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Buteau S, Yankoty LI, Letellier N, Benmarhnia T, Gamache P, Plante C, Goudreau S, Blais C, Perron S, Fournier M, Ragettli MS, Smargiassi A. Associations between environmental noise and myocardial infarction and stroke: Investigating the potential mediating effects of hypertension. ENVIRONMENTAL RESEARCH 2023; 231:116092. [PMID: 37172682 DOI: 10.1016/j.envres.2023.116092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 04/22/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND We investigated whether hypertension may be a mediator in the pathway linking environmental noise exposure to incident MI and stroke. METHODS Separately for MI and stroke, we built two population-based cohorts from linked health administrative data. Participants were residents of Montreal (Canada) between 2000 and 2014, aged 45 years and older who were free of hypertension and MI or stroke at time of entry. MI, stroke and hypertension were ascertained from validated case definitions. Residential long-term environmental noise exposure, expressed as the annual mean level acoustic equivalent 24 h (LAeq24h), was estimated from a land use regression model. We performed mediation analysis based on the potential outcomes framework. We used a Cox proportional hazards model for the exposure-outcome model and a logistic regression for the exposure-mediator model. In sensitivity analysis we applied a marginal structural approach to estimate the natural direct and indirect effects. RESULTS Each cohort included approximately 900 000 individuals, with 26 647 incident cases of MI and 16 656 incident cases of stroke. 36% of incident MI and 40% of incident stokes had previously developed hypertension. The estimated total effect per interquartile range increase (from 55.0 to 60.5 dB A) in the annual mean LAeq24h was 1.073 (95% confidence interval (CI): 1.070-1.077) for both MI for stroke. We found no evidence of exposure-mediator interaction for both outcomes. The relationships between environmental noise and MI and stroke was not mediated by hypertension. CONCLUSIONS This population-based cohort study suggests that the main route by which environmental noise exposure may cause MI or stroke is not through hypertension.
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Affiliation(s)
- Stéphane Buteau
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montreal, Canada; Quebec National Institute of Public Health, Montreal, Canada
| | - Larisa I Yankoty
- School of Public Health, Centre of Public Health Research, University of Montreal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Noémie Letellier
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | | | - Céline Plante
- Montreal Regional Department of Public Health, Montreal, Canada
| | - Sophie Goudreau
- Montreal Regional Department of Public Health, Montreal, Canada
| | - Claudia Blais
- Quebec National Institute of Public Health, Montreal, Canada; Faculty of Pharmacy, Laval University, Quebec, Canada
| | - Stéphane Perron
- Quebec National Institute of Public Health, Montreal, Canada
| | - Michel Fournier
- Montreal Regional Department of Public Health, Montreal, Canada
| | - Martina S Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Basel, Switzerland
| | - Audrey Smargiassi
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montreal, Canada; Quebec National Institute of Public Health, Montreal, Canada; School of Public Health, Centre of Public Health Research, University of Montreal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.
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Allum J, Meredith R, Uus K, Kirkham JJ, Dawes P. Association between hearing loss and deprivation among Welsh adults: a cross-sectional observational study. BMJ Open 2023; 13:e066419. [PMID: 37147086 PMCID: PMC10163448 DOI: 10.1136/bmjopen-2022-066419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVE To index levels of hearing loss with respect to area-level indices of deprivation in a Welsh population. DESIGN A cross-sectional observational study of all adults (aged >18) that attended Abertawe Bro Morgannwg University (ABMU) Health Board audiology services between 2016 and 2018. Service access, first hearing aid fitting appointment rates and hearing loss at time of first hearing aid provision were used to index population hearing loss versus area-level indices of deprivation based on patient postcode. SETTING Primary and secondary care. PARTICIPANTS 59 493 patient entries met the inclusion criteria. Patient entries were grouped by age (18-30, 31-40, 41-50, 51-60, 61-70, 71-80, >80 years) and deprivation decile. RESULTS The interaction between age group and deprivation decile predicted access rate to ABMU audiology services (b=-0.24, t(6858) = -2.86, p<0.01) with audiology services accessed more frequently by the most deprived versus the least deprived decile in every age group (p<0.05), except the >80 years. First hearing aid fitting rates were highest among the most deprived in the four youngest age groups (p<0.05). Severity of hearing loss at the time of first hearing aid fitting was worse among the most deprived in the five oldest age groups (p<0.01). CONCLUSIONS Hearing health inequalities are prevalent among adults accessing ABMU audiology services. Our findings suggest that deprivation increases the likelihood of developing hearing loss, brings earlier onset of hearing loss and is linked to delays in getting help for hearing problems. However, it is not possible to know the true scale of these disparities without knowing the hearing health of the Welsh adult population including those who do not seek help for hearing problems.
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Affiliation(s)
- Jack Allum
- Audiology Department, Swansea Bay University Health Board, Swansea, UK
| | - Rhys Meredith
- Audiology Department, Swansea Bay University Health Board, Swansea, UK
| | - Kai Uus
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jamie J Kirkham
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK
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Antoñón M, Pernía-Sánchez JV, Cancho-Soto T, Segovia-Molina I, Díez-Monge N, Cano A. Asthma control in children, socioeconomic inequality and health care. An Pediatr (Barc) 2023; 98:353-361. [PMID: 37055301 DOI: 10.1016/j.anpede.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/29/2022] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Socioeconomic inequality (SEI) can adversely affect asthma control. The aim of this study was to establish the association of SEI with asthma control in children and caregiver quality of life. METHODS We assessed socioeconomic status based on the area of residence, according to the at risk of poverty rate (ARPR). After stratifying the paediatric population of Castilla y León (Spain) in ARPR tertiles, we selected participants by stratified random sampling, and identified children with asthma aged 6-14 years from the health records of primary care centres. We collected data through questionnaires completed by parents. The primary outcomes were asthma control and caregiver quality of life. We assessed their association with SEI, health care quality measures and individual factors (such as parental educational attainment) by means of multivariate regression models. RESULT The ARPR tertile was not associated with asthma control, quality of life or health care quality. A medium or high maternal educational attainment was associated with a lower risk of making an unscheduled or urgent visit (OR = .50; 95% CI, .27-.95; P = .034) and paternal educational attainment was associated with a lower risk of uncontrolled asthma (OR = 0.51; 95% CI, .28-.94; P = .030). CONCLUSION In the sample under study, SEI assessed at the local level was not associated with asthma control in children. Other factors, such as parental educational attainment, may have a protective effect.
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Affiliation(s)
- Miguel Antoñón
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - Teresa Cancho-Soto
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Inés Segovia-Molina
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Nuria Díez-Monge
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain; Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Alfredo Cano
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain; Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain.
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Control del asma en niños, desigualdad socioeconómica y asistencia sanitaria. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Barry Y, Le Strat Y, Azria E, Gorza M, Pilkington H, Vandentorren S, Gallay A, Regnault N. Ability of municipality-level deprivation indices to capture social inequalities in perinatal health in France: A nationwide study using preterm birth and small for gestational age to illustrate their relevance. BMC Public Health 2022; 22:919. [PMID: 35534845 PMCID: PMC9082984 DOI: 10.1186/s12889-022-13246-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based policy-making to reduce perinatal health inequalities requires an accurate measure of social disparities. We aimed to evaluate the relevance of two municipality-level deprivation indices (DIs), the French-Deprivation-Index (FDep) and the French-European-Deprivation-Index (FEDI) in perinatal health through two key perinatal outcomes: preterm birth (PTB) and small-for-gestational-age (SGA). METHODS We used two data sources: The French National Perinatal Surveys (NPS) and the French national health data system (SNDS). Using the former, we compared the gradients of the associations between individual socioeconomic characteristics (educational level and income) and "PTB and SGA" and associations between municipality-level DIs (Q1:least deprived; Q5:most deprived) and "PTB and SGA". Using the SNDS, we then studied the association between each component of the two DIs (census data, 2015) and "PTB and SGA". Adjusted odds ratios (aOR) were estimated using multilevel logistic regression with random intercept at the municipality level. RESULTS In the NPS (N = 26,238), PTB and SGA were associated with two individual socioeconomic characteristics: maternal educational level (≤ lower secondary school vs. ≥ Bachelor's degree or equivalent, PTB: aOR = 1.43 [1.22-1.68], SGA: (1.31 [1.61-1.49]) and household income (< 1000 € vs. ≥ 3000 €, PTB: 1.55 [1.25-1.92], SGA: 1.69 [1.45-1.98]). For both FDep and FEDI, PTB and SGA were more frequent in deprived municipalities (Q5: 7.8% vs. Q1: 6.3% and 9.0% vs. 5.9% for PTB, respectively, and 12.0% vs. 10.3% and 11.9% vs. 10.2% for SGA, respectively). However, after adjustment, neither FDep nor FEDI showed a significant gradient with PTB or SGA. In the SNDS (N = 726,497), no FDep component, and only three FEDI components were significantly associated (specifically, the % of the population with ≤ lower secondary level of education with both outcomes (PTB: 1.5 [1.15-1.96]); SGA: 1.25 [1.03-1.51]), the % of overcrowded (i.e., > 1 person per room) houses (1.63 [1.15-2.32]) with PTB only, and unskilled farm workers with SGA only (1.52 [1.29-1.79]). CONCLUSION Some components of FDep and FEDI were less relevant than others for capturing ecological inequalities in PTB and SGA. Results varied for each DI and perinatal outcome studied. These findings highlight the importance of testing DI relevance prior to examining perinatal health inequalities, and suggest the need to develop DIs that are suitable for pregnant women. .
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Affiliation(s)
- Yaya Barry
- Non-Communicable Diseases and Trauma Division, Santé Publique France, the French National Public Health Agency, 12, rue du Val d'Osne, 94415, Saint-Maurice, France.
| | - Yann Le Strat
- Data Science Division, Santé Publique France, the French National Public Health Agency, Saint-Maurice, France
| | - Elie Azria
- Perinatal and Paediatric Epidemiology (EPOPé) Research Team, CRESS U1153, INSERM, Université de Paris, Paris, Obstetrical, France
- Maternity Unit, Paris Saint Joseph Hospital, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Maud Gorza
- Health Promotion and Prevention Division, Santé Publique France, the French National Public Health Agency, Saint-Maurice, France
| | - Hugo Pilkington
- Département de Géographie, Université Paris 8 Vincennes-Saint-Denis, UMR7533 Ladyss, Saint-Denis, France
| | - Sthéphanie Vandentorren
- Scientific and International Division, Santé Publique France, the French National Public Health Agency, Saint-Maurice, France
| | - Anne Gallay
- Non-Communicable Diseases and Trauma Division, Santé Publique France, the French National Public Health Agency, 12, rue du Val d'Osne, 94415, Saint-Maurice, France
| | - Nolwenn Regnault
- Non-Communicable Diseases and Trauma Division, Santé Publique France, the French National Public Health Agency, 12, rue du Val d'Osne, 94415, Saint-Maurice, France
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Atrey A, Pincus D, Khoshbin A, Haddad FS, Ward S, Aktar S, Ladha K, Ravi B. Access to hip arthroplasty and rates of complications in different socioeconomic groups : a review of 111,000 patients in a universal healthcare system. Bone Joint J 2022; 104-B:589-597. [PMID: 35491583 DOI: 10.1302/0301-620x.104b5.bjj-2021-1520.r2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Total hip arthroplasty (THA) is one of the most successful surgical procedures. The objectives of this study were to define whether there is a correlation between socioeconomic status (SES) and surgical complications after elective primary unilateral THA, and investigate whether access to elective THA differs within SES groups. METHODS We conducted a retrospective, population-based cohort study involving 202 hospitals in Ontario, Canada, over a 17-year period. Patients were divided into income quintiles based on postal codes as a proxy for personal economic status. Multivariable logistic regression models were then used to primarily assess the relationship between SES and surgical complications within one year of index THA. RESULTS Of 111,359 patients who underwent elective primary THA, those in the lower SES groups had statistically significantly more comorbidities and statistically significantly more postoperative complications. While there was no increase in readmission rates within 90 days, there was a statistically significant difference in the primary and secondary outcomes including all revisions due (with a subset of deep wound infection and dislocation). Results showed that those in the higher SES groups had proportionally more cases performed than those in lower groups. Compared to the highest SES quintile, the lower groups had 61% of the number of hip arthroplasties performed. CONCLUSION Patients in lower socioeconomic groups have more comorbidities, fewer absolute number of cases performed, have their procedures performed in lower-volume centres, and ultimately have higher rates of complications. This lack of access and higher rates of complications is a "double hit" to those in lower SES groups, and indicates that we should be concentrating efforts to improve access to surgeons and hospitals where arthroplasty is routinely performed in high numbers. Even in a universal healthcare system where there are no penalties for complications such as readmission, there seems to be an inequality in the access to THA. Cite this article: Bone Joint J 2022;104-B(5):589-597.
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Affiliation(s)
- Amit Atrey
- Orthopaedics, Saint Michael's Hospital, Toronto, Canada.,Division of Orthopaedics, University of Toronto, Toronto, Canada
| | - Daniel Pincus
- Division of Orthopaedics, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Amir Khoshbin
- Division of Orthopaedics, University of Toronto, Toronto, Canada
| | - Fares S Haddad
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Sarah Ward
- Division of Orthopaedics, University of Toronto, Toronto, Canada
| | - Suriya Aktar
- Orthopaedics, Saint Michael's Hospital, Toronto, Canada
| | - Karim Ladha
- Orthopaedics, Saint Michael's Hospital, Toronto, Canada.,Division of Orthopaedics, University of Toronto, Toronto, Canada
| | - Bheeshma Ravi
- Division of Orthopaedics, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
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Yuchi W, Brauer M, Czekajlo A, Davies HW, Davis Z, Guhn M, Jarvis I, Jerrett M, Nesbitt L, Oberlander TF, Sbihi H, Su J, van den Bosch M. Neighborhood environmental exposures and incidence of attention deficit/hyperactivity disorder: A population-based cohort study. ENVIRONMENT INTERNATIONAL 2022; 161:107120. [PMID: 35144157 DOI: 10.1016/j.envint.2022.107120] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Emerging studies have associated low greenspace and high air pollution exposure with risk of child attention deficit/hyperactivity disorder (ADHD). Population-based studies are limited, however, and joint effects are rarely evaluated. We investigated associations of ADHD incidence with greenspace, air pollution, and noise in a population-based birth cohort. METHODS We assembled a cohort from administrative data of births from 2000 to 2001 (N ∼ 37,000) in Metro Vancouver, Canada. ADHD was identified by hospital records, physician visits, and prescriptions. Cox proportional hazards models were applied to assess associations between environmental exposures and ADHD incidence adjusting for available covariates. Greenspace was estimated using vegetation percentage derived from linear spectral unmixing of Landsat imagery. Fine particulate matter (PM2.5) and nitrogen dioxide (NO2) were estimated using land use regression models; noise was estimated using a deterministic model. Exposure period was from birth until the age of three. Joint effects of greenspace and PM2.5 were analysed in two-exposure models and by categorizing values into quintiles. RESULTS During seven-year follow-up, 1217 ADHD cases were diagnosed. Greenspace was associated with lower incidence of ADHD (hazard ratio, HR: 0.90 [0.81-0.99] per interquartile range increment), while PM2.5 was associated with increased incidence (HR: 1.11 [1.06-1.17] per interquartile range increment). NO2 (HR: 1.01 [0.96, 1.07]) and noise (HR: 1.00 [0.95, 1.05]) were not associated with ADHD. There was a 50% decrease in the HR for ADHD in locations with the lowest PM2.5 and highest greenspace exposure, compared to a 62% increase in HR in locations with the highest PM2.5 and lowest greenspace exposure. Effects of PM2.5 were attenuated by greenspace in two-exposure models. CONCLUSIONS We found evidence suggesting environmental inequalities where children living in greener neighborhoods with low air pollution had substantially lower risk of ADHD compared to those with higher air pollution and lower greenspace exposure.
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Affiliation(s)
- Weiran Yuchi
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada
| | - Michael Brauer
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada
| | - Agatha Czekajlo
- Department of Forest Resource Management, Faculty of Forestry, The University of British Columbia, 2424 Main Mall, Vancouver, Canada
| | - Hugh W Davies
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada
| | - Zoë Davis
- Department of Forest and Conservation Sciences, Faculty of Forestry, The University of British Columbia, 2424 Main Mall, Vancouver, Canada
| | - Martin Guhn
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada
| | - Ingrid Jarvis
- Department of Forest and Conservation Sciences, Faculty of Forestry, The University of British Columbia, 2424 Main Mall, Vancouver, Canada
| | - Michael Jerrett
- Fielding School of Public Health, University of California at Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA, the United States
| | - Lorien Nesbitt
- Department of Forest Resource Management, Faculty of Forestry, The University of British Columbia, 2424 Main Mall, Vancouver, Canada
| | - Tim F Oberlander
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada; Department of Pediatrics, The University of British Columbia, 4480 Oak St. Vancouver, Canada
| | - Hind Sbihi
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada; BC Centre for Disease Control, Vancouver, Canada
| | - Jason Su
- School of Public Health, University of California at Berkeley, 2121 Berkeley Way West, Berkeley, CA, the United States
| | - Matilda van den Bosch
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada; Department of Forest and Conservation Sciences, Faculty of Forestry, The University of British Columbia, 2424 Main Mall, Vancouver, Canada; ISGlobal, Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, 08002 Barcelona, Spain; Centro de Investigación Biomédica en Red Instituto de Salud Carlos III, Calle de Melchor Fernández Almagro, 3, 28029, Madrid, Spain.
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Díaz-Geada A, Obradors-Rial N, Baena A, Teixidó-Compañó E, Colillas-Malet E, Mallah N, Moure-Rodríguez L, Caamaño-Isorna F, Barón-Garcia T. Contextual Determinants in Alcohol, Tobacco and Cannabis Consumption, Mood and Bullying during Adolescence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8480. [PMID: 34444240 PMCID: PMC8393869 DOI: 10.3390/ijerph18168480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 12/02/2022]
Abstract
The present study aimed to explore the differences in the consumption of alcohol, tobacco and cannabis, mood and bullying between adolescents. A cross-sectional study was carried out in five regions of Northern Spain (one in Galiza and four in central Catalonia) that share similar socioeconomic characteristics and encompass around 10,000 inhabitants each. Students living in Burela, Galiza (N = 71) were compared to those of Central Catalonia (N = 193). The independent variable was the municipality of residence. The dependent variables encompassed: weekly available pocket money, Family Affluence Scale, self-classified academic qualification, place of origin, alcohol consumption, tobacco and cannabis smoking, negative mood and bullying. The mean age and their 95% confidence intervals (95% CI) of participants were similar between the regions (Burela: 15.90 years (15.68-16.13) and Central Catalonia: 15.36 years (15.28-15.44)). More than half of the participants were females (Burela, Galiza (53.5%) and Catalonia (54.9%)). Prevalence ratios (PR) and their 95% CI were estimated using Poisson regression models. In comparison with adolescents from Burela (Galiza), those living in Central Catalonia had higher prevalence of diverse academic levels (adjusted PR = 3.92 (1.78-8.66)), tobacco consumption (adjusted PR = 2.41 (1.47-3.97)) and negative mood (adjusted PR = 5.97 (3.05-11.70)). Even when dealing with regions with similar socioeconomic characteristics and number of inhabitants, differences exist in terms of the socioeconomic level, tobacco consumption, mood and bullying, as reported by adolescents.
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Affiliation(s)
- Ainara Díaz-Geada
- Department of Public Health, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (A.D.-G.); (N.M.); (L.M.-R.)
| | - Núria Obradors-Rial
- Faculty of Health Sciences of Manresa, University of Vic—Central University of Catalonia (UVic-UCC), 08242 Manresa, Spain; (N.O.-R.); (E.T.-C.); (E.C.-M.); (T.B.-G.)
| | - Antoni Baena
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), 08018 Barcelona, Spain;
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia—ICO, Av. Granvia de L’Hospitalet 199-203, 08908 Barcelona, Spain
| | - Ester Teixidó-Compañó
- Faculty of Health Sciences of Manresa, University of Vic—Central University of Catalonia (UVic-UCC), 08242 Manresa, Spain; (N.O.-R.); (E.T.-C.); (E.C.-M.); (T.B.-G.)
| | - Ester Colillas-Malet
- Faculty of Health Sciences of Manresa, University of Vic—Central University of Catalonia (UVic-UCC), 08242 Manresa, Spain; (N.O.-R.); (E.T.-C.); (E.C.-M.); (T.B.-G.)
| | - Narmeen Mallah
- Department of Public Health, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (A.D.-G.); (N.M.); (L.M.-R.)
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Lucía Moure-Rodríguez
- Department of Public Health, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (A.D.-G.); (N.M.); (L.M.-R.)
| | - Francisco Caamaño-Isorna
- Department of Public Health, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (A.D.-G.); (N.M.); (L.M.-R.)
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Tivy Barón-Garcia
- Faculty of Health Sciences of Manresa, University of Vic—Central University of Catalonia (UVic-UCC), 08242 Manresa, Spain; (N.O.-R.); (E.T.-C.); (E.C.-M.); (T.B.-G.)
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Gan WQ, Kinner SA, Nicholls TL, Xavier CG, Urbanoski K, Greiner L, Buxton JA, Martin RE, McLeod KE, Samji H, Nolan S, Meilleur L, Desai R, Sabeti S, Slaunwhite AK. Risk of overdose-related death for people with a history of incarceration. Addiction 2021; 116:1460-1471. [PMID: 33047844 DOI: 10.1111/add.15293] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/21/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Reported associations between previous incarceration and the risk of overdose-related death are substantially heterogeneous, and previous studies are limited by an inability to control for confounding factors in risk assessment. This study investigated the associations of overdose-related death with previous incarceration and the number or cumulative duration of previous incarcerations, and individual or neighborhood characteristics that may potentially modify the associations. DESIGN AND SETTING A cohort study using a 20% random sample of residents in British Columbia, Canada. PARTICIPANTS A total of 765 690 people aged 23 years or older at baseline as of 1 January 2015. Mean age was 50 years; 49% were males. MEASUREMENTS Previous incarcerations that occurred during the 5-year exposure period (January 2010 to December 2014) were identified using provincial incarceration records. Overdose-related deaths that occurred during the 3-year follow-up period (January 2015 to December 2017) were identified using linked administrative health data. Baseline individual and neighborhood characteristics were retrieved from the provincial health insurance data. FINDINGS In the cohort, 5743 people had an incarceration history during the exposure period, and 634 people died from drug overdose during the follow-up period. The mortality rate was 897 and 22 per 100 000 person-years for people who did and did not have an incarceration history, respectively. After adjusting for baseline individual and neighborhood characteristics (without any interaction term), people who had an incarceration history were 4.04 times (95% confidence interval 3.23-5.06) more likely to die from drug overdose compared with people without an incarceration history. The association was stronger for females, people without diagnoses of substance use disorder and people without dispensation of opioids for pain or benzodiazepines (P < 0.001 for each interaction term). There was no discernible linear trend between the number or cumulative duration of previous incarcerations and the risk of overdose-related death. CONCLUSIONS Previous incarceration appears to be a major risk factor for overdose-related death.
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Affiliation(s)
- Wen Qi Gan
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Stuart A Kinner
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Tonia L Nicholls
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services, Coquitlam, BC, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Chloé G Xavier
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Leigh Greiner
- British Columbia Corrections, Ministry of Public Safety and Solicitor General, Victoria, BC, Canada
| | - Jane A Buxton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Ruth E Martin
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Katherine E McLeod
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Roshni Desai
- First Nations Health Authority, Vancouver, BC, Canada
| | - Soha Sabeti
- First Nations Health Authority, Vancouver, BC, Canada
| | - Amanda K Slaunwhite
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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10
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Yankoty LI, Gamache P, Plante C, Goudreau S, Blais C, Perron S, Fournier M, Ragettli MS, Fallah-Shorshani M, Hatzopoulou M, Liu Y, Smargiassi A. Manuscript title: Long─term residential exposure to environmental/transportation noise and the incidence of myocardial infarction. Int J Hyg Environ Health 2020; 232:113666. [PMID: 33296779 DOI: 10.1016/j.ijheh.2020.113666] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cardiovascular effects of environmental noise are a growing concern. However, the evidence remains largely limited to the association between road traffic noise and hypertension and coronary heart diseases. OBJECTIVES To investigate the association between long-term residential exposure to environmental/transportation noise and the incidence of myocardial infarction (MI) in the adult population living in Montreal. METHODS An open cohort of adults aged 45 years old and over, living on the island of Montreal and free of MI before entering the cohort was created for the years 2000-2014 with the Quebec Integrated Chronic Disease Surveillance System; a systematic surveillance system from the Canadian province of Quebec starting in 1996. Residential noise exposure was calculated in three ways: 1) total ambient noise levels estimated by Land use regression (LUR) models; 2) road traffic noise estimated by a noise propagation model CadnaA and 3) distances to transportation sources (roads, airport, railways). Incident MI was based on diagnostic codes in hospital admission records. Cox models with time-varying exposures (age as the time axis) were used to estimate the associations with various adjustments (material deprivation indicator, calendar year, nitrogen dioxide, stratification for sex). Indirect adjustment based on ancillary data for smoking was performed. RESULTS 1,065,414 individuals were followed (total of 9,000,443 person-years) and 40,718 (3.8%) developed MI. We found positive associations between total environmental noise, estimated by LUR models and the incidence of MI. Total noise LUR levels ranged from ~44 to ~79 dBA and varied slightly with the metric used. The adjusted hazard ratios (HRs) (also adjusted for smoking) were 1.12 (95% Confidence Intervals [CI]: 1.08-1.15), 1.11 (95%CI: 1.07-1.14) and 1.10 (95%CI: 1.06-1.14) per 10 dBA noise levels increase respectively in Level Accoustic equivalent 24 h (LAeq24 h), Level day-evening-night (Lden) and night level (Lnight). We found a borderline negative association between road noise levels estimated with CadnaA and MI (HR: 0.99 per 10 dBA; 95%CI: 0.98-1.00). Distances to major roads and highways were not associated with MI while the proximity to railways was positively associated with MI (HR for ≤100 vs > 1000 m: 1.07; 95%CI: 1.01-1.14). A negative association was found with the proximity to the airport noise exposure forecast (NEF25); HR (<1 vs >1000 m) = 0.88 (95%CI: 0.81-0.96). CONCLUSIONS These associations suggest that exposure to total environmental noise at current urban levels may be related to the incidence of MI. Additional studies with more accurate road noise estimates are needed to explain the counterintuitive associations with road noise and specific transportation sources.
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Affiliation(s)
- Larisa I Yankoty
- School of Public Health, Centre of Public Health Research, University of Montreal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | | | - Céline Plante
- Montreal Regional Department of Public Health, Canada
| | | | - Claudia Blais
- Quebec National Institute of Public Health National, Canada; Faculty of Pharmacy, Laval University, Canada
| | - Stéphane Perron
- School of Public Health, Centre of Public Health Research, University of Montreal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada; Quebec National Institute of Public Health National, Canada
| | | | - Martina S Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | | | | | - Ying Liu
- School of Public Health, Centre of Public Health Research, University of Montreal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Audrey Smargiassi
- School of Public Health, Centre of Public Health Research, University of Montreal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada; Quebec National Institute of Public Health National, Canada.
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11
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Mesterton J, Willers C, Dahlström T, Rolfson O. Comparison of individual and neighbourhood socioeconomic status in case mix adjustment of hospital performance in primary total hip replacement in Sweden: a register-based study. BMC Health Serv Res 2020; 20:645. [PMID: 32650767 PMCID: PMC7353710 DOI: 10.1186/s12913-020-05510-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/05/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Case mix adjustment is a pre-requisite for valid measurement of healthcare performance and socioeconomic status (SES) is important to account for. Lack of information on individual-level SES has led to investigations into using a proxy for SES based on patient area of residence. The objective of this study was to use neighbourhood SES for case mix adjustment of performance indicators in total hip replacement (THR) in Sweden, and to compare with use of individual SES. METHODS Data from patient administrative systems and the Swedish Hip Arthroplasty Register were extracted for all patients undergoing THR in four Swedish regions. For each subject, individual data and neighbourhood data on country of birth, educational level, and income were provided by Statistics Sweden. Three variables were selected for analysis of performance; EQ-5D, hip pain and length of stay (LoS). In addition to socioeconomic information, several important clinical characteristics were used as case mix factors. Regression analysis was used to study each variable's impact on the three outcome variables and model fit was evaluated using mean squared error. RESULTS A total of 27,121 patients operated between 2010 and 2016 were included in the study. Both educational level and income were higher when based on neighbourhood information than individual information, while proportion born in Sweden was similar. Higher SES was generally found to be associated with better outcomes and lower LoS, albeit with certain differences between the different measures of SES. The predictive ability of the models was increased when adding information on SES to the clinical characteristics. The increase in predictive ability was higher for individual SES compared to neighbourhood SES. When analysing performance for the two providers with most diverging case mix in terms of SES, the inclusion of SES altered the relative performance using individual as well as neighbourhood SES. CONCLUSIONS Incorporating SES improves case mix adjustment marginally compared to using only clinical information. In this patient group, geographically derived SES was found to improve case mix adjustment compared to only clinical information but not to the same extent as actual individual-level SES.
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Affiliation(s)
- Johan Mesterton
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden. .,Ivbar Institute AB, Stockholm, Sweden.
| | - Carl Willers
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Dahlström
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala university, Uppsala, Sweden
| | - Ola Rolfson
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,The Swedish Hip Arthroplasty Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
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12
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Buajitti E, Chiodo S, Rosella LC. Agreement between area- and individual-level income measures in a population-based cohort: Implications for population health research. SSM Popul Health 2020; 10:100553. [PMID: 32072008 PMCID: PMC7013127 DOI: 10.1016/j.ssmph.2020.100553] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/21/2022] Open
Abstract
Socioeconomic status is an important determinant of health, the measurement of which is of great significance to population health research. However, individual-level socioeconomic factors are absent from much health administrative data, resulting in widespread use of area-level measures in their place. This study aims to clarify the role of individual- and area-level socioeconomic status in Ontario, Canada, through comparison of income measures. Using data from four cycles (2005–2012) of the Canadian Community Health Survey, we assessed concordance between individual- and area-level income quintiles using percent agreement and Kappa statistics. Individual-level characteristics were compared at baseline. Cumulative adult premature mortality was calculated for 5-years following interview. Rates were calculated separately for area-level and individual-level income, and jointly for each combination of income groups. Multivariable negative binomial models were fit to estimate associations between area- and individual-level income quintile and premature mortality after adjustment for basic demographics (age, sex, interview cycle) and key risk factors (alcohol, smoking, physical activity, and body mass index). Agreement between individual- and area-level income measures was low. Kappa statistics for same and similar (i.e. ±1 quintile) measures were 0.11 and 0.48, indicating low and moderate agreement, respectively. Socioeconomic disparities in premature mortality were greater for individual-level income than area-level income. When rates were stratified by both area- and individual-level income quintiles simultaneously, individual-level income gradients persisted within each area-level income group. The association between income and premature mortality was significant for both measures, including after full adjustment. Area-level socioeconomic status is an inappropriate proxy for missing individual-level data. The low agreement between area- and individual-level income measures and differences in demographic profile indicate that the two socioeconomic status measures do not capture the same population groups. However, our findings demonstrate that both individual- and area-level income measures are associated with premature mortality, and describe unique socioeconomic inequities. Area- and individual-level income measures may not capture the same groups. Area-level socioeconomic status is not a valid proxy for individual-level data. Area- and individual-level income are independently meaningful for health outcomes. Measures can be used together to fully contextualize socioeconomic status.
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Affiliation(s)
- Emmalin Buajitti
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,ICES, Room G-106, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Sabrina Chiodo
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,ICES, Room G-106, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
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13
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Yuchi W, Sbihi H, Davies H, Tamburic L, Brauer M. Road proximity, air pollution, noise, green space and neurologic disease incidence: a population-based cohort study. Environ Health 2020; 19:8. [PMID: 31964412 PMCID: PMC6974975 DOI: 10.1186/s12940-020-0565-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/07/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Emerging evidence links road proximity and air pollution with cognitive impairment. Joint effects of noise and greenness have not been evaluated. We investigated associations between road proximity and exposures to air pollution, and joint effects of noise and greenness, on non-Alzheimer's dementia, Parkinson's and Alzheimer's disease and multiple sclerosis within a population-based cohort. METHODS We assembled administrative health database cohorts of 45-84 year old residents (N ~ 678,000) of Metro Vancouver, Canada. Cox proportional hazards models were built to assess associations between exposures and non-Alzheimer's dementia and Parkinson's disease. Given reduced case numbers, associations with Alzheimer's disease and multiple sclerosis were evaluated in nested case-control analyses by conditional logistic regression. RESULTS Road proximity was associated with all outcomes (e.g. non-Alzheimer's dementia hazard ratio: 1.14, [95% confidence interval: 1.07-1.20], for living < 50 m from a major road or < 150 m from a highway). Air pollutants were associated with incidence of Parkinson's disease and non-Alzheimer's dementia (e.g. Parkinson's disease hazard ratios of 1.09 [1.02-1.16], 1.03 [0.97-1.08], 1.12 [1.05-1.20] per interquartile increase in fine particulate matter, Black Carbon, and nitrogen dioxide) but not Alzheimer's disease or multiple sclerosis. Noise was not associated with any outcomes while associations with greenness suggested protective effects for Parkinson's disease and non-Alzheimer's dementia. CONCLUSIONS Road proximity was associated with incidence of non-Alzheimer's dementia, Parkinson's disease, Alzheimer's disease and multiple sclerosis. This association may be partially mediated by air pollution, whereas noise exposure did not affect associations. There was some evidence of protective effects of greenness.
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Affiliation(s)
- Weiran Yuchi
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Hind Sbihi
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Hugh Davies
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Lillian Tamburic
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Michael Brauer
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
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14
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ARGHITTU A, DETTORI M, MASIA M, AZARA A, DEMPSEY E, CASTIGLIA P. Social deprivation indexes and anti-influenza vaccination coverage in the elderly in Sardinia, Italy, with a focus on the Sassari municipality. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 59:E45-E50. [PMID: 31016267 PMCID: PMC6419305 DOI: 10.15167/2421-4248/jpmh2018.59.4s2.1077] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022]
Abstract
The aim of the present study was to evaluate the relationship between social deprivation indexes and anti-influenza vaccination coverage in the elderly population (over 65 years old) in Sardinia. This relationship was first observed in a regional context. An already-known deprivation index was used, and its trivial relationship with anti-influenza vaccination coverage was evaluated. Secondly, the same relationship was assessed in the homogeneous area of the Municipality of Sassari. This required the adoption of an ad hoc deprivation index, which allowed us to stratify the population into deprivation groups and to correlate vaccination coverage with socio-economic variables. The results showed that regional anti-influenza vaccination coverage increased linearly as deprivation decreased. This trend was confirmed in the Municipality of Sassari. Pearson’s analysis highlighted factors that significantly correlate with vaccination coverage. In Sardinia, the relationship between anti-influenza vaccination coverage and socio-economic status is consistent with the international panorama, and highlights the necessity to implement interventions to promote vaccination coverage among the elderly.
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Affiliation(s)
- A. ARGHITTU
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - M. DETTORI
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - M.D. MASIA
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - A. AZARA
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - E. DEMPSEY
- Department of Humanities and Social Sciences, University of Sassari, Italy
| | - P. CASTIGLIA
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
- Paolo Castiglia, Department of Medical, Surgical and Experimental Sciences, University of Sassari, via Padre Manzella 4, 07100 Sassari. Tel. +39 079 228032 - Fax +39 079 228054 - E-mail:
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15
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Toivakka M, Pihlapuro A, Tykkyläinen M, Mehtätalo L, Laatikainen T. The usefulness of small-area-based socioeconomic characteristics in assessing the treatment outcomes of type 2 diabetes patients: a register-based mixed-effect study. BMC Public Health 2018; 18:1258. [PMID: 30428885 PMCID: PMC6236994 DOI: 10.1186/s12889-018-6165-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/30/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Assessment of the differences in the outcomes of care by socioeconomic status (SES) is beneficial for both the efficient targeting of health care services and to decrease health inequalities. This study compares the effects of three patient-based SES predictors (earned income, educational attainment, employment status) with three small-area-based SES predictors (median income, educational attainment, proportion of the unemployed) on the treatment outcomes of type 2 diabetes patients. METHODS Mixed-effect modeling was applied to analyse how SES factors affect the treatment outcomes of type 2 diabetes patients. The treatment outcomes were assessed by the patients' latest available glycated hemoglobin A1C (HbA1c) value. We used electronic health records of type 2 diabetes patients from the regional electronic patient database, the patients' individual register-based SES information from Statistics Finland, and the SES information about the population of the postal code area of the patients from Statistics Finland. RESULTS The effects of attained education on the treatment outcomes, both at the patient-level and the small-area-level are quite similar. Age and male gender were associated with higher HbA1c values and lower education indicated higher HbA1c values. Unemployment was not associated with HbA1c values at either the patient-level or the area-level. Income gave divergent results: high values of HbA1c were associated with low patient incomes but the median income of the postal code area did not predict the treatment outcomes of patients. CONCLUSIONS Our comparative study of three SES factors shows that the effects of attained education on the treatment outcomes are rather similar, regardless of whether patient-based or small-area-based predictors are used. Small-area-based SES variables can be a good way to overcome the absence of individual SES information, but further research is needed to find the valid small-area factors by disease. This possibility of using more small-area-based data would be valuable in health service research and first-hand planning of health care services.
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Affiliation(s)
- Maija Toivakka
- Department of Geographical and Historical Studies, University of Eastern Finland, P.O. Box 111, FI-80101 Joensuu, Finland
| | - Aki Pihlapuro
- Joint municipal authority for North Karelia social and health services (Siun sote), Tikkamäentie 16, FI-80210 Joensuu, Finland
| | - Markku Tykkyläinen
- Department of Geographical and Historical Studies, University of Eastern Finland, P.O. Box 111, FI-80101 Joensuu, Finland
| | - Lauri Mehtätalo
- School of Computing, University of Eastern Finland, P.O. Box 111, FI-80101 Joensuu, Finland
| | - Tiina Laatikainen
- Joint municipal authority for North Karelia social and health services (Siun sote), Tikkamäentie 16, FI-80210 Joensuu, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
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16
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Adherence to follow-up in high-risk adenoma patients diagnosed by, and excluded from the Barcelona colorectal cancer screening programme. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 41:226-233. [PMID: 29295752 DOI: 10.1016/j.gastrohep.2017.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/12/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Colorectal cancer screening programmes have been shown to reduce incidence and mortality. High-risk adenomas (HRA) are the most frequently diagnosed lesions in these programmes, and these patients are referred to a specialist. However, few studies have evaluated the adherence of HRA patients to the recommended endoscopic follow-up. OBJECTIVES To analyse follow-up adherence and duration in patients diagnosed with HRA in a screening programme. METHODS Retrospective cohort study of patients diagnosed with HRA within one of the participating hospitals of the colorectal cancer screening programme of Barcelona, during the first round of the programme (2010-2011). The follow-up period was 75.5 months. Descriptive analyses, logistic regression and survival models were performed. RESULTS 602 patients were included in the study, 66.6% of which were men. The adherence rate was 83.7% (n=504). Follow-up colonoscopy was performed within the recommended time (36±6months) in 57.7%, with a mean follow-up of 34 months. The Cox regression only showed differences at the socioeconomic level, with a lower adherence rate in the most deprived quintile (HR 0.70; 95% CI, 0.53-0.93). CONCLUSIONS Compared to previous studies, the follow-up adherence rate is considered to be acceptable. However, follow-up was not performed within the recommended time frame in a high proportion of cases. There is a need to further explore the reasons leading to lower follow-up adherence in the most deprived socioeconomic group and to increase the equity of the programme beyond participation.
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Temam S, Varraso R, Pornet C, Sanchez M, Affret A, Jacquemin B, Clavel-Chapelon F, Rey G, Rican S, Le Moual N. Ability of ecological deprivation indices to measure social inequalities in a French cohort. BMC Public Health 2017; 17:956. [PMID: 29246202 PMCID: PMC5732455 DOI: 10.1186/s12889-017-4967-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 11/29/2017] [Indexed: 11/18/2022] Open
Abstract
Background Despite the increasing interest in place effect to explain health inequalities, there is currently no consensus on which kind of area-based socioeconomic measures researchers should use to assess neighborhood socioeconomic position (SEP). The study aimed to evaluate the reliability of different area-based deprivation indices (DIs) in capturing socioeconomic residential conditions of French elderly women cohort. Methods We assessed area-based SEP using 3 DIs: Townsend Index, French European Deprivation Index (FEDI) and French Deprivation index (FDep), among women from E3N (Etude épidémiologique auprès des femmes de la Mutuelle Générale de l’Education Nationale). DIs were derived from the 2009 French census at IRIS level (smallest geographical units in France). Educational level was used to evaluate individual-SEP. To evaluate external validity of the 3 DIs, associations between two well-established socially patterned outcomes among French elderly women (smoking and overweight) and SEP, were compared. Odd ratios were computed with generalized estimating equations to control for clustering effects from participants within the same IRIS. Results The analysis was performed among 63,888 women (aged 64, 47% ever smokers and 30% overweight). Substantial agreement was observed between the two French DIs (Kappa coefficient = 0.61) and between Townsend and FEDI (0.74) and fair agreement between Townsend and FDep (0.21). As expected among French elderly women, those with lower educational level were significantly less prone to be ever smoker (Low vs. High; OR [95% CI] = 0.43 [0.40–0.46]) and more prone to being overweight (1.89 [1.77–2.01]) than women higher educated. FDep showed expected associations at area-level for both smoking (most deprived vs. least deprived quintile; 0.77 [0.73–0.81]) and overweight (1.52 [1.44–1.62]). For FEDI opposite associations with smoking (1.13 [1.07–1.19]) and expected association with overweight (1.20 [1.13–1.28]) were observed. Townsend showed opposite associations to those expected for both smoking and overweight (1.51 [1.43–1.59]; 0.93 [0.88–0.99], respectively). Conclusion FDep seemed reliable to capture socioeconomic residential conditions of the E3N women, more educated in average than general French population. Results varied strongly according to the DI with unexpected results for some of them, which suggested the importance to test external validity before studying social disparities in health in specific populations. Electronic supplementary material The online version of this article (10.1186/s12889-017-4967-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sofia Temam
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France. .,Univ Paris Sud, Le Kremlin-Bicêtre, France. .,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France.
| | - Raphaëlle Varraso
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - Carole Pornet
- Agence Régionale de Santé (ARS) Basse-Normandie, Caen, France
| | - Margaux Sanchez
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France.,Univ Paris Sud, Le Kremlin-Bicêtre, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - Aurélie Affret
- Univ Paris Sud, Le Kremlin-Bicêtre, France.,Centre for Research in Epidemiology and Population Health (CESP), Mode de vie, gènes et santé: épidémiologie intégrée trans-générationnelle, INSERM, U1018, Villejuif, France
| | - Bénédicte Jacquemin
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France.,Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Françoise Clavel-Chapelon
- Univ Paris Sud, Le Kremlin-Bicêtre, France.,Centre for Research in Epidemiology and Population Health (CESP), Mode de vie, gènes et santé: épidémiologie intégrée trans-générationnelle, INSERM, U1018, Villejuif, France
| | | | - Stéphane Rican
- LADYSS, Laboratoire dynamiques sociales et recompositions des espaces, Université Paris Ouest Nanterre La Défense, Nanterre, France
| | - Nicole Le Moual
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
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18
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Li Y, Shi J, Yu S, Wang L, Liu J, Ren J, Gao S, Hui Z, Li J, Wu N, Yang B, Liu S, Qin M, Wang D, Liao X, Xing X, Du L, Yang L, Liu Y, Zhang Y, Zhang K, Qiao Y, He J, Dai M, Yao H. Effect of socioeconomic status on stage at diagnosis of lung cancer in a hospital-based multicenter retrospective clinical epidemiological study in China, 2005-2014. Cancer Med 2017; 6:2440-2452. [PMID: 28941012 PMCID: PMC5633542 DOI: 10.1002/cam4.1170] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/22/2017] [Accepted: 07/31/2017] [Indexed: 12/03/2022] Open
Abstract
There is inconsistent evidence of associations between socioeconomic status (SES) and lung cancer stage in non-Chinese populations up to now. We set out to determine how SES affects stage at diagnosis at both individual and area levels, from a hospital-based multicenter 10-year (2005-2014) retrospective clinical epidemiological study of 7184 primary lung cancer patients in mainland China. Individual-level SES data were measured based on two indicators from case report forms of the study: an individual's education and occupation. Seven census indicator variables were used as surrogates for the area-level SES with principal component analysis (PCA). Multivariate analysis was undertaken using binary logistic regressions and multinomial logit model to describe the association and explore the effect across tertiles on stage after adjusting for demographic variables. There was a significant stepwise gradient of effect across different stages in the highest tertile of area-level SES, comparing with the lowest tertile of area-level SES (ORs, 0.77, 0.67, and 0.29 for stage II, III, and IV). Patients with higher education were less likely to have stage IV lung cancer, comparing with the illiterate group (ORs, 0.52, 0.63, 0.71, 0.64 for primary school, middle school, high school, college degree or above subgroup, respectively). Findings suggest that the most socioeconomically deprived areas may be associated with a higher risk of advanced-stage lung cancer, and increasing educational level may be correlated with a lower risk to be diagnosed at advanced stage in both men and women.
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Affiliation(s)
- Yuanqiu Li
- Office of EpidemiologyChinese Center for Disease Control and PreventionBeijingChina
| | - Jufang Shi
- Program Office for Cancer Screening in Urban ChinaNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shicheng Yu
- Office of EpidemiologyChinese Center for Disease Control and PreventionBeijingChina
| | - Le Wang
- Program Office for Cancer Screening in Urban ChinaNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jianjun Liu
- Chinese Center for Disease Control and PreventionBeijingChina
| | - Jiansong Ren
- Program Office for Cancer Screening in Urban ChinaNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shugeng Gao
- Department of Thoracic SurgeryNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhouguang Hui
- Department of Radiation OncologyNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Junling Li
- Department of Medical OncologyNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ning Wu
- Department of Diagnostic RadiologyNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Boyan Yang
- Department of General MedicineNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shangmei Liu
- Department of PathologyNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Mingfang Qin
- Division for Chronic Non‐communicable Disease Prevention and ControlYunnan Center for Disease Control and PreventionKunmingChina
| | - Debin Wang
- School of Health Services ManagementAnhui Medical UniversityHefeiChina
| | - Xianzhen Liao
- Hunan Office for Cancer Control and ResearchHunan Cancer HospitalChangshaChina
| | - Xiaojing Xing
- Liaoning Office for Cancer Control and ResearchLiaoning Cancer Hospital & InstituteShenyangChina
| | - Lingbin Du
- Zhejiang Office for Cancer Control and ResearchZhejiang Cancer HospitalHangzhouChina
| | - Li Yang
- School of Public HealthGuangxi Medical UniversityNanningChina
| | - Yuqin Liu
- Cancer Epidemiology Research CenterGansu Provincial Cancer HospitalLanzhouChina
| | - Yongzhen Zhang
- Department of EpidemiologyShanxi Provincial Cancer HospitalTaiyuanChina
| | - Kai Zhang
- Program Office for Cancer Screening in Urban ChinaNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Cancer Department of Physical ExaminationNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Youlin Qiao
- Department of EpidemiologyNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jie He
- Program Office for Cancer Screening in Urban ChinaNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Thoracic SurgeryNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Min Dai
- Program Office for Cancer Screening in Urban ChinaNational Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hongyan Yao
- Office of EpidemiologyChinese Center for Disease Control and PreventionBeijingChina
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García-Olmos L, Rodríguez-Salvanés F, Batlle-Pérez M, Aguilar-Torres R, Porro-Fernández C, García-Cabello A, Carmona M, Ruiz-Alonso S, Garrido-Elustondo S, Alberquilla Á, Sánchez-Gómez LM, Sánchez de Madariaga R, Monge-Navarrete E, Benito-Ortiz L, Baños-Pérez N, Simón-Puerta A, López Rodríguez AB, Martínez-Álvarez MÁ, Velilla-Celma MÁ, Bernal-Gómez MI. Development and validation of a risk stratification model for prediction of disability and hospitalisation in patients with heart failure: a study protocol. BMJ Open 2017; 7:e014840. [PMID: 28600367 PMCID: PMC5623349 DOI: 10.1136/bmjopen-2016-014840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Chronic heart failure (CHF) reduces quality of life and causes hospitalisation and death. Identifying predictive factors of such events may help change the natural history of this condition. AIM To develop and validate a stratification system for classifying patients with CHF, according to their degree of disability and need for hospitalisation due to any unscheduled cause, over a period of 1 year. METHODS AND ANALYSIS Prospective, concurrent, cohort-type study in two towns in the Madrid autonomous region having a combined population of 1 32 851. The study will include patients aged over 18 years who meet the following diagnostic criteria: symptoms and typical signs of CHF (Framingham criteria) and left ventricular ejection fraction (EF)<50% or structural cardiac lesion and/or diastolic dysfunction in the presence of preserved EF (EF>50%).Outcome variables will be(a) Disability, as measured by the WHO Disability Assessment Schedule V.2.0 Questionnaire, and (b) unscheduled hospitalisations. The estimated sample size is 557 patients, 371 for predictive model development (development cohort) and 186 for validation purposes (validation cohort). Predictive models of disability or hospitalisation will be constructed using logistic regression techniques. The resulting model(s) will be validated by estimating the probability of outcomes of interest for each individual included in the validation cohort. ETHICS AND DISSEMINATION The study protocol has been approved by the Clinical Research Ethics Committee of La Princesa University Teaching Hospital (PI-705). All results will be published in a peer-reviewed journal and shared with the medical community at conferences and scientific meetings.
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Affiliation(s)
- Luis García-Olmos
- Multiprofessional Education Unit for Family and Community Care (South-east), Madrid, Spain
- Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid, Spain
| | | | | | - Río Aguilar-Torres
- Cardiology Department, La Princesa University Teaching Hospital, Madrid, Spain
| | | | | | - Montserrat Carmona
- Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid, Spain
- Telemedicine and e-Health Unit, Carlos III Institute of Health, Madrid, Spain
| | - Sergio Ruiz-Alonso
- Information Systems Department, Primary Care Management Division, Madrid, Spain
| | - Sofía Garrido-Elustondo
- Multiprofessional Education Unit for Family and Community Care (South-east), Madrid, Spain
- Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid, Spain
| | - Ángel Alberquilla
- Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid, Spain
- Multiprofessional Education Unit for Family and Community Care (Centre), Madrid, Spain
| | - Luis María Sánchez-Gómez
- Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid, Spain
- Carlos III Institute Agency for Health Technology Assessment (Agencia de Evaluación de Tecnologías Sanitarias-Instituto Carlos III/AETS-ISCIII), Madrid, Spain
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20
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Guillaume E, Pornet C, Dejardin O, Launay L, Lillini R, Vercelli M, Marí-Dell'Olmo M, Fernández Fontelo A, Borrell C, Ribeiro AI, de Pina MF, Mayer A, Delpierre C, Rachet B, Launoy G. Development of a cross-cultural deprivation index in five European countries. J Epidemiol Community Health 2016; 70:493-9. [PMID: 26659762 PMCID: PMC4853548 DOI: 10.1136/jech-2015-205729] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 10/25/2015] [Accepted: 11/13/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite a concerted policy effort in Europe, social inequalities in health are a persistent problem. Developing a standardised measure of socioeconomic level across Europe will improve the understanding of the underlying mechanisms and causes of inequalities. This will facilitate developing, implementing and assessing new and more effective policies, and will improve the comparability and reproducibility of health inequality studies among countries. This paper presents the extension of the European Deprivation Index (EDI), a standardised measure first developed in France, to four other European countries-Italy, Portugal, Spain and England, using available 2001 and 1999 national census data. METHODS AND RESULTS The method previously tested and validated to construct the French EDI was used: first, an individual indicator for relative deprivation was constructed, defined by the minimal number of unmet fundamental needs associated with both objective (income) poverty and subjective poverty. Second, variables available at both individual (European survey) and aggregate (census) levels were identified. Third, an ecological deprivation index was constructed by selecting the set of weighted variables from the second step that best correlated with the individual deprivation indicator. CONCLUSIONS For each country, the EDI is a weighted combination of aggregated variables from the national census that are most highly correlated with a country-specific individual deprivation indicator. This tool will improve both the historical and international comparability of studies, our understanding of the mechanisms underlying social inequalities in health and implementation of intervention to tackle social inequalities in health.
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Affiliation(s)
- Elodie Guillaume
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
| | - Carole Pornet
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
- Pôle Recherche, University Hospital of Caen, Caen, France
| | - Olivier Dejardin
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
- Pôle Recherche, University Hospital of Caen, Caen, France
| | - Ludivine Launay
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
- Centre François Baclesse, Avenue du Général Harris—BP5026, Caen, France
| | - Roberto Lillini
- Department of Sociology, PhD School in Applied Sociology and Methodology of Research, University of Milan-Bicocca, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Marina Vercelli
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Marc Marí-Dell'Olmo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | | | - Carme Borrell
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Ana Isabel Ribeiro
- Instituto de Engenharia Biomédica—INEB, Universidade do Porto—Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina do Porto, Universidade do Porto—Instituto de Saúde Pública da Universidade do Porto—ISPUP, Porto, Portugal
| | - Maria Fatima de Pina
- Instituto de Engenharia Biomédica—INEB, Universidade do Porto—Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina do Porto, Universidade do Porto—Instituto de Saúde Pública da Universidade do Porto—ISPUP, Porto, Portugal
| | | | - Cyrille Delpierre
- INSERM, U1027, Toulouse F-31300, Toulouse, France
- Université Toulouse III Paul-Sabatier, UMR1027, Toulouse F-31300, Toulouse, France
| | - Bernard Rachet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Guy Launoy
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
- Pôle Recherche, University Hospital of Caen, Caen, France
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21
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Hurtado JL, Bacigalupe A, Calvo M, Esnaola S, Mendizabal N, Portillo I, Idigoras I, Millán E, Arana-Arri E. Social inequalities in a population based colorectal cancer screening programme in the Basque Country. BMC Public Health 2015; 15:1021. [PMID: 26438240 PMCID: PMC4594998 DOI: 10.1186/s12889-015-2370-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 09/29/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND While it is known that a variety of factors (biological, behavioural and interventional) play a major role in the health of individuals and populations, the importance of the role of social determinants is less clear. The effect of social inequality on population-based screening for colorectal cancer (CRC) could limit the value of such programmes. The present study aims to determine whether such inequalities exist. METHODS Data was obtained from the population-based screening programme administered in the Autonomous Community of the Basque Country, Spain, with a target population aged 50 to 69, first invited to participate between 2009 and 2011. The magnitude of inequality was analysed using the odds ratio (taking the least disadvantaged socioeconomic quintile as the reference population), the population attributable risk and the relative index of inequality, based on the regression, which is the ratio of the rates in the most and least disadvantaged socioeconomic groups. RESULTS The target population comprised 242,394 people, with the test kit successfully sent to 95.1 % (230,510). The overall response rate was 64.3 % (67.1 in women and 61.4 % men). Among women, the highest participation was in the third quintile (71.5 %) and the lowest in the first - the least disadvantaged (65.7 %). The lowest and highest rates of people with identified lesions were in the second and fourth quintiles (14.7/1000 and 17.0/1000 respectively). Among men, the response rate was lowest in the fifth - most disadvantaged - quintile (60.2 %). The highest rate of identified lesions was in the fifth quintile; 38 % higher than the first (55.7/1000 compared to 41.0/1000). CONCLUSIONS Sex and socioeconomic group influence the rate of participation in the CRC programme and the rate of lesions found in the participants. Any public health programme is morally and ethically obliged to strive for equity and effectiveness. Improving participation of men and socially disadvantaged groups should be taken in account.
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Affiliation(s)
| | - Amaia Bacigalupe
- Department of Sociology 2, University of the Basque Country (UPV/EHU), Bizkaia, Spain.
| | - Montse Calvo
- Directorate of Health Planning, Department of Health, Basque Government, Araba, Spain.
| | - Santi Esnaola
- Directorate of Health Planning, Department of Health, Basque Government, Araba, Spain.
| | | | - Isabel Portillo
- Colorectal Cancer Screening Programme Coordinating Centre, Basque Health Service, Bizkaia, Spain.
| | - Isabel Idigoras
- Colorectal Cancer Screening Programme Coordinating Centre, Basque Health Service, Bizkaia, Spain.
| | - Eduardo Millán
- Healthcare Services Sub-directorate, Osakidetza-Basque Health Service, Araba, Spain.
| | - Eunate Arana-Arri
- Clinical Epidemiology Unit, Cruces University Hospital, BioCruces Health Research Institute, 48903, Barakaldo-Bizkaia, Spain.
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Filc D, Davidovich N, Novack L, Balicer RD. Is socioeconomic status associated with utilization of health care services in a single-payer universal health care system? Int J Equity Health 2014; 13:115. [PMID: 25431139 PMCID: PMC4260253 DOI: 10.1186/s12939-014-0115-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 11/10/2014] [Indexed: 11/29/2022] Open
Abstract
Objectives To assess an association of Socio-economic status with utilization of health care services between years 2002 and 2008 in Israel. Methods We retrospectively analyzed the utilization of health care services in a cohort of 100,000 members, 21 years and older, of a Clalit Health Services. The research compared utilization according to the neighborhood SES status; and clinic’s location as another SES proxy. Data included: Charlson Score morbidity factor, utilization of health care services (visits to primary physicians and specialists, purchase of pharmaceuticals, number of hospitalization days, visits to ED, utilization of laboratory tests and imaging). The analysis was performed using Generalized Linear Model (GLM) technique. Results People with lower SES visited more the ED and primary physicians and were hospitalized for longer periods. People with higher SES visited more specialists, bought more prescription drugs and used more medical imaging. The associations between SES and most of the services we analyzed did not change between 2002 and 2008. However, the gap between lower and higher SES levels in ED visits and the use of prescription drugs slightly increased over time, while the gap in visits to specialists decreased. Conclusions The research shows that even in a universal health care system SES is associated with utilization of health care services. In order to improve equity in utilization of services the Israeli public health should reduce economic barriers and in parallel invest in making information accessible to improve “navigation skills” for all.
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Affiliation(s)
- Dani Filc
- Department of Politics and Government, Ben-Gurion University, POB 653, Beer Sheva, 8410501, Israel.
| | - Nadav Davidovich
- Department of Health Systems Management, Ben-Gurion University, POB 653, Beer Sheva, 8410501, Israel.
| | - Lena Novack
- Department of Public Health, Ben-Gurion University, POB 653, Beer Sheva, 8410501, Israel.
| | - Ran D Balicer
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Arlozorov 101, Tel Aviv, Israel.
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23
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Mehdipanah R, Manzano A, Borrell C, Malmusi D, Rodriguez-Sanz M, Greenhalgh J, Muntaner C, Pawson R. Exploring complex causal pathways between urban renewal, health and health inequality using a theory-driven realist approach. Soc Sci Med 2014; 124:266-74. [PMID: 25486624 DOI: 10.1016/j.socscimed.2014.11.050] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Urban populations are growing and to accommodate these numbers, cities are becoming more involved in urban renewal programs to improve the physical, social and economic conditions in different areas. This paper explores some of the complexities surrounding the link between urban renewal, health and health inequalities using a theory-driven approach. METHODS We focus on an urban renewal initiative implemented in Barcelona, the Neighbourhoods Law, targeting Barcelona's (Spain) most deprived neighbourhoods. We present evidence from two studies on the health evaluation of the Neighbourhoods Law, while drawing from recent urban renewal literature, to follow a four-step process to develop a program theory. We then use two specific urban renewal interventions, the construction of a large central plaza and the repair of streets and sidewalks, to further examine this link. DISCUSSION In order for urban renewal programs to affect health and health inequality, neighbours must use and adapt to the changes produced by the intervention. However, there exist barriers that can result in negative outcomes including factors such as accessibility, safety and security. CONCLUSION This paper provides a different perspective to the field that is largely dominated by traditional quantitative studies that are not always able to address the complexities such interventions provide. Furthermore, the framework and discussions serve as a guide for future research, policy development and evaluation.
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Affiliation(s)
- Roshanak Mehdipanah
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, UK
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Ciber de Epidemiología y Salud Publica (CIBERESP), Spain
| | - Davide Malmusi
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Ciber de Epidemiología y Salud Publica (CIBERESP), Spain
| | - Maica Rodriguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Ciber de Epidemiología y Salud Publica (CIBERESP), Spain
| | | | - Carles Muntaner
- Bloomberg Faculty of Nursing, University of Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada; Department of Psychiatry and Public Health Sciences, University of Toronto, Toronto, Canada
| | - Ray Pawson
- School of Sociology and Social Policy, University of Leeds, UK
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24
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Garcia-Gil M, Elorza JM, Banque M, Comas-Cufí M, Blanch J, Ramos R, Méndez-Boo L, Hermosilla E, Bolibar B, Prieto-Alhambra D. Linking of primary care records to census data to study the association between socioeconomic status and cancer incidence in Southern Europe: a nation-wide ecological study. PLoS One 2014; 9:e109706. [PMID: 25329578 PMCID: PMC4203762 DOI: 10.1371/journal.pone.0109706] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 09/05/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Area-based measures of economic deprivation are seldom applied to large medical records databases to establish population-scale associations between deprivation and disease. OBJECTIVE To study the association between deprivation and incidence of common cancer types in a Southern European region. METHODS Retrospective ecological study using the SIDIAP (Information System for the Development of Research in Primary Care) database of longitudinal electronic medical records for a representative population of Catalonia (Spain) and the MEDEA index based on urban socioeconomic indicators in the Spanish census. Study outcomes were incident cervical, breast, colorectal, prostate, and lung cancer in 2009-2012. The completeness of SIDIAP cancer recording was evaluated through linkage of a geographic data subset to a hospital cancer registry. Associations between MEDEA quintiles and cancer incidence was evaluated using zero-inflated Poisson regression adjusted for sex, age, smoking, alcoholism, obesity, hypertension, and diabetes. RESULTS SIDIAP sensitivity was 63% to 92% for the five cancers studied. There was direct association between deprivation and lung, colorectal, and cervical cancer: incidence rate ratios (IRR) 1.82 [1.64-2.01], IRR 1.60 [1.34-1.90], IRR 1.22 [1.07-1.38], respectively, comparing the most deprived to most affluent areas. In wealthy areas, prostate and breast cancers were more common: IRR 0.92 [0.80-1.00], IRR 0.91 [0.78-1.06]. Adjustment for confounders attenuated the association with lung cancer risk (fully adjusted IRR 1.16 [1.08-1.25]), reversed the direction of the association with colorectal cancer (IRR 0.90 [0.84-0.95]), and did not modify the associations with cervical (IRR 1.27 [1.11-1.45]), prostate (0.74 [0.69-0.80]), and breast (0.76 [0.71-0.81]) cancer. CONCLUSIONS Deprivation is associated differently with the occurrence of various cancer types. These results provide evidence that MEDEA is a useful, area-based deprivation index for analyses of the SIDIAP database. This information will be useful to improve screening programs, cancer prevention and management strategies, to reach patients more effectively, particularly in deprived urban areas.
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Affiliation(s)
- Maria Garcia-Gil
- Research Unit, Family Medicine, Girona, Spain, and Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
- Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Catalunya, Spain
| | - Josep-Maria Elorza
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Marta Banque
- Cancer Prevention Unit and Cancer Registry, Department of Epidemiology and Evaluation, Hospital del Mar, Barcelona, Catalunya, Spain
| | - Marc Comas-Cufí
- Research Unit, Family Medicine, Girona, Spain, and Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Jordi Blanch
- Research Unit, Family Medicine, Girona, Spain, and Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Rafel Ramos
- Primary Care Services, Girona, Spain, and Catalan Institute of Health (ICS), Catalunya, Spain
| | - Leonardo Méndez-Boo
- Primary Care Information System, Catalan Institute of Health (ICS), Catalunya, Spain
| | - Eduardo Hermosilla
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Bonaventura Bolibar
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Daniel Prieto-Alhambra
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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25
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Stecksén A, Glader EL, Asplund K, Norrving B, Eriksson M. Education level and inequalities in stroke reperfusion therapy: observations in the Swedish stroke register. Stroke 2014; 45:2762-8. [PMID: 25074515 DOI: 10.1161/strokeaha.114.005323] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have revealed inequalities in stroke treatment based on demographics, hospital type, and region. We used the Swedish Stroke Register (Riksstroke) to test whether patient education level is associated with reperfusion (either or both of thrombolysis and thrombectomy) treatment. METHODS We included 85 885 patients with ischemic stroke aged 18 to 80 years registered in Riksstroke between 2003 and 2009. Education level was retrieved from Statistics Sweden, and thrombolysis, thrombectomy, patient, and hospital data were obtained from Riksstroke. We used multivariable logistic regression to analyze the association between reperfusion therapy and patient education. RESULTS A total of 3649 (4.2%) of the patients received reperfusion therapy. University-educated patients were more likely to be treated (5.5%) than patients with secondary (4.6%) or primary education (3.6%; P<0.001). The inequality associated with education was still present after adjustment for patient characteristics; university education odds ratio, 1.14; 95% confidence interval, 1.03 to 1.26 and secondary education odds ratio, 1.08; 95% confidence interval, 1.00 to 1.17 compared with primary education. Higher hospital specialization level was also associated with higher reperfusion levels (P<0.001). In stratified multivariable analyses by hospital type, significant treatment differences by education level existed only among large nonuniversity hospitals (university education odds ratio, 1.20; 95% confidence interval, 1.04-1.40; secondary education odds ratio, 1.14; 95% confidence interval, 1.01-1.29). CONCLUSIONS We demonstrated a social stratification in reperfusion, partly explained by patient characteristics and the local hospital specialization level. Further studies should address treatment delays, stroke knowledge, and means to improve reperfusion implementation in less specialized hospitals.
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Affiliation(s)
- Anna Stecksén
- From the Departments of Public Health and Clinical Medicine (A.S., E.-L.G., K.A.) and Statistics (M.E.), Umeå University, Umeå, Sweden; and Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.).
| | - Eva-Lotta Glader
- From the Departments of Public Health and Clinical Medicine (A.S., E.-L.G., K.A.) and Statistics (M.E.), Umeå University, Umeå, Sweden; and Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.)
| | - Kjell Asplund
- From the Departments of Public Health and Clinical Medicine (A.S., E.-L.G., K.A.) and Statistics (M.E.), Umeå University, Umeå, Sweden; and Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.)
| | - Bo Norrving
- From the Departments of Public Health and Clinical Medicine (A.S., E.-L.G., K.A.) and Statistics (M.E.), Umeå University, Umeå, Sweden; and Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.)
| | - Marie Eriksson
- From the Departments of Public Health and Clinical Medicine (A.S., E.-L.G., K.A.) and Statistics (M.E.), Umeå University, Umeå, Sweden; and Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.)
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Amien F, Myburgh NG, Butler N. Location of community pharmacies and prevalence of oral conditions in the Western Cape Province. Health SA 2013. [DOI: 10.4102/hsag.v18i1.687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Community pharmacists are approached regularly for oral health advice; most commonly for ulcers which could be indicative of oral cancer, HIV, and various systemic diseases. Community pharmacists should know how to manage these conditions yet they have very limited training to manage these conditions appropriately. The area location and socioeconomic status (SES) of the pharmacy should be considered as it may influence patient management. A study of this nature has not yet been conducted in the Western Cape Province of South Africa. To determine the prevalence and frequency of oral complaints at community pharmacies and if these parameters differ by metropolitan location and SES. A cross-sectional survey of 162 randomly-selected private sector pharmacies was conducted. The sample (n = 121) was stratified by SES and metropolitan location. An open-ended structured questionnaire was faxed to pharmacists. A telephonic interview was conducted a day later. Community pharmacists were asked about the frequency and type of oral health problems they encountered. Most pharmacists (91%) dealt with oral health problems frequently, most commonly for ulcers (55.8%), thrush (49.2%), and toothache (33.3%). The results did not differ by metropolitan location and SES (Chi-squared, Fisher’s Exact, p > 0.05), with the exception of toothache and mouth sores. Community pharmacists are an important part of an interdisciplinary team, and play a definite role in the early detection of oral health conditions, namely, caries, HIV and oral cancer. Training on common oral health conditions should be included in undergraduate pharmacy curricula and continuous professional development courses.Gemeenskapsaptekers word gereeld genader vir advies rakende mondgesondheid, hoofsaaklik mondsere wat ’n aanduiding kan wees van mondkanker, MIV en verskeie sistemiese siektes. Gemeenskapsaptekers moet weet hoe om hierdie kwessies te hanteer. Die ligging van die area en die sosio-ekonomiese status (SES) van die apteek moet in ag geneem word aangesien dit ’n invloed mag hê op die hantering van die pasiënt. ’n Studie van hierdie aard is nog nie in die Wes-Kaap Provinsie van Suid-Afrika onderneem nie. Die doel van hierdie studie is om die voorkoms en herhaling van klagtes oor mondsiektes by gemeenskapsapteke te bepaal en of hierdie parameters verskil na gelang van metropolitaanse ligging en SES. ’n Deursnee-opname van 162 ewekansig geselekteerde privaat sektor-apteke is onderneem. Die steekproef (n = 121) is gestratifiseer ten opsigte van SES en metropolitaanse ligging. ’n Oopeinde gestruktureerde vraelys is aan apteke gefaks. ’n Telefoniese onderhoud is ’n dag later gevoer. Gemeenskapsaptekers is gevra na die herhaling van en die tipe mondgesondheidsprobleme wat hulle teëgekom het. Die meeste aptekers (91%) het dikwels met mondprobleme te doen gekry, meestal mondsere (55.8%), mondsproei (49.2%) en tandpyn (33.3%). Die bevindinge het nie verskil na gelang van metropolitaanse ligging en SES (Chi-kwadraat, Fisher se eksakte toets, p > 0.05) nie, met die uitsondering van tandpyn en mondsere. Gemeenskapsaptekers vorm ’n belangrike deel van ’n interdissiplinêre span, en speel ’n definitiewe rol in die vroeë opsporing van mondgesondheidstoestande, naamlik tandverrotting, MIV en mondkanker. Opleiding in algemene mondgesondheidstoestande behoort deel te vorm van voorgraadse aptekerskurrikulums en voortgesette professionele ontwikkelingskursusse.
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Gan WQ, FitzGerald JM, Carlsten C, Sadatsafavi M, Brauer M. Associations of ambient air pollution with chronic obstructive pulmonary disease hospitalization and mortality. Am J Respir Crit Care Med 2013; 187:721-7. [PMID: 23392442 DOI: 10.1164/rccm.201211-2004oc] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Ambient air pollution has been suggested as a risk factor for chronic obstructive pulmonary disease (COPD). However, there is a lack of longitudinal studies to support this assertion. OBJECTIVES To investigate the associations of long-term exposure to elevated traffic-related air pollution and woodsmoke pollution with the risk of COPD hospitalization and mortality. METHODS This population-based cohort study included a 5-year exposure period and a 4-year follow-up period. All residents aged 45-85 years who resided in Metropolitan Vancouver, Canada, during the exposure period and did not have known COPD at baseline were included in this study (n = 467,994). Residential exposures to traffic-related air pollutants (black carbon, particulate matter <2.5 μm in aerodynamic diameter, nitrogen dioxide, and nitric oxide) and woodsmoke were estimated using land-use regression models and integrating changes in residences during the exposure period. COPD hospitalizations and deaths during the follow-up period were identified from provincial hospitalization and death registration databases. MEASUREMENTS AND MAIN RESULTS An interquartile range elevation in black carbon concentrations (0.97 × 10(-5)/m, equivalent to 0.78 μg/m(3) elemental carbon) was associated with a 6% (95% confidence interval, 2-10%) increase in COPD hospitalizations and a 7% (0-13%) increase in COPD mortality after adjustment for covariates. Exposure to higher levels of woodsmoke pollution (tertile 3 vs. tertile 1) was associated with a 15% (2-29%) increase in COPD hospitalizations. There were positive exposure-response trends for these observed associations. CONCLUSIONS Ambient air pollution, including traffic-related fine particulate pollution and woodsmoke pollution, is associated with an increased risk of COPD.
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Affiliation(s)
- Wen Qi Gan
- Department of Population Health, Hofstra North Shore-LIJ School of Medicine, Great Neck, NY 11021, USA.
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Pardo-Crespo MR, Narla NP, Williams AR, Beebe TJ, Sloan J, Yawn BP, Wheeler PH, Juhn YJ. Comparison of individual-level versus area-level socioeconomic measures in assessing health outcomes of children in Olmsted County, Minnesota. J Epidemiol Community Health 2013; 67:305-10. [PMID: 23322850 DOI: 10.1136/jech-2012-201742] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Socioeconomic status (SES) is an important determinant of health, but SES measures are frequently unavailable in commonly used datasets. Area-level SES measures are used as proxy measures of individual SES when the individual measures are lacking. Little is known about the agreement between individual-level versus area-level SES measures in mixed urban-rural settings. METHODS We identified SES agreement by comparing information from telephone self-reported SES levels and SES calculated from area-level SES measures. We assessed the impact of this agreement on reported associations between SES and rates of childhood obesity, low birth weight <2500 g and smoking within the household in a mixed urban-rural setting. RESULTS 750 households were surveyed with a response rate of 62%: 51% male, 89% Caucasian; mean child age 9.5 years. Individual-level self-reported income was more strongly associated with all three childhood health outcomes compared to area-level SES. We found significant disagreement rates of 22-31%. The weighted Cohen's κ indices ranged from 0.15 to 0.22, suggesting poor agreement between individual-level and area-level measures. CONCLUSION In a mixed urban-rural setting comprised of both rural and urbanised areas, area-level SES proxy measures significantly disagree with individual SES measures, and have different patterns of association with health outcomes from individual-level SES measures. Area-level SES may be an unsuitable proxy for SES when individual rather than community characteristics are of primary concern.
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Affiliation(s)
- Maria R Pardo-Crespo
- Division of Community Paediatric and Adolescent Medicine, Department of Paediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Alonso-Babarro A, Astray-Mochales J, Domínguez-Berjón F, Gènova-Maleras R, Bruera E, Díaz-Mayordomo A, Centeno Cortes C. The association between in-patient death, utilization of hospital resources and availability of palliative home care for cancer patients. Palliat Med 2013; 27:68-75. [PMID: 22492481 DOI: 10.1177/0269216312442973] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The impact of palliative home care programs on in-patient admissions and deaths has not been appropriately established. AIM The main objectives of this study have been to evaluate the frequency of in-patient hospital deaths and the use of hospital resources among cancer patients in two areas of the Madrid Region, as well as to assess differences between one area with and one without a palliative home care team (PHCT) in those variables. DESIGN AND SETTING We conducted a population-based study comparing two adjacent metropolitan areas of approximately 200,000 inhabitants each in the Madrid Region, Spain, measuring in-patient deaths, emergency room admissions and in-patient days among cancer patients who died in 2005. Only one of the two areas had a fully established PHCT. RESULTS 524/549 cancer patients (95%) had an identified place of death: 74% died in hospital, 17% at home, 6% in an in-patient hospice and 3% in a nursing home. The frequency of hospital deaths was significantly lower among patients of the PHCT area (61% versus 77%, p < 0.001), as well as the number of patients using emergency and in-patient services (68% versus 79%, p = 0.004, and 66 versus 76%, p = 0.012, respectively). After adjusting for other factors, the risk of hospital death was lower among patients older than 80 (OR, 95% CI, 0.3, 0.1-0.5), higher among patients with hematological malignancies (OR 6.1, 2.0-18.9) and lower among patients of the PHCT area (OR 0.4, 0.2-0.6). CONCLUSIONS Our findings suggest that a PHCT is associated with reduced in-patient deaths and overall hospitalization over the last two months of life.
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Janković J, Janević T, von dem Knesebeck O. Socioeconomic inequalities, health damaging behavior, and self-perceived health in Serbia: a cross-sectional study. Croat Med J 2012; 53:254-62. [PMID: 22661139 PMCID: PMC3368295 DOI: 10.3325/cmj.2012.53.254] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Aim To analyze the association of socioeconomic factors with self-perceived health in Serbia and examine whether this association can be partly explained by health behavior variables. Methods We used data from the 2007 Living Standards Measurement Study for Serbia. A representative sample of 13 831 persons aged ≥20 years was interviewed. The associations between demographic factors (age, sex, marital status, and type of settlement), socioeconomic factors (education, employment status, and household consumption tertiles), and health behavior variables (smoking, alcohol consumption) and self-perceived health were examined using logistic regression analyses. Results A stepwise gradient was found between education and self-perceived health for the total sample, men, and women. Compared to people with high education, people with low education had a 4.5 times higher chance of assessing their health as poor. Unemployed (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.29-2.10), inactive (OR, 2.82; 95% CI, 2.49-3.19), and the most deprived respondents (OR, 1.17; 95% CI, 1.02-1.34) were more likely to report poor self-perceived health than employed persons and the most affluent group. After adjustment for demographic and health behavior variables, the magnitudes of all associations decreased but remained clearly and significantly graded. Conclusions This study revealed inequalities in self-perceived health by socioeconomic position, in particular educational and employment status. The reduction of such inequalities through wisely tailored interventions that benefit people’s health should be a target of a national health policy in Serbia.
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Affiliation(s)
- Janko Janković
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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An ecological approach to examine lung cancer disparities due to sexual orientation. Public Health 2012; 126:605-12. [PMID: 22578298 DOI: 10.1016/j.puhe.2012.04.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 03/05/2012] [Accepted: 04/10/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To determine whether there is an association between geographical areas with greater sexual minority density, defined as gay and lesbian individuals, and incidence and mortality rates for lung cancer. STUDY DESIGN As individual surveillance data on sexual orientation are not available, this study used an ecological approach to examine the link between sexual minorities and lung cancer. METHODS Population-based surveillance data on the incidence of and mortality due to lung cancer from 1996 to 2004 were used from 12 Surveillance, Epidemiology and End Results (SEER) registries and 2000 Census data on same-sex-partnered households for the geographical area covered by SEER 12. Using multiple regression models, the county-level association of sexual minority density with incidence or mortality rates for lung cancer was examined. RESULTS A significant positive association was found between both incidence and mortality rates for lung cancer and areas with a higher density of sexual minority men, and a significant negative association was found between both incidence and mortality rates for lung cancer and areas with a higher density of sexual minority women. CONCLUSIONS In the absence of surveillance data, this novel methodological strategy approximates population-level lung cancer disparities for sexual minority populations at the aggregate level.
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Gan WQ, Davies HW, Koehoorn M, Brauer M. Association of long-term exposure to community noise and traffic-related air pollution with coronary heart disease mortality. Am J Epidemiol 2012; 175:898-906. [PMID: 22491084 DOI: 10.1093/aje/kwr424] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In metropolitan areas, road traffic is a major contributor to ambient air pollution and the dominant source of community noise. The authors investigated the independent and joint influences of community noise and traffic-related air pollution on risk of coronary heart disease (CHD) mortality in a population-based cohort study with a 5-year exposure period (January 1994-December 1998) and a 4-year follow-up period (January 1999-December 2002). Individuals who were 45-85 years of age and resided in metropolitan Vancouver, Canada, during the exposure period and did not have known CHD at baseline were included (n = 445,868). Individual exposures to community noise and traffic-related air pollutants, including black carbon, particulate matter less than or equal to 2.5 μm in aerodynamic diameter, nitrogen dioxide, and nitric oxide, were estimated at each person's residence using a noise prediction model and land-use regression models, respectively. CHD deaths were identified from the provincial death registration database. After adjustment for potential confounders, including traffic-related air pollutants or noise, elevations in noise and black carbon equal to the interquartile ranges were associated with 6% (95% confidence interval: 1, 11) and 4% (95% confidence interval: 1, 8) increases, respectively, in CHD mortality. Subjects in the highest noise decile had a 22% (95% confidence interval: 4, 43) increase in CHD mortality compared with persons in the lowest decile. These findings suggest that there are independent effects of traffic-related noise and air pollution on CHD mortality.
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Affiliation(s)
- Wen Qi Gan
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
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Shildkrot Y, Thomas F, Al-Hariri A, Fry CL, Haik BG, Wilson MW. Socioeconomic factors and diagnosis of uveal melanoma in the mid-southern United States. Curr Eye Res 2011; 36:824-30. [PMID: 21762015 DOI: 10.3109/02713683.2011.593109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To establish the base incidence of uveal melanoma in the mid-southern United States and to explore the regional frequency of uveal melanoma diagnosis as a function of area-based socioeconomic measures (ABSM) aggregated at the level of small geographic units delimited by Zoning Improvement Plan (ZIP) codes. METHODS Based on a retrospective chart review (1996-2007) of patients seen at our institutions with the diagnosis of uveal melanoma, the number of uveal melanoma cases was calculated for each ZIP-code in Arkansas, Mississippi, western Tennessee and Louisiana. The base incidence of uveal melanoma was calculated using the population size reported in the 2000 census as the population at risk for each geographic area. Data on the average house value and average household income reported in the 2000 census were used in a Poisson regression analysis to examine their effect on the frequency of uveal melanoma diagnosis. RESULTS There were 327 (of 1,669) regional ZIP-codes that were the source of 457 patients with uveal melanoma. Higher ABSM, defined as greater average house value or household income, were positively associated with the number of observed melanoma cases per ZIP-code. The annualized incidence of uveal melanoma was at least 3.5 cases per million in the areas studied. CONCLUSION Higher ABSM were associated with the increased frequency of uveal melanoma diagnosis in the regions studied. Extrapolating from similar trends observed with non-ocular cancers, this may signify a need for increased access to ophthalmologic care to ensure timely diagnosis.
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Affiliation(s)
- Yevgeniy Shildkrot
- Hamilton Eye Institute, Department of Ophthalmology, University of Tennessee Health Science Center, Tennessee, USA
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Gan WQ, Koehoorn M, Davies HW, Demers PA, Tamburic L, Brauer M. Long-term exposure to traffic-related air pollution and the risk of coronary heart disease hospitalization and mortality. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:501-7. [PMID: 21081301 PMCID: PMC3080932 DOI: 10.1289/ehp.1002511] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 11/16/2010] [Indexed: 05/18/2023]
Abstract
BACKGROUND Epidemiologic studies have demonstrated that exposure to road traffic is associated with adverse cardiovascular outcomes. OBJECTIVES We aimed to identify specific traffic-related air pollutants that are associated with the risk of coronary heart disease (CHD) morbidity and mortality to support evidence-based environmental policy making. METHODS This population-based cohort study included a 5-year exposure period and a 4-year follow-up period. All residents 45-85 years of age who resided in Metropolitan Vancouver during the exposure period and without known CHD at baseline were included in this study (n=452,735). Individual exposures to traffic-related air pollutants including black carbon, fine particles [aerodynamic diameter ≤ 2.5 µm (PM(2.5))], nitrogen dioxide (NO(2)), and nitric oxide were estimated at residences of the subjects using land-use regression models and integrating changes in residences during the exposure period. CHD hospitalizations and deaths during the follow-up period were identified from provincial hospitalization and death registration records. RESULTS An interquartile range elevation in the average concentration of black carbon (0.94 × 10(-5)/m filter absorbance, equivalent to approximately 0.8 µg/m(3) elemental carbon) was associated with a 3% increase in CHD hospitalization (95% confidence interval, 1-5%) and a 6% increase in CHD mortality (3-9%) after adjusting for age, sex, preexisting comorbidity, neighborhood socioeconomic status, and copollutants (PM(2.5) and NO(2)). There were clear linear exposure-response relationships between black carbon and coronary events. CONCLUSIONS Long-term exposure to traffic-related fine particulate air pollution, indicated by black carbon, may partly explain the observed associations between exposure to road traffic and adverse cardiovascular outcomes.
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Affiliation(s)
- Wen Qi Gan
- School of Environmental Health, University of British Columbia, Vancouver, British Columbia, Canada.
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Marra CA, Lynd LD, Harvard SS, Grubisic M. Agreement between aggregate and individual-level measures of income and education: a comparison across three patient groups. BMC Health Serv Res 2011; 11:69. [PMID: 21453534 PMCID: PMC3078843 DOI: 10.1186/1472-6963-11-69] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 03/31/2011] [Indexed: 11/10/2022] Open
Abstract
Background The association between lower socioeconomic status and poorer health outcomes has been observed using both individual-level and aggregate-level measures of income and education. While both are predictive of health outcomes, previous research indicates poor agreement between individual-level and aggregate-level measures. The purpose of this study was to determine the level of agreement between aggregate-level and individual-level measures of income and education among three distinct patient groups, specifically asthma, diabetes, and rheumatoid patients. Methods Individual-level measures of annual household income and education were derived from three separate surveys conducted among patients with asthma (n = 359), diabetes (n = 281) and rheumatoid arthritis (n = 275). Aggregate-level measures of income and education were derived from the 2001 Canadian census, including both census tract-and dissemination area-level measures. Cross-tabulations of individual-level income by aggregate-level income were used to determine the percentage of income classifications in agreement. The kappa statistic (simple and weighted), Spearman's rank correlations, and intra-class correlation coefficient (ICC) were also calculated. Individual-level and aggregate-level education was compared using Chi-Square tests within patient groups. Point biserial correlation coefficients between individual-level and aggregate-level education were computed. Results Individual-level income was poorly correlated with aggregate-level measures, which provided the worst estimations of income among patients in the lowest income category at the individual-level. Both aggregate-level measures were best at approximating individual-level income in patients with diabetes, in whom aggregate-level estimates were only significantly different from individual-level measures for patients in the lowest income category. Among asthma patients, the proportion of patients classified by aggregate-level measures as having a university degree was significantly lower than that classified by individual-level measures. Among diabetes and rheumatoid arthritis patients, differences between aggregate and individual-level measures of education were not significant. Conclusions Agreement between individual-level and aggregate-level measures of socioeconomic status may depend on the patient group as well as patient income. Research is needed to characterize differences between patient groups and help guide the choice of measures of socioeconomic status.
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Affiliation(s)
- Carlo A Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
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Changes in residential proximity to road traffic and the risk of death from coronary heart disease. Epidemiology 2010; 21:642-9. [PMID: 20585255 DOI: 10.1097/ede.0b013e3181e89f19] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Residential proximity to road traffic is associated with increased coronary heart disease (CHD) morbidity and mortality. It is unknown, however, whether changes in residential proximity to traffic could alter the risk of CHD mortality. METHODS We used a population-based cohort study with a 5-year exposure period and a 4-year follow-up period to explore the association between changes in residential proximity to road traffic and the risk of CHD mortality. The cohort comprised all residents aged 45-85 years who resided in metropolitan Vancouver during the exposure period and without known CHD at baseline (n = 450,283). Residential proximity to traffic was estimated using a geographic information system. CHD deaths during the follow-up period were identified using provincial death registration database. The data were analyzed using logistic regression. RESULTS Compared with the subjects consistently living away from road traffic (>150 m from a highway or >50 m from a major road) during the 9-year study period, those consistently living close to traffic (<or=150 m from a highway or <or=50 m from a major road) had the greatest risk of CHD mortality (relative risk [RR] = 1.29 [95% confidence interval = 1.18-1.41]). By comparison, those who moved closer to traffic during the exposure period had less increased risk than those who were consistently exposed (1.20 [1.00-1.43]), and those who moved away from traffic had even less increase in the risk (1.14 [0.95-1.37]). All analyses were adjusted for baseline age, sex, pre-existing comorbidities (diabetes, chronic obstructive pulmonary disease, hypertensive heart disease), and neighborhood socioeconomic status. CONCLUSIONS Living close to major roadways was associated with increased risk of coronary mortality, whereas moving away from major roadways was associated with decreased risk.
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Bastiaannet E, de Craen AJM, Kuppen PJK, Aarts MJ, van der Geest LGM, van de Velde CJH, Westendorp RGJ, Liefers GJ. Socioeconomic differences in survival among breast cancer patients in the Netherlands not explained by tumor size. Breast Cancer Res Treat 2010; 127:721-7. [PMID: 21076863 DOI: 10.1007/s10549-010-1250-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 10/27/2010] [Indexed: 11/24/2022]
Abstract
There seem to be socioeconomically differences in survival for females with breast cancer, usually associated with a higher stage of disease. However, differences within tumor size have not been studied. Aim of this study is to assess differences in survival according to socioeconomic status (SES), stratified for tumor size and stage at diagnosis, for females with breast cancer in the Netherlands. All females diagnosed with breast cancer (1995-2005) were selected from the Netherlands Cancer Registry. Patients were linked to a SES database according to postal code. A multivariable logistic regression was used to assess factors associated with SES. Overall survival (OS) and relative survival (RS) were calculated. Overall, 127,599 patients were included. Higher SES was associated with lower T-stage (P < 0.0001). A decreased survival (OS and RS) was found for patients with a lower SES. Also within different size groups, RS was different. Overall, 10-year OS for the high SES group was 65 and 58% for the low SES group (hazard ratio 1.1, P < 0.001) and RS was 79 versus 74% (relative excess risk, RER 1.2; P < 0.001). The socioeconomic differences remained statistically significant (P < 0.001) after adjustment for age, year of diagnosis, grade, TNM stage, and treatment. For the lowest SES group 777 deaths could be avoided. Socioeconomic differences in survival of breast cancer patients were observed in the Netherlands. Higher stage at diagnosis of patients with a lower SES only partly explains the decreased survival. Policies aimed at the reduction of socioeconomic health inequalities might be important to improve survival of breast cancer.
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Affiliation(s)
- E Bastiaannet
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Martín-Fernández J, del Cura-González MI, Gómez-Gascón T, Oliva-Moreno J, Domínguez-Bidagor J, Beamud-Lagos M, Pérez-Rivas FJ. Differences between willingness to pay and willingness to accept for visits by a family physician: a contingent valuation study. BMC Public Health 2010; 10:236. [PMID: 20459714 PMCID: PMC2883536 DOI: 10.1186/1471-2458-10-236] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 05/10/2010] [Indexed: 11/22/2022] Open
Abstract
Background The economic value attributed by users of health services in public health systems can be useful in planning and evaluation. This value can differ from the perspectives of Willingness to Pay (WTP) and Willingness to Accept [Compensation] (WTA). Our objective was to study the perceptions of the patient about the service provided by the family physician by means of the WTA/WTP ratio. Methods An economic evaluation study by the Contingent Valuation Method was designed. Interviews were conducted with 451 subjects at six health centres (four urban and two rural) in areas with different socioeconomic characteristics. A payment card was used to measure the WTP and WTA. Other characteristics of the subject or service that could influence these responses were collected. An explicative model was constructed to study the WTA/WTP relationship. Results Four hundred and four subjects (89.6%) expressed a WTP and WTA different from zero. The WTA/WTP quotient showed a median of 1.55 (interquartile range 1-3.08) and a mean of 3.30 (IC 95%: 2.84-3.75). The WTA/WTP ratio increases with age and in low-income areas. It decreases in professional groups with more specialized activities, with growing family income, and in the chronically ill. Other characteristics related to the perception of state of health, accessibility to the service, satisfaction, or perception of risk were not explicative. Conclusions Subjects who were older and had a less favourable socioeconomic situation expressed a higher WTA/WTP ratio when valuing the visit to the family physician. These characteristics could identify a profile of "aversion to loss" with respect to this service.
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Affiliation(s)
- Jesús Martín-Fernández
- San Martín de Valdeiglesias Health Center, 8th Primary Care Area Madrid Health Service, Spain.
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Dalmau-Bueno A, García-Altés A, Marí-Dell’Olmo M, Pérez K, Kunst AE, Borrell C. Veintidós años de evolución de las desigualdades socioeconómicas en la mortalidad en la ciudad de Barcelona. GACETA SANITARIA 2010; 24:20-7. [DOI: 10.1016/j.gaceta.2009.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 05/20/2009] [Accepted: 06/02/2009] [Indexed: 11/25/2022]
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Martín-Fernández J, Gómez-Gascón T, Oliva-Moreno J, del Cura-González MI, Domínguez-Bidagor J, Beamud-Lagos M, Sanz-Cuesta T. Perception of the economic value of primary care services: a Willingness to Pay study. Health Policy 2009; 94:266-72. [PMID: 19945763 DOI: 10.1016/j.healthpol.2009.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 10/20/2009] [Accepted: 11/01/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Identify the economic value the user attributes to the visit to the family physician, in a setting of a National Health System, by the Willingness to Pay (WTP) expressed. METHODS Economic evaluation study, by the contingent valuation method. Questions were asked about WTP using a payment card format. Interviews were conducted with 451 subjects, in areas with different socioeconomic characteristics. An ordered probit was used to evaluate model's validity. RESULTS Median WTP expressed was euro18 (interquartile range euro8-28), not including "zero-answers" of thirty-four subjects (7.5%). This value represents 2% of average adjusted family incomes. Patients with higher incomes or with chronic illnesses presented a probability of 5-14 percentage points of expressing a high WTP. For every point of increase of patient satisfaction, the probability of presenting a WTP in the lowest range decreases 7.0 percentage points. Subjects with a low education level and those older than 65 expressed a lower WTP. Accessibility, risk perception, nationality and having private insurance were not related to the WTP expressed. CONCLUSIONS Users of primary care have a clear perception of the economic value of care received from the family physician, even in a framework of providing services financed by taxes and without cost at the moment of use. This value increases in subjects with higher incomes, with greater need for care, or more satisfied.
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Affiliation(s)
- Jesús Martín-Fernández
- San Martín de Valdeiglesias Health Center, 1st La Bola St., 28680 San Martin de Valdeiglesias, Madrid Health Service, Madrid, Spain.
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Gomes FS, Vasconcellos MTL, Anjos LA. The use of income information of census enumeration area as a proxy for the household income in a household survey. Popul Health Metr 2009; 7:14. [PMID: 19772607 PMCID: PMC2760501 DOI: 10.1186/1478-7954-7-14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 09/22/2009] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Some of the Census Enumeration Areas' (CEA) information may help planning the sample of population studies but it can also be used for some analyses that require information that is more difficult to obtain at the individual or household level, such as income. This paper verifies if the income information of CEA can be used as a proxy for household income in a household survey. METHODS A population-based survey conducted from January to December 2003 obtained data from a probabilistic sample of 1,734 households of Niterói, Rio de Janeiro, Brazil. Uniform semi-association models were adjusted in order to obtain information about the agreement/disagreement structure of data. The distribution of nutritional status categories of the population of Niterói according to income quintiles was performed using both CEA- and household-level income measures and then compared using Wald statistics for homogeneity. Body mass index was calculated using body mass and stature data measured in the households and then used to define nutritional status categories according to the World Health Organization. All estimates and statistics were calculated accounting for the structural information of the sample design and a significance level lower than 5% was adopted. RESULTS The classification of households in the quintiles of household income was associated with the classification of these households in the quintiles of CEA income. The distribution of the nutritional status categories in all income quintiles did not differ significantly according to the source of income information (household or CEA) used in the definition of quintiles. CONCLUSION The structure of agreement/disagreement between quintiles of the household's monthly per capita income and quintiles of the head-of-household's mean nominal monthly income of the CEA, as well as the results produced by these measures when they were associated with the nutritional status of the population, showed that the CEA's income information can be used when income information at the individual or household levels is not available.
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Affiliation(s)
- Fabio S Gomes
- Escola Nacional de Ciências Estatísticas, Fundação Instituto Brasileiro de Geografia e Estatística, Rua André Cavalcanti 106, Sala 403, Bairro de Fátima, 20231-050 - Rio de Janeiro, RJ, Brazil
- Área de Alimentação, Nutrição e Câncer, Coordenação de Prevenção e Vigilância, Instituto Nacional de Câncer, Rua dos Inválidos 212, 4° andar, Centro, 20231-048 - Rio de Janeiro, RJ, Brazil
| | - Mauricio TL Vasconcellos
- Escola Nacional de Ciências Estatísticas, Fundação Instituto Brasileiro de Geografia e Estatística, Rua André Cavalcanti 106, Sala 403, Bairro de Fátima, 20231-050 - Rio de Janeiro, RJ, Brazil
| | - Luiz A Anjos
- Laboratório de Avaliação Nutricional e Funcional, Departamento de Nutrição Social, Universidade Federal Fluminense, Rua Mario Santos Braga 30, Sala 415, Campus do Valonguinho, 24020-140 - Niterói, RJ, Brazil
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, 21041-210 - Rio de Janeiro, RJ, Brazil
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Domínguez-Berjón MF, Borrell C, López R, Pastor V. Mortality and socioeconomic deprivation in census tracts of an urban setting in southern Europe. J Urban Health 2005; 82:225-36. [PMID: 15888637 PMCID: PMC3456560 DOI: 10.1093/jurban/jti047] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In southern European cities, research on deprivation and mortality inequalities using small-area analysis is recent. In many countries, the census tract (CT) is the smallest territorial unit for which population data are available. The aim of this study was to examine the association between mortality from all causes and socioeconomic deprivation in CTs in Barcelona (Spain). A cross-sectional ecologic study was carried out using mortality data for 1987-1995 and 1991 census variables. Mortality data were obtained from death certificates. Socioeconomic deprivation indicators were drawn from the census and included unemployment, inadequate education, and low social class. They were correlated, and a deprivation index was elaborated with them. The analysis was descriptive, and multivariate Poisson regression models were adjusted. The most deprived CTs tend to present higher mortality (49.7% of CT in the quartile associated with greatest deprivation were included in the top male mortality quartile and 40.4% in the top female mortality quartile), whereas the less deprived ones present lower mortality. For male mortality, the risk of dying among those in the quartile representing most deprivation is from 25 to 29% higher (depending on the indicator chosen) than the least deprived quartile, and for women, it is from 12 to 14% higher. We concluded that the mortality from all causes in the CT of a southern European city has shown a clear positive association with a variety of socioeconomic deprivation indicators drawn from the census. Studies of this nature may help to orient more specific studies in which CTs are grouped together as a function of particular population and/or health characteristics.
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