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Klocke A, Stadtmüller S. Two generations later: New evidence on health equalisation in youth. Soc Sci Med 2024; 342:116522. [PMID: 38183934 DOI: 10.1016/j.socscimed.2023.116522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 12/09/2023] [Accepted: 12/16/2023] [Indexed: 01/08/2024]
Abstract
In the 1990s, Patrick West argued that, in contrast to childhood and adulthood, youth was characterised by relative social equality in health. This equalisation hypothesis has since been empirically tested several times, but with inconclusive results. The objective of the present study was to provide an up-to-date contribution to the question of health equalisation in youth by drawing on data from the German longitudinal study Health Behaviour and Injuries at School Age (GUS). The target population of GUS comprised students who were in 5th grade at German public secondary schools in the school year 2014/15. Over 10,000 students from randomly selected schools participated in the initial survey wave and were followed up in annual surveys until 10th grade. As GUS included a variety of health-related variables as well as indicators for family affluence, we could examine how social inequalities affected the health and health behaviour of young people with increasing age. Our study goes beyond previous research in two ways. First, from a youth and health sociology perspective, we present reasons why we expect an increase in socially determined health inequalities in the present youth generation. Second, we fully exploit the potential of our panel data, and thus arrive at very reliable results. For self-rated general health, as well as for numerous mental health and health behaviour items, our data show that health inequalities emerged or increased during the observation period (ages 10-16 years). Despite some indications of equalisation, especially for the consumption of unhealthy food and beverages, most of our results contradict West's equalisation hypothesis and suggest that social inequalities play an increasing role in health disparities among youth in the process of growing up.
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Affiliation(s)
- Andreas Klocke
- Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318 Frankfurt (Main), Germany.
| | - Sven Stadtmüller
- Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318 Frankfurt (Main), Germany.
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Norman P, Exeter D, Shelton N, Head J, Murray E. (Un-) healthy ageing: Geographic inequalities in disability-free life expectancy in England and Wales. Health Place 2022; 76:102820. [PMID: 35690019 DOI: 10.1016/j.healthplace.2022.102820] [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] [Received: 12/03/2021] [Revised: 04/08/2022] [Accepted: 05/03/2022] [Indexed: 11/04/2022]
Abstract
Health expectancies are an indicator of healthy ageing that reflect quantity and quality of life. Using limiting long term illness and mortality prevalence, we calculate disability-free life expectancy for small areas in England and Wales between 1991 and 2011 for males and females aged 50-74, the life stage when people may be changing their occupation from main career to retirement or alternative work activities. We find that inequalities in disability-free life expectancy are deeply entrenched, including former coalfield and ex-industrial areas and that areas of persistent (dis-) advantage, worsening or improving deprivation have health change in line with deprivation change. A mixed health picture for rural and coastal areas requires further investigation as do the demographic processes which underpin these area level health differences.
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Affiliation(s)
- Paul Norman
- School of Geography, University of Leeds, UK.
| | - Dan Exeter
- School of Population Health, University of Auckland, New Zealand
| | - Nicola Shelton
- Research Department of Epidemiology and Public Health, University College London, UK
| | - Jenny Head
- Research Department of Epidemiology and Public Health, University College London, UK
| | - Emily Murray
- Research Department of Epidemiology and Public Health, University College London, UK
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Ebeling M, Rau R, Sander N, Kibele E, Klüsener S. Urban-rural disparities in old-age mortality vary systematically with age: evidence from Germany and England & Wales. Public Health 2022; 205:102-109. [PMID: 35276525 DOI: 10.1016/j.puhe.2022.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/06/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Population aging - which tends to be more pronounced in rural than in urban areas - poses important challenges for facilitating equal opportunities for aging well and 'aging in place.' Unmet health care needs among the older rural population may result in poorer health and higher mortality, but the scientific evidence of a systematic rural mortality disadvantage at older ages is scarce. We argue that systematic urban-rural mortality differences by age may be found if the confounding effect of life expectancy is considered. STUDY DESIGN Nationwide population-based study. METHODS We draw on age- and sex-specific data for the population aged 60+ years in NUTS-3 regions in Germany (2016-2018) and LAU-1 regions in England & Wales (2017-2019). To account for the confounding effect of life expectancy, we compare age-specific mortality only across urban and rural regions with similar life expectancy levels. We quantify statistical uncertainty with bootstrapping. RESULTS The results show a remarkable shift from higher mortality in urban regions to higher mortality in rural regions with increasing age, when controlling for the confounding effect of life expectancy. That is, the urban mortality disadvantage is strongest for the population aged 60-79 years, whereas the pattern shifts toward a rural mortality disadvantage for the population aged 80 years and older. This pattern is present at all levels of life expectancy, for both sexes and in both countries. CONCLUSION The shift from urban to rural excess mortality over age suggests that regions may vary in their capability to respond to arising health issues across older ages. This systematic mortality disadvantage is of high public health relevance and should be considered in designing policies to reduce regional mortality disparities.
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Affiliation(s)
- M Ebeling
- Karolinska Institutet, Stockholm, Sweden; Max Planck Institute for Demographic Research, Rostock, Germany.
| | - R Rau
- Max Planck Institute for Demographic Research, Rostock, Germany; University of Rostock, Rostock, Germany
| | - N Sander
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - E Kibele
- Statistical Office Bremen, Bremen, Germany
| | - S Klüsener
- Max Planck Institute for Demographic Research, Rostock, Germany; Federal Institute for Population Research (BiB), Wiesbaden, Germany; Vytautas Magnus University, Kaunas, Lithuania
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Dávila-Cervantes CA. Road injury burden in Mexico 1990 to 2019: Secondary data analysis from the Global Burden of Disease Study. ACCIDENT ANALYSIS AND PREVENTION 2021; 160:106316. [PMID: 34332290 DOI: 10.1016/j.aap.2021.106316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/30/2021] [Accepted: 07/16/2021] [Indexed: 02/05/2023]
Abstract
Road injuries have been a major cause of premature mortality and disability in Mexico. The objective of this paper is to report the findings from the Global Burden of Disease study (GBD-2019) on road injuries in Mexico at a national and subnational scale from 1990 to 2019, and to assess the association between road injury burden and the socio-demographic index. Following the 2019 Global Burden of Disease study road injury mortality, premature mortality, the years lived with disability and disability-adjusted life-years (DALYs) are reported. While the number of deaths from road injuries increased between 1990 and 2019, the age-standardized mortality rates declined. Pedestrian road injuries and motor vehicle road injuries accounted for 8 of every 10 deaths from road injury in 2019. Road injury mortality and DALY rates decreased nationally, but stagnated since 2011. The road injury burden was higher for men in all age groups. Pedestrian and motor vehicle road injuries caused the highest DALY rate in both males and females. There was no significant association between the SDI and the road injury age-standardized DALY rates. This study presents a comprehensive report of road injury burden of disease in Mexico. Mexico continues to have an incomplete, fragmented and poorly enforced legislative framework, with a large diversity between its 32 states. Thus, an integrated legislative and juridical effort is needed to continue reducing the road injury disease burden, which is tailored for specific age groups, vulnerable road users and high-burden areas.
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Fenton L, Wyper GM, McCartney G, Minton J. Socioeconomic inequality in recent adverse all-cause mortality trends in Scotland. J Epidemiol Community Health 2019; 73:971-974. [PMID: 31326891 PMCID: PMC6817697 DOI: 10.1136/jech-2019-212300] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 12/31/2022]
Abstract
Background Gains in life expectancies have stalled in Scotland, as in several other countries, since around 2012. The relationship between stalling mortality improvements and socioeconomic inequalities in health is unclear. Methods We calculate the difference, as percentage change, in all-cause, all-age, age-standardised mortality rates (ASMR) between 2006 and 2011 (period 1) and between 2012 and 2017 (period 2), for Scotland overall, by sex, and by Scottish Index of Multiple Deprivation (SIMD) quintile. Linear regression is used to summarise the relationship between SIMD quintile and mortality rate change in each period. Results Between 2006 and 2011, the overall ASMR fell by 10.6% (138/100 000), by 10.1% in women, and 11.8% in men, but between 2012 and 2017 the overall ASMR fell by only 2.6% (30/100 000), by 3.5% in women, and by 2.0% in men. Within the most deprived quintile, the overall ASMR fell by 8.6% (143/100 000) from 2006 to 2011 (7.2% in women; 9.8% in men), but rose by 1.5% (21/100 000) from 2012 to 2017 (0.7% in women; 2.1% in men). The socioeconomic gradient in ASMR improvement more than quadrupled, from 0.4% per quintile in period 1, to 1.7% per quintile in period 2. Conclusion From 2012 to 2017, socioeconomic gradients in mortality improvement in Scotland were markedly steeper than over the preceding 6 years. As a result, there has not only been a slowdown in overall reductions in mortality, but a widening of socioeconomic mortality inequalities.
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Affiliation(s)
- Lynda Fenton
- Public Health Observatory, NHS Health Scotland, Glasgow, UK .,Department of Public Health, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Grant Ma Wyper
- Public Health Observatory, NHS Health Scotland, Glasgow, UK
| | | | - Jon Minton
- Public Health Observatory, NHS Health Scotland, Glasgow, UK
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Cummins S, Clark C, Lewis D, Smith N, Thompson C, Smuk M, Stansfeld S, Taylor S, Fahy A, Greenhalgh T, Eldridge S. The effects of the London 2012 Olympics and related urban regeneration on physical and mental health: the ORiEL mixed-methods evaluation of a natural experiment. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
There is limited evidence for public health policy-makers on the health impacts of urban regeneration programmes.
Objectives
To assess whether or not the London 2012 Olympic and Paralympic Games, and related urban regeneration, were associated with an increase in physical activity and mental health and well-being; to assess whether or not any benefits were sustained over time; and to capture the experiences of residents of the Olympic host boroughs.
Design
Quasi-experimental prospective cohort study of adolescents and their parents/carers, with a nested qualitative longitudinal study of families.
Setting
London boroughs of Newham, Barking and Dagenham, Tower Hamlets and Hackney.
Participants
A cohort of 2254 adolescents in 25 schools; a repeat cross-sectional study of parents/carers and a sample of 20 families for the qualitative study.
Intervention
The London 2012 Olympic and Paralympic Games, and urban regeneration primarily associated with the redevelopment of the Olympic Park for legacy use.
Primary outcome measures
Change in the proportion of respondents meeting physical activity recommendations (using self-reported physical activity); change in the proportion of respondents reporting depression and anxiety and change in well-being score.
Main results
At 6 months, adolescents who became inactive were less likely to come from the intervention borough (Newham) than from comparison boroughs [risk ratio (RR) = 0.69, 95% confidence interval (CI) 0.51 to 0.93]. At 18 months, there were no statistically significant differences between intervention and comparison boroughs for all adolescent physical activity and screen-time transitions. Those who visited the Olympic Park more than once a month were the least likely to remain inactive (RR 0.11, 95% CI 0.02 to 0.48) and the least likely to become inactive (RR 0.38, 95% CI 0.24 to 0.60) compared with those who were active at baseline and at the 18-month follow-up. No impacts on parental/carer physical activity were observed. Adolescents who were ‘no longer depressed’ (RR 1.53, 95% CI 1.07 to 2.20) or ‘remained depressed’ (RR 1.78, 95% CI 1.12 to 2.83) at 6 months were more likely to be from the intervention borough. For well-being, there was no association between boroughs and change in well-being between baseline and the 6-month follow-up. At 18 months’ follow-up, adolescents who ‘remained depressed’ (RR 1.93, 95% CI 1.01 to 3.70) were more likely to be from the intervention borough than from comparison boroughs. No associations were observed for well-being at 18 months. There was limited evidence of change for parental mental health and well-being. The qualitative study found that residents generally welcomed the unexpected chance to live in a cleaner, safer and more unified environment. The findings suggested that the Games temporarily alleviated certain stressors in the social and physical environment. Overall, the Games lessened participants’ sense of social exclusion and appeared to generate a sense of inclusion and respite, even if this was only temporary. Study limitations include the potential for adolescents to not be assigned the correct level of exposure to urban regeneration and the effect of reductions in central and local public budgets owing to the UK Government’s deficit reduction programme.
Conclusions
This study provided the highest quality data to date on the short- and medium-term social and health impacts of sporting mega-events. We found limited evidence that the London 2012 Olympic and Paralympic Games had a positive effect on adolescent or parental physical activity, mental health or well-being.
Funding
The National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Steven Cummins
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Charlotte Clark
- Centre for Psychiatry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Daniel Lewis
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Neil Smith
- Centre for Psychiatry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claire Thompson
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Melanie Smuk
- Centre for Psychiatry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephen Stansfeld
- Centre for Psychiatry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie Taylor
- Centre for Psychiatry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Amanda Fahy
- Centre for Psychiatry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Sandra Eldridge
- Centre for Psychiatry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Murillo-Zamora E, Mendoza-Cano O, Trujillo-Hernández B, Guzmán-Esquivel J, Medina-González A, Huerta M, Sánchez-Piña RA, Lugo-Radillo A. Expected years of life lost through road traffic injuries in Mexico. Glob Health Action 2018; 10:1360629. [PMID: 28820342 PMCID: PMC5645682 DOI: 10.1080/16549716.2017.1360629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Road traffic injuries (RTIs) are a leading cause of premature mortality, mainly in low- and middle-income countries Objective: To estimate the 2014 burden of RTIs in Mexico calculating years of life lost (YLL) and age-standardized YLL rates (ASYLL), and to evaluate sex, age, and region-related differences in premature mortality. Methods: Mortality data were obtained from the National Institute of Statistics and Geography and 14,637 deaths of individuals 15 years of age and older were analyzed. The YLL and ASYLL were computed. Results: The overall burden of RTIs was 332,922 YLL and 82.4% of the deaths occurred in males. Males from 25 to 34 years of age and females from 15 to 24 years of age showed the highest age-adjusted YLL rates (933 and 158 YLL per 100,000 inhabitants, respectively). The national ASYLL rate was 416 per 100,000 inhabitants and the highest state-stratified mortality rates were observed in Tabasco (851), Sinaloa (709), Durango (656), Zacatecas (642), and Baja California Sur (570). Conclusions: RTIs contributed to the premature mortality rate in the study population. Our findings may be useful from a health policy perspective for designing and prioritizing interventions focused on the prevention of premature loss of life.
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Affiliation(s)
- Efrén Murillo-Zamora
- a Coordinación de Vigilancia Epidemiológica, Jefatura de Servicios de Prestaciones Médicas , Instituto Mexicano del Seguro Social , Colima , México
| | - Oliver Mendoza-Cano
- b Center for Health and the Global Environment , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,c Facultad de Ingeniería Civil , Universidad de Colima , Colima , México
| | | | - José Guzmán-Esquivel
- f Unidad de Investigación en Epidemiología Clínica , Instituto Mexicano del Seguro Social , Colima , México
| | - Alfredo Medina-González
- g Coordinación de Planeación y Enlace Institucional, Jefatura de Servicios de Prestaciones Médicas , Instituto Mexicano del Seguro Social , Colima , México
| | - Miguel Huerta
- h Centro Universitario de Investigaciones Biomédicas , Universidad de Colima , Colima , México
| | - Ramón Alberto Sánchez-Piña
- b Center for Health and the Global Environment , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Agustin Lugo-Radillo
- d CONACYT- Facultad de Medicina y Cirugía , Universidad Autónoma Benito Juárez de Oaxaca , Oaxaca , México
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Ward JL, Viner RM. Investigating equalisation of health inequalities during adolescence in four low-income and middle-income countries: an analysis of the Young Lives cohort study. BMJ Open 2018; 8:e022114. [PMID: 30185573 PMCID: PMC6129103 DOI: 10.1136/bmjopen-2018-022114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate if socioeconomic gradients in health reduce during adolescence (the equalisation hypothesis) in four low-income and middle-income countries (LMIC). SETTING Analysis of the Young Lives Study cohorts in Ethiopia, Peru, Vietnam and India. PARTICIPANTS A total of 3395 participants (across the four cohorts) aged 6-10 years at enrolment and followed up for 11 years. OUTCOMES MEASURED Change in income-related health inequalities from mid-childhood to late adolescence. Socioeconomic status was determined by wealth index quartile. The health indicators included were self-reported health, injuries in the previous 4 years, presence of long-term health problems, low mood, alcohol use, overweight/obesity, thinness and stunting. The relative risk of each adverse health outcome between highest and lowest wealth index quartile were compared across four waves of the study within each country. RESULTS We found steep socioeconomic gradients across multiple health indicators in all four countries. Socioeconomic gradients remained similar across all waves of the study, with no significant decrease during adolescence. CONCLUSION We found no consistent evidence of equalisation for income-related health inequalities in youth in these LMIC. Socioeconomic gradients for health in these cohorts appear to persist and be equally damaging across the early life course and during adolescence.
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Affiliation(s)
- Joseph L Ward
- UCL GOS Institute of Child Health, University College London, London, UK
| | - Russell M Viner
- UCL GOS Institute of Child Health, University College London, London, UK
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Gupta RP, Mukherjee M, Sheikh A, Strachan DP. Persistent variations in national asthma mortality, hospital admissions and prevalence by socioeconomic status and region in England. Thorax 2018; 73:706-712. [PMID: 30006496 PMCID: PMC6204968 DOI: 10.1136/thoraxjnl-2017-210714] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/19/2017] [Accepted: 01/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The UK-wide National Review of Asthma Deaths sought to identify avoidable factors from the high numbers of deaths, but did not examine variation by socioeconomic status (SES) or region. METHODS We used asthma deaths in England over the period 2002-2015 obtained from national deaths registers, summarised by quintiles of Index of Multiple Deprivation (IMD) and Government Office Region. Emergency asthma admissions were obtained from Hospital Episode Statistics for England 2001-2011. The prevalence of asthma was derived from the Health Survey for England 2010. Associations of mortality, admissions and prevalence with IMD quintile and region were estimated cross-sectionally using incidence rate ratios (IRRs) adjusted for age and sex and, where possible, smoking. RESULTS Asthma mortality decreased among more deprived groups at younger ages. Among 5-44 year olds, those in the most deprived quintile, mortality was 19% lower than those in the least deprived quintile (IRR 0.81 (95% CI 0.69 to 0.96). In older adults, this pattern was reversed (45-74 years: IRR 1.37 (1.24-1.52), ≥75 years: IRR 1.30 (1.22-1.39)). In 5-44 year olds the inverse trend with asthma mortality contrasted with large positive associations for admissions (IRR 3.34 (3.30-3.38)) and prevalence of severe symptoms (IRR 2.38 (1.70-3.33)). Prevalence trends remained after adjustment for smoking. IRRs for asthma mortality, admissions and prevalence showed significant heterogeneity between English regions. CONCLUSIONS Despite asthma mortality, emergency admissions and prevalence decreasing over recent decades, England still experiences significant SES and regional variations. The previously undocumented inverse relation between deprivation and mortality in the young requires further investigation.
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Affiliation(s)
- Ramyani P Gupta
- Population Health Research Institute, St George's, University of London, London, UK
| | - Mome Mukherjee
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - David P Strachan
- Population Health Research Institute, St George's, University of London, London, UK
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Kontopantelis E, Mamas MA, van Marwijk H, Buchan I, Ryan AM, Doran T. Increasing socioeconomic gap between the young and old: temporal trends in health and overall deprivation in England by age, sex, urbanity and ethnicity, 2004-2015. J Epidemiol Community Health 2018; 72:636-644. [PMID: 29555873 PMCID: PMC6031281 DOI: 10.1136/jech-2017-209895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/13/2018] [Accepted: 03/01/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND At a low geographical level, little is known about the associations between population characteristics and deprivation, and their trends, which would be directly affected by the house market, labour pressures and government policies. We describe temporal trends in health and overall deprivation in England by age, sex, urbanity and ethnicity. METHODS Repeated cross-sectional whole population study for England, 2004-2015, at a low geographical level (average 1500 residents). We calculated weighted medians of the Index of Multiple Deprivation (IMD) for each subgroup of interest. RESULTS Over time, we observed increases in relative deprivation for people aged under 30, and aged 30-59, while median deprivation decreased for those aged 60 or over. Subgroup analyses indicated that relative overall deprivation was consistently higher for young adults (aged 20-29) and infants (aged 0-4), with increases in deprivation for the latter. Levels of overall deprivation in 2004 greatly varied by ethnicity, with the lowest levels observed for White British and the highest for Blacks. Over time, small reductions were observed in the deprivation gap between White British and all other ethnic groups. Findings were consistent across overall IMD and its health and disability subdomain, but large regional variability was also observed. CONCLUSIONS Government policies, the financial crisis of 2008, education funding and the increasing cost of houses relative to real wages are important parameters in interpreting our findings. Socioeconomic deprivation is an important determinant of health and the inequalities this work highlights may have significant implications for future fiscal and healthcare policy.
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Affiliation(s)
- Evangelos Kontopantelis
- Faculty of Biology Medicine and Health, University of Manchester, Greater Manchester, UK
- NIHR School for Primary Care Research, University of Manchester, Greater Manchester, UK
| | - Mamas A Mamas
- Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Harm van Marwijk
- Faculty of Biology Medicine and Health, University of Manchester, Greater Manchester, UK
- NIHR School for Primary Care Research, University of Manchester, Greater Manchester, UK
| | - Iain Buchan
- Faculty of Biology Medicine and Health, University of Manchester, Greater Manchester, UK
- Healthcare Research, Microsoft Research Cambridge, Cambridge, UK
| | - Andrew M Ryan
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
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Maheswaran R, Strong M, Clifford P, Brewins L. Socioeconomic deprivation, mortality and health of within-city migrants: a population cohort study. J Epidemiol Community Health 2018; 72:519-525. [PMID: 29434024 DOI: 10.1136/jech-2017-210166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Evidence linking selective migration (the situation where people in good health move from deprived to affluent areas, whilst people in poor health move in the opposite direction) within local areas to mortality is inconclusive. METHODS Mortality in within-city migrants was examined using a Sheffield population cohort, adjusted for moves to care homes. The cohort comprised 310 894 people aged 25+ years in 2001 followed up for 9.18 years, with 42 252 (13.6%) deaths. Information on pre-existing medical conditions, socioeconomic indicators and smoking was available from a sample survey. RESULTS Relative risks (95% CI) of mortality in migrants from deprived to affluent areas were lower compared with people remaining in deprived areas; 0.53 (0.42 to 0.65), 0.70 (0.61 to 0.80), 0.76 (0.68 to 0.86), 0.93 (0.88 to 1.00) and 0.98 (0.93 to 1.03) in the 25-44, 45-64, 65-74, 75-84 and 85+ year age bands, respectively. They also had lower prevalence ORs (95% CI) for bronchitis (0.59 (0.39 to 0.89)), asthma (0.70 (0.53 to 0.93)), depression (0.59 (0.38 to 0.94)), and were less likely to receive benefits (0.60 (0.47 to 0.76)) and less likely to smoke (0.66 (0.51 to 0.85)).Conversely, mortality relative risks in migrants from affluent to deprived areas were higher compared with people remaining in affluent areas; 1.71 (1.37 to 2.12), 1.59 (1.40 to 1.82), 1.44 (1.26 to 1.63), 1.18 (1.10 to 1.27) and 1.04 (1.00 to 1.09) in the corresponding age groups. They also had higher prevalence odds ratios for long-term illness (2.37 (1.71 to 3.29)), asthma (1.71 (1.25 to 2.35)), diabetes (3.03 (1.70 to 5.41)), depression (2.71 (1.74 to 4.21)), were more likely to receive benefits (2.25 (1.65 to 3.07)) and more likely to smoke (1.51 (1.12 to 2.05)). CONCLUSIONS People moving from deprived to affluent areas had lower mortality and better health, and vice versa, especially in the younger age groups. This study provides strong evidence linking selective migration within local areas to mortality.
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Affiliation(s)
- Ravi Maheswaran
- Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mark Strong
- Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Phil Clifford
- North of England Commissioning Support, Sheffield, UK
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Morais Neto OL, Andrade AL, Guimarães RA, Mandacarú PMP, Tobias GC. Regional disparities in road traffic injuries and their determinants in Brazil, 2013. Int J Equity Health 2016; 15:142. [PMID: 27852263 PMCID: PMC5112733 DOI: 10.1186/s12939-016-0433-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 09/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent decades middle-income countries have experienced a rapid increase in the number of cars and motorcycles. Increased deaths and hospitalizations due to road traffic injuries (RTI) has been observed in several countries as a result. In this study we assessed the determinants of RTIs in Brazil by mode of transportation and compared differences in RTI rates among macro-regions. METHODS We used data from the National Health Survey (NHS) conducted in 2013 by the Brazilian Institute of Geography and Statistics and the Ministry of Health. NHS is a comprehensive household survey which includes a representative sample (N = 60,198) of individuals aged 18 years or older. The prevalence and determinants of RTI were estimated according to different modes of transport (car/van, motorcycle, and other) and regions of the country. Bivariate and multivariable logistic regression models were applied to assess crude and adjusted odds ratios, respectively, and their 95 % CI for RTI determinants. RESULTS The prevalence of RTI for the Southeast, South, Central-West, Northeast and North regions of Brazil was 2.4 %, 2.9 %, 4.4 %, 3.4 % and 4.8 %, respectively, pointing to important differences among regions. High percentages of motorcyclists were observed in the Northeast and North regions. For motorcyclists, factors associated with RTIs were being male (OR = 2.6;95 % CI:2.3;3.0), aged 18-29 (OR = 3.2; 95 % CI:2.7;3.8) and 30-39 years (OR = 2.0;95 % CI:1.7;2.5), black (OR = 1.4;95 % CI:1.1;1.7), having elementary educational (OR = 1.5;95 % CI:1.1;1.9), reporting binge drinking behavior (OR = 1.3;95 % CI:1.1;1.5), and living in the Central-West (OR = 2.0;95 % CI:1.6;2.5), Northeast (OR = 1.8;95 % CI:1.5;2.1) and North (OR = 2.0;95 % CI:1.6; 2.5) regions of the country. The independent variables associated with RTI for car/van occupants were being male (OR = 1.7;95 % CI:1.4;2.1), aged 18-29 (OR = 1.5;95 % CI:1.1;2.0) and 30-39 years (OR = 2.5;95 % CI:1.9;3.2), reporting binge drinking behavior (OR = 2.0;95 % CI:1.6;2.5) and living in the South region (OR = 1.6;95 % CI:1.3;2.1). CONCLUSIONS There were considerable regional disparities in RTI rates across Brazil's regions. Motorcyclists contributed to the high RTI rates in these regions as did demographic factors and behaviors such as alcohol use. These findings can help guide interventions to reduce the burden of RTIs in Brazil.
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Affiliation(s)
- Otaliba Libanio Morais Neto
- Departamento de Saúde Coletiva. Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Rua 235, S/N, Setor Universitário, Goiânia, Goiás Cep: 74605-050 Brazil
| | - Ana Lúcia Andrade
- Departamento de Saúde Coletiva. Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Rua 235, S/N, Setor Universitário, Goiânia, Goiás Cep: 74605-050 Brazil
| | - Rafael Alves Guimarães
- Mestrado do Programa de Pós-Graduação em Enfermagem, Universidade Federal de Goiás, Rua 227 Qd 68, S/N - Setor Leste Universitário, Goiânia, Goiás CEP: 74605-080 Brazil
| | - Polyana Maria Pimenta Mandacarú
- Centro de Excelência em Ensino, Pesquisa e Projetos – Leide das Neves Ferreira, Rua 26, 521 - Jardim Santo Antônio, Goiânia, GO 74853-070 Brazil
- Programa de Pós-Graduação em Medicina Tropical e Saúde Pública, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Rua 235, S/N, Setor Universitário, Goiânia, Goiás Cep: 74605-050 Brazil
| | - Gabriela Camargo Tobias
- Programa de Pós-Graduação em Medicina Tropical e Saúde Pública, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Rua 235, S/N, Setor Universitário, Goiânia, Goiás Cep: 74605-050 Brazil
- Secretaria Municipal de Saúde de Senador Canedo, Av. Dom Manoel - Res. Boa Vista, Sen. Canedo, GO 75250-000 Brazil
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Dibben C, Playford C, Mitchell R. Be(ing) prepared: Guide and Scout participation, childhood social position and mental health at age 50-a prospective birth cohort study. J Epidemiol Community Health 2016; 71:275-281. [PMID: 27834224 PMCID: PMC5318648 DOI: 10.1136/jech-2016-207898] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 09/05/2016] [Accepted: 09/08/2016] [Indexed: 11/10/2022]
Abstract
Background Mental health is a major concern in many countries. We explore whether youth participation in the Scouts and Guides could protect mental health in later life and in particular whether it might reduce inequalities in mental health associated with early life socioeconomic position. Methods Using the 1958 birth cohort National Child Development Study, we tested whether Scouts–Guide attendance was associated with mental health (SF-36, Mental Health Index (MHI-5)) controlling for childhood risk factors and interacted with social class. Results Of the 9603 cohort members, 28% had participated in the Scouts–Guides. The average MHI-5 score was 74.8 (SD 18.2) at age 50. After adjustment, for potential childhood confounders, participation in Scouts–Guides was associated with a better MHI-5 score of 2.22 (CI 1.32 to 3.08). Among those who had not been a Scout–Guide, there was a gradient in mental health at age 50 by childhood social position, adjusting for other childhood risk factors. This gradient was absent among those who had been a Scout–Guide. Scout–Guides had an 18% lower odds of an MHI-5 score indicative of mood or anxiety disorder. The findings appeared robust to various tests for residual confounding. Conclusions Participation in Guides or Scouts was associated with better mental health and narrower mental health inequalities, at age 50. This suggests that youth programmes that support resilience and social mobility through developing the potential for continued progressive self-education, ‘soft’ non-cognitive skills, self-reliance, collaboration and activities in natural environments may be protective of mental health in adulthood.
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Affiliation(s)
- Chris Dibben
- University of Edinburgh, Institute of Geography, Edinburgh, UK
| | - Chris Playford
- University of Edinburgh, Administrative Data Research Centre Scotland, Edinburgh, UK
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De Grande H, Vandenheede H, Deboosere P. Educational inequalities in young-adult mortality between the 1990s and the 2000s: regional differences in Belgium. Arch Public Health 2015; 73:11. [PMID: 25780561 PMCID: PMC4360928 DOI: 10.1186/s13690-014-0059-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/20/2014] [Indexed: 11/29/2022] Open
Abstract
Background This study addresses educational inequalities in young-adult mortality between the 1990s and the 2000s by comparing trends in the three different regions in Belgium stratified by sex. Social inequalities in mortality are of major concern to public health but are rarely studied at young ages. Substantial health differences have been found between the Flemish (FR) and Walloon region (WR) concerning (healthy) life expectancy and avoidable mortality, but little is known about regional differentials in young-adult mortality, and comparisons with the Brussels-Capital Region (BCR) have thus far never been made. Methods Data are derived from record linkage between the Belgian censuses of 1991 and 2001 and register data on death and emigration for the periods 01/03/1991-01/03/1999 and 01/10/2001-01/10/2009. Analyses are restricted to young adults aged 25 to 34 years at the moment of each of the censuses. Absolute (directly standardized mortality rates (ASMRs)) and relative (mortality rate ratio using Poisson regression) measures were calculated. Results There is a significant drop in young-adult mortality between the 1990s and the 2000s in all regions and both sexes, with the strongest decline in the BCR (e.g. ASMR of men declined from 165.6 [151.1-180.1] per 100,000 person years to 73.8 [88.3-98.3]). The mortality rates remain highest in the WR in the 2000s Between the 1990s and the 2000s, a remarkable change in the educational distribution occurred as well, with much lower proportions of primary educated in all regions in the 2000s in favour of higher proportions in all other educational levels, especially in higher education. All educational groups show lower mortality over time, except for lower educated men in the FR. Conclusions There is a positive evolution towards lower mortality among the young-adult Belgian population. The WR trails behind in this evolution, which calls for tailored preventive actions. Educational inequalities are marked in all regions and time periods. A more general discussion is needed on the responsibility of society in rendering support and capability to enhance the state of well-being of those not able to achieve a high social position. Electronic supplementary material The online version of this article (doi:10.1186/s13690-014-0059-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hannelore De Grande
- Department of Sociology - Interface Demography, Vrije Universiteit Brussel, Pleinlaan 5, 1050 Brussels (Elsene), Belgium
| | - Hadewijch Vandenheede
- Department of Sociology - Interface Demography, Vrije Universiteit Brussel, Pleinlaan 5, 1050 Brussels (Elsene), Belgium
| | - Patrick Deboosere
- Department of Sociology - Interface Demography, Vrije Universiteit Brussel, Pleinlaan 5, 1050 Brussels (Elsene), Belgium
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Smith NR, Lewis DJ, Fahy A, Eldridge S, Taylor SJC, Moore DG, Clark C, Stansfeld SA, Cummins S. Individual socio-demographic factors and perceptions of the environment as determinants of inequalities in adolescent physical and psychological health: the Olympic Regeneration in East London (ORiEL) study. BMC Public Health 2015; 15:150. [PMID: 25884502 PMCID: PMC4339478 DOI: 10.1186/s12889-015-1459-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 01/23/2015] [Indexed: 12/03/2022] Open
Abstract
Background Populations living in urban areas experience greater health inequalities as well as higher absolute burdens of illness. It is well-established that a range of social and environmental factors determine these differences. Less is known about the relative importance of these factors in determining adolescent health within a super diverse urban context. Methods A cross-sectional sample of 3,105 adolescent participants aged 11 to 12 were recruited from 25 schools in the London boroughs of Newham, Tower Hamlets, Hackney and Barking & Dagenham. Participants completed a pseudo-anonymised paper-based questionnaire incorporating: the Warwick-Edinburgh Mental Well-being Scale used for assessing positive mental well-being, the Short Moods and Feelings Questionnaire based on the DSM III-R criteria for assessment of depressive symptoms, the Youth-Physical Activity Questionnaire and a self-assessment of general health and longstanding illness. Prevalence estimates and unadjusted linear models estimate the extent to which positive well-being scores and time spent in physical/sedentary activity vary by socio-demographic and environmental indicators. Logistic regression estimated the unadjusted odds of having fair/(very)poor general health, a long standing illness, or depressive symptoms. Fully adjusted mixed effects models accounted for clustering within schools and for all socio-demographic and environmental indicators. Results Compared to boys, girls had significantly lower mental well-being and higher rates of depressive symptoms, reported fewer hours physically active and more hours sedentary, and had poorer general health after full adjustment. Positive mental well-being was significantly and positively associated with family affluence but the overall relationship between mental health and socioeconomic factors was weak. Mental health advantage increased as positive perceptions of the neighbourhood safety, aesthetics, walkability and services increased. Prevalence of poor health varied by ethnic group, particularly for depressive symptoms, general health and longstanding illness suggesting differences in the distribution of the determinants of health across ethnic groups. Conclusions During adolescence perceptions of the urban physical environment, along with the social and economic characteristics of their household, are important factors in explaining patterns of health inequality.
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Affiliation(s)
- Neil R Smith
- Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Daniel J Lewis
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Amanda Fahy
- Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Derek G Moore
- Institute for Research in Child Development, School of Psychology, University of East London, Stratford Campus, Water Lane Stratford, London, E15 4NO, UK.
| | - Charlotte Clark
- Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Stephen A Stansfeld
- Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Steven Cummins
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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Zhou SM, Lyons RA, Bodger OG, John A, Brunt H, Jones K, Gravenor MB, Brophy S. Local modelling techniques for assessing micro-level impacts of risk factors in complex data: understanding health and socioeconomic inequalities in childhood educational attainments. PLoS One 2014; 9:e113592. [PMID: 25409038 PMCID: PMC4237439 DOI: 10.1371/journal.pone.0113592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 10/29/2014] [Indexed: 11/29/2022] Open
Abstract
Although inequalities in health and socioeconomic status have an important influence on childhood educational performance, the interactions between these multiple factors relating to variation in educational outcomes at micro-level is unknown, and how to evaluate the many possible interactions of these factors is not well established. This paper aims to examine multi-dimensional deprivation factors and their impact on childhood educational outcomes at micro-level, focusing on geographic areas having widely different disparity patterns, in which each area is characterised by six deprivation domains (Income, Health, Geographical Access to Services, Housing, Physical Environment, and Community Safety). Traditional health statistical studies tend to use one global model to describe the whole population for macro-analysis. In this paper, we combine linked educational and deprivation data across small areas (median population of 1500), then use a local modelling technique, the Takagi-Sugeno fuzzy system, to predict area educational outcomes at ages 7 and 11. We define two new metrics, "Micro-impact of Domain" and "Contribution of Domain", to quantify the variations of local impacts of multidimensional factors on educational outcomes across small areas. The two metrics highlight differing priorities. Our study reveals complex multi-way interactions between the deprivation domains, which could not be provided by traditional health statistical methods based on single global model. We demonstrate that although Income has an expected central role, all domains contribute, and in some areas Health, Environment, Access to Services, Housing and Community Safety each could be the dominant factor. Thus the relative importance of health and socioeconomic factors varies considerably for different areas, depending on the levels of each of the other factors, and therefore each component of deprivation must be considered as part of a wider system. Childhood educational achievement could benefit from policies and intervention strategies that are tailored to the local geographic areas' profiles.
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Affiliation(s)
- Shang-Ming Zhou
- Institute of Life Science, College of Medicine, Swansea University, Swansea, United Kingdom
| | - Ronan A. Lyons
- Institute of Life Science, College of Medicine, Swansea University, Swansea, United Kingdom
| | - Owen G. Bodger
- Institute of Life Science, College of Medicine, Swansea University, Swansea, United Kingdom
| | - Ann John
- Institute of Life Science, College of Medicine, Swansea University, Swansea, United Kingdom
| | - Huw Brunt
- Public Health Wales, Temple of Peace and Health, Cathays Park, Cardiff, United Kingdom
| | - Kerina Jones
- Institute of Life Science, College of Medicine, Swansea University, Swansea, United Kingdom
| | - Mike B. Gravenor
- Institute of Life Science, College of Medicine, Swansea University, Swansea, United Kingdom
| | - Sinead Brophy
- Institute of Life Science, College of Medicine, Swansea University, Swansea, United Kingdom
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Vallejo-Torres L, Hale D, Morris S, Viner RM. Income-related inequality in health and health-related behaviour: exploring the equalisation hypothesis. J Epidemiol Community Health 2014; 68:615-21. [PMID: 24619989 PMCID: PMC4112435 DOI: 10.1136/jech-2013-203306] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Previous studies have found the socioeconomic gradient in health among adolescents to be lower than that observed during childhood and adulthood. The aim of this study was to examine income-related inequalities in health and health-related behaviour across the lifespan in England to explore ‘equalisation’ in adolescence. Methods We used five years of data (2006–2010) from the Health Survey for England to explore inequalities in six indicators: self-assessed general health, longstanding illness, limiting longstanding illness, psychosocial wellbeing, obesity and smoking status. We ran separate analyses by age/gender groups. Inequality was measured using concentration indices. Results Our findings for longstanding illnesses, psychosocial wellbeing and obesity were consistent with the equalisation hypothesis. For these indicators, the extent of income-related inequality was lower among late adolescents (16–19 years) and young adults (20–24 years) compared to children and young adolescents (under 15 years), mid- and late-adults (25–44 and 45–64 years) and the elderly (65+ years). The remaining indicators showed lower inequality among adolescents compared to adults, but higher inequality when compared with children. Conclusions Our work shows that inequalities occur across the life-course but that for some health issues there may be a period of equalisation in late adolescence and early adulthood.
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Affiliation(s)
- Laura Vallejo-Torres
- Department of Applied Health Research, University College London, London, UK Center for Biomedical Research of the Canary Islands (CIBICAN), Universidad de la Laguna, Tenerife, Spain Departamento de Economía de las Instituciones, Estadística Económica y Econometría, Universidad de la Laguna, Tenerife, Spain
| | - Daniel Hale
- UCL Institute of Child Health, University College London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Russell M Viner
- UCL Institute of Child Health, University College London, London, UK
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Are health inequalities between differently deprived areas evident at different ages? A longitudinal study of census records in England and Wales, 1991-2001. Health Place 2013; 26:88-93. [PMID: 24412656 DOI: 10.1016/j.healthplace.2013.12.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 12/02/2013] [Accepted: 12/09/2013] [Indexed: 11/24/2022]
Abstract
The notion that mortality inequalities between differently deprived areas vary by age is logical since not all causes of death increase in risk with age and not all causes of death are related to the gradient of deprivation. In addition to the cause-age and cause-deprivation relationships, population migration may redistribute the population such that the health-deprivation relationship varies by age. We calculate cross-sectional all cause mortality and self-reported limiting long-term illness (LLTI) rate ratios of most to least deprived areas to demonstrate inequalities at different ages. We use longitudinal data to investigate whether there are changes in the distribution of cohorts between differently deprived areas over time and whether gradients of LLTI with deprivation also change. We find similar deprivation inequalities by age for all cause mortality and self-reported health with less inequality for young adults and the elderly but the greatest inequalities during mid life. Over time there are systematic movements of cohorts between differently deprived areas and associated increases and decreases in the gradient of LLTI across deprivation. It seems likely that population migration does influence inequalities by age. Further work should investigate whether the situation exists for other morbidities and, to better inform public health policy, whether restricting summary measures of area health to ages between 30 and 60 when inequalities are greatest will highlight between area differences.
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Grimaud O, McCarthy M, Conceição C. Strategies for public health research in European Union countries. Eur J Public Health 2013; 23 Suppl 2:35-8. [DOI: 10.1093/eurpub/ckt153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McCarthy M, Zeegers Paget D. Public Health Innovation and Research in Europe: introduction to the supplement. Eur J Public Health 2013; 23 Suppl 2:2-5. [DOI: 10.1093/eurpub/ckt147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Green MA. The equalisation hypothesis and changes in geographical inequalities of age based mortality in England, 2002–2004 to 2008–2010. Soc Sci Med 2013; 87:93-8. [DOI: 10.1016/j.socscimed.2013.03.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 03/19/2013] [Accepted: 03/21/2013] [Indexed: 10/27/2022]
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