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Bhojani N, Miller LE, Zorn KC, Chughtai B, Elterman DS, Bhattacharyya S, Chew BH. Prevalence and determinants of shared decision-making for PSA testing in the United States. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00843-x. [PMID: 38671083 DOI: 10.1038/s41391-024-00843-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Shared decision-making (SDM) is recommended for prostate-specific antigen (PSA) testing but appears underutilized. This population-based study assessed the prevalence and determinants of SDM for PSA testing among US men. METHODS We assessed PSA testing rates and SDM engagement in men aged 40 and older without prostate cancer history using the 2019 National Health Interview Survey. SDM was defined as discussing the advantages and disadvantages of PSA testing with a physician. We used multivariable logistic regression with machine learning to identify factors associated with lack of SDM. RESULTS Among 9723 eligible participants (mean age 58 years), lifetime PSA testing prevalence was 45.9% and the 1-year testing incidence was 29.1%. Only 24.1% reported engaging in SDM with a physician, while 62.9% never discussed PSA testing. Younger age and lower education levels were the primary determinants of decreased SDM engagement. Men with less education engaged in SDM less than half as often as those with higher education levels across all age groups. CONCLUSIONS Societal guidelines recommend SDM for PSA testing. However, most men, regardless of age, have never engaged in SDM conversations with a healthcare provider about PSA testing, especially those with less education. More efforts are needed to improve patient-provider conversations about the potential benefits and harms of PSA testing.
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Affiliation(s)
- Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Larry E Miller
- Department of Biostatistics, Miller Scientific, Johnson City, TN, USA.
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Bilal Chughtai
- Department of Urology, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Dean S Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | | | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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Zapata-Moya AR, Freese J, Bracke P. Mechanism substitution in preventive innovations: Dissecting the reproduction of health inequalities in the United States. Soc Sci Med 2023; 337:116262. [PMID: 37898013 DOI: 10.1016/j.socscimed.2023.116262] [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: 03/18/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/30/2023]
Abstract
In the last three decades, numerous studies in different countries have corroborated the main postulates of the Fundamental Cause Theory (FCT), providing evidence showing how health inequalities are reproduced as society increases its capacity to control disease and/or avoid its consequences through preventive innovations. However, documenting the reproductive logic proposed by the theory requires the development of a dynamic analytical approach to consider socioeconomic disparities in the incorporation of multiple preventive innovations over time, which could act as mediating mechanisms of the durable relationship between socioeconomic status and health/mortality. This study draws on data from different waves of the National Health Interview Survey and the National Health and Nutrition Examination Survey to analyze the diffusion processes of various innovations in the U.S. The results of the study show that educational inequalities emerge, are amplified, and are reduced by the continuous diffusion of preventive innovations, supporting the meta-hypothesis of substitution of mediating mechanisms according to the interconnections of FCT and Diffusion of Innovation Theory.
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Affiliation(s)
- Angel R Zapata-Moya
- Universidad Pablo de Olavide, Department of Anthropology, Basic Psychology and Public Health, Seville, Spain; Centre for Sociology and Urban Policies - The Urban Governance Lab, Universidad Pablo de Olavide, Seville, Spain.
| | - Jeremy Freese
- Stanford University, Department of Sociology, United States.
| | - Piet Bracke
- Ghent University, Department of Sociology, Health and Demographic Research, Ghent, Belgium.
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Kopasker D, Katikireddi SV, Santos JV, Richiardi M, Bronka P, Rostila M, Cecchini M, Ali S, Emmert-Fees K, Bambra C, Hoven H, Backhaus I, Balaj M, Eikemo TA. Microsimulation as a flexible tool to evaluate policies and their impact on socioeconomic inequalities in health. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100758. [PMID: 37876527 PMCID: PMC10590730 DOI: 10.1016/j.lanepe.2023.100758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Daniel Kopasker
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK
| | | | - João Vasco Santos
- Public Health Unit, ACES Grande Porto V – Porto Ocidental, ARS Norte, Portugal
- MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Portugal
- CINTESIS - Centre for Health Technology and Services Research, Portugal
| | - Matteo Richiardi
- Centre for Microsimulation and Policy Analysis, University of Essex, UK
| | - Patryk Bronka
- Centre for Microsimulation and Policy Analysis, University of Essex, UK
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Sweden
- Aging Research Center (ARC), Karolinska Institutet, Sweden
| | - Michele Cecchini
- Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Shehzad Ali
- Department of Epidemiology and Biostatistics, Western University, Canada
- Department of Health Sciences, University of York, UK
- WHO Collaborating Centre for Knowledge Translation and HTA in Health Equity, Canada
| | - Karl Emmert-Fees
- School of Medicine and Health, Technical University of Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Germany
| | - Clare Bambra
- Population Health Sciences Institute, University of Newcastle, UK
| | - Hanno Hoven
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Germany
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | - Insa Backhaus
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | - Mirza Balaj
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
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Hong J, Dembo RS, DaWalt LS, Brilliant M, Berry-Kravis EM, Mailick M. The effect of college degree attainment on neurodegenerative symptoms in genetically at-risk women. SSM Popul Health 2022; 19:101262. [PMID: 36238818 PMCID: PMC9550653 DOI: 10.1016/j.ssmph.2022.101262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 12/02/2022] Open
Abstract
Using longitudinal data, the present study examined the association between college degree attainment and the manifestation of neurodegenerative symptoms among women (n = 93) at elevated genetic risk. The neurodegenerative symptoms investigated in this study are due to FXTAS (Fragile X-associated Tremor/Ataxia Syndrome), a condition with onset after age 50. Those at risk for FXTAS have a mutation of a single gene found on the X chromosome. FXTAS is characterized by intention tremor, gait ataxia, executive function deficits, memory issues, and neuropathy. College degree attainment has been shown to provide neuroprotective effects in the general population, delaying the development of neurodegenerative conditions such as Alzheimer's disease. For this reason, college degree attainment is a potentially salient resource for those at risk of FXTAS. The results of the present research indicated significantly more severe FXTAS symptoms in women who did not attain a college degree as compared with those who were college graduates, although the two groups were similar in age, genetic risk, household income, health behaviors, and general health problems. Furthermore, symptoms in those who did not attain a college degree worsened over the 9-year study period at a significantly faster rate than the college graduates. The association between college degree attainment and FXTAS symptoms was significantly mediated by depression, which was lower among the graduates than those who did not attain a college degree. Thus, the present research is an example of how a sociodemographic factor can mitigate neurodegenerative conditions in genetically at-risk adults.
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Affiliation(s)
- Jinkuk Hong
- Waisman Center, University of Wisconsin-Madison, USA,Corresponding author. Waisman Center, 1500 Highland Ave. Room 555, Madison, WI, 53706, USA.
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Health and health behaviors in China: Anomalies in the SES-health gradient? SSM Popul Health 2022; 17:101069. [PMID: 35313609 PMCID: PMC8933530 DOI: 10.1016/j.ssmph.2022.101069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/27/2022] [Accepted: 03/08/2022] [Indexed: 12/18/2022] Open
Abstract
Objectives Fundamental Cause Theory (FCT) predicts that higher socioeconomic status (SES) leads to better health outcomes, through mechanisms including health-promoting behaviors. Most studies supporting FCT use data from Western countries. However, limited empirical studies from China, as well as theoretical considerations suggested by China's unique history and culture, raise questions about the generalizability of FCT to the Chinese context. This study explores whether the associations between SES, health behaviors, and health status in Western countries are also observed in China, and to what extent behavioral risk factors explain socioeconomic disparities in Chinese health. Data and method Using data on adults age 45+ from the nationally-representative 2015 China Health and Retirement Longitudinal Study (CHARLS; n = 14,420), we conduct regressions of multiple health outcomes (self-rated health, disease count, and several common chronic conditions) on demographic characteristics, SES (measured via education and wealth), and behavioral risk factors (smoking, high-frequency drinking, and overweight). To assess whether behavioral risk factors mediate the SES-health association, we use the Karlson, Holm and Breen (KHB) mediation analysis method. Results Supporting FCT, both education and wealth predict higher self-rated health and lower risk of arthritis. However, inconsistent with FCT, neither education nor wealth predict disease count, diabetes, or hypertension; education shows some positive association with cardiovascular disease; and higher SES is strongly associated with higher risk of dyslipidemia. Prevalence of smoking and high-frequency drinking are flat by wealth and inversely U-shaped by education, while overweight is somewhat concentrated in the highest SES groups. Results of mediation analyses show both suppression and mediation effects. Conclusion High prevalence of behavioral risk factors across SES groups appears to damage health in much of the Chinese population, and thus attenuates social gradients in health. A broader range of cultural, historical, and political factors should be incorporated into FCT's theoretical framework, particularly in non-Western contexts. Most research on the SES-health association uses data from Western countries. This study examine links between SES (education and wealth) and health in China. Greater education and wealth sometimes predict worse health and health behaviors. Countervailing cultural mechanisms may sometimes reverse health gradients in China.
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Costa C, Santana P. Trends of amenable deaths due to healthcare within the European Union countries. Exploring the association with the economic crisis and education. SSM Popul Health 2021; 16:100982. [PMID: 34926783 PMCID: PMC8648806 DOI: 10.1016/j.ssmph.2021.100982] [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: 04/15/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 02/03/2023] Open
Abstract
The study of premature deaths from causes that are generally preventable given the current availability of healthcare - called amenable deaths due to healthcare - provides information on the quality of services. However, they are not only impacted by healthcare characteristics: other factors are also likely to influence. Therefore, identifying the association between amenable deaths due to healthcare and health determinants, such as education, might be the key to preventing these deaths in the future. Still unclear however, is how this works and how amenable deaths due to healthcare are distributed and evolve within the European Union (EU) below the national level. We therefore studied the geographical and temporal patterns of amenable deaths due to healthcare in the 259 EU regions from 1999 to 2016, including the 2007-2008 financial crisis and the post-2008 economic downturn, and identified whether any association with education exists. A cross-sectional ecological study was carried out. Using a hierarchical Bayesian model, we estimated the average smoothed Standardized Mortality Ratios (sSMR). A regression model was also applied to measure the relative risks (RR) at 95% credible intervals for cause-specific mortality association with education. Results show that amenable deaths due to healthcare decreased globally. Nevertheless, the decrease is not the same across all regions, and inequalities within countries do persist, with lower mortality ratios seen in regions from Central European countries and higher mortality ratios in regions from Eastern European countries. Also, the evolution trend reveals that after the financial crisis, the number of these deaths increased in regions across almost all EU countries. Moreover, educational disparities in mortality emerged, and a statistical association was found between amenable deaths due to healthcare and early exit from education and training. These results confirm that identifying and understanding the background of regional differences may lead to a better understanding of the amenable deaths due to healthcare and allow for the application of more effective policies.
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Affiliation(s)
- Claudia Costa
- Centre of Studies in Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, Portugal
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, Portugal
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7
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Kim I. Spatial distribution of neighborhood-level housing prices and its association with all-cause mortality in Seoul, Korea (2013-2018): A spatial panel data analysis. SSM Popul Health 2021; 16:100963. [PMID: 34820502 PMCID: PMC8599165 DOI: 10.1016/j.ssmph.2021.100963] [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: 06/25/2021] [Revised: 09/27/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
Housing prices are known to be a relevant indicator of the socioeconomic position of the neighborhood. In a society where the market system mainly drives housing prices, residents' spatial patterning is formulated according to their socioeconomic position. Dividing the 2013-2018 entire study period into three periods, we explored the spatial distribution of housing prices and all-cause mortality and their association in Seoul, the country's capital city. The government authorities' data and 2015 census data were used for the study. We mapped the spatial distribution of housing prices and all-cause mortality and investigated the changes in distribution. We conducted a pooled ordinary least square (OLS) and spatial panel regression analysis to estimate housing prices elasticity of all-cause mortality. We also explored the possible mediating role of housing prices on the educational composition's effect on all-cause mortality. We found the common trends of increasing spatial patterning of housing prices and all-cause mortality. The magnitude of spatial patterning was far greater in housing prices than all-cause mortality. A pooled OLS regression analysis found that a 1% increase in housing price was associated with a 0.11% reduction in all-cause mortality after controlling the explanatory variables. Attenuation in the regression coefficient's magnitude was found after adding the neighborhood's educational composition to the model. As a result of spatial panel analysis, we found a direction and scale similar to the housing price elasticity of all-cause mortality in the final pooled OLS model. The results suggested that spatial health inequality in Korea's urban space mainly stems from socioeconomic inequality.
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Affiliation(s)
- Ikhan Kim
- Department of Medical Humanities and Social Medicine, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan, 49267, South Korea
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8
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La Parra-Casado D, Solheim EF, Estévez JF. Health inequalities between Roma and non-Roma populations in Europe: A study of 118,834 individuals combining the UNDP Roma and the EU-SILC surveys. Scand J Public Health 2021:14034948211056210. [PMID: 34796767 DOI: 10.1177/14034948211056210] [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: 11/16/2022]
Abstract
AIMS This study aimed to compare the self-rated health status of the Roma and of the general population by gender and educational level in six Central and Eastern European countries. METHODS We analysed the United Nations Development Program Regional Roma Survey and EUROSTAT's European Union Statistics on Income and Living Conditions surveys from 2011 for Bulgaria, Croatia, Czechia, Hungary, Romania and Slovakia. Using logistic regression, predicted probabilities of good or very good self-rated health were estimated for the Roma (n=11,401), Roma neighbours (n=5857) and the general population (n=101,579) stratified by gender, and adjusted by age, country and educational level. RESULTS There was a distinctive social gradient in self-rated health between the groups among both men and women, and a gap between primary versus secondary or tertiary education among all three groups, but Roma (men) and their neighbours with secondary or higher education had significantly worse predicted self-rated health compared to the general population with similar qualifications. CONCLUSIONS These results strongly suggest that ethnicity and gender should be considered as fundamental causes that explain structural health inequalities. Consequently, future research and policy initiatives to reduce health inequities should acknowledge the impact of ethnic minorities and how these fundamental causes extend the general population's social gradient in health. Study designs enabling direct comparisons between ethnic groups and the general population should be applied. More and better data about ethnic minorities are needed to document and monitor existing health inequalities.
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Affiliation(s)
| | - Erling F Solheim
- Department of Social Sciences, UiT the Arctic University of Norway, Norway
| | - Jesús F Estévez
- Institute of International Economy, University of Alicante, Spain
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9
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Trends in absolute and relative educational inequalities in health during times of labour market restructuring in coastal areas: The HUNT Study, Norway. Soc Sci Med 2021; 292:114541. [PMID: 34799180 DOI: 10.1016/j.socscimed.2021.114541] [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: 04/10/2021] [Revised: 10/04/2021] [Accepted: 11/04/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Restructuring labour markets offers natural population-level experiments of great social epidemiological interest. Many coastal areas have endured substantial restructuring of their local labour markets following declines in small-scale fishing and transitions to new employment opportunities. It is unknown how educational inequalities in health have developed in formerly fishery-dependent communities during such restructuring. In this study, we compare trends in social inequalities in health in Norwegian coastal areas with adjacent geographical areas between 1984 and 2019. METHODS We used cross-sectional population-based data from the Trøndelag Health Study (HUNT), collected four times: HUNT1 (1984-86), HUNT2 (1995-97), HUNT3 (2006-08) and HUNT4 (2017-19). Adults above 30 years of age were included. Using Poisson regression, we calculated absolute and relative educational inequalities in self-rated health, using slope (SII) and relative (RII) indices of inequality. RESULTS Trends in absolute and relative inequalities in rural coastal health were generally more favourable than in adjacent geographical areas. We found a statistically significant trend of declining relative educational inequalities in self-rated health in the rural coastal population from HUNT1 to HUNT4. Absolute inequalities overall increased from HUNT1 to HUNT4, although a declining trend followed HUNT2. Nonetheless, the rural coastal population exhibited the highest prevalence of poor self-rated health across the four decades. CONCLUSIONS Although absolute educational inequalities in self-rated health widened in all geographical areas, the smallest increase was in rural coastal areas. Relative educational inequalities narrowed in this rural coastal population. Considering the concurrent processes of large-scale investments in the Norwegian public sector and welfare schemes, increased fishing fleet safety, and employment opportunities in aquaculture, our findings do not suggest that potential positive effects on public health of this restructuring have benefitted inhabitants with higher educational attainment more than inhabitants with lower educational attainment in this rural coastal population.
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Clouston SAP, Link BG. A retrospective on fundamental cause theory: State of the literature, and goals for the future. ANNUAL REVIEW OF SOCIOLOGY 2021; 47:131-156. [PMID: 34949900 PMCID: PMC8691558 DOI: 10.1146/annurev-soc-090320-094912] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Fundamental Cause Theory (FCT) was originally proposed to explain how socioeconomic inequalities in health emerged and persisted over time. The concept was that higher socioeconomic status helped some people to avoid risks and adopt protective strategies using flexible resources - knowledge, money, power, prestige and beneficial social connections. As a sociological theory, FCT addressed this issue by calling on social stratification, stigma, and racism as they affected medical treatments and health outcomes. The last comprehensive review was completed a decade ago. Since then, FCT has been tested, and new applications have extended central features. The current review consolidates key foci in the literature in order to guide future research in the field. Notable themes emerged around types of resources and their usage, approaches used to test the theory, and novel extensions. We conclude that after 25 years of use, there remain crucial questions to be addressed.
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Affiliation(s)
- Sean A. P. Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Bruce G. Link
- School of Public Policy and Department of Sociology, University of California at Riverside, Riverside, CA, USA
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11
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Slurink IA, Götz HM, van Aar F, van Benthem BH. Educational level and risk of sexually transmitted infections among clients of Dutch sexual health centres. Int J STD AIDS 2021; 32:1004-1013. [PMID: 33993803 DOI: 10.1177/09564624211013670] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to assess whether educational level is an independent determinant for sexually transmitted infections (STIs) among clients consulting Dutch sexual health centres (SHCs). With data from the National STI surveillance database (2015-2017), generalized estimating equations corrected for (sexual) risk factors were used to estimate associations between educational level and chlamydia and gonorrhoea among women (n = 146,020), heterosexual men (n = 82,882) and men who have sex with men (MSM) (n = 52,149) and syphilis and HIV among MSM. Compared to the highest educational level (bachelor/master), all lower educational levels were associated with gonorrhoea among women (adjusted odds ratio 1.40; 95% CI 1.18-1.66 for higher general/pre-university level to 3.57; 95% CI 2.66-4.81 for no education/elementary school level) and heterosexual men (respectively 1.36; 1.06-1.74 to 3.84; 2.89-5.09). Women with no education/elementary school level (1.37; 1.17-1.62) and heterosexual clients with (pre-)vocational secondary educational level were more likely to test positive for chlamydia (women: 1.43; 1.39-1.48 and heterosexual men: 1.31; 1.26-1.37) than clients with higher general/pre-university level or bachelor/master level. In MSM, (pre-)vocational secondary educational level was associated with chlamydia (1.16; 1.11-1.22), gonorrhoea (1.15; 1.10-1.21) and syphilis (1.18; 1.08-1.29), and both (pre-)vocational secondary educational level (1.48; 1.25-1.76) and no education/elementary school level (1.81; 1.09-3.00) were associated with HIV. Lower educational levels were independent determinants of STI in SHC clients. Sexual health centres could facilitate STI testing and care among lower educated people by prioritizing their access.
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Affiliation(s)
- Isabel Al Slurink
- Centre for Infectious Disease Control, 10206National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,CoRPS, Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, 7899Tilburg University, Tilburg, The Netherlands
| | - Hannelore M Götz
- Centre for Infectious Disease Control, 10206National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.,Department of Public Health, 6993Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fleur van Aar
- Centre for Infectious Disease Control, 10206National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Birgit Hb van Benthem
- Centre for Infectious Disease Control, 10206National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Educational Disparities in COVID-19 Prevention in China: The Role of Contextual Danger, Perceived Risk, and Interventional Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073383. [PMID: 33805222 PMCID: PMC8036684 DOI: 10.3390/ijerph18073383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/22/2021] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
Despite the social disparities in COVID-19 infection, little is known about factors influencing social disparities in preventive behaviors during the pandemic. This study examined how educational disparities in mask-wearing, handwashing, and limiting public outings might be contingent upon three factors: contextual cue of danger, perceived risk of local outbreak, and interventional context with different levels of intensity (i.e, Wuhan vs. other areas). Data were obtained from a telephone survey of 3327 adults, who were recruited through a random-digit-dial method to be representative of all cell phone users in China. Interviews were conducted from 28 April to 26 May 2020. Stratified multiple regression models showed that educational disparities in all three behaviors were only consistently observed among people exposed to context cues of danger, with an enhanced sense of risk of a local outbreak, or in areas other than Wuhan. College education seems to make a difference in handwashing regardless of contextual cues of danger or perception of risk. The findings suggested that, in the process of an epidemic, emerging threats in one's immediate environment or raised awareness of risks are important conditions triggering educational disparities in prevention. However, effective public health interventions could potentially reduce such disparities.
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Ólafsdóttir S, Beckfield J. Health Inequalities: What do we know and what do we need to know? Soc Sci Med 2020; 267:113575. [PMID: 33317861 DOI: 10.1016/j.socscimed.2020.113575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Sigrun Ólafsdóttir
- Department of Sociology, University of Iceland, Sturlugata 3, Reykjavík, 101, Iceland.
| | - Jason Beckfield
- Dept. of Sociology Harvard University, William James Hall, Cambridge, MA 02138, MA, USA
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