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Leveau CM, Velázquez GA. COVID-19 mortality: educational inequalities and socio-spatial context in two provinces of Argentina. Rev Peru Med Exp Salud Publica 2024; 41:171-177. [PMID: 39166640 PMCID: PMC11300695 DOI: 10.17843/rpmesp.2024.412.13201] [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: 01/07/2024] [Accepted: 03/27/2024] [Indexed: 08/23/2024] Open
Abstract
Motivation for the study. There are very few studies on the educational inequalities in COVID-19 mortality, taking into account social contextual factors. Main findings. We found educational inequalities of COVID-19 mortality during both the 2020 and 2021 waves, regardless of the level of poverty and urbanization in the departments of Mendoza and San Juan provinces (Argentina). Implications. Preventive policies should focus not only in areas with high levels of poverty, but also in areas with adults of low educational level. With the aim of describing the association between sociodemographic characteristics and contextual factors with COVID-19 mortality during 2020-2021 in the provinces of Mendoza and San Juan in Argentina, we conducted an ecological study, which included the sociodemographic factors: age, sex and educational level, and the contextual factors: poverty and urbanization at the departmental level. The analyses were estimated using negative binomial Bayesian hierarchical models. Educational inequalities existed regardless of socioeconomic context and level of urbanization. The exception was the age group 65 years and older during 2021, which, regardless of educational level, showed a higher risk of death by COVID-19 in departments with high levels of structural poverty. In conclusion, educational inequality is an indicator of social inequality that increases vulnerability to COVID-19 mortality.
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Affiliation(s)
- Carlos M Leveau
- Instituto de Producción, Economía y Trabajo, Universidad Nacional de Lanús. Remedios de Escalada, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Buenos Aires, Argentina
| | - Guillermo A Velázquez
- Instituto de Geografía, Historia y Ciencias Sociales, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
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Kruckow S, Tolstrup JS. All cause and cause specific mortality in 15-24-year-olds in Denmark 2010 to 2022: nationwide study of socioeconomic predictors. BMJ MEDICINE 2024; 3:e000685. [PMID: 39175917 PMCID: PMC11340248 DOI: 10.1136/bmjmed-2023-000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/12/2024] [Indexed: 08/24/2024]
Abstract
Objective To assess inequalities in all cause and cause specific mortality in young people and if there are differences across gender and age groups. Design Nationwide cohort study of socioeconomic predictors. Setting Denmark, 1 January 2010 to 31 December 2022. Participants All Danes of ages 15 to 24 years during the study period summing to a total of 9 314 807 person years and 2297 deaths. Participant and parental information were linked to obtain information on socioeconomic background to investigate differences in parents' educational level, employment status, and family's disposable income, using annually updated nationwide registers. Main outcome measures All cause and cause specific mortality including natural deaths (ie, medical conditions and diseases) and unnatural deaths (accidents, suicides, and homicides). Poisson regression was used to calculate incidence rate ratios and 95% confidence intervals (CI). Results Overall mortality rate was 24.7 (95% CI 23.7 to 25.7) and higher for men (33.2 (31.5 to 34.8)) compared with women (15.8 (14.6 to 16.9)). All cause and cause specific mortality were higher in financially disadvantaged groups compared with more affluent groups, and consistently so for all three measures of socioeconomic position. Results generally reflected a dose dependent association showing a higher mortality with lower levels of socioeconomic position. For instance, incidence rate ratios of all cause mortality related to parents' education was 2.3 (95% CI 2.0 to 2.7) for elementary level, 1.5 (1.3 to 1.6) for low, and 1.3 (1.1 to 1.4) for medium level as compared with high level. For deaths, incidence rate ratios of elementary education level compared with the most well educated group were 2.2 (1.5 to 3.2) for natural causes, 3.3 (2.5 to 4.4) for accidents, 1.6 (1.2 to 2.2) for suicides, and 3.1 (0.8 to 12) for homicides. Associations were similar in strata of men and women and by age group (15-17 v 18-24 years). Mortality in young men was considerably higher than in young women for all of the causes. Conclusion Young people from disadvantaged backgrounds have a markedly higher mortality from all causes than those from more affluent families. The socioeconomic position of their parents was associated with premature mortality in a dose dependent manner meaning that this effect is not only a concern for marginalised groups. Public health attention should be directed to respond to these inequities by strengthening advocacy for adolescent health, ensuring focus on adolescents in health policies and strategies, using the response to adolescent health as an indicator of equity, and prioritising research into the underlying mechanisms linking socioeconomic position in adolescence and mortality.
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Affiliation(s)
- Sofie Kruckow
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Leveau CM. [Homicides in southern South American cities: educational inequalities and economic fluctuations]. CAD SAUDE PUBLICA 2024; 40:e00228923. [PMID: 38922227 PMCID: PMC11192574 DOI: 10.1590/0102-311xes228923] [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: 12/19/2023] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 06/27/2024] Open
Abstract
Information on how economic fluctuations affect educational inequalities in homicides in Latin America is scarce. This study aimed to: (a) analyze the temporal variations of educational inequalities related to homicide mortality and (b) compare these inequalities between years of economic growth and recession in southern South America cities from 2000 to 2019. Data from seven urban areas in three countries in the Southern Cone of South America were used: Mendoza and Rosario (Argentina); Belo Horizonte, Curitiba, Rio de Janeiro, and São Paulo (Brazil); and Santiago (Chile). Poisson models were estimated by using age, sex, city of residence, year of economic growth or recession, and schooling level as explanatory variables. Results showed significant differences in the temporal evolution of homicide rates in the seven cities, although populations with a low schooling level always showed the most vulnerability. The four Brazilian cities, analyzed together, showed greater educational inequalities related to homicides in years of economic recession when compared to those of economic growth. On the one hand, the indiscriminate use of force by the State against criminal groups seems to increase social inequality in homicide mortality. On the other hand, criminal fragmentation and economic crisis can exacerbate these inequalities by increasing territorial disputes between criminal groups.
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Affiliation(s)
- Carlos Marcelo Leveau
- Instituto de Producción, Economía y Trabajo, Universidad Nacional de Lanús, Lanús, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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Bucci T, Romiti GF, Corica B, Shantsila A, Teo WS, Park HW, Shimizu W, Tse HF, Proietti M, Chao TF, Lip GYH. Educational status and the risk of adverse outcomes in Asian patients with atrial fibrillation: a report from the prospective APHRS-AF Registry. Minerva Med 2024; 115:308-319. [PMID: 38727706 DOI: 10.23736/s0026-4806.24.09159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of educational status (ES) on the clinical course of Asian patients with atrial fibrillation (AF). METHODS We used data from the prospective APHRS-AF Registry. ES was classified as follows: low (primary school), medium (secondary), and high (University). The primary outcome was a composite of all-cause death, thromboembolic events, acute coronary syndrome, and heart failure. Secondary outcomes were each component of the primary outcome, cardiovascular death, and major bleeding. The one-year risk of primary and secondary outcomes was assessed through Cox-regressions. Adherence to the Atrial fibrillation Better Care (ABC) pathway was assessed. RESULTS Among 2697 AF patients (69±12 years, 34.8% females), 34.6% had low ES; 37.3% had medium ES; and 28.1% had high ES. Compared to patients with medium-high ES, patients with low ES were older, more often females, with a higher prevalence of cardiovascular risk factors, and a lower ABC pathway adherence (30.4% vs. 40.2%, P<0.001). On multivariable analysis, low ES was associated with a higher risk for the primary outcome (HR 1.52,95%CI 1.11-2.06) and all-cause death (HR 1.76,95%CI 1.10-2.83) than medium-high ES. A significant interaction was found for the risk of composite outcome among the different age strata, with the higher risk in the elderly (P for int=0.008), whereas the beneficial effect of the ABC pathway was irrespective of ES (P for int=0.691). CONCLUSIONS In Asian AF patients, low ES is associated with high mortality. Efforts to improve education and include ES evaluation in the integrated care approach for AF are necessary to reduce the cardiovascular burden in these patients.
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Affiliation(s)
- Tommaso Bucci
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of General and Specialized Surgery, Sapienza University, Rome, Italy
| | - Giulio F Romiti
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Bernadette Corica
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Alena Shantsila
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Wee-Siong Teo
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Hyung-Wook Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, School of Clinical Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Subacute Care, IRCCS Maugeri Scientific Clinical Institutes, Milan, Italy
| | - Tze-Fan Chao
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan (R.O.C.)
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (R.O.C.)
| | - Gregory Y H Lip
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK -
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Kundu J, Goli S, James KS. Education and non-communicable diseases in India: an exploration of gendered heterogeneous relationships. Int Health 2024:ihae037. [PMID: 38785303 DOI: 10.1093/inthealth/ihae037] [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: 11/12/2023] [Revised: 03/26/2024] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND While the association between education and non-communicable diseases (NCDs) is well established, it remains unclear whether this association varies by gender. The aim of this study was to examine two critical research questions: whether the association of education and NCDs is conditioned by gender and, if so, what are the factors contributing to this? METHODS Data from the Longitudinal Aging Study in India Wave 1 (2017-2018) was used for the empirical analysis. The study employs bivariate, binary logistic regression and Oaxaca decomposition analyses. RESULTS The results reveal that the net likelihood of having at least one chronic NCD increases with an increase in education level for men (<5 y of schooling: odds ratio [OR] 1.18 [95% confidence interval {CI} 1.09 to 1.28]; ≥10 y of schooling: OR 1.43 [95% CI 1.33 to 1.53]). However, for women, the result showed a contrasting pattern. The decomposition analysis revealed that the distinctive roles of marital status and working status in the diagnosis of morbidity for men and women are the key factors behind the gendered heterogeneous relationship of education and NCDs in India. CONCLUSIONS The study found that it is important to acknowledge the potential impact of self-reporting bias in morbidity data while examining the relationship between education and NCDs.
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Affiliation(s)
- Jhumki Kundu
- Centre for Ageing Studies, International Institute for Population Sciences, Mumbai, Maharashtra 400088, India
| | - Srinivas Goli
- Department of Fertility and Social Demography, International Institute for Population Sciences, Mumbai, Maharashtra 400088, India
| | - K S James
- Tulane University, New Orleans, LA, USA
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Liew TM, Ang LC. Examining the non-linear effects of education on Alzheimer's and non-Alzheimer's disease: Sex-stratified analysis of 17,671 older persons. Soc Sci Med 2024; 348:116845. [PMID: 38598986 PMCID: PMC11105760 DOI: 10.1016/j.socscimed.2024.116845] [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: 02/01/2024] [Revised: 03/08/2024] [Accepted: 03/27/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Higher educational attainment is strongly associated with a reduced risk of neurocognitive disorders (NCDs). However, the literature is not yet clear on (1) the minimum years of compulsory education that would sufficiently mitigate the risk of NCDs, and (2) whether educational attainment has differential effects across sexes. To bridge these gaps, this study sought to model potential non-linear relationship between years of education and NCD risk, across men and women. METHODS The study recruited 17,671 participants from Alzheimer's Disease Centres across United States, aged≥50 years and had normal cognition at baseline. Participants were followed up almost annually, and underwent standardized assessments to diagnose various aetiologies of NCDs. Cox proportional hazard regression was conducted to examine the relationship between years of education and NCD risk, stratified by sexes. Years of education were modelled using restricted cubic spline. RESULTS Lesser years of education were associated with higher NCD risk in both sexes (specifically, when <12 years of education; HR 1.80-3.48), yet with key differences across sexes. In women, a linear relationship was observed whereby increasing years of education reduced NCD risk correspondingly; but in men, the relationship was non-linear whereby adding years of education beyond 12 years did not reduce NCD risk further. Men of lower educational attainment were at risk of both Alzheimer's Disease (AD; HR up to 3.45) and non-AD (HR up to 2.57), while women of lower educational attainment were only at risk of AD (HR up to 2.11). CONCLUSIONS Educational attainment alters NCD risk differently across sexes, emphasizing the relevance of sex-specific research to better understand the moderating role of sex on NCD risk. The findings also highlight the need to reconsider public policies related to equitable access to education, as well as traditional assumptions on the minimum years of compulsory education.
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Affiliation(s)
- Tau Ming Liew
- Department of Psychiatry, Singapore General Hospital, Singapore, Singapore; SingHealth Duke-NUS Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Li Chang Ang
- Medicine Academic Clinical Programme, Singapore General Hospital, Singapore, Singapore
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Tarkiainen L, Martikainen P, Junna L, Remes H. Contribution of causes of death to changing inequalities in life expectancy by income in Finland, 1997-2020. J Epidemiol Community Health 2024; 78:241-247. [PMID: 38233161 DOI: 10.1136/jech-2023-221705] [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: 11/17/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Socioeconomic inequalities in mortality originate from different causes of death. Alcohol-related and smoking-related deaths are major drivers of mortality inequalities across Europe. In Finland, the turn from widening to narrowing mortality disparities by income in the early 2010s was largely attributable to these causes of death. However, little is known about recent inequalities in life expectancy (LE) and lifespan variation. METHODS We used individual-level total population register-based data with annual information on disposable household income and cause-specific mortality for ages 30-95+, and assessed the contribution of smoking on mortality using the Preston-Glei-Wilmoth method. We calculated trends in LE at age 30 and SD in lifespan by income quintile in 1997-2020 and conducted age and cause-of-death decompositions of changes in LE. RESULTS Disparity in LE and lifespan variation by income increased in 2015-2020, largely attributable to the stagnation of both measures in the lowest income quintile. The LE gap between the extreme quintiles in 2018-2020 was 11.2 (men) and 5.9 (women) years, of which roughly 40% was attributable to alcohol and smoking. However, the recent widening of the gap and the stagnation in LE in the lowest quintile over time were not driven by any specific cause-of-death group. CONCLUSIONS After a decade of narrowing inequalities in LE and lifespan variation in Finland, the gaps between income groups are growing again. Increasing LE disparity and stagnating mortality on the lowest income levels are no longer attributable to smoking and alcohol-related deaths but are more comprehensive, originating from most cause-of-death groups.
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Affiliation(s)
- Lasse Tarkiainen
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck - Center for Social Inequalities in Population Health, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck - Center for Social Inequalities in Population Health, University of Helsinki, Helsinki, Finland
- Max-Planck-Institute for Demographic Research, Rostock, Germany
| | - Liina Junna
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck - Center for Social Inequalities in Population Health, University of Helsinki, Helsinki, Finland
| | - Hanna Remes
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck - Center for Social Inequalities in Population Health, University of Helsinki, Helsinki, Finland
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Balaj M, Henson CA, Aronsson A, Aravkin A, Beck K, Degail C, Donadello L, Eikemo K, Friedman J, Giouleka A, Gradeci I, Hay SI, Jensen MR, Mclaughlin SA, Mullany EC, O'connell EM, Sripada K, Stonkute D, Sorensen RJ, Solhaug S, Vonen HD, Westby C, Zheng P, Mohammad T, Eikemo TA, Gakidou E. Effects of education on adult mortality: a global systematic review and meta-analysis. Lancet Public Health 2024; 9:e155-e165. [PMID: 38278172 PMCID: PMC10901745 DOI: 10.1016/s2468-2667(23)00306-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND The positive effect of education on reducing all-cause adult mortality is known; however, the relative magnitude of this effect has not been systematically quantified. The aim of our study was to estimate the reduction in all-cause adult mortality associated with each year of schooling at a global level. METHODS In this systematic review and meta-analysis, we assessed the effect of education on all-cause adult mortality. We searched PubMed, Web of Science, Scopus, Embase, Global Health (CAB), EconLit, and Sociology Source Ultimate databases from Jan 1, 1980, to May 31, 2023. Reviewers (LD, TM, HDV, CW, IG, AG, CD, DS, KB, KE, and AA) assessed each record for individual-level data on educational attainment and mortality. Data were extracted by a single reviewer into a standard template from the Global Burden of Diseases, Injuries, and Risk Factors Study. We excluded studies that relied on case-crossover or ecological study designs to reduce the risk of bias from unlinked data and studies that did not report key measures of interest (all-cause adult mortality). Mixed-effects meta-regression models were implemented to address heterogeneity in referent and exposure measures among studies and to adjust for study-level covariates. This study was registered with PROSPERO (CRD42020183923). FINDINGS 17 094 unique records were identified, 603 of which were eligible for analysis and included data from 70 locations in 59 countries, producing a final dataset of 10 355 observations. Education showed a dose-response relationship with all-cause adult mortality, with an average reduction in mortality risk of 1·9% (95% uncertainty interval 1·8-2·0) per additional year of education. The effect was greater in younger age groups than in older age groups, with an average reduction in mortality risk of 2·9% (2·8-3·0) associated with each additional year of education for adults aged 18-49 years, compared with a 0·8% (0·6-1·0) reduction for adults older than 70 years. We found no differential effect of education on all-cause mortality by sex or Socio-demographic Index level. We identified publication bias (p<0·0001) and identified and reported estimates of between-study heterogeneity. INTERPRETATION To our knowledge, this is the first systematic review and meta-analysis to quantify the importance of years of schooling in reducing adult mortality, the benefits of which extend into older age and are substantial across sexes and economic contexts. This work provides compelling evidence of the importance of education in improving life expectancy and supports calls for increased investment in education as a crucial pathway for reducing global inequities in mortality. FUNDING Research Council of Norway and the Bill & Melinda Gates Foundation.
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Norström T, Ramstedt M. The impact of the COVID-19 pandemic on mortality in Sweden-Did it differ across socioeconomic groups? Eur J Epidemiol 2024; 39:137-145. [PMID: 38177570 PMCID: PMC10904510 DOI: 10.1007/s10654-023-01068-3] [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: 07/18/2023] [Accepted: 10/23/2023] [Indexed: 01/06/2024]
Abstract
The characterization of the socioeconomic profile of COVID-19 mortality is limited. Likewise, the mapping of potential indirect adverse outcomes of the pandemic, such as suicide and alcohol abuse, along socioeconomic lines is still meagre. The main aim of this paper is to (i) depict SES-differences in COVID-19 mortality, and (ii) to assess the impact of the COVID-19 pandemic on suicide and alcohol mortality across socioeconomic groups. We used Swedish monthly data spanning the period January 2016-December 2021. We chose education as indicator of socioeconomic status (SES). The following causes of deaths were included in the analysis: COVID-19, all-cause mortality excluding COVID-19, suicide and a composite index of alcohol-specific deaths. SARIMA-modelling was used to assess the impact of the pandemic on suicide and alcohol-specific mortality. Two alternative measures of the pandemic were used: (1) a dummy that was coded 1 during the pandemic (March 2020 and onwards), and 0 otherwise, and (2) the Oxford COVID-19 Government Response Tracker's Stringency Index. There was a marked SES-gradient in COVID-19 mortality in the working-age population (25-64) which was larger than for other causes of death. A SES-gradient was also found in the old-age population, but this gradient did not differ from the gradient for other causes of death. The outcome from the SARIMA time-series analyses suggested that the pandemic did not have any impact on suicide or alcohol-specific mortality in any of the educational and gender groups.
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Affiliation(s)
- Thor Norström
- Swedish Institute for Social Research (SOFI), Stockholm University, 106 91, Stockholm, Sweden.
| | - Mats Ramstedt
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
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Piñeiro B, Spijker JJA, Trias-Llimós S, Blanes Llorens A, Permanyer I. Trends in cause-specific mortality: deaths of despair in Spain, 1980-2019. J Public Health (Oxf) 2023; 45:854-862. [PMID: 37491646 PMCID: PMC10687877 DOI: 10.1093/pubmed/fdad133] [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] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Research from various countries has shown increases in alcohol- and drug-related deaths and suicide, known as 'deaths of despair' over recent decades, particularly among low-educated middle-aged individuals. However, little is known about trends in death-of-despair causes in Spain. Therefore, we aim to descriptively examine this among 25-64-year-olds from 1980 to 2019 and by educational attainment for the years 2017-19. METHODS We obtained mortality and population data from the National Institute of Statistics to estimate age-standardized mortality rates and assess educational inequalities using the relative index of inequality (RII). RESULTS Deaths of despair as a share of total mortality slightly increased from 2000 onwards, particularly among 25-64-year-old men (from 9 to 10%). Only alcohol-related mortality declined relatively more since 1980 compared with all-cause mortality. Regarding educational differences, low-educated men presented higher mortality rates in all death-of-despair causes (alcohol-related: RII 3.54 (95% CI: 2.21-5.66); drug-related: RII 3.49 (95% CI: 1.80-6.77); suicide: RII 1.97 (95% CI: 1.49-2.61)). Women noteworthy differences were only observed for alcohol-related (RII 3.50 (95% CI: 2.13-5.75)). CONCLUSIONS Findings suggest an increasing proportion of deaths of despair among 25-64-year-olds since 2000, particularly among men. Public health policies are needed to reduce and prevent these premature and preventable causes of mortality.
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Affiliation(s)
- Bárbara Piñeiro
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
| | - Jeroen J A Spijker
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
| | - Sergi Trias-Llimós
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
| | - Amand Blanes Llorens
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
| | - Iñaki Permanyer
- Centre d’Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, 08193 Bellaterra/Barcelona, Spain
- ICREA, 08010 Barcelona, Spain
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Redondo-Sánchez D, Fernández-Navarro P, Rodríguez-Barranco M, Nuñez O, Petrova D, García-Torrecillas JM, Jiménez-Moleón JJ, Sánchez MJ. Socio-economic inequalities in lung cancer mortality in Spain: a nation-wide study using area-based deprivation. Int J Equity Health 2023; 22:145. [PMID: 37533035 PMCID: PMC10399030 DOI: 10.1186/s12939-023-01970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Lung cancer is the main cause of cancer mortality worldwide and in Spain. Several previous studies have documented socio-economic inequalities in lung cancer mortality but these have focused on specific provinces or cities. The goal of this study was to describe lung cancer mortality in Spain by sex as a function of socio-economic deprivation. METHODS We analysed all registered deaths from lung cancer during the period 2011-2017 in Spain. Mortality data was obtained from the National Institute of Statistics, and socio-economic level was measured with the small-area deprivation index developed by the Spanish Society of Epidemiology, with the census tract of residence at the time of death as the unit of analysis. We computed crude and age-standardized rates per 100,000 inhabitants by sex, deprivation quintile, and type of municipality (rural, semi-rural, urban) considering the 2013 European standard population (ASR-E). We further calculated ASR-E ratios between the most deprived (Q5) and the least deprived (Q1) areas and mapped census tract smoothed standardized lung cancer mortality ratios by sex. RESULTS We observed 148,425 lung cancer deaths (80.7% in men), with 73.5 deaths per 100,000 men and 17.1 deaths per 100,000 women. Deaths from lung cancer in men were five times more frequent than in women (ASR-E ratio = 5.3). Women residing in the least deprived areas had higher mortality from lung cancer (ASR-E = 22.2), compared to women residing in the most deprived areas (ASR-E = 13.2), with a clear gradient among the quintiles of deprivation. For men, this pattern was reversed, with the highest mortality occurring in areas of lower socio-economic level (ASR-E = 99.0 in Q5 vs. ASR-E = 86.6 in Q1). These socio-economic inequalities remained fairly stable over time and across urban and rural areas. CONCLUSIONS Socio-economic status is strongly related to lung cancer mortality, showing opposite patterns in men and women, such that mortality is highest in women residing in the least deprived areas and men residing in the most deprived areas. Systematic surveillance of lung cancer mortality by socio-economic status may facilitate the assessment of public health interventions aimed at mitigating cancer inequalities in Spain.
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Grants
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- Not applicable Acciones de Movilidad CIBERESP, 2022
- JC2019-039691-I Juan de la Cierva Fellowship from the Ministry of Science and the National Research Agency of Spain
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Affiliation(s)
- Daniel Redondo-Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain.
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain.
| | - Pablo Fernández-Navarro
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, 28029, Spain
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
| | - Olivier Nuñez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, 28029, Spain
| | - Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
| | - Juan Manuel García-Torrecillas
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Emergency and Research Unit, Torrecárdenas University Hospital, Almería, 04009, Spain
| | - Jose Juan Jiménez-Moleón
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, 18071, Spain
| | - María-José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
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12
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Long D, Mackenbach JP, Klokgieters S, Kalėdienė R, Deboosere P, Martikainen P, Heggebø K, Leinsalu M, Bopp M, Brønnum-Hansen H, Costa G, Eikemo T, Nusselder WJ. Widening educational inequalities in mortality in more recent birth cohorts: a study of 14 European countries. J Epidemiol Community Health 2023; 77:400-408. [PMID: 37094941 PMCID: PMC10176379 DOI: 10.1136/jech-2023-220342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/01/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Studies of period changes in educational inequalities in mortality have shown important changes over time. It is unknown whether a birth cohort perspective paints the same picture. We compared changes in inequalities in mortality between a period and cohort perspective and explored mortality trends among low-educated and high-educated birth cohorts. DATA AND METHODS In 14 European countries, we collected and harmonised all-cause and cause-specific mortality data by education for adults aged 30-79 years in the period 1971-2015. Data reordered by birth cohort cover persons born between 1902 and 1976. Using direct standardisation, we calculated comparative mortality figures and resulting absolute and relative inequalities in mortality between low educated and high educated by birth cohort, sex and period. RESULTS Using a period perspective, absolute educational inequalities in mortality were generally stable or declining, and relative inequalities were mostly increasing. Using a cohort perspective, both absolute and relative inequalities increased in recent birth cohorts in several countries, especially among women. Mortality generally decreased across successive birth cohorts among the high educated, driven by mortality decreases from all causes, with the strongest reductions for cardiovascular disease mortality. Among the low educated, mortality stabilised or increased in cohorts born since the 1930s in particular for mortality from cardiovascular diseases, lung cancer, chronic obstructive pulmonary disease and alcohol-related causes. CONCLUSIONS Trends in mortality inequalities by birth cohort are less favourable than by calendar period. In many European countries, trends among more recently born generations are worrying. If current trends among younger birth cohorts persist, educational inequalities in mortality may further widen.
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Affiliation(s)
- Di Long
- Department of Public Health, Erasmus MC, Rotterdam, Netherlands
| | | | - Silvia Klokgieters
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ramunė Kalėdienė
- Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Patrick Deboosere
- Department of Sociology, Vrije Universiteit Brussel, Brussel, Belgium
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Kristian Heggebø
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
- NOVA, Oslo Metropolitan University, Oslo, Norway
| | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Giuseppe Costa
- Department of Clinical Medicine and Biology, University of Turin, Torino, Italy
| | - Terje Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
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13
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Educational inequalities in heart failure mortality and the cycles of the internal armed conflict in Colombia: An observational panel study of ecological data, 1999-2017. Heliyon 2023; 9:e13050. [PMID: 36785819 PMCID: PMC9918747 DOI: 10.1016/j.heliyon.2023.e13050] [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: 03/10/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Heart failure (HF) is a significant clinical problem and an important public health issue due to the morbidity and mortality that it causes, especially in a population that is aging and affected by social stressors such as armed conflict. We aim to describe the inequalities and trends of HF mortality by educational level in Colombia between 1999 and 2017 compared with the cycles of the internal armed conflict during the same period. An observational study of ecological data panels, with aggregates at the national level, was conducted. Information from death certificates with HF as the basic cause of death (COD) was used. Variables of the year of death, sex, age, department of residence, and educational level were considered. Mortality rates adjusted for age were calculated. A joinpoint regression was used to model the trend of rates by educational level. We found that both men and women with primary education had the highest adjusted mortality rates: among men, RR_primary = 19.06 deaths/100,000 inhabitants, SE = 0.13 vs. RR_tertiary = 4.85, SE = 0.17, and similar differences among women. Mortality rates tended to decrease at all educational levels, with a greater reduction in people with higher educational levels. In both sexes, the behavior of the relative index of inequality showed significant inequality, albeit with a strong reduction during the last decade. Mortality due to HF in Colombia shows inequalities by educational level. In the prevention of HF, education should be considered a structural social determinant. In addition, we analyzed the potential role of the Colombian long-term armed conflict in the observed trends. We highlighted the role of the health sector, together with other sectors (education, work, and housing), in developing intersectoral public policies that contribute to the reduction of cardiovascular mortality disparities.
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14
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Grytten N, Myhr KM, Celius EG, Benjaminsen E, Midgard R, Vatne A, Aarseth JH, Mannseth J, Torkildsen Ø. Cancer related mortality in multiple sclerosis. A population based cohort study. Mult Scler Relat Disord 2023; 69:104417. [PMID: 36423459 DOI: 10.1016/j.msard.2022.104417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/27/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cancer is a major cause of death, but how cancer influences mortality risk in Multiple Sclerosis (MS) is unclear. OBJECTIVES Determine all-cause mortality and mortality following a cancer diagnosis among MS patients compared with matched population controls. METHODS Norwegian MS patients born 1930 - 1979 (n= 6950) followed-up 1953 - 2016, were matched with 37 922 controls. We compared incident cancer diagnosis from the Cancer Registry of Norway, date of death from the Cause of Death Registry, education from the National Education Database, by multivariate Cox proportional hazard regression. RESULTS Hazard ratio (HR) and 95% confidence interval (CI) for all-cause mortality among MS patients was 4.97 (4.64 - 5.33), and 2.61 (2.29 - 2.98) for mortality following a cancer diagnosis. Mortality in MS was highest following urinary- (2.53: 1.55 - 4.14), colorectal- (2.14: 1.47 - 3.11), hematological- (1.76: 1.08 - 2.88), ovarian - 2.30 (1.73-3.06) and breast cancer diagnosis (2.61: 1.85 - 3.68), compared to controls. High education was inversely associated with mortality among MS patients. CONCLUSIONS All-cause mortality was five- fold and mortality following a cancer diagnosis was two- fold increased among MS patients. Mortality following specific cancers raises the possibility of diagnostic neglect.
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Affiliation(s)
- Nina Grytten
- Norwegian Multiple Sclerosis Competence Centre, sDept. of Neurology, Haukeland University Hospital; Dept. of Clinical Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Dept. of Neurology, Haukeland University Hospital, Bergen, Norway.
| | - Kjell-Morten Myhr
- Dept. of Clinical Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Dept. of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Elisabeth G Celius
- Dept of Neurology, Oslo University Hospital Ullevål, Oslo, Norway; Institute of clinical medicine, University of Oslo, Oslo, Norway
| | | | - Rune Midgard
- Dept. of Neurology, Molde Hospital, Molde, Norway; Norwegian University of Science and Technology
| | - Anita Vatne
- Dept. of Rehabilitation, Southern Norway Hospital
| | - Jan H Aarseth
- The Norwegian Multiple Sclerosis Registry and Biobank, Dept. of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Janne Mannseth
- The Norwegian Multiple Sclerosis Registry and Biobank, Dept. of Neurology, Haukeland University Hospital, Bergen, Norway; Dept. of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Øivind Torkildsen
- Dept. of Clinical Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Dept. of Neurology, Haukeland University Hospital, Bergen, Norway
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15
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Hvidberg MF, Frølich A, Lundstrøm SL. Catalogue of socioeconomic disparities and characteristics of 199+ chronic conditions-A nationwide register-based population study. PLoS One 2022; 17:e0278380. [PMID: 36584039 PMCID: PMC9803180 DOI: 10.1371/journal.pone.0278380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Real-world information on socioeconomic differences within and between chronic conditions represents an important data source for treatments and decision-makers executing and prioritising healthcare resources. AIMS The aim of this study was to estimate the prevalence and mean of socioeconomic disparities from educational, income, and socioeconomic positions of 199 chronic conditions and disease groups, including sex and age group estimates, for use in planning of care services and prioritisation, by healthcare professionals, decision-makers and researchers. METHODS The study population includes all Danish residents 16 years and above, alive on 1 January 2013 (n = 4,555,439). The data was established by linking seven national registers encompassing educational achievements, incomes, socioeconomic positions, hospital- and general practice services, and filled-in out-of-hospital prescriptions. The health register data were used to identify the 199+ chronic conditions. Socioeconomic differences were primarily measured as differences in educational prevalence levels from low to high educational achievements using a ratio. Furthermore, multiple binary logistic regression models were carried out to control for potential confounding and residual correlations of the crude estimates. RESULTS The prevalence of having one or more chronic conditions for patients with no educational achievement was 768 per thousand compared to 601.3 for patients with higher educational achievement (ratio 1.3). Across disease groups, the highest educational differences were found within disease group F-mental and behavioural (ratio 2.5), E-endocrine, nutritional and metabolic disease (ratio 2.4), I-diseases of the circulatory system (ratio 2.1) and, K-diseases of the digestive system (ratio 2.1). The highest educational differences among the 29 common diseases were found among schizophrenia (ratio 5.9), hyperkinetic disorders (ratio 5.2), dementia (ratio 4.9), osteoporosis (ratio 3.9), type 2 diabetes (ratio 3.8), chronic obstructive pulmonary disease COPD (ratio 3.3), heart conditions and stroke (ratios ranging from 2.3-3.1). CONCLUSIONS A nationwide catalogue of socioeconomic disparities for 199+ chronic conditions and disease groups is catalogued and provided. The catalogue findings underline a large scope of socioeconomic disparities that exist across most chronic conditions. The data offer essential information on the socioeconomic disparities to inform future socially differentiated treatments, healthcare planning, etiological, economic, and other research areas.
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Affiliation(s)
- Michael Falk Hvidberg
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- University of York, York, United Kingdom
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sanne Lykke Lundstrøm
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, The Capital Region of Denmark
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16
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Trend of Admissions Due to Chronic Lower Respiratory Diseases: An Ecological Study. Healthcare (Basel) 2022; 11:healthcare11010065. [PMID: 36611526 PMCID: PMC9818740 DOI: 10.3390/healthcare11010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Objective: This study aimed to examine the trend of hospital admissions related to chronic lower respiratory diseases in England and Wales between 1999 and 2020. Method: This ecological analysis used data that were made accessible to the public and were taken from the Patient Episode Database for Wales (PEDW) and the Hospital Episode Statistics (HES) databases in England for the time span between April 1999 and April 2020. The patients were grouped into four age groups: under 15, 15−59, 60−74, and 75 years and above. Results: In 2020, there were 432,193 chronic lower respiratory disease hospital admissions, which increased from 239,606 in 1999. The hospital admission rate increased by 57.5% (from 459.54 (95% CI 457.71−461.38) in 1999 to 723.70 (95% CI 721.55−725.85) in 2020 per 100,000 people, p < 0.5). The majority of hospital admissions for chronic lower respiratory diseases were found to be directly linked to age (more prevalent in the 75+ age group). Moreover, female hospital admission rates for chronic lower respiratory diseases grew by 85.2% between 1999 and 2020, increasing from 445.45 (95% CI 442.92−447.97) to 824.96 (95% CI 821.73−828.19) per 100,000 people. Conclusion: The rate of hospital admissions due to chronic lower respiratory diseases has sharply increased during the past two decades. COPD was the most common cause for chronic lower respiratory disease admissions. Ageing was also found to be a factor in increased hospital admissions. Future studies are warranted to identify other risk factors of hospital admissions due to chronic lower respiratory diseases and specifically COPD.
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17
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Super-additive associations between parity and education level on mortality from cardiovascular disease and other causes: the Japan Collaborative Cohort Study. BMC Womens Health 2022; 22:278. [PMID: 35794595 PMCID: PMC9261019 DOI: 10.1186/s12905-022-01805-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background While women’s parity status and education level have independent associations with cardiovascular and other diseases, no studies have evaluated the additive interaction of these two factors. Therefore, we examined the additive interaction between parity and education level on mortality from stroke, coronary heart disease, total cardiovascular disease, cancer, non-cardiovascular disease, and non-cancer causes, and all causes in Japanese women. Methods This study followed 41,242 women aged 40–79 years without a history of cardiovascular disease or cancer from 1988 to 1990 until 2009. Baseline parity and education level were classified into four categories, with highly educated parous women as the reference group. Cox proportional hazards regression analyses were performed to calculate the risk of mortality. We also assessed the additive interactions between parity and education level on mortality from cardiovascular disease and other causes using the relative excess risk due to interaction obtained using Cox models. Results During the median follow-up period of 19.1 years, we identified 6299 deaths. In a multivariable model adjusted for cardiovascular disease and other disease risk factors, nulliparous women with low education levels had increased multivariable-adjusted hazard ratios of 1.67 (95% confidence interval [CI] 1.13, 2.47) for stroke, 1.98 (95% CI 1.15, 3.39) for coronary heart disease, 1.71 (95% CI 1.34,2.18) for total cardiovascular disease, 1.69 (95% CI 1.33, 2.14) for non-cardiovascular and non-cancer, and 1.51 (95% CI 1.30, 1.75) for all-cause mortality when compared with highly educated parous women. Moreover, we observed significant additive interactions between parity and education level on total cardiovascular disease mortality (P = 0.04), non-cardiovascular disease and non-cancer mortality (P = 0.01), and all-cause mortality (P = 0.005). Conclusions Nulliparity and low education levels are super-additively associated with total cardiovascular disease, non-cardiovascular and non-cancer, and all-cause mortality risks, suggesting that nulliparous women with low education levels need specific support for preventing mortality related to cardiovascular and other diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01805-y.
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18
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Louca P, Tran TQB, Toit CD, Christofidou P, Spector TD, Mangino M, Suhre K, Padmanabhan S, Menni C. Machine learning integration of multimodal data identifies key features of blood pressure regulation. EBioMedicine 2022; 84:104243. [PMID: 36084617 PMCID: PMC9463529 DOI: 10.1016/j.ebiom.2022.104243] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Association studies have identified several biomarkers for blood pressure and hypertension, but a thorough understanding of their mutual dependencies is lacking. By integrating two different high-throughput datasets, biochemical and dietary data, we aim to understand the multifactorial contributors of blood pressure (BP). METHODS We included 4,863 participants from TwinsUK with concurrent BP, metabolomics, genomics, biochemical measures, and dietary data. We used 5-fold cross-validation with the machine learning XGBoost algorithm to identify features of importance in context of one another in TwinsUK (80% training, 20% test). The features tested in TwinsUK were then probed using the same algorithm in an independent dataset of 2,807 individuals from the Qatari Biobank (QBB). FINDINGS Our model explained 39·2% [4·5%, MAE:11·32 mmHg (95%CI, +/- 0·65)] of the variance in systolic BP (SBP) in TwinsUK. Of the top 50 features, the most influential non-demographic variables were dihomo-linolenate, cis-4-decenoyl carnitine, lactate, chloride, urate, and creatinine along with dietary intakes of total, trans and saturated fat. We also highlight the incremental value of each included dimension. Furthermore, we replicated our model in the QBB [SBP variance explained = 45·2% (13·39%)] cohort and 30 of the top 50 features overlapped between cohorts. INTERPRETATION We show that an integrated analysis of omics, biochemical and dietary data improves our understanding of their in-between relationships and expands the range of potential biomarkers for blood pressure. Our results point to potentially key biological pathways to be prioritised for mechanistic studies. FUNDING Chronic Disease Research Foundation, Medical Research Council, Wellcome Trust, Qatar Foundation.
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Affiliation(s)
- Panayiotis Louca
- Department of Twin Research and Genetic Epidemiology, King's College London, London, England, SE1 7EH, United Kingdom
| | - Tran Quoc Bao Tran
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Clea du Toit
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Paraskevi Christofidou
- Department of Twin Research and Genetic Epidemiology, King's College London, London, England, SE1 7EH, United Kingdom
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, England, SE1 7EH, United Kingdom
| | - Massimo Mangino
- Department of Twin Research and Genetic Epidemiology, King's College London, London, England, SE1 7EH, United Kingdom; NIHR Biomedical Research Centre at Guy's and St Thomas' Foundation Trust, London, SE1 9RT, United Kingdom
| | - Karsten Suhre
- Bioinformatics Core, Weill Cornell Medicine-Qatar, Doha, Qatar; Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - Sandosh Padmanabhan
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom.
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London, England, SE1 7EH, United Kingdom.
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Vacková J, Rimárová K, Motlová L, Švestková R, Fichtnerová E, Kuželková A, Dorko E, Kaňuková L, Diabelková J, Shuranová L, Bendová M. Generational differences in selected aspects of social situation and health status of foreigners living in the Czech Republic. Cent Eur J Public Health 2022; 30 Suppl:S68-S74. [PMID: 35841229 DOI: 10.21101/cejph.a7243] [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: 12/12/2021] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Demographic differentiation caused by the history of migration in the Czech and Slovak Republics led the authors of this article to analyse generational differences in the groups of foreigners living in the Czech Republic (CR) and the impact of generational differences on selected aspects of their social situation and perceived health. The crucial research question was whether and to what degree do different generations of foreigners vary from each other and what impact this has had on their social situation and health determinants. METHODS The main goal was to examine mutual relationships between selected characteristics of social situation and health determinants in various groups of foreigners living in the CR. A total of 1,003 questionnaires among foreigners officially living in the Czech Republic were collected and analysed. In the area of subjective perception of health, a comparison of foreigners with Czech citizens (representative sample of Czech seniors; 1,172 respondents) in the age category 65+ was made in order to find out whether this perception differs between senior foreign nationals and senior Czechs. RESULTS Older individuals (50-64 years and 65+ years) appeared to have the best integration into Czech society. This age generation felt positive about stay and migration status in the CR. Older foreigners differ from older Czech citizens who tend to refer to their health as very good to rather good compared to foreigners who described their health as neither good nor bad. The middle generation (30-49 years) of foreigners was characterized by hard work and the initial stages of integration into Czech society. This group also reported positive feelings about living in the CR relative to their home country. CONCLUSION The oldest generation of foreigners is the best integrated in the Czech Republic (with regard to selected aspects tested in this article). This generation is able to offer new immigrant effective integration strategies. However, they assess their subjective health one degree worse in comparison with Czech seniors (representative sample), this finding should lead to the setting of preventive programmes related to a healthy lifestyle, including lifestyle for foreigners living in the Czech Republic.
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Affiliation(s)
- Jitka Vacková
- Institute of Social and Special-Pedagogical Sciences, Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Kvetoslava Rimárová
- Department of Public Health and Hygiene, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovak Republic
| | - Lenka Motlová
- Institute of Social and Special-Pedagogical Sciences, Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Renata Švestková
- Institute of Social and Special-Pedagogical Sciences, Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Eva Fichtnerová
- Institute of Social and Special-Pedagogical Sciences, Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Anna Kuželková
- Institute of Social and Special-Pedagogical Sciences, Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Erik Dorko
- Department of Public Health and Hygiene, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovak Republic
| | - Lívia Kaňuková
- Department of Public Health and Hygiene, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovak Republic
| | - Jana Diabelková
- Department of Public Health and Hygiene, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovak Republic
| | - Lesia Shuranová
- Institute of Social and Special-Pedagogical Sciences, Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Markéta Bendová
- Institute of Social and Special-Pedagogical Sciences, Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
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Diaconu V, van Raalte A, Martikainen P. Why we should monitor disparities in old-age mortality with the modal age at death. PLoS One 2022; 17:e0263626. [PMID: 35139112 PMCID: PMC8827466 DOI: 10.1371/journal.pone.0263626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/22/2022] [Indexed: 11/18/2022] Open
Abstract
Indicators based a fixed “old” age threshold have been widely used for assessing socioeconomic disparities in mortality at older ages. Interpretation of long-term trends and determinants of these indicators is challenging because mortality above a fixed age that in the past would have reflected old age deaths is today mixing premature and old-age mortality. We propose the modal (i.e., most frequent) age at death, M, an indicator increasingly recognized in aging research, but which has been infrequently used for monitoring mortality disparities at older ages. We use mortality and population exposure data by occupational class over the 1971-2017 period from Finnish register data. The modal age and life expectancy indicators are estimated from mortality rates smoothed with penalized B-splines. Over the 1971-2017 period, occupational class disparities in life expectancy at 65 and 75 widened while disparities in M remained relatively stable. The proportion of the group surviving to the modal age was constant across time and occupational class. In contrast, the proportion surviving to age 65 and 75 has roughly doubled since 1971 and showed strong occupational class differences. Increasing socioeconomic disparities in mortality based on fixed old age thresholds may be a feature of changing selection dynamics in a context of overall declining mortality. Unlike life expectancy at a selected fixed old age, M compares individuals with similar survival chances over time and across occupational classes. This property makes trends and differentials in M easier to interpret in countries where old-age survival has improved significantly.
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Affiliation(s)
- Viorela Diaconu
- Lifespan Inequalities Research Group, Max Planck Institute for Demographic Research, Rostock, Germany
- * E-mail:
| | - Alyson van Raalte
- Lifespan Inequalities Research Group, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Pekka Martikainen
- Lifespan Inequalities Research Group, Max Planck Institute for Demographic Research, Rostock, Germany
- Population Research Unit (PRU), Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Health Equity Studies (CHESS), Department of Public Health Sciences, Stockholm University and Karolinska Institutet, Stockholm, Sweden
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García-Castrillo P, González-Álvarez MA. Inequality in the Face of Death: The Income Gradient in Mortality of the Spanish Pre-Recession Working-Age Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312379. [PMID: 34886105 PMCID: PMC8657191 DOI: 10.3390/ijerph182312379] [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: 08/31/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022]
Abstract
The purpose of this paper is to evaluate the association between socioeconomic status (SES) and mortality over a three-year period for working-age Spaniards (2007-2009), paying particular attention to the effect of income level. The analysis is relatively new in Spain, and the studies are limited. Neither income nor wealth are included in existing Spanish mortality studies. The main reason for this limitation is the nature of the data sets used, mainly Census Records. We overcome this problem by using data on 693,994 individuals taken from a Social Security sampling and used to estimate the probabilities of death for each income decile and the mortality rate ratios in three different models: (1) using only income, controlled by age and sex, (2) adding socio-economic and geographical variables, and (3) adding level of education. However, the data used here also have some limitations. They do not include government employees, the military or the Department of Justice personnel, whose exclusion we believe causes an under-representation of highly educated people in our sample. The results confirm that there is a non-linear relationship between mortality and income. This non-linear relationship implies that income redistribution resulting from progressive taxation systems could lead to higher reductions in mortality for low-income groups than the reductions induced in the mortality of the high-income population, thus reducing overall mortality.
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Lee YC, Chang KY, Sethi S. Association of Chronic Lower Respiratory Disease With County Health Disparities in New York State. JAMA Netw Open 2021; 4:e2134268. [PMID: 34842926 PMCID: PMC8630571 DOI: 10.1001/jamanetworkopen.2021.34268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Chronic lower respiratory disease (CLRD) is the fourth leading cause of death in the United States, which imposes a considerable burden on individuals, families, and societies. The association between county-level health disparity and CLRD outcomes in New York state needs investigation. OBJECTIVE To evaluate the associations of CLRD outcomes with county-level health disparities in New York state. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, CLRD age-adjusted hospitalization for 2016 and mortality rates from 2014 to 2016 were obtained from the New York state Community Health Indicator Reports provided by the New York state Department of Health. County Health Rankings were used to evaluate various health factors to provide a summary z score for each county representing the county health status and how that county ranks in the state. Data analysis was performed from November 2020 to March 2021. MAIN OUTCOMES AND MEASURES The main outcomes were age-adjusted hospitalization and mortality rates for CLRD. The z score was calculated from the County Health Rankings, which includes subindicators of health behaviors, clinical care, social and economic factors, and physical environment. Pearson r and linear regression models were estimated. RESULTS During the study, 60 335 discharges were documented as CLRD hospitalizations in 2016 and 20 612 people died from CLRD from 2014 to 2016 in New York state. After adjusting for age, the CLRD hospitalization rate was 27.6 per 10 000 population, and the mortality rate was 28.9 per 100 000 population. Among 62 counties, Bronx had the highest hospitalization rate (64.7 per 10 000 population) whereas Hamilton had the lowest hospitalization rate (6.6 per 10 000 population). Mortality rates ranged from 17.4 per 100 000 population in Kings to 62.9 per 100 000 population in Allegany. County Health Rankings indicated Nassau had the lowest z score (the healthiest), at -1.17, but Bronx had the highest z score (the least healthy), at 1.43, for overall health factors in 2018. An increase of 1 point in social and economic factors z score was associated with an increase of 17.6 hospitalizations per 10 000 population (β = 17.61 [95% CI, 10.36 to 24.87]; P < .001). A 1-point increase in health behaviors z score was associated with an increase of 41.4 deaths per 100 000 population (β = 41.42 [95% CI, 29.88 to 52.97]; P < .001). CONCLUSIONS AND RELEVANCE In this cross-sectional study, CLRD outcomes were significantly associated with county-level health disparities in New York state. These findings suggest that public health interventions and resources aimed at improving CLRD outcomes should be tailored and prioritized in health disadvantaged areas.
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Affiliation(s)
- Yu-Che Lee
- Department of Medicine, University at Buffalo–Catholic Health System, Buffalo, New York
| | - Ko-Yun Chang
- Division of Chest Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sanjay Sethi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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Leveau CM, Tapia Granados JA. Educational inequalities in suicide in the highly volatile economy of Argentina. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1771-1778. [PMID: 33582827 DOI: 10.1007/s00127-021-02041-9] [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] [Received: 08/12/2020] [Accepted: 01/29/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Little is known about how economic fluctuations affect educational inequalities in mortality in low- or middle-income countries. The objective of this study is to analyze the temporal variations in educational differentials in suicide in four Argentinian provinces. METHODS Data on suicides for ages 25 years and over and three age groups (25-44, 45-64, and 65 +) in four Argentinian provinces during the period 1999-2013 were linked to population data and information on the educational level of the deceased. Regression models were estimated using age, sex, year, province of residence, educational level, and economic character of the year (expansion or recession) as explanatory variables. RESULTS The educational gap in suicide mortality widened since the expansion following the crisis of 1999-2002, and then only decreased in 2005 and 2011. For ages 45-64, the confidence intervals of the suicide rate overlapped each year, and the suicide rate of the middle-high education population exceeded the suicide rate of the low-education population in 2 recession years, 1999 and 2002. Considering the years of economic expansion or recession as a dichotomous variable, at ages 45-64 differences in suicide rates by educational level disappeared during years of recession, while they were present in years of expansion. CONCLUSION Suicides rise during economic downturns but these periods could reduce the educational gaps of suicide mortality by increasing the vulnerability of adults of high educational level to changes in the economy.
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Affiliation(s)
- Carlos M Leveau
- Departamento de Salud Comunitaria, Universidad Nacional de Lanús, Av. 29 de Septiembre 3901, Remedios de Escalada, Argentina.
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
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van Nieuwenhuizen BP, Sekercan A, Tan HL, Blom MT, Lok A, van den Born BJH, Kunst AE, van Valkengoed IGM. Is the Association Between Education and Sympathovagal Balance Mediated by Chronic Stressors? Int J Behav Med 2021; 29:426-437. [PMID: 34580830 PMCID: PMC9338002 DOI: 10.1007/s12529-021-10027-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
Background This study investigated whether raised chronic stress in low education groups contributes to education differences in cardiovascular disease by altering sympathovagal balance. Methods This study included cross-sectional data of 10,202 participants from the multi-ethnic, population-based HELIUS-study. Sympathovagal balance was measured by baroreflex sensitivity (BRS), the standard deviation of the inter-beat interval (SDNN) and the root mean square of successive differences between normal heartbeats (RMSSD). The associations between chronic stressors (work, home, psychiatric, financial, negative life events, lack of job control and perceived discrimination) in a variety of domains and BRS, SDNN and RMSSD were assessed using linear regression, adjusted for age, ethnicity, waist-to-hip ratio and pack-years smoked. Mediation analysis was used to assess the contribution of chronic stress to the association between education and sympathovagal balance. Results Modest but significant associations were observed between financial stress and BRS and SDNN in women, but not in RMSSD nor for any outcome measure in men. Women with the highest category of financial stress had 0.55% lower BRS (ms/mmHg; β = -0.055; CI = -0.098, -0.011) and 0.61% lower SDNN (ms; β = -0.061; CI = -0.099, -0.024) than those in the lowest category. Financial stress in women contributed 7.1% to the association between education and BRS, and 13.8% to the association between education and SDNN. Conclusion No evidence was found for the hypothesized pathway in which sympathovagal balance is altered by chronic stress, except for a small contribution of financial stress in women. Supplementary Information The online version contains supplementary material available at 10.1007/s12529-021-10027-9.
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Affiliation(s)
| | - Aydin Sekercan
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, OLVG, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Clinical and Experimental Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Marieke T Blom
- Department of Clinical and Experimental Cardiology Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H van den Born
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Kelly D, Steiner A. The impact of community Men's Sheds on the physical health of their users. Health Place 2021; 71:102649. [PMID: 34392057 DOI: 10.1016/j.healthplace.2021.102649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/12/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
With men more susceptible than women to illness and mortality, and less likely to access primary healthcare services, there have been calls for more male friendly spaces within communities to engage 'hard to reach' men in physical health improvement. Research has shown that Men's Shed (Shed) activity can provide localised support for the mental health and social wellbeing of men within communities, yet less is known about Sheds' impacts on physical health. Drawing on qualitative interviews with 62 Sheds users, this study conceptualises proposed pathways from which Shed activity can lead to positive physical health outcomes. Findings showed that in attending a community Men's Shed and taking part in activities users reported (i) increased mobility and decreased sedentary behavior, (ii) increased ability to overcome physical illness or injury, (iii) improved diet, (iv) decreased alcohol use, and (v) improved physical health knowledge. These findings support wider recommendations for community-based male friendly approaches to physical health improvement, and stress the importance of health and care service delivery beyond boundaries of 'standard' NHS settings, especially when targeting those viewed as 'hard to reach'. While initiatives like Sheds do not offer a replacement of primary healthcare services, they have the potential to fit within existing health and social care practices as an alternative local health-engagement space for men.
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Affiliation(s)
- Danielle Kelly
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, M201 George Moore Building, Cowcaddens Road, Glasgow, G4 0BA, United Kingdom.
| | - Artur Steiner
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, M201 George Moore Building, Cowcaddens Road, Glasgow, G4 0BA, United Kingdom.
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Martikainen P, Korhonen K, Jelenkovic A, Lahtinen H, Havulinna A, Ripatti S, Borodulin K, Salomaa V, Davey Smith G, Silventoinen K. Joint association between education and polygenic risk score for incident coronary heart disease events: a longitudinal population-based study of 26 203 men and women. J Epidemiol Community Health 2021; 75:651-657. [PMID: 33408166 DOI: 10.1136/jech-2020-214358] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/03/2020] [Accepted: 12/16/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Genetic vulnerability to coronary heart disease (CHD) is well established, but little is known whether these effects are mediated or modified by equally well-established social determinants of CHD. We estimate the joint associations of the polygenetic risk score (PRS) for CHD and education on CHD events. METHODS The data are from the 1992, 1997, 2002, 2007 and 2012 surveys of the population-based FINRISK Study including measures of social, behavioural and metabolic factors and genome-wide genotypes (N=26 203). Follow-up of fatal and non-fatal incident CHD events (N=2063) was based on nationwide registers. RESULTS Allowing for age, sex, study year, region of residence, study batch and principal components, those in the highest quartile of PRS for CHD had strongly increased risk of CHD events compared with the lowest quartile (HR=2.26; 95% CI: 1.97 to 2.59); associations were also observed for low education (HR=1.58; 95% CI: 1.32 to 1.89). These effects were largely independent of each other. Adjustment for baseline smoking, alcohol use, body mass index, igh-density lipoprotein (HDL) and total cholesterol, blood pressure and diabetes attenuated the PRS associations by 10% and the education associations by 50%. We do not find strong evidence of interactions between PRS and education. CONCLUSIONS PRS and education predict CHD events, and these associations are independent of each other. Both can improve CHD prediction beyond behavioural risks. The results imply that observational studies that do not have information on genetic risk factors for CHD do not provide confounded estimates for the association between education and CHD.
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Affiliation(s)
- Pekka Martikainen
- Population Research Unit, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
- Centre for Health Equity Studies, Stockholm University, Stockholm, Sweden
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Kaarina Korhonen
- Population Research Unit, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
| | - Aline Jelenkovic
- Department of Physiology, University of the Basque Country, Bilbao, País Vasco, Spain
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hannu Lahtinen
- Population Research Unit, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
| | - Aki Havulinna
- Institute for Molecular Medicine Finland, Helsinki, Finland
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
| | - Samuli Ripatti
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Institute for Molecular Medicine Finland, Helsinki, Finland
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Katja Borodulin
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
- Age Institute, Helsinki, Finland
| | - Veikko Salomaa
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
| | - George Davey Smith
- Department of Social Medicine, University of Bristol, Bristol, Bristol, UK
| | - Karri Silventoinen
- Population Research Unit, University of Helsinki Faculty of Social Sciences, Helsinki, Finland
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Buja A, Fonzo M, Sperotto M, De Battisti E, Baldovin T, Cocchio S, Furlan P, Saia M, Scapellato ML, Viel G, Baldo V, Bertoncello C. Education level and hospitalization for ambulatory care sensitive conditions: an education approach is required. Eur J Public Health 2021; 30:207-212. [PMID: 31321416 DOI: 10.1093/eurpub/ckz122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies in several different countries and settings suggest that ambulatory care-sensitive conditions (ACSCs)-related hospitalizations could be associated more with socioeconomic variables than with the quality of primary healthcare services. The aim of the present study was to analyze the potential links between education levels or other social determinants and ACSC-related hospitalization rates. METHODS We analyzed a total of 467 504 records of ordinary discharges after acute hospitalization in 2015-16 for patients 20-74 years old residing in the Veneto Region. We calculated the prevention quality indicators (PQIs) developed by the Agency for Healthcare Research and Quality. Rate ratios (RRs) and 95% confidence intervals (95% CIs) were estimated with a set of Poisson regressions to measure the relative risk by sociodemographic level. RESULTS Hospitalizations for ACSCs accounted for 3.9% of all hospital admissions (18 436 discharges), and the crude hospitalization rate for ACSCs among 20- to 74-year-olds was 26.6 per 10 000 inhabitants (95% CI, 25.8-27.4). For all conditions, we found a significant association with formal education. In the case of the overall composite PQI#90, e.g. poorly educated people (primary school or no schooling) were at significantly higher risk of hospitalization for ACSCs than the better educated (RR, 4.50; 95% CI, 4.13-4.91). CONCLUSIONS Currently available administrative data regarding ACSCs may be used effectively for reveal equity issues in the provision of health care. Our results indicate that an educational approach inside Primary Health Care could address the extra risk for preventable healthcare demands associated with poorly educated patients.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Marco Fonzo
- School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Padova, Italy
| | - Milena Sperotto
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Elisa De Battisti
- School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Padova, Italy
| | - Tatjana Baldovin
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Silvia Cocchio
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Patrizia Furlan
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Mario Saia
- ULSS 6 Euganea, Veneto Region, Padova, Italy
| | - Maria Luisa Scapellato
- Department of Cardiological, Thoracic and Vascular Sciences, Occupational Medicine Unit, University of Padua, Padova, Italy
| | - Guido Viel
- Department of Cardiological, Thoracic and Vascular Sciences, Legal Medicine Unit, University of Padua, Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
| | - Chiara Bertoncello
- Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padova, Italy
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28
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Liu YT. Associations between socioeconomic development and mortality—a small area panel data analysis in Taiwan, 2000–2015. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01104-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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29
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Long D, Mackenbach J, Martikainen P, Lundberg O, Brønnum-Hansen H, Bopp M, Costa G, Kovács K, Leinsalu M, Rodríguez-Sanz M, Menvielle G, Nusselder W. Smoking and inequalities in mortality in 11 European countries: a birth cohort analysis. Popul Health Metr 2021; 19:3. [PMID: 33516235 PMCID: PMC7847590 DOI: 10.1186/s12963-021-00247-2] [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] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/21/2021] [Indexed: 01/17/2023] Open
Abstract
Purpose To study the trends of smoking-attributable mortality among the low and high educated in consecutive birth cohorts in 11 European countries. Methods Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung cancer mortality rates using the Preston-Glei-Wilmoth method. Rate ratios and rate differences among the low and high-educated were estimated and used to estimate the contribution of inequality in smoking-attributable mortality to inequality in total mortality. Results In most countries, smoking-attributable mortality decreased in consecutive birth cohorts born between 1906 and 1961 among low- and high-educated men and high-educated women, but not among low-educated women among whom it increased. Relative educational inequalities in smoking-attributable mortality increased among both men and women with no signs of turning points. Absolute inequalities were stable among men but slightly increased among women. The contribution of inequality in smoking-attributable mortality to inequality in total mortality decreased in consecutive generations among men but increased among women. Conclusions Smoking might become less important as a driver of inequalities in total mortality among men in the future. However, among women, smoking threatens to further widen inequalities in total mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12963-021-00247-2.
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Affiliation(s)
- Di Long
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Johan Mackenbach
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Olle Lundberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | | | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Giuseppe Costa
- Department of Clinical Medicine and Biology, University of Turin, Torino, Italy
| | | | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden.,Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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30
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Jakobsen MU, Trolle E, Outzen M, Mejborn H, Grønberg MG, Lyndgaard CB, Stockmarr A, Venø SK, Bysted A. Intake of dairy products and associations with major atherosclerotic cardiovascular diseases: a systematic review and meta-analysis of cohort studies. Sci Rep 2021; 11:1303. [PMID: 33446728 PMCID: PMC7809206 DOI: 10.1038/s41598-020-79708-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/11/2020] [Indexed: 01/29/2023] Open
Abstract
Specific types of dairy products may be differentially associated with atherosclerotic cardiovascular disease (CVD). We conducted a systematic review and meta-analysis of cohort studies to summarize findings on the associations between total dairy product intake and intake of dairy product subgroups and the risk of major atherosclerotic CVDs in the general adult population. Our protocol was registered in PROSPERO (CRD42019125455). PubMed and Embase were systematically searched through 15 August 2019. For high versus low intake and dose-response meta-analysis, random-effects modelling was used to calculate summary risk ratios (RR). There were 13 cohort studies included for coronary heart disease (CHD), 7 for ischemic stroke and none for peripheral artery disease. High-fat milk was positively associated with CHD (RR 1.08 (95% confidence interval 1.00-1.16) per 200 g higher intake/day) and cheese was inversely associated with CHD (RR 0.96 (95% confidence interval 0.93-0.98) per 20 g higher intake/day). Heterogeneity, however, was observed in high versus low meta-analyses. Milk was inversely associated with ischemic stroke in high versus low meta-analysis only. In conclusion, this systematic review indicates a positive association of high-fat milk and an inverse association of cheese with CHD risk. The findings should be interpreted in the context of the observed heterogeneity.
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Affiliation(s)
- Marianne Uhre Jakobsen
- grid.5170.30000 0001 2181 8870Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Ellen Trolle
- grid.5170.30000 0001 2181 8870Division for Risk Assessment and Nutrition, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Malene Outzen
- grid.5170.30000 0001 2181 8870Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Heddie Mejborn
- grid.5170.30000 0001 2181 8870Division for Risk Assessment and Nutrition, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Manja G. Grønberg
- grid.5170.30000 0001 2181 8870Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Christian Bøge Lyndgaard
- grid.5170.30000 0001 2181 8870Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Anders Stockmarr
- grid.5170.30000 0001 2181 8870Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Stine K. Venø
- grid.27530.330000 0004 0646 7349Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anette Bysted
- grid.5170.30000 0001 2181 8870Division for Food Technology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
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Abstract
OBJECTIVE Alterations in sympathovagal balance are associated with cardiovascular disease. If sympathovagal balance differs across socioeconomic groups, it may reflect a mechanism through which disparities in cardiovascular disease occur. We therefore assessed the association between education and occupation with measures of sympathovagal balance in a large multiethnic sample. METHODS We included cross-sectional data of 10,202 South Asian Surinamese, African Surinamese, Ghanaian, Turkish, Moroccan, and Dutch-origin participants from the Healthy Life in an Urban Setting study. Sympathovagal balance was measured by baroreflex sensitivity (BRS) and the standard deviation of the interbeat interval, calculated from changes in blood pressure and interbeat intervals, from 5-minute recordings. We calculated geometric means and estimated the relative index of inequality, using age- and ethnicity-adjusted linear regression, to quantify the association between education and occupation and sympathovagal balance. In addition, we assessed whether the association was consistent across ethnic groups. RESULTS The geometric means of BRS ranged from 8.16 ms/mm Hg (confidence interval [CI] = 7.91-8.43 ms/mm Hg) in low-educated to 14.00 ms/mm Hg (CI = 13.53-14.48 ms/mm Hg) in highly educated women, and from 8.32 ms/mm Hg (CI, 7.97-8.69 ms/mm Hg) in low-educated to 12.25 ms/mm Hg (CI = 11.86-12.66 ms/mm Hg) in highly educated men. High education and occupation were statistically significantly associated with higher BRS and standard deviation of the interbeat interval. Compared with the participants of Dutch origin, a pattern of weaker associations was found in the Surinamese and Ghanaian ethnic groups, but not the Turkish and Moroccan groups. CONCLUSIONS There is a clear socioeconomic gradient in measures of sympathovagal balance, indicating that sympathovagal balance may play a role in socioeconomic disparities in cardiovascular morbidity and mortality.
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Angus C, Pryce R, Holmes J, de Vocht F, Hickman M, Meier P, Brennan A, Gillespie D. Assessing the contribution of alcohol-specific causes to socio-economic inequalities in mortality in England and Wales 2001-16. Addiction 2020; 115:2268-2279. [PMID: 32237009 PMCID: PMC7687183 DOI: 10.1111/add.15037] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/02/2020] [Accepted: 02/28/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS When measuring inequalities in health, public health and addiction research has tended to focus on differences in average life-span between socio-economic groups. This does not account for the extent to which age of death varies between individuals within socio-economic groups or whether this variation differs between groups. This study assesses (1) socio-economic inequalities in both average life-span and variation in age at death, (2) the extent to which these inequalities can be attributed to alcohol-specific causes (i.e. those attributable only to alcohol) and (3) how this contribution has changed over time. DESIGN Cause-deleted life table analysis of national mortality records. SETTING England and Wales, 2001-16. CASES All-cause and alcohol-specific deaths for all adults aged 18+, stratified by sex, age and quintiles of the index of multiple deprivation (IMD). MEASUREMENTS Life expectancy at age 18 yearss and standard deviation in age at death within IMD quintiles and the contribution of alcohol to overall differences in both measures between the highest and lowest IMD quintiles by comparing observed and cause-deleted inequality 'gaps'. FINDINGS In 2016, alcohol-specific causes reduced life expectancy for men and women by 0.26 and 0.14 years, respectively, and increased the standard deviation in age at death. These causes also increased the inequality gap in life expectancy by 0.33 years for men and 0.17 years for women, and variation in age at death by 0.14 years and 0.13 years, respectively. For both measures, the contribution of alcohol to mortality inequalities rose after 2001 and subsequently fell back. For women, alcohol accounted for 3.6% of inequality in age at death and 6.0% of life-span uncertainty, suggesting that using only the former may underestimate alcohol-induced inequalities. There was no comparable difference for men. CONCLUSIONS Deaths from alcohol-specific causes increase inequalities in both life expectancy and variation in age of death between socio-economic groups. Using both measures can provide a fuller picture of overall inequalities in health.
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Affiliation(s)
- Colin Angus
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - Rob Pryce
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - John Holmes
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - Frank de Vocht
- NIHR School for Public Health Research,School of Social and Community MedicineBristolUK
| | - Matthew Hickman
- NIHR School for Public Health Research,School of Social and Community MedicineBristolUK
| | - Petra Meier
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - Alan Brennan
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
| | - Duncan Gillespie
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK,NIHR School for Public Health Research
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Kasajima M, Hashimoto H. Social policies and change in education-related disparities in mortality in Japan, 2000-2010. SSM Popul Health 2020; 12:100692. [PMID: 33241104 PMCID: PMC7672318 DOI: 10.1016/j.ssmph.2020.100692] [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: 07/23/2020] [Revised: 09/26/2020] [Accepted: 11/03/2020] [Indexed: 01/08/2023] Open
Abstract
Persistent socioeconomic disparity in mortality is a widely observed phenomenon despite improvements in the economic standard of living and the prevailing universal healthcare coverage policy. In this study, we selected Japan as a case in which public universal coverage has maintained horizontal equity in healthcare access while demographic and economic challenges have affected the life chances of vulnerable subpopulations over the past decade. We assessed the changing trends in the education-related disparity in mortality over a decade across demographic subpopulations for different causes of death, with the goal of generating social policy lessons to contribute to closing the mortality gap. Using a deterministic data merge between nationwide census and death records, we estimated age- and sex-specific mortality rates for 14 causes and their education-related gradients with absolute and relative indices of inequality in 2000 and 2010 via Poisson regression. Estimation parameters were standardized to the age structure of the sub-population of high school graduates in 2000 as the reference. The results demonstrated that the relative gaps in all-cause mortality persisted despite a decrease in the average mortality rate over the study period. The absolute gaps in mortality increased for preventable causes of death associated with lifestyle behavior choices. The average mortality worsened among socioeconomically vulnerable populations such as youth and women, who were left behind in the existing social/economic policy. External causes of death such as suicide and traffic accidents showed decreasing absolute gaps in a subpopulation targeted by universal social and labor policy measures. These change patterns indicate that, compared with a high-risk approach, a universal policy approach to dealing with societal and fundamental causes of health inequality seems more effective in reducing the education-related mortality gap in both absolute and relative terms. Socioeconomic gaps in mortality persist despite extended healthcare coverage. Education-related mortality gaps were confirmed in 2000 and 2010 in Japan. Relative inequality in preventable diseases increased under checkup-for-all policy. Youth and women, left behind in the current social policy, faced worsened gaps. Mortality gaps decreased when a universal policy on societal causes was adopted.
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Affiliation(s)
- Megumi Kasajima
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hideki Hashimoto
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Costa C, Freitas A, Almendra R, Santana P. The Association between Material Deprivation and Avoidable Mortality in Lisbon, Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228517. [PMID: 33212953 PMCID: PMC7698341 DOI: 10.3390/ijerph17228517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/04/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
There is considerable evidence pointing to the existence of a socioeconomic gradient in mortality, which tends to be steeper in urban areas. Similar to other European cities, Lisbon is far from homogeneous since considerable geographical inequalities exist between the more advantaged and the more deprived neighborhoods. The main goals of this study are to describe the geographical pattern of premature deaths (before 65 years old), avoidable deaths (preventable and amenable to healthcare) and cause-specific mortality (HIV/AIDS and suicide) in Lisbon, at the lower administrative level (civil parish, in Portuguese: Freguesia), and analyze the statistical association between mortality risk and deprivation, before (1999–2003) and during the economic crisis (2008–2012). Smoothed Standardized Mortality Ratios (sSMR) and Relative Risk (RR) with 95% credible intervals were calculated to identify the association between mortality and deprivation. The analysis of the geographical distribution of cause-specific mortality reveals that civil parishes with high sSMR in the first period continued to present higher mortality rates in the second. Moreover, a significant statistical association was found between all the causes of death and deprivation, except suicide. These findings contribute to understanding how social conditions influence health outcomes and can offer insights about potential policy directions for local government.
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Affiliation(s)
- Claudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
- Correspondence:
| | - Angela Freitas
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
| | - Ricardo Almendra
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
- Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
- Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal
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Golz RA, Flum DR, Sanchez SE, Liu X, Donovan C, Drake FT. Geographic Association Between Incidence of Acute Appendicitis and Socioeconomic Status. JAMA Surg 2020; 155:330-338. [PMID: 32129808 DOI: 10.1001/jamasurg.2019.6030] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Some studies based on proportions of patients with perforated appendicitis (PA) among all patients with acute appendicitis (AA) have found an association between socioeconomic status (SES) and risk of perforation. A potential limitation is their use of proportions, which assumes that incidence of AA is evenly distributed across populations at risk. This assumption may be invalid, and SES may have a more complex association with both AA and PA. Objective To generate population-based incidences of AA and PA and to examine geographic patterns of incidence alongside geographic patterns of SES. Design, Setting, and Participants Retrospective study of data from Washington's Comprehensive Hospital Abstract Reporting System and the 2010 US census. Geographic methods were used to identify patterns of age- and sex-standardized incidence in Washington State between 2008 and 2012. The study included all patients discharged with International Classification of Diseases, Ninth Revision codes for AA or PA. Data were analyzed between November 2016 and December 2018. Exposures Location of primary residence. Main Outcomes and Measures Age- and sex-standardized incidence for AA and PA was generated for each census tract (CT). Global spatial autocorrelation was examined using Moran index (0.0 = completely random incidence; 1.0 = fully dependent on location). Clusters of low-incidence CTs (cold spots) and high-incidence CTs (hot spots) were identified for AA. Census-based SES data were aggregated for hot spots and cold spots and then compared. Results Statewide, over the 5-year study period, there were 35 730 patients with AA (including 9780 cases of PA), of whom 16 574 were women (46.4%). Median age of the cohort was 29 years (IQR, 16-48 years). Statewide incidence of AA and PA was 106 and 29 per 100 000 person-years (PY), respectively. Crude incidence was higher within the male population and peaked at age 10 to 19 years. Age- and sex-standardized incidence of AA demonstrated significant positive spatial autocorrelation (Moran index, 0.30; P < .001), but autocorrelation for PA was only half as strong (0.16; P < .001). Median incidence of AA was 118.1 per 100 000 PY among hot spots vs 86.2 per 100 000 PY among cold spots (P < .001). Socioeconomic status was higher in cold spots vs hot spots: mean proportion of college-educated adults was 56% vs 26% (P < .001), and mean per capita income was $44 691 vs $30 027 (P < .001). Conclusions and Relevance Age- and sex-standardized incidence of appendicitis is not randomly distributed across geographic subunits, and geographic clustering of AA is twice as strong as PA. Socioeconomic advantages, such as higher income and secondary education, are strongly associated with lower incidence of AA. These findings challenge conventional views that AA occurs randomly and has no predisposing characteristics beyond age/sex. Socioeconomic status, and likely other geographically circumscribed factors, are associated with incidence of AA.
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Affiliation(s)
- Reece A Golz
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.,Department of Geography, San Francisco State University, San Francisco, California
| | - David R Flum
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Sabrina E Sanchez
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.,Department of Surgery, University of Washington School of Medicine, Seattle
| | - XiaoHang Liu
- Department of Geography, San Francisco State University, San Francisco, California
| | - Courtney Donovan
- Department of Geography, San Francisco State University, San Francisco, California
| | - F Thurston Drake
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.,Department of Surgery, University of Washington School of Medicine, Seattle
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Alvis-Zakzuk NJ, Arroyave I, Castañeda-Orjuela C, De La Hoz-Restrepo F, Alvis-Guzman N. Education and pneumonia mortality: a trend analysis of its inequalities in Colombian adults. BMJ Open Respir Res 2020; 7:e000695. [PMID: 33199401 PMCID: PMC7670943 DOI: 10.1136/bmjresp-2020-000695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To explore the existence and trends of social inequalities related to pneumonia mortality in Colombian adults using educational level as a proxy of socioeconomic status. METHODS We obtained individual and anonymised registries from death certificates due to pneumonia for 1998-2015. Educational level data were gathered from microdata of the Colombian Demography Health Surveys. Rate ratios (RR) were estimated by using Poisson regression models, comparing mortality of educational groups with mortality in the highest education group. Relative index of inequality (RII) was measured to assess changes in disparities, regressing mortality on the midpoint of the cumulative distribution of education, thereby considering the size of each educational group. RESULTS For adults 25+ years, the risk of dying was significantly higher among lower educated. The RRs depict increased risks of dying comparing lower and highest education level, and this tendency was stronger in woman than in men (RR for primary education=2.34 (95% CI 2.32 to 2.36), RR for secondary education=1.77 (95% CI 1.75 to 1.78) versus RR for primary education=1.83 (95% CI 1.81 to 1.85), RR for secondary education=1.51 (95% CI 1.50 to 1.53)). According to age groups, young adults (25-44 years) showed the largest inequality in terms of educational level; RRs for pneumonia mortality regarding the tertiary educated groups show increased mortality in the lower and secondary educated, and these differences decreased with ages. RII in pneumonia mortality among adult men was 2.01 (95% CI 2.00 to 2.03) and in women 2.46 (95% CI 2.43 to 2.48). The RII was greatest at young ages, for both sexes. Time trends showed steadily significant increases for RII in both men and women (estimated annual percentage change (EAPC)men=3.8; EAPCwomen=2.6). CONCLUSION A significant increase on the educational inequalities in mortality due to pneumonia during all period was found among men and women. Efforts to reduce pneumonia mortality in adults improving population health by raising education levels should be strengthened with policies that assure widespread access to economic and social opportunities.
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Affiliation(s)
- Nelson J Alvis-Zakzuk
- Observatorio Nacional de Salud, Instituto Nacional de Salud, Bogota, Colombia
- Ciencias de la Salud, Universidad de la Costa-CUC, Barranquilla, Colombia
| | - Ivan Arroyave
- Escuela Nacional de Salud Pública, Universidad de Antioquia, Medellin, Colombia
| | | | | | - Nelson Alvis-Guzman
- Ciencias Económicas, Universidad de Cartagena, Cartagena, Colombia
- Health Technology Assesment, ALZAK Foundation, Cartagena, Colombia
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A population-based cohort study of socio-demographic risk factors for COVID-19 deaths in Sweden. Nat Commun 2020; 11:5097. [PMID: 33037218 PMCID: PMC7547672 DOI: 10.1038/s41467-020-18926-3] [Citation(s) in RCA: 193] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/18/2020] [Indexed: 12/23/2022] Open
Abstract
As global deaths from COVID-19 continue to rise, the world’s governments, institutions, and agencies are still working toward an understanding of who is most at risk of death. In this study, data on all recorded COVID-19 deaths in Sweden up to May 7, 2020 are linked to high-quality and accurate individual-level background data from administrative registers of the total population. By means of individual-level survival analysis we demonstrate that being male, having less individual income, lower education, not being married all independently predict a higher risk of death from COVID-19 and from all other causes of death. Being an immigrant from a low- or middle-income country predicts higher risk of death from COVID-19 but not for all other causes of death. The main message of this work is that the interaction of the virus causing COVID-19 and its social environment exerts an unequal burden on the most disadvantaged members of society. Better understanding of who is at highest risk of death from COVID-19 is important for public health planning. Here, the authors demonstrate an unequal mortality burden associated with socially disadvantaged groups in Sweden.
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Nunes AR. General and specified vulnerability to extreme temperatures among older adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2020; 30:515-532. [PMID: 31081378 DOI: 10.1080/09603123.2019.1609655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/01/2019] [Indexed: 06/09/2023]
Abstract
Extreme temperatures pose significant risks to human health and well-being. Older adults are particularly at risk and their susceptibility is a function of vulnerability to general daily life circumstances and to specified events or threats. For the first time, this paper develops a combined general and specified approach to understand the determinants of vulnerability. The findings show that most participants exhibit high levels of heat-related vulnerability, followed by cold-related vulnerability and lastly, general vulnerability. General vulnerability was shown to be primarily shaped by financial, physical and social assets. Whilst, specified vulnerability was found to be mainly shaped by human, physical and placed based assets. Such findings present opportunities to focus on the types of assets that contribute to reducing vulnerability. These findings also suggest that the role assets play in shaping vulnerability must be attended to if we are to fully understand and effectively implement strategies to reduce vulnerability.
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Vestbo J, Janson C, Nuevo J, Price D. Observational studies assessing the pharmacological treatment of obstructive lung disease: strengths, challenges and considerations for study design. ERJ Open Res 2020; 6:00044-2020. [PMID: 33083435 PMCID: PMC7553106 DOI: 10.1183/23120541.00044-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/01/2020] [Indexed: 11/05/2022] Open
Abstract
Randomised controlled trials (RCTs) are the gold standard for evaluating treatment efficacy in patients with obstructive lung disease. However, due to strict inclusion criteria and the conditions required for ascertaining statistical significance, the patients included typically represent as little as 5% of the general obstructive lung disease population. Thus, studies in broader patient populations are becoming increasingly important. These can be randomised effectiveness trials or observational studies providing data on real-world treatment effectiveness and safety data that complement efficacy RCTs. In this review we describe the features associated with the diagnosis of asthma and chronic obstructive pulmonary disease (COPD) in the real-world clinical practice setting. We also discuss how RCTs and observational studies have reported opposing outcomes with several treatments and inhaler devices due to differences in study design and the variations in patients recruited by different study types. Whilst observational studies are not without weaknesses, we outline recently developed tools for defining markers of quality of observational studies. We also examine how observational studies are capable of providing valuable insights into disease mechanisms and management and how they are a vital component of research into obstructive lung disease. As we move into an era of personalised medicine, recent observational studies, such as the NOVEL observational longiTudinal studY (NOVELTY), have the capacity to provide a greater understanding of the value of a personalised healthcare approach in patients in clinical practice by focussing on standardised outcome measures of patient-reported outcomes, physician assessments, airway physiology, and blood and airway biomarkers across both primary and specialist care.
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Affiliation(s)
- Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Christer Janson
- Dept of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | - David Price
- Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Pechholdová M, Jasilionis D. Contrasts in alcohol-related mortality in Czechia and Lithuania: Analysis of time trends and educational differences. Drug Alcohol Rev 2020; 39:846-856. [PMID: 32909686 PMCID: PMC7756221 DOI: 10.1111/dar.13157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/18/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Globally, Czechia and Lithuania are among the top-ranking countries in terms of high alcohol consumption. This study highlights notable contrasts in temporal trends in alcohol-related mortality and identifies country-specific patterns in educational differences. DESIGN AND METHODS The study uses harmonised cause-of-death series from the Human Cause of Death Database. Mortality disparities by education were assessed using census-linked mortality data. Directly standardised death rates were used to estimate levels of national and group-specific mortality. Relative and absolute mortality differences by education were assessed by range-type measures (Poisson regression mortality ratios and rate differences) and Gini-type measures. RESULTS Between 1994-1995 and 2016, the absolute difference between Czechia and Lithuania in terms of alcohol-related age-standardised death rates (per 1 000 000) decreased from 450 for males and 130 for females to 76 in males and 11 in females. In both countries, alcohol-related mortality was markedly higher among persons of lower education levels. Lithuanian males experienced the highest absolute inequalities measured by rate difference between the low and high educated (740 per million), while Lithuanian females showed the most pronounced relative inequalities (6.70-fold difference between low and high educated). The corresponding figures were less than half for Czechia. DISCUSSION AND CONCLUSIONS Reducing educational disparities in alcohol-related mortality within both countries would have a substantial impact on overall levels. Policies aimed at targeting the lowest priced and illegal alcohols and reducing levels of harmful drinking should be a priority, especially in Lithuania.
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Affiliation(s)
- Markéta Pechholdová
- Department of Demography, Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic
| | - Domantas Jasilionis
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany.,Demographic Research Centre, Faculty of Social Sciences, Vytautas Magnus University, Kaunas, Lithuania
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41
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Willems B, Cullati S, Prez VD, Jolidon V, Burton-Jeangros C, Bracke P. Cancer Screening Participation and Gender Stratification in Europe. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2020; 61:377-395. [PMID: 32686508 DOI: 10.1177/0022146520938708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The current study examines whether the extent of macrolevel gender inequality affects the association between women's educational attainment and their participation in cervical and breast cancer screening and how this relationship is moderated by a country's cancer screening strategy (organized vs. opportunistic). A multilevel design with women (Ncervical = 99,794; Nbreast = 55,021) nested in 30 European countries was used to analyze data from the European Health Interview Survey (2013-2015). Results of multilevel logistic regression models demonstrate that higher macrolevel gender inequality is associated with (a) a lower overall likelihood that women have had a mammography and Pap smear and (b) a larger gap in participation between women with low and high levels of education, regardless of a country's screening strategy (i.e., no moderation by a country's screening strategy was found). We conclude that macrolevel gender stratification should not be neglected when designing cancer screening policy.
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Affiliation(s)
| | - Stéphane Cullati
- University of Geneva, Geneva, GE, Switzerland
- University of Fribourg, Switzerland
| | | | | | | | - Piet Bracke
- Ghent University, Gent, Oost-Vlaanderen, Belgium
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Khalatbari-Soltani S, Blyth FM, Naganathan V, Handelsman DJ, Le Couteur DG, Seibel MJ, Waite LM, Cvejic E, Cumming RG. Socioeconomic status, health-related behaviours, and death among older people: the Concord health and aging in men project prospective cohort study. BMC Geriatr 2020; 20:261. [PMID: 32727399 PMCID: PMC7391572 DOI: 10.1186/s12877-020-01648-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/13/2020] [Indexed: 11/13/2022] Open
Abstract
Background Conflicting evidence exists regarding the association of socioeconomic status (SES) with mortality among older people and little is known about the mechanisms underlying this association. We investigated the association of SES with mortality among older Australian men. We also investigated potential mediating effects of health-related behaviours in SES-mortality associations. Methods We used data from a prospective population-based cohort (the Concord Health and Aging in Men Project), in Sydney, Australia. The main outcomes were all-cause and cause-specific mortality. Educational attainment, occupational position, source of income, housing tenure, and a cumulative SES score were assessed at baseline. Longitudinally assessed alcohol consumption, smoking, physical activity, and body mass index were investigated as potential mediators. Associations were quantified using Cox regression. Results We evaluated 1527 men (mean age: 77.4 ± 5.5 years). During a mean follow-up time of 9.0 years, 783 deaths occurred. For deaths from all causes, the adjusted hazard ratio (HR) for the lowest tertile of cumulative SES score versus the highest tertile was 1.44 (95% CI 1.21 to 1.70); the corresponding sub-HRs were 1.35 (0.96 to 1.89) for cardiovascular disease (CVD) mortality; 1.58 (1.15 to 2.18) for cancer mortality, and 1.86 (1.36 to 2.56) for non-CVD, non-cancer mortality. SES-mortality associations were attenuated by 11–25% after adjustment for mediating health-related behaviours. Conclusion Low SES is associated with increased mortality in older Australian men and health-related behaviours accounted for less than one-fourth of these associations. Further research is needed to fully understand the mechanisms underlying SES inequalities in mortality among older people.
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Affiliation(s)
- Saman Khalatbari-Soltani
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia. .,ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, Australia.
| | - Fiona M Blyth
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Ageing and Alzheimer's Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Ageing and Alzheimer's Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.,ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia
| | - Markus J Seibel
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia
| | - Louise M Waite
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Ageing and Alzheimer's Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Erin Cvejic
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Robert G Cumming
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia. .,ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, Australia. .,Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
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Social Inequalities and Loneliness as Predictors of Ageing Well: A Trend Analysis Using Mixed Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155314. [PMID: 32718010 PMCID: PMC7432820 DOI: 10.3390/ijerph17155314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/20/2022]
Abstract
Background: This study examines if education, income, and loneliness are associated with physical functioning and optimism in an ageing population in Germany. Furthermore, time trends of physical functioning and optimism as well as of associations with social inequality and loneliness are analyzed. Methods: The German Ageing Survey (DEAS), a longitudinal population-based survey of individuals aged 40 years and older, was used (four waves between 2008 and 2017, total sample size N = 23,572). Physical functioning and optimism were introduced as indicators of ageing well. Educational level, net equivalent income, and loneliness were used as predictors in linear mixed models for longitudinal data. Results: Time trends show that physical functioning decreases over time, while optimism slightly increases. Education and income are positively associated with physical functioning, while higher loneliness correlates with lower physical functioning. Higher optimism was associated with higher income and particularly with lower loneliness. Income and notable educational inequalities in physical functioning increase over time. Time trends of the associations with optimism show decreasing income inequalities and increasing disparities in loneliness. Conclusions: Increasing educational inequalities in physical functioning and a strong association of loneliness with optimism provide information for further interventions. Targeted health promotion among the aged and addressing maladaptive social cognition are options to tackle these issues. Key areas for action on healthy ageing include, for instance, the alignment of health systems to the needs of older populations or the creation of age-friendly environments.
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Rydland HT, Fjær EL, Eikemo TA, Huijts T, Bambra C, Wendt C, Kulhánová I, Martikainen P, Dibben C, Kalėdienė R, Borrell C, Leinsalu M, Bopp M, Mackenbach JP. Educational inequalities in mortality amenable to healthcare. A comparison of European healthcare systems. PLoS One 2020; 15:e0234135. [PMID: 32614848 PMCID: PMC7332057 DOI: 10.1371/journal.pone.0234135] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Educational inequalities in health and mortality in European countries have often been studied in the context of welfare regimes or political systems. We argue that the healthcare system is the national level feature most directly linkable to mortality amenable to healthcare. In this article, we ask to what extent the strength of educational differences in mortality amenable to healthcare vary among European countries and between European healthcare system types. METHODS This study uses data on mortality amenable to healthcare for 21 European populations, covering ages 35-79 and spanning from 1998 to 2006. ISCED education categories are used to calculate relative (RII) and absolute inequalities (SII) between the highest and lowest educated. The healthcare system typology is based on the latest available classification. Meta-analysis and ANOVA tests are used to see if and how they can explain between-country differences in inequalities and whether any healthcare system types have higher inequalities. RESULTS All countries and healthcare system types exhibited relative and absolute educational inequalities in mortality amenable to healthcare. The low-supply and low performance mixed healthcare system type had the highest inequality point estimate for the male (RII = 3.57; SII = 414) and female (RII = 3.18; SII = 209) population, while the regulation-oriented public healthcare systems had the overall lowest (male RII = 1.78; male SII = 123; female RII = 1.86; female SII = 78.5). Due to data limitations, results were not robust enough to make substantial claims about typology differences. CONCLUSIONS This article aims at discussing possible mechanisms connecting healthcare systems, social position, and health. Results indicate that factors located within the healthcare system are relevant for health inequalities, as inequalities in mortality amenable to medical care are present in all healthcare systems. Future research should aim at examining the role of specific characteristics of healthcare systems in more detail.
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Affiliation(s)
- Håvard T. Rydland
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Erlend L. Fjær
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Terje A. Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Tim Huijts
- Research Centre for Education and the Labour Market, Maastricht University, Maastricht, The Netherlands
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Claus Wendt
- Sociology of Health and Healthcare Systems, University of Siegen, Siegen, Germany
| | - Ivana Kulhánová
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | - Chris Dibben
- School of Geosciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Carme Borrell
- Agència de Salut de Pública de Barcelona, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
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Mendonça CR, Noll M, Rodrigues APDS, Vitorino PVDO, Mendes MDA, Silveira EA. Association of Pain, Severe Pain, and Multisite Pain with the Level of Physical Activity and Sedentary Behavior in Severely Obese Adults: Baseline Data from the DieTBra Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4478. [PMID: 32580400 PMCID: PMC7345744 DOI: 10.3390/ijerph17124478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/16/2022]
Abstract
The study aimed to assess the prevalence of pain, severe pain, and pain in four or more regions associated with physical activity and sedentary behavior, as well as other associated factors in severely obese adults (Body Mass Index ≥ 35 kg/m2). Baseline data from the DieTBra Trial were analyzed. The outcome variables were pain (yes/no) and pain in four or more sites (yes/no), as identified by the Brazilian version of the Nordic Musculoskeletal Questionnaire, along with the presence of severe pain (yes/no), identified based on the Numerical Pain Rating Scale (≥8). The main independent variables were moderate to vigorous physical activity (MVPA), light physical activity, and sedentary behavior, assessed by triaxial accelerometry. The variables were analyzed using multiple hierarchical Poisson regression. In 150 individuals (men, 14.67%; and women, 85.33%), with a mean age of 39.6 ± 0.7 years, there was a high prevalence of pain (89.33%), severe pain (69.33%), and pain in four or more regions (53.33%). The associated factors were shorter MVPA time with pain (p = 0.010); arthritis/arthrosis (p = 0.007) and the use of muscle relaxants (p = 0.026) with severe pain; and economic class C (p = 0.033), and economic class D (p = 0.003), along with arthritis and arthrosis (p = 0.025) with pain in four or more sites. There were no significant associations between sedentary behavior and any of the three outcomes analyzed. These findings indicate that, in severely obese individuals, shorter MVPA time is associated with a higher prevalence of pain. Future studies on physical activity intervention may contribute to the reduction in the prevalence and severity of pain in adults with severe obesity.
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Affiliation(s)
- Carolina Rodrigues Mendonça
- Postgraduate Program in Health Sciences, Faculdade de Medicina, Universidade Federal de Goiás, Goiás 74605-050, Brazil; (A.P.d.S.R.); (E.A.S.)
| | - Matias Noll
- Instituto Federal Goiano (IF Goiano), Goiás 74270-040, Brazil;
| | - Ana Paula dos Santos Rodrigues
- Postgraduate Program in Health Sciences, Faculdade de Medicina, Universidade Federal de Goiás, Goiás 74605-050, Brazil; (A.P.d.S.R.); (E.A.S.)
| | - Priscila Valverde de Oliveira Vitorino
- Postgraduate Program in Health Sciences, Professor of the School of Social Sciences and Health, Pontifical Catholic University of Goiás, Goiânia, Goiás 74605-010, Brazil;
| | | | - Erika Aparecida Silveira
- Postgraduate Program in Health Sciences, Faculdade de Medicina, Universidade Federal de Goiás, Goiás 74605-050, Brazil; (A.P.d.S.R.); (E.A.S.)
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Lopuszanska-Dawid M, Kołodziej H, Lipowicz A, Szklarska A, Kopiczko A, Bielicki T. Social class-specific secular trends in height among 19-year old Polish men: 6th national surveys from 1965 till 2010. ECONOMICS AND HUMAN BIOLOGY 2020; 37:100832. [PMID: 31924589 DOI: 10.1016/j.ehb.2019.100832] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 06/10/2023]
Abstract
The results presented in this study concern the assessment of the secular trend of body height in 10 % a random national sample (N = 134,224) representing all regions of Poland in 8 homogeneous social groups over 45 years in Poland (1965-2010). Very significant political, social and economic changes in Poland occurred in the period studied. The political revolution that began in Poland at the turn of the 1980s and 1990s dramatically changed the picture of social inequalities in the country. It rapidly transformed (in different directions and to a different degree) the economic situation, working conditions, lifestyles and the prestige of particular social classes and professional groups. A positive secular trend was observed in 19-year-old participants in the period analysed in all homogeneous socio-professional groups, however, with different intensity in each group. The highest body height increases in 1965-2010 were observed in the sons of farmers with post-primary father's education (7.77 cm). The lowest were observed among the sons of professionals, only 5.45 cm. Although social distances between extreme socio-economic groups significantly decreased (from 4.89 cm in 1965 to 2.76 cm in 2010), social gradients of body height, despite the improvement in the standards of living of the entire society remained exceptionally stable and unchanged for nearly half a century.
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Affiliation(s)
- M Lopuszanska-Dawid
- Józef Pilsudski University of Physical Education in Warsaw, Department of Biomedical Sciences, Marymoncka 34, 00-968 Warsaw 45, Poland.
| | - H Kołodziej
- Wroclaw University of Environmental and Life Sciences, The Faculty of Biology and Animal Science, Department of Anthropology, C. K. Norwida 25, 50-375 Wrocław, Poland
| | - A Lipowicz
- Wroclaw University of Environmental and Life Sciences, The Faculty of Biology and Animal Science, Department of Anthropology, C. K. Norwida 25, 50-375 Wrocław, Poland
| | - A Szklarska
- Polish Academy of Sciences, Palace of Culture and Science, Plac Defilad 1, 00-901 Warsaw, Poland
| | - A Kopiczko
- Józef Pilsudski University of Physical Education in Warsaw, Department of Biomedical Sciences, Marymoncka 34, 00-968 Warsaw 45, Poland
| | - T Bielicki
- Polish Academy of Sciences, Palace of Culture and Science, Plac Defilad 1, 00-901 Warsaw, Poland
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Youn JC, Chung WB, Ezekowitz JA, Hong JH, Nam H, Kyoung DS, Kim IC, Lyon AR, Kang SM, Jung HO, Chang K, Oh YS, Youn HJ, Baek SH, Kim HC. Cardiovascular disease burden in adult patients with cancer: An 11-year nationwide population-based cohort study. Int J Cardiol 2020; 317:167-173. [PMID: 32360647 DOI: 10.1016/j.ijcard.2020.04.080] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/19/2020] [Accepted: 04/27/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is an important cause of morbidity and mortality in patients with cancer. However, the real-world CVD burden of adult cancer patients has not been well established. This study aimed to evaluate the prevalence and mortality of pre-existing and new-onset CVD in patients with cancers. METHODS We analysed the prevalence and mortality of pre-existing and new-onset CVD in 41,034 adult patients with ten common solid cancers in a single payer system using data from the Korean National Health Insurance Service-National Sample Cohort from 2002 to 2013. RESULTS When all types of cancer were included, 11.3% (n = 4647) of patients had pre-existing CVD when they were diagnosed with cancer. After excluding patients with pre-existing CVD, 15.7% of cancer patients (n = 5703) were newly diagnosed with CVD during the follow-up period (median 68 months). Both pre-existing and new-onset CVD were associated with increased risk of overall mortality and 5-year mortality. Multivariate analysis to predict all-cause mortality indicated both pre-existing and new-onset CVD, male sex, old age, prior history of diabetes or chronic kidney disease, suburban residential area, and low-income status as significant factors. CONCLUSIONS Eleven percent of cancer patients had pre-existing CVD at the time of cancer diagnosis, and about 16% of cancer patients without pre-existing CVD were newly diagnosed with CVD, mostly within 5 years after the cancer diagnosis. Proper management of pre-existing CVD is necessary and pre-emptive prevention of new-onset CVD may alter treatment options and outcomes.
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Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Justin A Ezekowitz
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Jung Hwa Hong
- Department of Health Insurance Research, NHIS Medical Center, Ilsan Hospital, Goyang, Republic of Korea
| | - Hyewon Nam
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Republic of Korea
| | - Dae-Sung Kyoung
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Republic of Korea
| | - In-Cheol Kim
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton & Harefield NHS Foundation Trust and the National Heart & Lung Institute, Imperial College London, London, UK
| | - Seok-Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Seog Oh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hong Baek
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyeon Chang Kim
- Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Schneider A, Blüher S, Grittner U, Anton V, Schaeffner E, Ebert N, Jakob O, Martus P, Kuhlmey A, Wenning V, Schnitzer S. Is there an association between social determinants and care dependency risk? A multi-state model analysis of a longitudinal study. Res Nurs Health 2020; 43:230-240. [PMID: 32314415 DOI: 10.1002/nur.22022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 01/12/2023]
Abstract
Despite a growing body of knowledge about the morbidities and functional impairment that frequently lead to care dependency, the role of social determinants is not yet well understood. The purpose of this study was to examine the effect of social determinants on care dependency onset and progression. We used data from the Berlin Initiative Study, a prospective, population-based cohort study including 2,069 older participants living in Berlin. Care dependency was defined as requiring substantial assistance in at least two activities of daily living for 90 min daily (level 1) or 3+ hours daily (level 2). Multi-state time to event regression modeling was used to estimate the effects of social determinants (partnership status, education, income, and sex), morbidities, and health behaviors, characteristics, and conditions. During the study period, 556 participants (27.5%) changed their status of care dependency. Participants without a partner at baseline were at a higher risk to become care-dependent than participants with a partner (hazard ratio [HR], 95% confidence interval [CI]: 1.24 (1.02-1.51)). After adjustment for other social determinants, morbidities and health behaviors, characteristics, and conditions the risk decreased to a HR of 1.19 (95% CI: 0.79-1.79). Results indicate that older people without a partner may tend to be at higher risk of care dependency onset but not at higher risk of care dependency progression. Clinicians should inquire about and consider patients' partnership status as they evaluate care needs.
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Affiliation(s)
- Alice Schneider
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany.,Institute of Public Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Stefan Blüher
- Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Verena Anton
- Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Natalie Ebert
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | | | - Peter Martus
- Institute of Clinical Epidemiology and Medical Biostatistics, Eberhard Karls-University, Tübingen, Germany
| | - Adelheid Kuhlmey
- Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | | | - Susanne Schnitzer
- Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Haeberer M, León-Gómez I, Pérez-Gómez B, Tellez-Plaza M, Rodríguez-Artalejo F, Galán I. Desigualdades sociales en la mortalidad cardiovascular en España desde una perspectiva interseccional. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Haeberer M, León-Gómez I, Pérez-Gómez B, Tellez-Plaza M, Rodríguez-Artalejo F, Galán I. Social inequalities in cardiovascular mortality in Spain from an intersectional perspective. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:282-289. [PMID: 31784414 DOI: 10.1016/j.rec.2019.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/10/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION AND OBJECTIVES There is an interaction between age, sex, and educational level, among other factors, that influences mortality. To date, no studies in Spain have comprehensively analyzed social inequalities in cardiovascular mortality by considering the joint influence of age, sex, and education (intersectional perspective). METHODS Study of all deaths due to all-cause cardiovascular disease, ischemic heart disease, heart failure, and cerebrovascular disease among people aged ≥ 30 years in Spain in 2015. Data were obtained from the Spanish Office of Statistics. The relative index of inequality (RII) and the slope index of inequality (SII) were calculated by using Poisson regression models with age-adjusted mortality. The RII is interpreted as the relative risk of mortality between the lowest and the highest educational level, and the SII as the absolute difference in mortality. RESULTS The RII for all-cause cardiovascular mortality was 1.88 (95%CI, 1.80-1.96) in women and 1.44 (95%CI, 1.39-1.49) in men. The SII was 178.46 and 149.43 deaths per 100 000, respectively. The greatest inequalities were observed in ischemic heart disease and heart failure in younger women, with a RII higher than 4. There were no differences between sexes in inequalities due to cerebrovascular disease. CONCLUSIONS Cardiovascular mortality is inversely associated with educational level. This inequality mostly affects premature mortality due to cardiac causes, especially among women. Monitoring this problem could guide the future Cardiovascular Health Strategy in the National Health System, to reduce inequality in the first cause of death.
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Affiliation(s)
- Mariana Haeberer
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, IdiPAZ, Madrid, Spain
| | - Inmaculada León-Gómez
- Departamento de Epidemiología de Enfermedades Crónicas, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Pérez-Gómez
- Departamento de Epidemiología de Enfermedades Crónicas, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Tellez-Plaza
- Departamento de Epidemiología de Enfermedades Crónicas, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Iñaki Galán
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, IdiPAZ, Madrid, Spain; Departamento de Epidemiología de Enfermedades Crónicas, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
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