1
|
Gensowski M, Gørtz M. The education-health gradient: Revisiting the role of socio-emotional skills. JOURNAL OF HEALTH ECONOMICS 2024; 97:102911. [PMID: 38924908 DOI: 10.1016/j.jhealeco.2024.102911] [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: 07/06/2023] [Revised: 04/30/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
Is the education-health gradient inflated because both education and health are associated with unobserved socio-emotional skills? We find that the gradient in health behaviors and outcomes is reduced by about 15 to 50% from accounting for fine-grained personality facets and up to another 50% from Locus of Control. Traditional aggregated Big-Five scales, however, have a much smaller contribution to the gradient. We use sibling-fixed effects to net out the contribution from genes and shared childhood environment, decomposing the gradient into its components with an order-invariant method. We rely on a large survey (N = 28,261) linked to high-quality Danish administrative registers with information on parental background and objectively measured diagnoses and care use. Accounting for Locus of Control yields the strongest gradient reduction in self-rated health status and objective diagnoses (30%-50%), and in health behaviors the most important factor is Extraversion, a skill that has been shown to be malleable in interventions.
Collapse
Affiliation(s)
| | - Mette Gørtz
- IZA, Germany; University of Copenhagen, Department of Economics, Denmark; Center for Economic Behavior and Inequality (CEBI), Denmark
| |
Collapse
|
2
|
Stein DT, Reitsma MB, Geldsetzer P, Agoudavi K, Aryal KK, Bahendeka S, Brant LCC, Farzadfar F, Gurung MS, Guwatudde D, Houehanou YCN, Malta DC, Martins JS, Saeedi Moghaddam S, Mwangi KJ, Norov B, Sturua L, Zhumadilov Z, Bärnighausen T, Davies JI, Flood D, Marcus ME, Theilmann M, Vollmer S, Manne-Goehler J, Atun R, Sudharsanan N, Verguet S. Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries. Nat Med 2024; 30:414-423. [PMID: 38278990 DOI: 10.1038/s41591-023-02769-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/15/2023] [Indexed: 01/28/2024]
Abstract
Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally representative, cross-sectional surveys. We raised diagnosis (diagnosis scenario) and treatment (treatment scenario) levels for all wealth quintiles to match the best-performing country quintile and estimated the change in 10-year cardiovascular disease (CVD) risk of individuals initiated on treatment. We observed greater health benefits among bottom wealth quintiles in middle-income countries and in countries with larger baseline disparities in hypertension management. Lower-middle-income countries would see the greatest absolute benefits among the bottom quintiles under the treatment scenario (29.1 CVD cases averted per 1,000 people living with hypertension in the bottom quintile (Q1) versus 17.2 in the top quintile (Q5)), and the proportion of total CVD cases averted would be largest among the lowest quintiles in upper-middle-income countries under both diagnosis (32.0% of averted cases in Q1 versus 11.9% in Q5) and treatment (29.7% of averted cases in Q1 versus 14.0% in Q5) scenarios. Targeted improvements in hypertension diagnosis and treatment could substantially reduce socioeconomic-based inequalities in CVD burden in low- and middle-income countries.
Collapse
Affiliation(s)
- Dorit Talia Stein
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marissa B Reitsma
- Department of Health Policy, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Kokou Agoudavi
- Noncommunicable Disease Program, Ministry of Health, Lomé, Togo
| | - Krishna Kumar Aryal
- Bergen Centre for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Silver Bahendeka
- MKPGMS-Uganda Martyrs University, Kampala, Uganda
- St. Francis Hospital, Nsambya, Kampala, Uganda
| | - Luisa C C Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | | | - Deborah Carvalho Malta
- Department Maternal Child and Public Health, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - João Soares Martins
- Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Díli, Timor-Leste
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Kibachio Joseph Mwangi
- World Health Organization, Pretoria, South Africa
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Bolormaa Norov
- Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
| | - Lela Sturua
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | | | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala
| | - Maja E Marcus
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Sebastian Vollmer
- Department of Economics & Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| |
Collapse
|
3
|
Deng H, Du J, Gao J, Wang Q. Network percolation reveals adaptive bridges of the mobility network response to COVID-19. PLoS One 2021; 16:e0258868. [PMID: 34752462 PMCID: PMC8577732 DOI: 10.1371/journal.pone.0258868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
Human mobility is crucial to understand the transmission pattern of COVID-19 on spatially embedded geographic networks. This pattern seems unpredictable, and the propagation appears unstoppable, resulting in over 350,000 death tolls in the U.S. by the end of 2020. Here, we create the spatiotemporal inter-county mobility network using 10 TB (Terabytes) trajectory data of 30 million smart devices in the U.S. in the first six months of 2020. We investigate the bond percolation process by removing the weakly connected edges. As we increase the threshold, the mobility network nodes become less interconnected and thus experience surprisingly abrupt phase transitions. Despite the complex behaviors of the mobility network, we devised a novel approach to identify a small, manageable set of recurrent critical bridges, connecting the giant component and the second-largest component. These adaptive links, located across the United States, played a key role as valves connecting components in divisions and regions during the pandemic. Beyond, our numerical results unveil that network characteristics determine the critical thresholds and the bridge locations. The findings provide new insights into managing and controlling the connectivity of mobility networks during unprecedented disruptions. The work can also potentially offer practical future infectious diseases both globally and locally.
Collapse
Affiliation(s)
- Hengfang Deng
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA, United States of America
| | - Jing Du
- Department of Civil and Coastal Engineering, University of Florida, Gainsville, FL, United States of America
| | - Jianxi Gao
- Department of Computer Science and Center for Network Science and Technology, Rensselaer Polytechnic Institute, Troy, NY, United States of America
| | - Qi Wang
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA, United States of America
| |
Collapse
|
4
|
Fors S, Wastesson JW, Morin L. Growing Income-Based Inequalities in Old-Age Life Expectancy in Sweden, 2006-2015. Demography 2021; 58:2117-2138. [PMID: 34528078 DOI: 10.1215/00703370-9456514] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sweden is known for high life expectancy and economic egalitarianism, yet in recent decades it has lost ground in both respects. This study tracked income inequality in old-age life expectancy and life span variation in Sweden between 2006 and 2015, and examined whether patterns varied across levels of neighborhood deprivation. Income inequality in remaining life expectancy at ages 65, 75, and 85 increased. The gap in life expectancy at age 65 grew by more than a year between the lowest and the highest income quartiles, for both men (from 3.4 years in 2006 to 4.5 years in 2015) and women (from 2.3 to 3.4 years). This widening income gap in old-age life expectancy was driven by different rates of mortality improvement: individuals with higher incomes increased their life expectancy at a faster rate than did those with lower incomes. Women with the lowest incomes experienced no improvement in old-age life expectancy. Furthermore, life span variation increased in the lowest income quartile, while it decreased slightly among those in the highest quartile. Income was found to be a stronger determinant of old-age life expectancy than neighborhood deprivation.
Collapse
Affiliation(s)
- Stefan Fors
- Aging Research Center, Karolinska Institutet & Stockholm Universitet, Solna, Sweden.,Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Jonas W Wastesson
- Aging Research Center, Karolinska Institutet & Stockholm Universitet, Solna, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lucas Morin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Inserm CIC 1431, CHU Besançon, Besançon, France.,Inserm U1018, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Villejuif, France
| |
Collapse
|
5
|
Deeg DJ, De Tavernier W, de Breij S. Occupation-Based Life Expectancy: Actuarial Fairness in Determining Statutory Retirement Age. FRONTIERS IN SOCIOLOGY 2021; 6:675618. [PMID: 34497844 PMCID: PMC8419329 DOI: 10.3389/fsoc.2021.675618] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/05/2021] [Indexed: 06/09/2023]
Abstract
This study examines occupation-based differences in life expectancy and the extent to which health accounts for these differences. Twentyseven-year survival follow-up data were used from the Dutch population-based Longitudinal Aging Study Amsterdam (n = 2,531), initial ages 55-85 years. Occupation was based on longest-held job. Results show that the non-skilled general, technical and transport domains had an up to 3.5-year shorter life expectancy than the academic professions, accounting for the compositional characteristics age and gender. Statutory retirement age could be made to vary accordingly, by allowing a proportionally greater pension build-up in the shorter-lived domains. Health accounted for a substantial portion of the longevity difference, ranging from 20 to 66%, depending on the health indicator. Thus, health differences between occupational domains today can be used as a means to tailor retirement ages to individuals' risks of longevity. These data provide a proof of principle for the development of an actuarially fair method to determine statutory retirement ages.
Collapse
Affiliation(s)
- Dorly J.H. Deeg
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Wouter De Tavernier
- Centre for Comparative Welfare Studies, Aalborg University, Aalborg, Denmark
| | - Sascha de Breij
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
6
|
Hirani JLJ. Inattention or reluctance? Parental responses to vaccination reminder letters. JOURNAL OF HEALTH ECONOMICS 2021; 76:102439. [PMID: 33601095 DOI: 10.1016/j.jhealeco.2021.102439] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 06/12/2023]
Abstract
This paper studies non-adherence in the Danish Childhood Vaccination Program using a nationwide introduction of a vaccination reminder letter policy and administrative data from 2011-2017. First, I provide causal estimates of how the reminder letter policy affects vaccination adherence using a Regression Discontinuity Design (RDD). Second, I link parental responses to the reminder letter to parents' causes for being non-adherent. I find that the reminder letter policy positively affects adherence. However, 72% of non-adherent parents are non-responsive to the reminder letter indicating that reluctance and not inattention is the leading cause for non-adherence. Thus, other policies beyond reminder letters - such as mandatory vaccination laws - are necessary to substantially increase vaccination coverage.
Collapse
Affiliation(s)
- Jonas Lau-Jensen Hirani
- The Danish Center for Social Science Research (VIVE), Herluf Trolles Gade 11, 1052 Copenhagen, Denmark.
| |
Collapse
|
7
|
Paranjpe MD, Chin AC, Paranjpe I, Reid NJ, Duy PQ, Wang JK, O'Hagan R, Arzani A, Haghdel A, Lim CC, Orhurhu V, Urits I, Ngo AL, Glicksberg BS, Hall KT, Mehta D, Cooper RS, Nadkarni GN. Self-reported health without clinically measurable benefits among adult users of multivitamin and multimineral supplements: a cross-sectional study. BMJ Open 2020; 10:e039119. [PMID: 33148746 PMCID: PMC7643504 DOI: 10.1136/bmjopen-2020-039119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/29/2020] [Accepted: 09/02/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Multiple clinical trials fail to identify clinically measurable health benefits of daily multivitamin and multimineral (MVM) consumption in the general adult population. Understanding the determinants of widespread use of MVMs may guide efforts to better educate the public about effective nutritional practices. The objective of this study was to compare self-reported and clinically measurable health outcomes among MVM users and non-users in a large, nationally representative adult civilian non-institutionalised population in the USA surveyed on the use of complementary health practices. DESIGN Cross-sectional analysis of the effect of MVM consumption on self-reported overall health and clinically measurable health outcomes. PARTICIPANTS Adult MVM users and non-users from the 2012 National Health Interview Survey (n=21 603). PRIMARY AND SECONDARY OUTCOME MEASURES Five psychological, physical, and functional health outcomes: (1) self-rated health status, (2) needing help with routine needs, (3) history of 10 chronic diseases, (4) presence of 19 health conditions in the past 12 months, and (5) Kessler 6-Item (K6) Psychological Distress Scale to measure non-specific psychological distress in the past month. RESULTS Among 4933 adult MVM users and 16 670 adult non-users, MVM users self-reported 30% better overall health than non-users (adjusted OR 1.31; 95% CI 1.17 to 1.46; false discovery rate adjusted p<0.001). There were no differences between MVM users and non-users in history of 10 chronic diseases, number of present health conditions, severity of current psychological distress on the K6 Scale and rates of needing help with daily activities. No effect modification was observed after stratification by sex, education, and race. CONCLUSIONS MVM users self-reported better overall health despite no apparent differences in clinically measurable health outcomes. These results suggest that widespread use of multivitamins in adults may be a result of individuals' positive expectation that multivitamin use leads to better health outcomes or a self-selection bias in which MVM users intrinsically harbour more positive views regarding their health.
Collapse
Affiliation(s)
- Manish D Paranjpe
- Health Sciences and Technology, Harvard Medical School, Boston, Massachusetts, USA
| | - Alfred C Chin
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Ishan Paranjpe
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Phan Q Duy
- Medical Scientist Training Program, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jason K Wang
- Health Sciences and Technology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ross O'Hagan
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Artine Arzani
- Weill Cornell Medical College, New York City, New York, USA
| | | | - Clarence C Lim
- Texas A&M University System Health Science Center College of Medicine, Bryan, Texas, USA
| | - Vwaire Orhurhu
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Pain Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ivan Urits
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Pain Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anh L Ngo
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Benjamin S Glicksberg
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kathryn T Hall
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Darshan Mehta
- Harvard Medical School, Boston, Massachusetts, USA
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | | | - Girish N Nadkarni
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| |
Collapse
|
8
|
Coveney M, García-Gómez P, van Doorslaer E, Van Ourti T. Thank goodness for stickiness: Unravelling the evolution of income-related health inequalities before and after the Great Recession in Europe. JOURNAL OF HEALTH ECONOMICS 2020; 70:102259. [PMID: 31931267 DOI: 10.1016/j.jhealeco.2019.102259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
The Great Recession in Europe sparked concerns that the crisis would lead to increased income related health inequalities (IRHI). Did this come to pass, and what role, if any, did government transfers play in the evolution of these inequalities? Motivated by these questions, this paper seeks to (i) study the evolution of IRHI during the crisis, and (ii) decompose these evolutions to examine the separate roles of government versus market transfers. Using panel data for 7 EU countries from 2004 to 2013, we find no evidence that IRHI persistently rose after 2008, even in countries most affected by the crisis. Our decomposition reveals that, while the health of the poorest did indeed worsen during the crisis, IRHI were prevented from increasing by the relative stickiness of old age pension benefits compared to the market incomes of younger groups. Austerity measures weakened the IRHI reducing effect of government transfers.
Collapse
Affiliation(s)
- Max Coveney
- Erasmus School of Economics, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands; Tinbergen Institute; NETSPAR, the Netherlands.
| | - Pilar García-Gómez
- Erasmus School of Economics, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands; Tinbergen Institute; NETSPAR, the Netherlands.
| | - Eddy van Doorslaer
- Erasmus School of Economics, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands; Tinbergen Institute; NETSPAR, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands.
| | - Tom Van Ourti
- Erasmus School of Economics, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands; Tinbergen Institute; NETSPAR, the Netherlands.
| |
Collapse
|
9
|
Guo H, Chang Z, Wu J, Li W. Air pollution and lung cancer incidence in China: Who are faced with a greater effect? ENVIRONMENT INTERNATIONAL 2019; 132:105077. [PMID: 31415963 DOI: 10.1016/j.envint.2019.105077] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Whether socioeconomic indicators modify the relationship between air pollution exposure and health outcomes remains uncertain, especially in developing countries. OBJECTIVE This work aims to examine modification effects of socioeconomic indicators on the association between PM2.5 and annual incidence rate of lung cancer for males in China. METHODS We performed a nationwide analysis in 295 counties (districts) from 2006 to 2014. Using multivariable linear regression models controlling for weather conditions and socioeconomic indicators, we examined modification effects in the stratified and combined datasets according to the tertile and binary divisions of socioeconomic indicators. We also extensively investigated whether the roles of socioeconomic modifications were sensitive to the further adjustment of demographic factors, health and behaviour covariates, household solid fuel consumption, the different operationalization of socioeconomic indicators and PM2.5 exposure with single and moving average lags. RESULTS We found a stronger relationship between PM2.5 and incidence rate of male lung cancer in urban areas, in the lower economic or lower education counties (districts). If PM2.5 changes by 10 μg/m3, then the shift in incidence rate relative to its mean was significantly higher by 3.97% (95% CI: 2.18%, 4.96%, p = 0.000) in urban than in rural areas. With regard to economic status, if PM2.5 changes by 10 μg/m3, then the change in incidence rate relative to its mean was significantly lower by 0.99% (95% CI: -2.18%, 0.20%, p = 0.071) and 1.39% (95% CI: -2.78%, 0.00%, p = 0.037) in the middle and high economic groups than in the low economic group, respectively. The change in incidence rate relative to its mean was significantly lower by 1.98% (95% CI: -3.18%, -0.79%, p = 0.001) and 2.78% (95% CI: -4.17%, -1.39%, p = 0.000) in the middle and high education groups compared with the low education group, respectively, if PM2.5 changes by 10 μg/m3. We found no robust modification effects of employment rate and urbanisation growth rate. CONCLUSION Male residents in urban areas, in the lower economic or lower education counties are faced with a greater effect of PM2.5 on the incidence rate of lung cancer in China. The findings emphasize the need for public health intervention and urban planning initiatives targeting the urban-rural, educational or economic disparities in health associated with air pollution exposure. Future prediction on air pollution-induced health effects should consider such socioeconomic disparities, especially for the dominant urban-rural disparity in China.
Collapse
Affiliation(s)
- Huagui Guo
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, SAR, PR China; Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen 518057, PR China.
| | - Zheng Chang
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong, SAR, PR China.
| | - Jiansheng Wu
- Key Laboratory for Urban Habitat Environmental Science and Technology, Shenzhen Graduate School, Peking University, Shenzhen 518055, PR China; Key Laboratory for Earth Surface Processes, Ministry of Education, College of Urban and Environmental Sciences, Peking University, Beijing 100871, PR China.
| | - Weifeng Li
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, SAR, PR China; Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen 518057, PR China.
| |
Collapse
|
10
|
Kinge JM, Modalsli JH, Øverland S, Gjessing HK, Tollånes MC, Knudsen AK, Skirbekk V, Strand BH, Håberg SE, Vollset SE. Association of Household Income With Life Expectancy and Cause-Specific Mortality in Norway, 2005-2015. JAMA 2019; 321:1916-1925. [PMID: 31083722 PMCID: PMC6515574 DOI: 10.1001/jama.2019.4329] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IMPORTANCE Examining causes of death and making comparisons across countries may increase understanding of the income-related differences in life expectancy. OBJECTIVES To describe income-related differences in life expectancy and causes of death in Norway and to compare those differences with US estimates. DESIGN AND SETTING A registry-based study including all Norwegian residents aged at least 40 years from 2005 to 2015. EXPOSURES Household income adjusted for household size. MAIN OUTCOMES AND MEASURES Life expectancy at 40 years of age and cause-specific mortality. RESULTS In total, 3 041 828 persons contributed 25 805 277 person-years and 441 768 deaths during the study period (mean [SD] age, 59.3 years [13.6]; mean [SD] number of household members per person, 2.5 [1.3]). Life expectancy was highest for women with income in the top 1% (86.4 years [95% CI, 85.7-87.1]) which was 8.4 years (95% CI, 7.2-9.6) longer than women with income in the lowest 1%. Men with the lowest 1% income had the lowest life expectancy (70.6 years [95% CI, 69.6-71.6]), which was 13.8 years (95% CI, 12.3-15.2) less than men with the top 1% income. From 2005 to 2015, the differences in life expectancy by income increased, largely attributable to deaths from cardiovascular disease, cancers, chronic obstructive pulmonary disease, and dementia in older age groups and substance use deaths and suicides in younger age groups. Over the same period, life expectancy for women in the highest income quartile increased 3.2 years (95% CI, 2.7-3.7), while life expectancy for women in the lowest income quartile decreased 0.4 years (95% CI, -1.0 to 0.2). For men, life expectancy increased 3.1 years (95% CI, 2.5-3.7) in the highest income quartile and 0.9 years (95% CI, 0.2-1.6) in the lowest income quartile. Differences in life expectancy by income levels in Norway were similar to differences observed in the United States, except that life expectancy was higher in Norway in the lower to middle part of the income distribution in both men and women. CONCLUSIONS AND RELEVANCE In Norway, there were substantial and increasing gaps in life expectancy by income level from 2005 to 2015. The largest differences in life expectancy between Norway and United States were for individuals in the lower to middle part of the income distribution.
Collapse
Affiliation(s)
- Jonas Minet Kinge
- Norwegian Institute of Public Health, Oslo, Norway
- University of Oslo, Oslo, Norway
| | | | - Simon Øverland
- Norwegian Institute of Public Health, Oslo, Norway
- University of Bergen, Bergen, Norway
| | | | | | - Ann Kristin Knudsen
- Norwegian Institute of Public Health, Oslo, Norway
- University of Bergen, Bergen, Norway
| | - Vegard Skirbekk
- Norwegian Institute of Public Health, Oslo, Norway
- Mailman School of Public Health, Columbia University, New York, New York
| | - Bjørn Heine Strand
- Norwegian Institute of Public Health, Oslo, Norway
- University of Oslo, Oslo, Norway
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Oslo University Hospital, Oslo, Norway
| | | | - Stein Emil Vollset
- University of Bergen, Bergen, Norway
- Department of Health Metrics Sciences and Institute for Health Metrics and Evaluation, University of Washington, Seattle
| |
Collapse
|