for a mean (SD) of 8.8 (5.2) years during which 49 096 deaths (12%) were observed. Low educational attainment (compared with high) was associated with 83.6 (men; 95% CI, 81.8-85.5) and 54.8 (women; 95% CI, 53.4-56.2) additional deaths per 10 000 person-years, of which 66% (men) and 80% (women) were explained by lifestyle factors. Inequalities in mortality were primarily a result of greater exposure and clustering of unhealthy lifestyle factors among low SES groups; with some exceptions among women, little evidence of differential vulnerability was identified. Conclusions and Relevance In this cohort study, differential exposure to lifestyle risk factors was an important mediator of socioeconomic inequalities in mortality. Public health interventions are needed, particularly among low SES groups, to address smoking, physical inactivity, alcohol use, and the socioenvironmental contexts within which these risk factors develop.
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Affiliation(s)
- Klajdi Puka
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Charlotte Buckley
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, United Kingdom
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Aurélie M. Lasserre
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Program on Substance Abuse and World Health Organization Collaborating Centres, Public Health Agency of Catalonia, Barcelona, Spain
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
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Foster HME, Ho FK, Mair FS, Jani BD, Sattar N, Katikireddi SV, Pell JP, Niedzwiedz CL, Hastie CE, Anderson JJ, Nicholl BI, Gill JMR, Celis-Morales C, O'Donnell CA. The association between a lifestyle score, socioeconomic status, and COVID-19 outcomes within the UK Biobank cohort. BMC Infect Dis 2022; 22:273. [PMID: 35351028 PMCID: PMC8964028 DOI: 10.1186/s12879-022-07132-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/24/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Infection with SARS-CoV-2 virus (COVID-19) impacts disadvantaged groups most. Lifestyle factors are also associated with adverse COVID-19 outcomes. To inform COVID-19 policy and interventions, we explored effect modification of socioeconomic-status (SES) on associations between lifestyle and COVID-19 outcomes. METHODS Using data from UK-Biobank, a large prospective cohort of 502,536 participants aged 37-73 years recruited between 2006 and 2010, we assigned participants a lifestyle score comprising nine factors. Poisson regression models with penalised splines were used to analyse associations between lifestyle score, deprivation (Townsend), and COVID-19 mortality and severe COVID-19. Associations between each exposure and outcome were examined independently before participants were dichotomised by deprivation to examine exposures jointly. Models were adjusted for sociodemographic/health factors. RESULTS Of 343,850 participants (mean age > 60 years) with complete data, 707 (0.21%) died from COVID-19 and 2506 (0.76%) had severe COVID-19. There was evidence of a nonlinear association between lifestyle score and COVID-19 mortality but limited evidence for nonlinearity between lifestyle score and severe COVID-19 and between deprivation and COVID-19 outcomes. Compared with low deprivation, participants in the high deprivation group had higher risk of COVID-19 outcomes across the lifestyle score. There was evidence for an additive interaction between lifestyle score and deprivation. Compared with participants with the healthiest lifestyle score in the low deprivation group, COVID-19 mortality risk ratios (95% CIs) for those with less healthy scores in low versus high deprivation groups were 5.09 (1.39-25.20) and 9.60 (4.70-21.44), respectively. Equivalent figures for severe COVID-19 were 5.17 (2.46-12.01) and 6.02 (4.72-7.71). Alternative SES measures produced similar results. CONCLUSIONS Unhealthy lifestyles are associated with higher risk of adverse COVID-19, but risks are highest in the most disadvantaged, suggesting an additive influence between SES and lifestyle. COVID-19 policy and interventions should consider both lifestyle and SES. The greatest public health benefit from lifestyle focussed COVID-19 policy and interventions is likely to be seen when greatest support for healthy living is provided to the most disadvantaged groups.
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Affiliation(s)
- Hamish M E Foster
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Frederick K Ho
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Bhautesh D Jani
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Srinivasa Vittal Katikireddi
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Claire L Niedzwiedz
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Claire E Hastie
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jana J Anderson
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Barbara I Nicholl
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jason M R Gill
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Carlos Celis-Morales
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Catherine A O'Donnell
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK. Kate.O'
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71
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Diderichsen F, Whitehead M, Dahlgren G. Planning for health equity in the crossfire between science and policy. Scand J Public Health 2022; 50:875-881. [PMID: 35319311 DOI: 10.1177/14034948221082450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The persistence of health inequalities means that many public health professionals face an ongoing task to develop and update policies to tackle them. However, although the inequalities might be unchanged, the political priorities in the many policy areas involved are changing and the ambition to reduce the health divide is constantly facing strong forces pushing in the opposite direction. Recent proposals to re-think health inequalities need to be treated with caution because they are disconnected from what is needed for policy-making in this area. From our experience of 35 years in developing strategies to tackle health inequalities, we still see many entry points with space for local and national improvements, but it is crucial to ask the right questions. The aim of this Commentary is to present a new framework of eight questions that might provide a helpful structure for the necessary dialogue between researchers and policy-makers. Even if answers are not yet available for all of them, we believe that discussing them for a specific population in a specific political context will be fruitful to inform policy on the ground.
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72
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Bornscheuer L, Lundin A, Forsell Y, Lavebratt C, Melas PA. The cannabinoid receptor-1 gene interacts with stressful life events to increase the risk for problematic alcohol use. Sci Rep 2022; 12:4963. [PMID: 35322131 PMCID: PMC8941304 DOI: 10.1038/s41598-022-08980-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/15/2022] [Indexed: 02/07/2023] Open
Abstract
Problematic alcohol use is a major contributor to the global burden of death and disabilities, and it represents a public health concern that has grown substantially following the COVID-19 pandemic. The available treatment options remain limited and to develop better pharmacotherapies for alcohol misuse we need to identify suitable biological targets. Previous research has implicated the brain’s endocannabinoid system (ECS) in psychiatric and stress-related outcomes, including substance use and habituation to repeated stress. Moreover, genetic variants in the cannabinoid-1 receptor gene (CNR1; CB1R) have been associated with personality traits, which are in turn predictors of substance use disorders. To date, however, no human genome-wide association study has provided evidence for an involvement of the ECS in substance use outcomes. One reason for this ECS-related “missing heritability” may be unexamined gene-environment interactions. To explore this possibility, we conducted cross-sectional analyses using DNA samples and stress-exposure data from a longitudinal Swedish population-based study (N = 2,915). Specifically, we genotyped rs2023239, a functional C/T single nucleotide polymorphism in CNR1, previously reported to be associated with CNR1 binding in the brain, subjective reward following alcohol intake, and alcohol cue-elicited brain activation. Our two outcomes of interest were (i) problematic alcohol use based on the Alcohol Use Disorders Identification Test (AUDIT), and (ii) personality trait scores based on the Five Factor Model. We found no baseline association between rs2023239 and problematic alcohol use or personality traits. However, there was a clear trend for interaction between rs2023239’s risk allele (C) and stressful life events (SLEs) in both childhood and adulthood, which predicted problematic alcohol use. Although not significant, there was also some indication that the risk allele interacted with child SLEs to increase scores on neuroticism. Our study supports the notion that the ECS can affect alcohol intake behaviors by interacting with life adversities and is—to the best of our knowledge—the first to focus on the interaction between CNR1 and stressors in both childhood and adulthood in humans. Further studies are warranted to confirm these findings.
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Affiliation(s)
- Lisa Bornscheuer
- Department of Public Health Sciences, Stockholm University, 10691, Stockholm, Sweden.,Center for Molecular Medicine, L8:00, Karolinska University Hospital, 17176, Stockholm, Sweden
| | - Andreas Lundin
- Department of Global Public Health, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Yvonne Forsell
- Department of Global Public Health, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Catharina Lavebratt
- Center for Molecular Medicine, L8:00, Karolinska University Hospital, 17176, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176, Stockholm, Sweden
| | - Philippe A Melas
- Center for Molecular Medicine, L8:00, Karolinska University Hospital, 17176, Stockholm, Sweden. .,Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, 11364, Stockholm, Sweden.
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73
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Leeuw E, Yashadhana A, Hitch D. Long COVID: sustained and multiplied disadvantage. Med J Aust 2022; 216:222-224. [PMID: 35249215 PMCID: PMC9115005 DOI: 10.5694/mja2.51435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/17/2021] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Evelyne Leeuw
- Centre for Health Equity Training Research and Evaluation (CHETRE) USNW Sydney Sydney NSW
- Ingham Institute Sydney NSW
- CHETRE South Western Sydney Local Health District Sydney NSW
| | - Aryati Yashadhana
- Centre for Health Equity Training Research and Evaluation (CHETRE) USNW Sydney Sydney NSW
- Ingham Institute Sydney NSW
- CHETRE South Western Sydney Local Health District Sydney NSW
| | - Danielle Hitch
- Western Health Sunshine Hospital Melbourne VIC
- Deakin University Geelong VIC
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74
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Gouveia N, Slovic AD, Kanai CM, Soriano L. Air Pollution and Environmental Justice in Latin America: Where Are We and How Can We Move Forward? Curr Environ Health Rep 2022; 9:152-164. [PMID: 35146705 DOI: 10.1007/s40572-022-00341-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Air pollution in Latin America is a major environmental threat, yet few studies have focused on aspects of environmental justice with regard to air pollution in the region. We examined the scientific literature and described whether and how this issue has been addressed, identify possible gaps in knowledge, and offer suggestions for future research to contribute to policies that seek greater equity concerning air pollution impacts in Latin America. RECENT FINDINGS There is a limited literature that has addressed issues of environmental justice or environmental health inequalities about air pollution in Latin America, with studies concentrated in Brazil, Mexico, and Chile. Studies that examined disparities in exposure to air pollution found a clear pattern of higher exposure in socially deprived areas. Studies that examined disparities in health impacts associated with air pollution have mixed results, but many found a clear modification of effect with those in the lower socioeconomic groups presenting greater effects. Despite Latin America's colonial and slavery history, no studies have considered ethnicity or minority populations. The literature shows that health risks (exposure and susceptibility) associated with air pollution are unevenly distributed among Latin American populations. Methodological approaches varied and can be improved in future studies, especially for exposure assessment to air pollution, as well as for assigning socioeconomic position to individuals. Using smaller geographic units and spatial regression techniques will allow a reduction in measurement error. Attempts should be made to include both individual and contextual socioeconomic indicators in the analysis. Better quality information will help understand these differential exposures and effects and provide inputs to policies to tackle these inequalities.
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Affiliation(s)
- Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Av. Dr. Arnaldo, 455, Sao Paulo, SP, 01246-903, Brazil.
| | - Anne Dorothée Slovic
- Department of Environmental Health, University of Sao Paulo School of Public Health, Av. Dr. Arnaldo, Sao Paulo, SP, 715, Brazil
| | - Claudio Makoto Kanai
- Department of Preventive Medicine, University of Sao Paulo Medical School, Av. Dr. Arnaldo, 455, Sao Paulo, SP, 01246-903, Brazil
| | - Lucas Soriano
- Department of Preventive Medicine, University of Sao Paulo Medical School, Av. Dr. Arnaldo, 455, Sao Paulo, SP, 01246-903, Brazil
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75
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Elsenburg LK, Rieckmann A, Nguyen TL, Bengtsson J, Andersen AMN, Taylor-Robinson D, Lange T, Rod NH. Mediation of the parental education gradient in early adult mortality by childhood adversity: a population-based cohort study of more than 1 million children. THE LANCET PUBLIC HEALTH 2022; 7:e146-e155. [DOI: 10.1016/s2468-2667(21)00275-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/17/2021] [Accepted: 11/26/2021] [Indexed: 12/26/2022] Open
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76
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Davidsen K, Carstensen S, Kriegbaum M, Bruunsgaard H, Lund R. Do partnership dissolutions and living alone affect systemic chronic inflammation? A cohort study of Danish adults. J Epidemiol Community Health 2022; 76:jech-2021-217422. [PMID: 35012967 DOI: 10.1136/jech-2021-217422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/13/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Partnership breakups and living alone are associated with several adverse health outcomes. The aim of this study, carried out in Denmark, is to investigate whether accumulated numbers of divorces/partnership breakups or years lived alone across 26 years of adult life are associated with levels of inflammation, and if vulnerability with regards to gender or educational level can be identified. METHODS 4835 participants from the Copenhagen Aging and Midlife Biobank (CAMB) aged 48-62 years were included. Data on accumulated numbers of partnership breakups and years living alone were retrieved from a national standardised annual register. Inflammatory markers interleukin 6 (IL-6) and high sensitivity C-reactive protein (hsCRP) were measured in blood samples. Multivariate linear regression analyses were adjusted for age, educational level, early major life events, body mass index, chronic diseases, medicinal intake affecting inflammation, acute inflammation and personality scores. RESULTS For men, an association was found between an increasing number of partnership breakups or number of years living alone and higher levels of inflammatory markers. No such association was found for women, and no evidence of partnership breakups and educational level having a joint effect was found for either gender. CONCLUSION The findings suggest a strong association between years lived alone or accumulated number of partnership breakups and low-grade inflammation for middle-aged men, but not for women. Among those of either sex with a lower level of education, no specific vulnerability to accumulated years lived alone or number of breakups was identified.
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Affiliation(s)
- Karolina Davidsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Simon Carstensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margit Kriegbaum
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Helle Bruunsgaard
- Department of Clinical Immunology; Centre of Inflammation and Metabolism; Centre for Physical Activity Research, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rikke Lund
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Section of Social Medicine, Department of Public Helath, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Kobenhavn, Denmark
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77
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Fernández-Medina IM, Ruíz-Fernández MD, Gálvez-Ramírez F, Martínez-Mengíbar E, Ruíz-García ME, Jiménez-Lasserrotte MDM, Ortega-Galán ÁM, Hernández-Padilla JM. The Experiences of Home Care Nurses in Regard to the Care of Vulnerable Populations: A Qualitative Study. Healthcare (Basel) 2021; 10:21. [PMID: 35052185 PMCID: PMC8774707 DOI: 10.3390/healthcare10010021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Home care nurses have become the main references in home care for vulnerable patients. In patients' homes they offer comprehensive and continuous care to both the vulnerable population and their families. The aim of this qualitative study was to explore experiences and perspectives of home care nurses regarding the care of vulnerable patients in Spain. We conducted in-depth semi-structured interviews with 15 home care nurses working with a vulnerable population. From a data analysis, two themes and four subthemes emerged: (1) "barriers to providing home care to vulnerable populations", with the following subthemes: "the particularities of the patient and their home caregivers" and "perceived barriers for the involvement of home care nurses in the care"; and (2) "the emotional cost of home care" with the subthemes "home care is draining for caregivers" and "the impact of home care on the home care nurses". These findings show us that nurses face a number of difficulties in home care for vulnerable patients. The training of nurses in certain competencies and skills by the social health services would enhance the quality of care offered to these patients.
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Affiliation(s)
| | - María Dolores Ruíz-Fernández
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almeria, Spain
- Facultad Ciencias de la Salud, Universidad Autónoma de Chile, Temuco 7500000, Chile
| | - Felisa Gálvez-Ramírez
- Basic Health Zone Puerto de la Torre, Sanitary Distric Málaga-Guadalhorce, Andalusian Health System, 29009 Malaga, Spain
| | | | | | | | | | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almeria, Spain
- Department of Adult, Child and Midwifery, School of Health and Education, Middlesex University, London NW4 4BT, UK
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78
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Veldman K, Pingel R, Hallqvist J, G Bean C, Hammarström A. How does social support shape the association between depressive symptoms and labour market participation: a four-way decomposition. Eur J Public Health 2021; 32:8-13. [PMID: 34871391 PMCID: PMC9090166 DOI: 10.1093/eurpub/ckab185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Little is known about factors that may explain the association between depressive symptoms and poor labour market participation (LMP). The aim of this study is to examine the mediation and interaction effects of social support on the association between depressive symptoms and LMP. Methods Data were used from 985 participants (91% of the initial cohort) of the Northern Swedish Cohort, a longitudinal study of Swedish participants followed from adolescence throughout adulthood. Depressive symptoms were measured at age 16, social support at age 21 and LMP from age 30 to 43. Poor LMP was defined as being unemployed for a total of 6 months or more between the ages of 30 and 43. A four-way decomposition approach was applied to identify direct, mediation and interaction effects, together and separately. Results Both depressive symptoms during adolescence and social support at young adulthood were associated with poor LMP [odds ratio (OR) = 1.70, 95% confidence interval (CI) 1.17–2.47 and OR = 2.56, 95% CI 1.78-3.68 respectively]. The association between depressive symptoms and poor LMP was partially mediated by a lack of social support. No interaction effect of a lack of social support was found. Conclusion The results suggest that depressive symptoms influence not only later LMP but also the intermediary level of social support, and in turn influencing later LMP. Recommendations for public health are to detect and treat depressive symptoms at an early stage and to focus on the development of social skills, facilitating the increased availability of social support, thereby improving future LMP.
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Affiliation(s)
- Karin Veldman
- Department of Health Sciences, Community & Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ronnie Pingel
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Johan Hallqvist
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Christopher G Bean
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,School of Psychology, University of Adelaide, Australia
| | - Anne Hammarström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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79
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Diderichsen F, Bender AM, Lyth AC, Andersen I, Pedersen J, Bjørner JB. Mediating role of multimorbidity in inequality in mortality: a register study on the Danish population. J Epidemiol Community Health 2021; 76:jech-2021-218211. [PMID: 34862249 DOI: 10.1136/jech-2021-218211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/18/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The social inequality in mortality is due to differential incidence of several disorders and injury types, as well as differential survival. The resulting clustering and possible interaction in disadvantaged groups of several disorders make multimorbidity a potentially important component in the health divide. This study decomposes the effect of education on mortality into a direct effect, a pure indirect effect mediated by multimorbidity and a mediated interaction between education and multimorbidity. METHODS The study uses the Danish population registers on the total Danish population aged 45-69 years. A multimorbidity index based on all somatic and psychiatric hospital contacts as well as prescribed medicines includes 22 diagnostic groups weighted together by their 5 years mortality risk as weight. The Aalen additive hazard model is used to estimate and decompose the 5 years risk difference in absolute numbers of deaths according to educational status. RESULTS Most (69%-79%) of the effect is direct not involving multimorbidity, and the mediated effect is for low educated women 155 per 100 000 of which 87 is an effect of mediated interaction. For low educated men, the mediated effect is 250 per 100 000 of which 93 is mediated interaction. CONCLUSION Multimorbidity plays an important role in the social inequality in mortality among middle aged in Denmark and mediated interaction represents 5%-17%. As multimorbidity is a growing challenge in specialised health systems, the mediated interaction might be a relevant indicator of inequities in care of multimorbid patients.
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Affiliation(s)
- Finn Diderichsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Mette Bender
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | | | - Ingelise Andersen
- Institute of Public Health, Section of Social Medicine, Copenhagen University, Copenhagen, Denmark
| | - Jacob Pedersen
- The National Research Center for Work Environment, Copenhagen, Denmark
| | - Jakob Bue Bjørner
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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80
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Diderichsen F, Andersen I, Mathisen J. Depression and diabetes: The role of syndemics in the social inequality of disability. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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81
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Nygaard SS, Srivarathan A, Mathisen J, Kristiansen M, Christensen U, Kvorning MF, Lund R. Challenges and lessons learnt from conducting a health survey in an ethnically diverse population. Scand J Public Health 2021; 50:995-1006. [PMID: 34711102 DOI: 10.1177/14034948211054663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: To document the challenges of developing and executing an interviewer-driven survey questionnaire in an ethnically diverse and deprived social housing area undergoing reconstruction in Denmark. Methods: The survey was initially planned to be conducted in three waves (before, during and after reconstruction of the housing area), based on a questionnaire covering health, wellbeing and social relations. The first two waves took place in 2018 and 2019 (invited n=~600 per wave) and the third wave will be conducted once the reconstruction is finalised. The approach to the third wave is under revision by the research team. The questionnaire was translated from Danish into the seven most common languages in the housing area. A bilingual interview team went door to door interviewing residents. Field notes were collected systematically during each wave to document the process. Results: The response rates were 35% (n=209) and 22% (n=132) for waves 1 and 2, respectively. There was an overall decrease in response rates between waves 1 and 2 for all language groups, but particularly for Arabic and Turkish-speaking men. The most frequently stated reasons for non-participation included illness and language barriers. The key lessons learnt were that overcoming linguistic and cultural barriers to conducting research among residents in this social housing area requires time and resources. Conclusions: Several challenges are associated with conducting a survey in ethnically diverse and deprived social housing areas. Documenting the challenges and learning from experience are both important, in order to include this hard-to-reach population in health research.
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Affiliation(s)
- Siv Steffen Nygaard
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Denmark
| | - Abirami Srivarathan
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Denmark
| | - Jimmi Mathisen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Denmark
| | - Maria Kristiansen
- Center for Healthy Aging, University of Copenhagen, Denmark.,Department of Public Health, Section for Health Services Research, University of Copenhagen, Denmark
| | - Ulla Christensen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Denmark
| | | | - Rikke Lund
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Denmark
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82
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Sengoku T, Ishizaki T, Goto Y, Iwao T, Ohtera S, Sakai M, Kato G, Nakayama T, Takahashi Y. Prevalence of type 2 diabetes by age, sex and geographical area among two million public assistance recipients in Japan: a cross-sectional study using a nationally representative claims database. J Epidemiol Community Health 2021; 76:391-397. [PMID: 34711673 DOI: 10.1136/jech-2020-216158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 10/11/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Recognising the importance of the social determinants of health, the Japanese government introduced a health management support programme targeted at type 2 diabetes (T2D) for public assistance recipients (PAR) in 2018. However, evidence of the T2D prevalence among PAR is lacking. We aimed to estimate T2D prevalence by age and sex among PAR, compared with the prevalence among health insurance enrollees (HIE). Additionally, regional differences in T2D prevalence among PAR were examined. METHODS This was a cross-sectional study using 1-month health insurance claims of both PAR and HIE. The Fact-finding Survey data on Medical Assistance and the National Database of Health Insurance Claims data were used. T2D prevalence among PAR and HIE were assessed by age and sex, respectively. Moreover, to examine regional differences in T2D prevalence of inpatients and outpatients among PAR, T2D crude prevalence and age-standardised prevalence were calculated by prefecture. Multilevel logistic regression analysis was also conducted at the city level. RESULTS T2D crude prevalence was 7.7% in PAR (inpatients and outpatients). Among outpatients, the prevalence was 7.5% in PAR and 4.1% in HIE, respectively. The mean crude prevalence and age-standardised prevalence of T2D (inpatients and outpatients) among 47 prefectures were 7.8% and 3.9%, respectively. In the city-level analysis, the OR for the prevalence of T2D by region ranged from 0.31 to 1.51. CONCLUSION The prevalence of T2D among PAR was higher than HIE and there were regional differences in the prevalence of PAR. Measures to prevent the progression of diabetes among PAR by region are needed.
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Affiliation(s)
- Tami Sengoku
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Yoshihito Goto
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | | | - Shosuke Ohtera
- Kyoto University Hospital, Kyoto, Japan.,National Institute of Public Health, Wako, Japan
| | - Michi Sakai
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan.,Comprehensive Unit for Health Economic Evidence Review and Decision Support, Ritsumeikan University, Kyoto, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
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Webb KA, Mavhu W, Langhaug L, Chitiyo V, Matyanga P, Charashika P, Patel D, Prost A, Ferrand RA, Bernays S, Cislaghi B, Neuman M. 'I was trying to get there, but I couldn't': social norms, vulnerability and lived experiences of home delivery in Mashonaland Central Province, Zimbabwe. Health Policy Plan 2021; 36:1441-1450. [PMID: 34139011 DOI: 10.1093/heapol/czab058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/04/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Increasing facility-based delivery rates is pivotal to reach Sustainable Development Goals to improve skilled attendance at birth and reduce maternal and neonatal mortality in low- and middle-income countries (LMICs). The translation of global health initiatives into national policy and programmes has increased facility-based deliveries in LMICs, but little is known about the impact of such policies on social norms from the perspective of women who continue to deliver at home. This qualitative study explores the reasons for and experiences of home delivery among women living in rural Zimbabwe. We analysed qualitative data from 30 semi-structured interviews and 5 focus group discussions with women who had delivered at home in the previous 6 months in Mashonaland Central Province. We found evidence of strong community-level social norms in favour of facility-based delivery. However, despite their expressed intention to deliver at a facility, women described how multiple, interacting vulnerabilities resulted in delivery outside of a health facility. While identified as having delivered 'at home', narratives of birth experiences revealed the majority of women in our study delivered 'on the road', en route to the health facility. Strong norms for facility-based delivery created punishments and stigmatization for home delivery, which introduced additional risk to women at the time of delivery and in the postnatal period. These consequences for breaking social norms promoting facility-based delivery for all further increased the vulnerability of women who delivered at home or on the road. Our findings highlight that equitable public health policy and programme designs should include efforts to actively identify, mitigate and evaluate unintended consequences of social change created as a by-product of promoting positive health behaviours among those most vulnerable who are unable to comply.
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Affiliation(s)
- Karen A Webb
- Organization for Public Health Interventions and Development (OPHID), 20 Cork Road, Belgravia, Harare, Zimbabwe
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - W Mavhu
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), 4 Bath Rd, Belgravia, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - L Langhaug
- Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Meyrick Park, Mabelreign, Harare, Zimbabwe
| | - V Chitiyo
- Organization for Public Health Interventions and Development (OPHID), 20 Cork Road, Belgravia, Harare, Zimbabwe
| | - P Matyanga
- Organization for Public Health Interventions and Development (OPHID), 20 Cork Road, Belgravia, Harare, Zimbabwe
| | - P Charashika
- Organization for Public Health Interventions and Development (OPHID), 20 Cork Road, Belgravia, Harare, Zimbabwe
| | - D Patel
- Organization for Public Health Interventions and Development (OPHID), 20 Cork Road, Belgravia, Harare, Zimbabwe
| | - A Prost
- University College London, London, UK
| | - Rashida A Ferrand
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- Biomedical Research and Training Institute (BRTI), 10 Seagrave Road, Avondale, Harare
| | - S Bernays
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- University of Sydney, School of Public Health, University of Sydney, Camperdown, 2006, Australia
| | - B Cislaghi
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - M Neuman
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
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84
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Vulnerable Older Adults' Identification, Geographic Distribution, and Policy Implications in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010642. [PMID: 34682392 PMCID: PMC8535285 DOI: 10.3390/ijerph182010642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022]
Abstract
With the population aging and urbanization in China, vulnerable older adults tend to show more complex characteristics, bringing great challenges to public health policies. Using China Longitudinal Aging Social Survey data 2014, this paper builds a comprehensive index system for the identification of vulnerable older adults from three dimensions, including health, economy, and social support, then divides older adults into four support levels and six small classes by using the typological method. The results show that older adults in urgent need of assistance or priority are those poor in health and economic conditions, 1.46% of them are highly vulnerable because of the lack of social support; 12.76% of them obtain a certain social support are moderately vulnerable; and 34.72% of them are slightly vulnerable with disadvantage in only one dimension. The geographic distribution of different types of vulnerable older adults varies significantly. The paper provides evidence to design more feasible and specific policies with comprehensive considerations for different types of vulnerable older adults residing in different regions.
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85
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Ortiz FR, Ardenghi TM, Maroneze M, Paiva SM, Pordeus IA. Do untreated caries influence the school leaving of adolescents? A cohort study. Braz Dent J 2021; 32:72-79. [PMID: 34614063 DOI: 10.1590/0103-6440202104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/15/2021] [Indexed: 11/22/2022] Open
Abstract
The objective was assess the influence of untreated caries and socioeconomic status (SES) on school dropout among adolescents. A six-year cohort study was conducted with random sample of adolescents (12 years-old) who had been evaluated initially in 2012 from Santa Maria, Brazil. Sex, socioeconomic status (mother's education and household income), and untreated caries were collected at the baseline. The outcome variable was collected at the follow-up through self-report and was divided into three categories: adolescents who only studied, who studied and employed, and who school dropouts. A multinomial regression model was performed to assess the influence of oral disease and SES on school leaving, through relative risk ratio (RRR) and 95% confidence interval (95% CI). From of 1,134 adolescents evaluated at the baseline, 768 participants with a mean age of 17.5 years were re-evaluated at follow-up (67.8% response rate). Male (RRR: 2.31; 95%CI: 1.19-4.48) and adolescents with untreated caries at the baseline had an increment in school-leaving (RRR: 2.26; 95%CI: 1.12-4.56). Mothers with low education (RRR: 2.24; 95%CI: 1.09-4.61) had a higher probability of having children who leave school. Untreated caries and low SES in early adolescence can influence the tendency to school dropouts.
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Affiliation(s)
- Fernanda Ruffo Ortiz
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Department of Stomatology, Faculty of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil
| | - Thiago Machado Ardenghi
- Department of Stomatology, Faculty of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil
| | - Marilia Maroneze
- Department of Stomatology, Faculty of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil.,SOBRESP Faculty of Health Sciences, Santa Maria, RS, Brazil
| | - Saul Martins Paiva
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Isabela Almeida Pordeus
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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86
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Chae DH, Snipes SA, Chung KW, Martz CD, LaVeist TA. Vulnerability and Resilience: Use and Misuse of These Terms in the Public Health Discourse. Am J Public Health 2021; 111:1736-1740. [PMID: 34554819 PMCID: PMC8561197 DOI: 10.2105/ajph.2021.306413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/04/2022]
Affiliation(s)
- David H Chae
- David H. Chae and Kara W. Chung are with the Department of Social, Behavioral, and Population Sciences and Thomas A. LaVeist is with the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Shedra A. Snipes is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Connor D. Martz is with the Department of Human Development and Family Science, Auburn University, Auburn, AL
| | - Shedra A Snipes
- David H. Chae and Kara W. Chung are with the Department of Social, Behavioral, and Population Sciences and Thomas A. LaVeist is with the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Shedra A. Snipes is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Connor D. Martz is with the Department of Human Development and Family Science, Auburn University, Auburn, AL
| | - Kara W Chung
- David H. Chae and Kara W. Chung are with the Department of Social, Behavioral, and Population Sciences and Thomas A. LaVeist is with the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Shedra A. Snipes is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Connor D. Martz is with the Department of Human Development and Family Science, Auburn University, Auburn, AL
| | - Connor D Martz
- David H. Chae and Kara W. Chung are with the Department of Social, Behavioral, and Population Sciences and Thomas A. LaVeist is with the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Shedra A. Snipes is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Connor D. Martz is with the Department of Human Development and Family Science, Auburn University, Auburn, AL
| | - Thomas A LaVeist
- David H. Chae and Kara W. Chung are with the Department of Social, Behavioral, and Population Sciences and Thomas A. LaVeist is with the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Shedra A. Snipes is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Connor D. Martz is with the Department of Human Development and Family Science, Auburn University, Auburn, AL
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87
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The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows. Public Health 2021; 199:20-24. [PMID: 34534885 DOI: 10.1016/j.puhe.2021.08.009] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022]
Abstract
This year marks the 30th anniversary of the Dahlgren and Whitehead model of the main determinants of health, sometimes known as 'The Rainbow Model'. In this article, we reflect on developments over those thirty years before going on to look to the future. We start by telling the story of our model's idiosyncratic journey from initial rejection to worldwide acclaim. We reflect on the many ways in which the model has been used over the years and why it has proved illuminating for people in so many different positions. It is equally important to understand what it does not do and what it was never intended to do, as sometimes the conceptual debate gets side-tracked by mistaken assumptions. We take some space to outline how we ourselves use the model with the complementary Diderichsen Framework to explain the pathways and mechanisms by which the known determinants of health bring about the social gradients in health that are observed within countries. We conclude by looking to the future and what further needs to be done to capture insights for action on the determinants and drivers of health and of growing inequalities in the post-pandemic world.
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88
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Antequera A, Lawson DO, Noorduyn SG, Dewidar O, Avey M, Bhutta ZA, Chamberlain C, Ellingwood H, Francis D, Funnell S, Ghogomu E, Greer-Smith R, Horsley T, Juando-Prats C, Jull J, Kristjansson E, Little J, Nicholls SG, Nkangu M, Petticrew M, Rada G, Rizvi A, Shamseer L, Sharp MK, Tufte J, Tugwell P, Verdugo-Paiva F, Wang H, Wang X, Mbuagbaw L, Welch V. Improving Social Justice in COVID-19 Health Research: Interim Guidelines for Reporting Health Equity in Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9357. [PMID: 34501949 PMCID: PMC8431098 DOI: 10.3390/ijerph18179357] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 01/12/2023]
Abstract
The COVID-19 pandemic has highlighted the global imperative to address health inequities. Observational studies are a valuable source of evidence for real-world effects and impacts of implementing COVID-19 policies on the redistribution of inequities. We assembled a diverse global multi-disciplinary team to develop interim guidance for improving transparency in reporting health equity in COVID-19 observational studies. We identified 14 areas in the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist that need additional detail to encourage transparent reporting of health equity. We searched for examples of COVID-19 observational studies that analysed and reported health equity analysis across one or more social determinants of health. We engaged with Indigenous stakeholders and others groups experiencing health inequities to co-produce this guidance and to bring an intersectional lens. Taking health equity and social determinants of health into account contributes to the clinical and epidemiological understanding of the disease, identifying specific needs and supporting decision-making processes. Stakeholders are encouraged to consider using this guidance on observational research to help provide evidence to close the inequitable gaps in health outcomes.
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Affiliation(s)
- Alba Antequera
- Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
| | - Daeria O. Lawson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (D.O.L.); (S.G.N.); (L.M.)
| | - Stephen G. Noorduyn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (D.O.L.); (S.G.N.); (L.M.)
| | - Omar Dewidar
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada; (O.D.); (T.H.); (J.L.); (M.N.); (P.T.); (V.W.)
| | - Marc Avey
- Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada;
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
- Institute for Global Health & Development, The Aga Khan University, Karachi 74800, Pakistan
| | - Catherine Chamberlain
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia;
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, WA 6150, Australia
| | - Holly Ellingwood
- Department of Psychology, Faculty of Arts and Social Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada;
- Public Safety, Ottawa, ON K1A 0P8, Canada
| | - Damian Francis
- Center for Health and Social Issues, School of Health and Human Performance, Georgia College, Milledgville, GA 31061, USA;
| | - Sarah Funnell
- Department of Family Medicine, Queen’s University, Kingston, ON K7L 3G2, Canada;
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Elizabeth Ghogomu
- Bruyère Research Institute, University of Ottawa, Ottawa, ON K1N 5C8, Canada;
| | - Regina Greer-Smith
- Healthcare Research Associates, LLC/The S.T.A.R. Initiative, Los Angeles, CA 90033, USA;
| | - Tanya Horsley
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada; (O.D.); (T.H.); (J.L.); (M.N.); (P.T.); (V.W.)
- Research Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, ON K1S 5N8, Canada
| | - Clara Juando-Prats
- Applied Health Research Center, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada;
- Dalla School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Janet Jull
- Faculty of Health Sciences, School of Rehabilitation Therapy, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.J.); (A.R.)
| | - Elizabeth Kristjansson
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Julian Little
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada; (O.D.); (T.H.); (J.L.); (M.N.); (P.T.); (V.W.)
| | - Stuart G. Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
| | - Miriam Nkangu
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada; (O.D.); (T.H.); (J.L.); (M.N.); (P.T.); (V.W.)
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Gabriel Rada
- Epistemonikos Foundation, Santiago 7510299, Chile; (G.R.); (F.V.-P.)
- UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile, Santiago Región Metropolitana, Santiago 8331150, Chile
| | - Anita Rizvi
- Faculty of Health Sciences, School of Rehabilitation Therapy, Queen’s University, Kingston, ON K7L 3N6, Canada; (J.J.); (A.R.)
| | - Larissa Shamseer
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON M5B 1T8, Canada;
| | - Melissa K. Sharp
- Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin DO2 H638, Ireland;
| | | | - Peter Tugwell
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada; (O.D.); (T.H.); (J.L.); (M.N.); (P.T.); (V.W.)
- Bruyère Research Institute, University of Ottawa, Ottawa, ON K1N 5C8, Canada;
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
| | - Francisca Verdugo-Paiva
- Epistemonikos Foundation, Santiago 7510299, Chile; (G.R.); (F.V.-P.)
- UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile, Santiago Región Metropolitana, Santiago 8331150, Chile
| | - Harry Wang
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada;
| | - Xiaoqin Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (D.O.L.); (S.G.N.); (L.M.)
| | - Vivian Welch
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada; (O.D.); (T.H.); (J.L.); (M.N.); (P.T.); (V.W.)
- Bruyère Research Institute, University of Ottawa, Ottawa, ON K1N 5C8, Canada;
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89
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Zago PTN, Maffacciolli R, Mattioni FC, Dalla-Nora CR, Rocha CMF. Nursing actions promoting adherence to tuberculosis treatment: scoping review. Rev Esc Enferm USP 2021; 55:e20200300. [PMID: 34435609 DOI: 10.1590/1980-220x-reeusp-2020-0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze actions promoting adherence to tuberculosis treatment that are being carried out by nurses in different countries. METHOD Scoping review with selection of articles on the subject in LILACS, MEDLINE, IBECS, BDENF, SciELO, CINAHL, Embase, Web of Science, and Scopus databases. RESULTS Forty studies, published between 2009 and 2020, allowed the identification of nursing actions in two thematic categories. In the category "Nursing care: TB patients' specific needs to promote adherence to treatment", actions involving clinical aspects, professionals' knowledge and skills, educational and relational processes were identified. In the category "The role of nursing in coping with the social determinants of health to promote adherence to treatment", interventions related to the strengthening of family and community support, the inclusion of socioeconomic issues in care plans, and respect for cultural differences were highlighted. CONCLUSION Nursing work directed to the adherence to disease treatment requires the development of technical, ethical and, above all, political skills, aiming to increase the success of the actions carried out by these professionals.
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Affiliation(s)
- Priscila Tadei Nakata Zago
- Secretaria Estadual da Saúde do Rio Grande do Sul, Hospital Sanatório Partenon, Porto Alegre, RS, Brazil
| | - Rosana Maffacciolli
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
| | - Fernanda Carlise Mattioni
- Grupo Hospitalar Conceição, Serviço de Saúde Comunitária, Escola de Saúde Pública/SES, Porto Alegre, RS, Brazil
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90
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Peña S, Mäkelä P, Laatikainen T, Härkänen T, Männistö S, Heliövaara M, Koskinen S. Joint effects of alcohol use, smoking and body mass index as an explanation for the alcohol harm paradox: causal mediation analysis of eight cohort studies. Addiction 2021; 116:2220-2230. [PMID: 33404149 DOI: 10.1111/add.15395] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/29/2020] [Accepted: 12/23/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Lower socio-economic status (SES) is associated with higher alcohol-related harm despite lower levels of alcohol use. Differential vulnerability due to joint effects of behavioural risk factors is one potential explanation for this 'alcohol harm paradox'. We analysed to what extent socio-economic inequalities in alcohol-mortality are mediated by alcohol, smoking and body mass index (BMI), and their joint effects with each other and with SES. DESIGN Cohort study of eight health examination surveys (1978-2007) linked to mortality data. SETTING Finland. PARTICIPANTS A total of 53 632 Finnish residents aged 25+ years. MEASUREMENTS The primary outcome was alcohol-attributable mortality. We used income as an indicator of SES. We assessed the joint effects between income and mediators (alcohol use, smoking and BMI) and between the mediators, adjusting for socio-demographic indicators. We used causal mediation analysis to calculate the total, direct, indirect and mediated interactive effects using Aalen's additive hazards models. FINDINGS During 1 085 839 person-years of follow-up, we identified 865 alcohol-attributable deaths. We found joint effects for income and alcohol use and income and smoking, resulting in 46.8 and 11.4 extra deaths due to the interaction per 10 000 person-years. No interactions were observed for income and BMI or between alcohol and other mediators. The lowest compared with the highest income quintile was associated with 5.5 additional alcohol deaths per 10 000 person-years (95% confidence interval = 3.7, 7.3) after adjusting for confounders. The proportion mediated by alcohol use was negative (-69.3%), consistent with the alcohol harm paradox. The proportion mediated by smoking and BMI and their additive interactions with income explained 18.1% of the total effect of income on alcohol-attributable mortality. CONCLUSIONS People of lower socio-economic status appear to be more vulnerable to the effects of alcohol use and smoking on alcohol-attributable mortality. Behavioural risk factors and their joint effects with income may explain part of the alcohol harm paradox.
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Affiliation(s)
- Sebastián Peña
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.,Doctoral Programme in Population Health, University of Helsinki, Helsinki, Finland.,Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Pia Mäkelä
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Laatikainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, Faculty of Medicine, University of Eastern Finland, Kuopio, Finland.,Joint Municipal Authority for North Karelia Social and Health Services (Siun sote), Joensuu, Finland
| | - Tommi Härkänen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Satu Männistö
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Markku Heliövaara
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Seppo Koskinen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
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91
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Sawyer ADM, van Lenthe F, Kamphuis CBM, Terragni L, Roos G, Poelman MP, Nicolaou M, Waterlander W, Djojosoeparto SK, Scheidmeir M, Neumann-Podczaska A, Stronks K. Dynamics of the complex food environment underlying dietary intake in low-income groups: a systems map of associations extracted from a systematic umbrella literature review. Int J Behav Nutr Phys Act 2021; 18:96. [PMID: 34256794 PMCID: PMC8276221 DOI: 10.1186/s12966-021-01164-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/25/2021] [Indexed: 02/08/2023] Open
Abstract
Background Inequalities in obesity pertain in part to differences in dietary intake in different socioeconomic groups. Examining the economic, social, physical and political food environment of low-income groups as a complex adaptive system – i.e. a system of multiple, interconnected factors exerting non-linear influence on an outcome, can enhance the development and assessment of effective policies and interventions by honouring the complexity of lived reality. We aimed to develop and apply novel causal loop diagramming methods in order to construct an evidence-based map of the underlying system of environmental factors that drives dietary intake in low-income groups. Methods A systematic umbrella review was conducted on literature examining determinants of dietary intake and food environments in low-income youths and adults in high/upper-middle income countries. Information on the determinants and associations between determinants was extracted from reviews of quantitative and qualitative studies. Determinants were organised using the Determinants of Nutrition and Eating (DONE) framework. Associations were synthesised into causal loop diagrams that were subsequently used to interpret the dynamics underlying the food environment and dietary intake. The map was reviewed by an expert panel and systems-based analysis identified the system paradigm, structure, feedback loops and goals. Results Findings from forty-three reviews and expert consensus were synthesised in an evidence-based map of the complex adaptive system underlying the food environment influencing dietary intake in low-income groups. The system was interpreted as operating within a supply-and-demand, economic paradigm. Five sub-systems (‘geographical accessibility’, ‘household finances’, ‘household resources’, ‘individual influences’, ‘social and cultural influences’) were presented as causal loop diagrams comprising 60 variables, conveying goals which undermine healthy dietary intake. Conclusions Our findings reveal how poor dietary intake in low-income groups can be presented as an emergent property of a complex adaptive system that sustains a food environment that increases the accessibility, availability, affordability and acceptability of unhealthy foods. In order to reshape system dynamics driving unhealthy food environments, simultaneous, diverse and innovative strategies are needed to facilitate longer-term management of household finances and socially-oriented practices around healthy food production, supply and intake. Ultimately, such strategies must be supported by a system paradigm which prioritises health. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01164-1.
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Affiliation(s)
- Alexia D M Sawyer
- Department of Public and Occupational Health, Amsterdam University Medical Centres, University of Amsterdam, Room J2-211, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands.
| | - Frank van Lenthe
- Department of Public Health, Erasmus Medical Centre, Rotterdam, 3000 CA, The Netherlands
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, 3584 CH, The Netherlands
| | - Laura Terragni
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Gun Roos
- Consumer Research Institute, Oslo Metropolitan University, 0170, Oslo, Norway
| | - Maartje P Poelman
- Department of Social Sciences, Wageningen University, Wageningen, 6706 KN, The Netherlands
| | - Mary Nicolaou
- Department of Public and Occupational Health, Amsterdam University Medical Centres, University of Amsterdam, Room J2-211, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands
| | - Wilma Waterlander
- Department of Public and Occupational Health, Amsterdam University Medical Centres, University of Amsterdam, Room J2-211, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands
| | - Sanne K Djojosoeparto
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, 3584 CB, The Netherlands
| | - Marie Scheidmeir
- Psychology Institute, Johannes Gutenberg University Mainz, D-55122, Mainz, Germany
| | | | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam University Medical Centres, University of Amsterdam, Room J2-211, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands
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92
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Hicks B, Veronesi G, Ferrario MM, Forrest H, Whitehead M, Diderichsen F, Tunstall-Pedoe H, Kuulasmaa K, Sans S, Salomaa V, Thorand B, Peters A, Soderberg S, Cesana G, Bobak M, Iacoviello L, Palmieri L, Zeller T, Blankenberg S, Kee F. Roles of allostatic load, lifestyle and clinical risk factors in mediating the association between education and coronary heart disease risk in Europe. J Epidemiol Community Health 2021; 75:1147-1154. [PMID: 34049926 PMCID: PMC8588289 DOI: 10.1136/jech-2020-215394] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 05/13/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Previous studies have shown that differential exposure to lifestyle factors may mediate the association between education and coronary heart diseases (CHD). However, few studies have examined the potential roles of allostatic load (AL) or differential susceptibility. METHODS 25 310 men and 26 018 women aged 35-74 and CHD free at baseline were identified from 21 European cohorts and followed for a median of 10 years, to investigate the mediating role of AL, as well as of smoking, alcohol use and body mass index (BMI), on educational differences in CHD incidence, applying marginal structural models and three-way decomposition. RESULTS AL is a mediator of the association between educational status and CHD incidence, with the highest proportion mediated observed among women and largely attributable to differential exposure, (28% (95% CI 19% to 44%)), with 8% (95% CI 0% to 16%) attributable to differential susceptibility. The mediating effects of smoking, alcohol and BMI, compared with AL, were relatively small for both men and women. CONCLUSION Overall, the educational inequalities in CHD incidence were partially mediated through differential exposure to AL. By contrast, the mediation of the educational gradient in CHD by investigated lifestyle risk factors was limited. As differential susceptibility in men was found to have a predominant role in the accumulation of AL in low educational classes, the investigation of AL-related risk factors is warranted.
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Affiliation(s)
- Blánaid Hicks
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Giovanni Veronesi
- Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Marco M Ferrario
- Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Hannah Forrest
- Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Margaret Whitehead
- Department of Public Health and Policy, Institute of Population Health and Sciences, University of Liverpool, Liverpool, UK
| | - Finn Diderichsen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hugh Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, UK
| | - Kari Kuulasmaa
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Susana Sans
- Catalan Department of Health, Barcelona, Spain
| | - Veikko Salomaa
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
| | - Stefan Soderberg
- Department of Public Health and Clinical Medicine, Umea Universitet, Umea, Sweden
| | - Giancarlo Cesana
- Research Centre on Public Health, Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Licia Iacoviello
- Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Ageing, National Institute of Health, Roma, Lazio, Italy
| | - Tanja Zeller
- Department of Cardiology, University Heart and Vascular Centre, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Centre, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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93
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Bloom MS, Valachovic EL, Begum TF, Kucklick JR, Brock JW, Wenzel AG, Wineland RJ, Cruze L, Unal ER, Newman RB. Association between gestational phthalate exposure and newborn head circumference; impacts by race and sex. ENVIRONMENTAL RESEARCH 2021; 195:110763. [PMID: 33516688 DOI: 10.1016/j.envres.2021.110763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/29/2020] [Accepted: 01/13/2021] [Indexed: 05/15/2023]
Abstract
Observational and experimental studies report associations between gestational phthalate exposure and fetal development, yet few data exist to characterize phthalate effects on head circumference (HC) or to estimate the impact of race or sex. To address this data gap, we enrolled 152 African American and 158 white mothers with uncomplicated singleton pregnancies from the Charleston, South Carolina (USA) metropolitan area in a prospective birth cohort. Study participants provided up to two urine specimens during mid and late gestation, completed a study questionnaire, and allowed access to hospital birth records. We measured eight phthalate monoester metabolites using liquid chromatography with tandem mass spectrometry, and calculated molar sums of phthalate parent diesters. After specific gravity correction, we tested for associations between phthalates and neonatal HC (cm) and cephalization index (cm/g) using multiple informant linear regression with inverse probability weighting to account for selection bias between repeated urine sampling, adjusted for maternal race, age, body mass index, education, and smoking. We explored interactions by maternal race and infant sex. A doubling of urinary monoethyl phthalate (MEP) concentration was associated with a -0.49% (95%CI: -0.95%, -0.02%) smaller head circumference, although seven other phthalate metabolites were null. There were no statistically significant associations with cephalization index. HC was larger for whites than African American newborns (p < 0.0001) but similar for males and females (p = 0.16). We detected interactions for maternal race with urinary monobutyl phthalate (MBP; p = 0.03), monobenzyl phthalate (MBzP; p = 0.01), monoethylhexyl phthalate (MEHP; p = 0.05), monomethyl phthalate (MMP; p = 0.02), and the sum of dibutyl phthalate metabolites (∑DBP; p = 0.05), in which reduced HC circumference associations were stronger among whites than African Americans, and interactions for sex with MBP (p = 0.08) and MiBP (p = 0.03), in which associations were stronger for females than males. Our results suggest that gestational phthalate exposure is associated with smaller neonatal HC and that white mothers and female newborns have greater susceptibility.
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Affiliation(s)
- Michael S Bloom
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA.
| | - Edward L Valachovic
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Thoin F Begum
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY, USA
| | - John R Kucklick
- National Institute of Standards and Technology, Hollings Marine Laboratory, Charleston, SC, USA
| | - John W Brock
- Department of Chemistry, University of North Carolina Asheville, Asheville, NC, USA
| | - Abby G Wenzel
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Rebecca J Wineland
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Lori Cruze
- Department of Biology, Wofford College, Spartanburg, SC, USA
| | - Elizabeth R Unal
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Roger B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
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94
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Thern E, Landberg J. Understanding the differential effect of alcohol consumption on the relation between socio-economic position and alcohol-related health problems: results from the Stockholm Public Health Cohort. Addiction 2021; 116:799-808. [PMID: 32738005 PMCID: PMC8048434 DOI: 10.1111/add.15213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/20/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
AIM To test (i) whether the harmful effects of average volume of alcohol consumption (AC) and heavy episodic drinking (HED) differ by socio-economic position (SEP), and (ii) if so, to what extent such differential effects can be attributed to an unequal distribution of harmful levels and patterns of drinking, health, life-style and social factors. DESIGN A longitudinal cohort study with baseline in 2002 or 2006, with record-linkage to national registers. SETTING Stockholm County, Sweden. PARTICIPANTS A total of 37 484 individuals, aged 25-70 years, responding to the survey in 2002 or 2006. MEASUREMENTS The outcome of alcohol-related health problems was obtained from the National Patient Register and Cause of Death Register using the Swedish index diagnoses related to alcohol use. Self-reported information on occupational class (measure of SEP), AC, HED as well as other health-related factors were extracted from the surveys. Average follow-up time was 13.3 years. FINDINGS During follow-up, a total of 1237 first-time events of alcohol-related health problems occurred. After initial adjustments, heavy drinking appeared to be more harmful to individuals with low SEP compared with high SEP (P = 0.001). Differences in HED frequency explained the largest part of the differential effect of AC. Engaging in weekly HED was more harmful to individuals with low SEP (P = 0.031) than high SEP. Differences in AC, together with other factors, explained a large part of the differential effect of HED. Conclusions The greater adverse impact of alcohol consumption on health in Sweden on people with lower socio-economic position may be largely attributable to higher prevalence of heavy episodic drinking, as well as other behavioral and social risk factors.
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Affiliation(s)
- Emelie Thern
- Department of Public Health SciencesStockholm UniversityStockholmSweden
| | - Jonas Landberg
- Department of Public Health SciencesStockholm UniversityStockholmSweden,Department of Clinical NeuroscienceKarolinska InstituteStockholmSweden
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95
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Veronesi G, Grassi G, Savelli G, Quatto P, Zambon A. Big data, observational research and P-value: a recipe for false-positive findings? A study of simulated and real prospective cohorts. Int J Epidemiol 2021; 49:876-884. [PMID: 31620789 PMCID: PMC7394945 DOI: 10.1093/ije/dyz206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND An increasing number of observational studies combine large sample sizes with low participation rates, which could lead to standard inference failing to control the false-discovery rate. We investigated if the 'empirical calibration of P-value' method (EPCV), reliant on negative controls, can preserve type I error in the context of survival analysis. METHODS We used simulated cohort studies with 50% participation rate and two different selection bias mechanisms, and a real-life application on predictors of cancer mortality using data from four population-based cohorts in Northern Italy (n = 6976 men and women aged 25-74 years at baseline and 17 years of median follow-up). RESULTS Type I error for the standard Cox model was above the 5% nominal level in 15 out of 16 simulated settings; for n = 10 000, the chances of a null association with hazard ratio = 1.05 having a P-value < 0.05 were 42.5%. Conversely, EPCV with 10 negative controls preserved the 5% nominal level in all the simulation settings, reducing bias in the point estimate by 80-90% when its main assumption was verified. In the real case, 15 out of 21 (71%) blood markers with no association with cancer mortality according to literature had a P-value < 0.05 in age- and gender-adjusted Cox models. After calibration, only 1 (4.8%) remained statistically significant. CONCLUSIONS In the analyses of large observational studies prone to selection bias, the use of empirical distribution to calibrate P-values can substantially reduce the number of trivial results needing further screening for relevance and external validity.
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Affiliation(s)
- Giovanni Veronesi
- Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Giordano Savelli
- U.O. Medicina Nucleare, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Piero Quatto
- Department of Economics, Management and Statistics
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milano, Italy
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96
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Harari L, Lee C. Intersectionality in quantitative health disparities research: A systematic review of challenges and limitations in empirical studies. Soc Sci Med 2021; 277:113876. [PMID: 33866085 DOI: 10.1016/j.socscimed.2021.113876] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 01/12/2023]
Abstract
RATIONALE Quantitative health disparities research has increasingly employed intersectionality as a theoretical tool to investigate how social characteristics intersect to generate health inequality. Yet, intersectionality was not designed to quantify, predict, or identify health disparities, and, as a result, multiple criticisms against its misapplication in health disparities research have been made. As such, there is an emerging need to evaluate the growing body of quantitative research that aims to investigate health disparities through an intersectional lens. METHODS We conducted a systematic review from earliest records to January 2020 to (i) describe the scope of limitations when applying intersectionality to quantitative health disparities research, and (ii) identify recommendations to improve the future integration of intersectionality with this scholarship. We identified relevant publications with electronic searches in PubMed and CA Web of Science. Studies eligible for inclusion were English-language publications that used quantitative methodologies to investigate health disparities among adults in the U.S. while explicitly claiming to adopt an intersectional perspective. Out of 1279 articles reviewed, 65 were eligible for inclusion. RESULTS Our review found that, while the value of intersectionality to the study of health disparities is evident, the existing research struggles with meeting intersectionality's fundamental assumptions. In particular, four limitations were found to be widespread: narrowing the measurements of intersectionality, intersectional groups, and health outcomes; placing primacy on the study of certain intersectional groups to the neglect of others; overlooking underlying explanatory mechanisms that contribute to the health disparities experienced by intersectional groups; and, lacking in the use of life-course perspectives to show how health disparities vary across different life stages. CONCLUSION If the goal of health equality is to be achieved among diverse intersectional groups, future research must be assisted by the collection and examination of data that overcomes these limitations.
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Affiliation(s)
- Lexi Harari
- Department of Sociology, University of California-Riverside, Riverside, CA, USA
| | - Chioun Lee
- Department of Sociology, University of California-Riverside, Riverside, CA, USA.
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97
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Green MJ, Whitley E, Niedzwiedz CL, Shaw RJ, Katikireddi SV. Social contact and inequalities in depressive symptoms and loneliness among older adults: A mediation analysis of the English Longitudinal Study of Ageing. SSM Popul Health 2021; 13:100726. [PMID: 33521227 PMCID: PMC7820553 DOI: 10.1016/j.ssmph.2021.100726] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/13/2020] [Accepted: 12/30/2020] [Indexed: 02/05/2023] Open
Abstract
Background Social contact, including remote contact (by telephone, email, letter or text), could help reduce social inequalities in depressive symptoms and loneliness among older adults. Methods Data were from the 8th wave of the English Longitudinal Study of Aging (2016/17), stratified by age (n = 1578 aged <65; n = 4026 aged 65+). Inverse probability weighting was used to estimate average effects of weekly in-person and remote social contact on depressive symptoms (score of 3+ on 8-item CES-D scale) and two measures of loneliness (sometimes/often feels lonely vs hardly ever/never; and top quintile of UCLA loneliness scale vs all others). We also estimated controlled direct effects of education, partner status, and wealth on loneliness and depressive symptoms under two scenarios: 1) universal infrequent (<weekly) in-person social contact; and 2) universal weekly remote social contact. Results Weekly in-person social contact was associated on average with reduced odds of loneliness, but associations with remote social contact were weak. Lower education raised odds of depressive symptoms and loneliness, but differences were attenuated with infrequent in-person contact. Respondents living alone experienced more depressive symptoms and loneliness than those living with a partner, and less wealth was associated with more depressive symptoms. With universal infrequent in-person contact, these differences narrowed among those aged under 65 but widened among those aged 65+. Universal weekly remote contact had relatively little impact on inequalities. Conclusions Reduced in-person social contact may increase depressive symptoms and loneliness among older adults, especially for those aged 65+ who live alone. Reliance on remote social contact seems unlikely to compensate for social inequalities. In-person but not remote contact associated with less depression/loneliness. In-person contact < weekly reduces educational inequalities in depression/loneliness. In those aged 65+ partner/wealth inequalities widen with <weekly in-person contact. Weekly remote contact has little impact on inequalities in depression/loneliness.
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Affiliation(s)
- Michael J Green
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, UK
| | - Elise Whitley
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, UK
| | | | - Richard J Shaw
- Institute of Health & Wellbeing, University of Glasgow, UK
| | - S Vittal Katikireddi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, UK.,Public Health Scotland, UK
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98
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Rein SM, Smith CJ, Chaloner C, Stafford A, Rodger AJ, Johnson MA, McDonnell J, Burns F, Madge S, Miners A, Sherr L, Collins S, Speakman A, Phillips AN, Lampe FC. Prospective association of social circumstance, socioeconomic, lifestyle and mental health factors with subsequent hospitalisation over 6-7 year follow up in people living with HIV. EClinicalMedicine 2021; 31:100665. [PMID: 33554077 PMCID: PMC7846674 DOI: 10.1016/j.eclinm.2020.100665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Predictors of hospitalisation in people with HIV (PLHIV) in the contemporary treatment era are not well understood. METHODS This ASTRA sub-study used clinic data linkage and record review to determine occurrence of hospitalisations among 798 PLHIV from baseline questionnaire (February to December 2011) until 1 June 2018. Associations of baseline social circumstance, socioeconomic, lifestyle, mental health, demographic and clinical factors with repeated all-cause hospitalisation from longitudinal data were investigated using Prentice-Williams-Peterson models. Associations were also assessed in 461 individuals on antiretroviral therapy (ART) with viral load ≤50 copies/ml and CD4 count ≥500 cells/ µl. FINDINGS Rate of hospitalisation was 5.8/100 person-years (95% CI: 5.1-6.5). Adjusted for age, demographic group and time with diagnosed HIV, the following social circumstance, socioeconomic, lifestyle and mental health factors predicted hospitalisation: no stable partner (adjusted hazard ratio (aHR)=1.59; 95% CI=1.16-2.20 vs living with partner); having children (aHR=1.50; 1.08-2.10); non-employment (aHR=1.56; 1.07-2.27 for unemployment; aHR=2.39; 1.70-3.37 for sick/disabled vs employed); rented housing (aHR=1.72; 1.26-2.37 vs homeowner); not enough money for basic needs (aHR=1.82; 1.19-2.78 vs enough); current smoking (aHR=1.39; 1.02-1.91 vs never); recent injection-drug use (aHR=2.11; 1.30-3.43); anxiety symptoms (aHRs=1.39; 1.01-1.91, 2.06; 1.43-2.95 for mild and moderate vs none/minimal); depressive symptoms (aHRs=1.67; 1.17-2.38, 1.91; 1.30-2.78 for moderate and severe vs none/minimal); treated/untreated depression (aHRs=1.65; 1.03-2.64 for treated depression only, 1.87; 1.39-2.52 for depressive symptoms only; 1.53; 1.05-2.24; for treated depression and depressive symptoms, versus neither). Associations were broadly similar in those with controlled HIV and high CD4. INTERPRETATION Social circumstance, socioeconomic disadvantage, adverse lifestyle factors and poorer mental health are strong predictors of hospitalisation in PLHIV, highlighting the need for targeted interventions and care. FUNDING British HIV Association (BHIVA) Research Award (2017); SMR funded by a PhD fellowship from the Royal Free Charity.
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Affiliation(s)
- Sophia M. Rein
- Institute for Global Health, UCL, London, United Kingdom
| | | | | | - Adam Stafford
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Fiona Burns
- Institute for Global Health, UCL, London, United Kingdom
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Sara Madge
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Alec Miners
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Lorraine Sherr
- Institute for Global Health, UCL, London, United Kingdom
| | | | | | | | - Fiona C. Lampe
- Institute for Global Health, UCL, London, United Kingdom
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99
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Valentin G, Friis K, Nielsen CP, Larsen FB, Langdahl BL. Fragility fractures and health-related quality of life: does socio-economic status widen the gap? A population-based study. Osteoporos Int 2021; 32:63-73. [PMID: 32681362 DOI: 10.1007/s00198-020-05540-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/07/2020] [Indexed: 01/09/2023]
Abstract
UNLABELLED Studying 12,839 fracture cases and 91,426 controls, we found that fractures of the spine and hip are associated with clinically important HRQoL deficits up to 5 years post-fracture. Fracture cases with a low educational attainment are more likely to report very low HRQoL due to a low pre-fracture HRQoL. INTRODUCTION The aim of this study was to explore the short-term and long-term impact of fractures on health-related quality of life (HRQoL) and to study the effect of educational attainment as a proxy for socio-economic status (SES) on post-fracture HRQoL. METHODS In a population-based survey including 12,839 fracture cases and 91,426 controls, HRQoL was measured using the physical component score (PCS) and the mental component score (MCS) of the 12-Item Short Form Health Survey (SF-12). Information about fractures, age, sex, ethnicity, comorbidity and SES was obtained from national registers. Multiple regression analysis was conducted to measure the mean HRQoL difference, termed deficit, between non-fracture controls and fracture cases (all fractures combined and fractures at six different skeletal sites). RESULTS PCS and MCS were significantly lower among fracture cases than among controls. Statistically and clinically important PCS deficits (≥ 5 points) were observed among people with fractures of the spine and hip up to 5 years post-fracture and among people with upper arm fractures up to 1 year post-fracture. Greater deficits were observed for MCS but not for PCS in post-fracture HRQoL in the low than in the high SES group. CONCLUSION Fractures of the spine and hip are associated with clinically important deficits in physical HRQoL up to 5 years post-fracture. Low educational attainment widened the gap in mental but not in physical post-fracture HRQoL. However, due to low pre-fracture PCS and MCS, people with a low educational attainment and fractures were more likely to report very low HRQoL post-fracture.
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Affiliation(s)
- G Valentin
- DEFACTUM, Department of Public Health and Health Services Research, Central Denmark Region, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - K Friis
- DEFACTUM, Department of Public Health and Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - C P Nielsen
- DEFACTUM, Department of Public Health and Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - F B Larsen
- DEFACTUM, Department of Public Health and Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - B L Langdahl
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology (MEA), Aarhus University Hospital, Aarhus, Denmark
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100
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Landberg J, Trolldal B, Norström T. Is the theory of collectivity of drinking cultures valid across educational groups? Drug Alcohol Rev 2020; 40:472-480. [PMID: 33354893 PMCID: PMC7986749 DOI: 10.1111/dar.13232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/15/2020] [Accepted: 11/22/2020] [Indexed: 11/29/2022]
Abstract
Introduction To explore whether Skog's theory of collectivity of drinking cultures is valid across groups with different socioeconomic position (SEP). Methods Individual‐level information on alcohol consumption and SEP for the years 2004–2014 were retrieved from the Monitoring Project; a nationally representative monthly alcohol use survey. The analytical sample consisted of 162 369 respondents aged 25–79 years. SEP was measured by education level. Alcohol use was measured by yearly volume of consumption and frequency of heavy episodic drinking (HED). Respondents were divided into six SEP‐groups based on their education level and sex. Mean yearly volume consumption and prevalence of monthly HED was calculated for each group and graphically plotted against the overall mean volume of consumption. Results The yearly changes in overall mean consumption during the study period reflected a collective shift in drinking across groups with basic, intermediate and high education. There were also indications that changes in overall mean consumption reflected collective shifts in the prevalence of HED across the SEP‐groups. Moreover, while the magnitude of the associations for both average volume and HED differed somewhat in strength across the SEP‐groups, they were clearly in the same, positive, direction. Discussion and Conclusions Our findings add support for including a socioeconomic dimension to Skog's theory of collectivity of drinking cultures. Future studies should replicate our analyses on cases and periods with more tangible changes in the price and availability of alcohol.
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Affiliation(s)
- Jonas Landberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Björn Trolldal
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Swedish Council for Information on Alcohol and other Drugs, Stockholm, Sweden
| | - Thor Norström
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
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