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Tao C, Li Z, Fan Y, Huang Y, Wan T, Shu M, Han S, Qian H, Yan W, Xu Q, Xia Y, Lu C, Li Y. Estimating lead-attributable mortality burden by socioeconomic status in the USA. Int J Epidemiol 2024; 53:dyae089. [PMID: 38990179 DOI: 10.1093/ije/dyae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 06/27/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND This study aimed to estimate population-level and state-level lead-attributable mortality burdens stratified by socioeconomic status (SES) class in the USA. METHODS Based on the National Health and Nutrition Examination Survey (NHANES), we constructed individual-level SES scores from income, employment, education and insurance data. We assessed the association between the blood lead levels (BLL) and all-cause mortality by Cox regression in the NHANES cohort (n = 31 311, 4467 deaths). With estimated hazard ratios (HR) and prevalences of medium (2-5 μg/dL) and high (≥ 5 μg/dL) BLL, we computed SES-stratified population-attributable fractions (PAFs) of all-cause mortality from lead exposure across 1999-2019. We additionally conducted a systematic review to estimate the lead-attributable mortality burden at state-level. RESULTS The HR for every 2-fold increase in the BLL decreased from 1.23 (1.10-1.38) for the lowest SES class to 1.05 (0.90-1.23) for the highest SES class. Across all SES quintiles, medium BLL exhibited a greater mortality burden. Individuals with lower SES had higher lead-attributable burdens, and such disparities haver persisted over the past two decades. In 2017-19, annually 67 000 (32 000-112 000) deaths in the USA were attributable to lead exposure, with 18 000 (2000-41 000) of these deaths occurring in the lowest SES class. Substantial disparities in the state-level mortality burden attributable to lead exposure were also highlighted. CONCLUSIONS These findings suggested that disparities in lead-attributable mortality burden persisted within US adults, due to heterogeneities in the effect sizes of lead exposure as well as in the BLL among different SES classes.
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Affiliation(s)
- Chengzhe Tao
- Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi Center for Disease Control and Prevention, Wuxi Medical Center, Nanjing Medical University, Wuxi, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhi Li
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yun Fan
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yuna Huang
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Tingya Wan
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mingxue Shu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Shuwen Han
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hong Qian
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Wenkai Yan
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qiaoqiao Xu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yankai Xia
- Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi Center for Disease Control and Prevention, Wuxi Medical Center, Nanjing Medical University, Wuxi, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Chuncheng Lu
- Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi Center for Disease Control and Prevention, Wuxi Medical Center, Nanjing Medical University, Wuxi, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - You Li
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
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Hara K, Kanda M, Kuwabara H, Kobayashi Y, Inoue T. Association between the quantity of stroke care units and the complement of neurosurgical and neurology specialists in Japan: A retrospective study. J Stroke Cerebrovasc Dis 2024; 33:107734. [PMID: 38670322 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107734] [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: 10/03/2023] [Revised: 12/13/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Stroke care units provide advanced intensive care for unstable patients with acute stroke. We conducted a survey to clarify the differences in stroke care units between urban and regional cities and the relationship between the number of stroke care unit beds and neurologists. METHODS This retrospective observational study was conducted in 2,857 and 4,184 hospitals in urban and regional cities in 47 provinces of Japan, respectively, between January 2020 and August 2023. Tokyo and ordinance-designated cities in provinces were defined as urban cities, and those without such cities were defined as regional cities. The primary endpoint was the presence or absence of a stroke care unit. RESULTS Multiple linear regression analysis revealed that the presence of stroke care units was significantly associated with the number of neurosurgical specialists. Receiver operating characteristic curve analysis was performed to predict the number of personnel required for stroke care unit installation based on the number of neurosurgical specialists. The area under the receiver operating characteristic curve, Youden index, sensitivity, and specificity were 0.721, 0.483, 0.783, and 0.700, respectively. CONCLUSIONS Our study underscores the indispensability of SCUs in stroke treatment, advocating for a strategic allocation of medical resources, heightened accessibility to neurosurgical specialists, and a concerted effort to address geographic and resource imbalances. The identified cutoff value of 8.99 neurosurgical specialists per 100,000 population serves as a practical benchmark for optimizing SCU establishment, thereby potentially mitigating stroke-related mortality.
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Affiliation(s)
- Kentaro Hara
- Department of Operation Center, National Hospital Organization Nagasaki Medical Center, Nagasaki 856-8562, Japan; Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan; Healthcare Management Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Masato Kanda
- Healthcare Management Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
| | - Hiroyo Kuwabara
- Healthcare Management Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
| | - Takahiro Inoue
- Healthcare Management Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan.
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Prust ML, Forman R, Ovbiagele B. Addressing disparities in the global epidemiology of stroke. Nat Rev Neurol 2024; 20:207-221. [PMID: 38228908 DOI: 10.1038/s41582-023-00921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Stroke is the second leading cause of death and the third leading cause of disability worldwide. Though the burden of stroke worldwide seems to have declined in the past three decades, much of this effect reflects decreases in high-income countries (HICs). By contrast, the burden of stroke has grown rapidly in low-income and middle-income countries (LMICs), where epidemiological, socioeconomic and demographic shifts have increased the incidence of stroke and other non-communicable diseases. Furthermore, even in HICs, disparities in stroke epidemiology exist along racial, ethnic, socioeconomic and geographical lines. In this Review, we highlight the under-acknowledged disparities in the burden of stroke. We emphasize the shifting global landscape of stroke risk factors, critical gaps in stroke service delivery, and the need for a more granular analysis of the burden of stroke within and between LMICs and HICs to guide context-appropriate capacity-building. Finally, we review strategies for addressing key inequalities in stroke epidemiology, including improvements in epidemiological surveillance and context-specific research efforts in under-resourced regions, development of the global workforce of stroke care providers, expansion of access to preventive and treatment services through mobile and telehealth platforms, and scaling up of evidence-based strategies and policies that target local, national, regional and global stroke disparities.
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Affiliation(s)
- Morgan L Prust
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
| | - Rachel Forman
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Bruce Ovbiagele
- Department of Neurology, University of California-San Francisco School of Medicine, San Francisco, CA, USA
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Hasani WSR, Muhamad NA, Hanis TM, Maamor NH, Chen XW, Omar MA, Cheng Kueh Y, Abd Karim Z, Hassan MRA, Musa KI. The global estimate of premature cardiovascular mortality: a systematic review and meta-analysis of age-standardized mortality rate. BMC Public Health 2023; 23:1561. [PMID: 37587427 PMCID: PMC10429077 DOI: 10.1186/s12889-023-16466-1] [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] [Received: 03/24/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a significant cause of premature mortality worldwide, with a growing burden in recent years. Despite this, there is a lack of comprehensive meta-analyses that quantify the extent of premature CVD mortality. Study addressed this gap by estimating the pooled age-standardized mortality rate (ASMR) of premature CVD mortality. METHODS We conducted a systematic review of published CVD mortality studies that reported ASMR as an indicator for premature mortality measurement. All English articles published as of October 2022 were searched in four electronic databases: PubMed, Scopus, Web of Science (WoS), and the Cochrane Central Register of Controlled Trials (CENTRAL). We computed pooled estimates of ASMR using random-effects meta-analysis. We assessed heterogeneity from the selected studies using the I2 statistic. Subgroup analyses and meta regression analysis was performed based on sex, main CVD types, income country level, study time and age group. The analysis was performed using R software with the "meta" and "metafor" packages. RESULTS A total of 15 studies met the inclusion criteria. The estimated global ASMR for premature mortality from total CVD was 96.04 per 100,000 people (95% CI: 67.18, 137.31). Subgroup analysis by specific CVD types revealed a higher ASMR for ischemic heart disease (ASMR = 15.57, 95% CI: 11.27, 21.5) compared to stroke (ASMR = 12.36, 95% CI: 8.09, 18.91). Sex-specific differences were also observed, with higher ASMRs for males (37.50, 95% CI: 23.69, 59.37) than females (15.75, 95% CI: 9.61, 25.81). Middle-income countries had a significantly higher ASMR (90.58, 95% CI: 56.40, 145.48) compared to high-income countries (21.42, 95% CI: 15.63, 29.37). Stratifying by age group indicated that the age groups of 20-64 years and 30-74 years had a higher ASMR than the age group of 0-74 years. Our multivariable meta-regression model suggested significant differences in the adjusted ASMR estimates for all covariates except study time. CONCLUSIONS This meta-analysis synthesized a comprehensive estimate of the worldwide burden of premature CVD mortality. Our findings underscore the continued burden of premature CVD mortality, particularly in middle-income countries. Addressing this issue requires targeted interventions to mitigate the high risk of premature CVD mortality in these vulnerable populations.
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Affiliation(s)
- Wan Shakira Rodzlan Hasani
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Selangor, Malaysia.
| | - Nor Asiah Muhamad
- Sector for Evidence-Based Healthcare, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Tengku Muhammad Hanis
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Nur Hasnah Maamor
- Sector for Evidence-Based Healthcare, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Xin Wee Chen
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, 47000, Selangor, Malaysia
| | - Mohd Azahadi Omar
- Sector for Biostatistics and Data Repository, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Selangor, Malaysia
| | - Yee Cheng Kueh
- Biostatistics and Research Methodology Unit, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Zulkarnain Abd Karim
- Office of The Manager to Biomedical Research Policy & Strategic Planning Unit, Institutes for Medical Research, Setia Alam 40170, Selangor, Malaysia
| | | | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
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Yan M. State-level disparities in burden of ischemic heart diseases mortality attributable to ambient fine particulate matter in the United States, 1990-2019: Observational analysis for the Global Burden of Disease (2019) study. CHEMOSPHERE 2023; 311:137033. [PMID: 36349585 DOI: 10.1016/j.chemosphere.2022.137033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND ambient fine particulate air pollution (PM2.5) is an important yet often overlooked risk factor for cardiovascular disease in the United States. However, epidemiologic evidence suggests that current knowledge does not comprehensively capture state-level disparities in mortality for ambient PM2.5-related ischemic heart diseases. METHODS I performed serial cross sectional analysis with ambient PM2.5-attributable ischemic heart diseases decedents between 1990 and 2019. I used the Global Health Data Exchange to extract age adjusted mortality rates in each state, and used Joinpoint software to calculate average annual percentage change. RESULTS the average age adjusted mortality rates (AAMR) for ischemic heart diseases attributable to ambient PM2.5 for both sex ranged from 1.5 (1.3-1.8) per 100,000 in Hawaii to 1.1 (0.9-1.3) per 100,000 in Mississippi, respectively. The rate of change in AAMR varied widely across states. Compared with the national level, the number of states with smaller decline has increased from 3 before 2002 to 10 after 2011. Oregon, Idaho, and Montana showed an upward trend in AAMR, which was independent of sex after 2011. Between 1990 and 2019, average AAMR for ischemic heart diseases attributable to ambient PM2.5 was higher for male than female in all states. But the number of states with sex disparities in the rate of change has decreased, from 13 in 1990-2002 to 5 after 2011. CONCLUSIONS wide state-level disparities exist in burden of ischemic heart diseases attributable to ambient PM2.5. After 2011, the association between rate of AAMR decline and sex weakened across states. State-level policies and programs are needed to address the avoidable burden of ischemic heart diseases deaths attributable to ambient particulate pollution, with priority for states with a higher burden.
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Affiliation(s)
- Mengmeng Yan
- Urban Vocational College of Sichuan, Chengdu, China; University of Electronic Science and Technology of China, Chengdu, China; Sichuan Cancer Hospital & Institute, Chengdu, China.
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Song S, Gaynor AM, Cruz E, Lee S, Gazes Y, Habeck C, Stern Y, Gu Y. Mediterranean Diet and White Matter Hyperintensity Change over Time in Cognitively Intact Adults. Nutrients 2022; 14:3664. [PMID: 36079921 PMCID: PMC9460774 DOI: 10.3390/nu14173664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/27/2022] [Accepted: 08/31/2022] [Indexed: 11/21/2022] Open
Abstract
Current evidence on the impact of Mediterranean diet (MeDi) on white matter hyperintensity (WMH) trajectory is scarce. This study aims to examine whether greater adherence to MeDi is associated with less accumulation of WMH. This population-based longitudinal study included 183 cognitively intact adults aged 20−80 years. The MeDi score was obtained from a self-reported food frequency questionnaire; WMH was assessed by 3T MRI. Multivariable linear regression was used to estimate the effect of MeDi on WMH change. Covariates included socio-demographic factors and brain markers. Moderation effects by age, gender, and race/ethnicity were examined, followed by stratification analyses. Among all participants, WMH increased from baseline to follow-up (mean difference [follow-up-baseline] [standard deviation] = 0.31 [0.48], p < 0.001). MeDi adherence was negatively associated with the increase in WMH (β = −0.014, 95% CI = −0.026−−0.001, p = 0.034), adjusting for all covariates. The association between MeDi and WMH change was moderated by age (young group = reference, p-interaction[middle-aged × MeDi] = 0.075, p-interaction[older × MeDi] = 0.037). The association between MeDi and WMH change was observed among the young group (β = −0.035, 95% CI = −0.058−−0.013, p = 0.003), but not among other age groups. Moderation effects by gender and race/ethnicity did not reach significance. Greater adherence to MeDi was associated with a lesser increase in WMH over time. Following a healthy diet, especially at younger age, may help to maintain a healthy brain.
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Affiliation(s)
- Suhang Song
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, USA
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA 30602, USA
| | - Alexandra M. Gaynor
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, USA
| | - Emily Cruz
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, USA
| | - Seonjoo Lee
- Department of Psychiatry and Biostatistics, Columbia University, New York, NY 10032, USA
- Mental Health Data Science, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Yunglin Gazes
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, USA
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY 10032, USA
- Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA
| | - Christian Habeck
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, USA
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY 10032, USA
- Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA
| | - Yaakov Stern
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, USA
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY 10032, USA
- Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Yian Gu
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, USA
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY 10032, USA
- Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA
- Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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Affiliation(s)
- Lewis B Morgenstern
- Michigan Medicine and School of Public Health, University of Michigan, Ann Arbor (L.B.M.)
| | - Amytis Towfighi
- University of Southern California (A.T.).,Los Angeles County Department of Health Services (A.T.).,LAC+USC Medical Center (A.T.)
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Song S, Duan Y, Huang J, Wong MCS, Chen H, Trisolini MG, Labresh KA, Smith SC, Jin Y, Zheng ZJ. Socioeconomic Inequalities in Premature Cancer Mortality Among U.S. Counties During 1999 to 2018. Cancer Epidemiol Biomarkers Prev 2021; 30:1375-1386. [PMID: 33947656 DOI: 10.1158/1055-9965.epi-20-1534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/06/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study investigated socioeconomic inequalities in premature cancer mortality by cancer types, and evaluated the associations between socioeconomic status (SES) and premature cancer mortality by cancer types. METHODS Using multiple databases, cancer mortality was linked to SES and other county characteristics. The outcome measure was cancer mortality among adults ages 25-64 years in 3,028 U.S. counties, from 1999 to 2018. Socioeconomic inequalities in mortality were calculated as a concentration index (CI) by income (annual median household income), educational attainment (% with bachelor's degree or higher), and unemployment rate. A hierarchical linear mixed model and dominance analyses were used to investigate SES associated with county-level mortality. The analyses were also conducted by cancer types. RESULTS CIs of SES factors varied by cancer types. Low-SES counties showed increasing trends in mortality, while high-SES counties showed decreasing trends. Socioeconomic inequalities in mortality among high-SES counties were larger than those among low-SES counties. SES explained 25.73% of the mortality. County-level cancer mortality was associated with income, educational attainment, and unemployment rate, at -0.24 [95% (CI): -0.36 to -0.12], -0.68 (95% CI: -0.87 to -0.50), and 1.50 (95% CI: 0.92-2.07) deaths per 100,000 population with one-unit SES factors increase, respectively, after controlling for health care environment and population health. CONCLUSIONS SES acts as a key driver of premature cancer mortality, and socioeconomic inequalities differ by cancer types. IMPACT Focused efforts that target socioeconomic drivers of mortalities and inequalities are warranted for designing cancer-prevention implementation strategies and control programs and policies for socioeconomically underprivileged groups.
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Affiliation(s)
- Suhang Song
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York
| | - Yuqi Duan
- Department of Global Health, School of Public Health, Peking University, Beijing, P.R. China.,Institute for Global Health, Peking University, Beijing, P.R. China
| | - Junjie Huang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, P.R. China
| | - Martin C S Wong
- Department of Global Health, School of Public Health, Peking University, Beijing, P.R. China.,Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, P.R. China
| | - Hongda Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | | | | | - Sidney C Smith
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, P.R. China. .,Institute for Global Health, Peking University, Beijing, P.R. China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, P.R. China.,Institute for Global Health, Peking University, Beijing, P.R. China
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