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Toorang F, Amiri P, Djazayery A, Pouraram H, Takian A. Worse becomes the worst: obesity inequality, its determinants and policy options in Iran. Front Public Health 2024; 12:1225260. [PMID: 38384892 PMCID: PMC10880032 DOI: 10.3389/fpubh.2024.1225260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
Background This tracked obesity inequality and identified its determinants among the population of Iran. In addition, it examined the impact of implemented policies on these inequalities. Methods This study was performed in two phases. First, we conducted a rapid review of the disparity in obesity prevalence in Iran. Then we investigated the main determinants of this inequality in a qualitative study. In addition, we examined Iran's policies to deal with obesity from the perspective of equality. We conducted 30 Semi-structured interviews with various obesity stakeholders selected through a purposive snowball sampling method between November 25, 2019, and August 5, 2020. In the inductive approach, we used the content analysis method based on the Corbin and Status framework to analyze the data using MAXQDA-2020. The consolidating criteria for reporting a Qualitative Study (COREQ-32) were applied to conduct and report the study. Results Inequalities in the prevalence of obesity in terms of place of residence, gender, education, and other socioeconomic characteristics were identified in Iran. Participants believed that obesity and inequality are linked through immediate and intermediate causes. Inequality in access to healthy foods, physical activity facilities, and health care are the immediate causes of this inequality. Intermediate factors include inequality against women, children, and refugees, and inequality in access to information, education, and financial resources. Policymakers should implement equity-oriented obesity control policies such as taxing unhealthy foods, subsidizing healthy foods, providing healthy and free meals in schools, especially in disadvantaged areas, and providing nutrient-rich foods to low-income families. Also, environmental re-engineering to increase opportunities for physical activity should be considered. Of course, for the fundamental reduction of these inequalities, the comprehensive approach of all statesmen is necessary. Conclusion Obesity inequality is a health-threatening issue in Iran that can prevent achieving human development goals. Targeting the underlying causes of obesity, including inequalities, must be considered.
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Affiliation(s)
- Fatemeh Toorang
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Science, Tehran, Iran
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolghassem Djazayery
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Pouraram
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Departments of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
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Harkko J, Pietiläinen O, Jousilahti P, Rahkonen O, Kouvonen A, Lallukka T. Trajectories of CVD medication after statutory retirement: contributions of pre-retirement sociodemographic, work and health-related factors: a register study in Finland. BMC Geriatr 2023; 23:570. [PMID: 37723432 PMCID: PMC10506324 DOI: 10.1186/s12877-023-04272-8] [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: 07/03/2022] [Accepted: 09/01/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are prevalent in older people, but few studies focus on developmental patterns in CVD medication directly after transition to statutory retirement. We thus aimed to identify trajectories of CVD medication after retirement, and their sociodemographic, work and health-related determinants. METHODS We used complete register data of former employees of the City of Helsinki, Finland. All who reached their statutory retirement in 2000-2013, with five-year follow-up data (n = 6,505, 73% women), were included. Trajectories of CVD medication were identified with group-based trajectory modelling using data from Finnish Social Insurance Institution's reimbursement register. Sociodemographic, work and health-related determinants of trajectory group membership were analysed using multinomial logistic regression. RESULTS Six trajectories of CVD medication were distinguished: "constant low" (35%), "late increase" (6%), "early increase" (5%), "constant high" (39%), "high and decreasing " (8%), and "low and decreasing" (7%). The majority (74%) of the retirees fell into the "constant low" and "constant high" categories. Lower occupational class and increased pre-retirement sickness absence were associated with the "constant high" trajectory. Further, those with lower educational attainment were more prone to be in the "early increase" trajectory. CONCLUSIONS Individuals in lower socioeconomic positions or with a higher number of pre-retirement sickness absence may be considered at higher risk and might benefit from early interventions, e.g. lifestyle interventions and interventions targeting working conditions, or more frequent monitoring.
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Affiliation(s)
- Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
- University of Helsinki, P.O. Box 20 (Tukholmankatu 8 B), N00014, Helsinki, Finland.
| | - Olli Pietiläinen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Tea Lallukka
- University of Helsinki, P.O. Box 20 (Tukholmankatu 8 B), N00014, Helsinki, Finland.
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
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Leveau CM, Hussein M, Tapia-Granados JA, Velázquez GA. Economic fluctuations and educational inequalities in premature ischemic heart disease mortality in Argentina. CAD SAUDE PUBLICA 2023; 39:e00181222. [PMID: 37255190 PMCID: PMC10549982 DOI: 10.1590/0102-311xen181222] [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: 09/27/2022] [Revised: 02/15/2023] [Accepted: 03/02/2023] [Indexed: 06/01/2023] Open
Abstract
Although mortality from ischemic heart disease has declined over the past decades in Argentina, ischemic heart disease remains one of the most frequent causes of death. This study aimed to describe the role of individual and contextual factors on premature ischemic heart disease mortality and to analyze how educational differentials in premature ischemic heart disease mortality changed during economic fluctuations in two provinces of Argentina from 1990 to 2018. To test the relationship between individual (age, sex, and educational level) and contextual (urbanization, poverty, and macroeconomic variations) factors, a multilevel Poisson model was estimated. When controlling for the level of poverty at the departmental level, we observed inequalities in premature ischemic heart disease mortality according to the educational level of individuals, affecting population of low educational level. Moreover, economic expansion was related to an increase in ischemic heart disease mortality, however, expansion years were not associated with increasing educational inequalities in ischemic heart disease mortality. At the departmental level, we found no contextual association beween area-related socioeconomic level and the risk of ischemic heart disease mortality. Despite the continuing decline in ischemic heart disease mortality in Argentina, this study highlighted that social inequalities in mortality risk increased over time. Therefore, prevention policies should be more focused on populations of lower socioeconomic status in Argentina.
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Affiliation(s)
- Carlos Marcelo Leveau
- Instituto de Producción, Economía y Trabajo, Universidad Nacional de Lanús, Lanús, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Mustafa Hussein
- Graduate School of Public Health, The City University of New York, New York, U.S.A
| | | | - Guillermo A Velázquez
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
- Instituto de Geografía, Historia y Ciencias Sociales, Consejo Nacional de Investigaciones Científicas y Técnicas/Universidad Nacional del Centro de la Provincia de Buenos Aires, Buenos Aires, Argentina
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Rasmussen AN, Petersen KS, Overgaard C. An Overwhelming Burden of Psychosocial Stress: Life With Ischemic Heart Disease for Midlife Patients With Low Socioeconomic Status and Lack of Flexible Resources. QUALITATIVE HEALTH RESEARCH 2021; 31:2666-2677. [PMID: 34605705 DOI: 10.1177/10497323211043493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The largest social inequalities in ischemic heart disease are found in the midlife population. These inequalities are often explained by lifestyle factors, while the role of structural factors and psychosocial stress are generally less acknowledged. In this study, we explore the influence of psychosocial stress on life with ischemic heart disease for midlife patients with low socioeconomic status and lack of flexible resources. In-depth interviews were conducted with 18 participants, and a critical hermeneutic approach was used to analyze and interpret data. We found that the participants were exposed to several external psychosocial stressors related to their family relationships, employment conditions, and experiences of stigmatization. These stressors reinforced each other and created an overwhelming burden of psychosocial stress. Our findings call for supportive interventions that target external psychosocial stressors and stressful feelings among this vulnerable group of patients.
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Kuntz B, Kroll LE, Hoebel J, Schumann M, Zeiher J, Starker A, Lampert T. [Time trends of occupational differences in smoking behaviour of employed men and women in Germany : Results of the 1999-2013 microcensus]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:1388-1398. [PMID: 30215103 DOI: 10.1007/s00103-018-2818-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Studies show that people with a low occupational status are more likely to smoke than those with a high occupational status. Against the background of a general decline in tobacco consumption, time trends of occupational differences in smoking behaviour of employed men and women in Germany were examined. METHODS The analyses were based on the last five waves of the German microcensus that included questions about smoking (1999, 2003, 2005, 2009 and 2013), taking only employed men and women aged 18-64 years into account (n = 688,746). Information on occupational position was summarised using international classifications of occupation (ISEI-08 and ISCO-08). Raw and model-based standardized prevalence estimates of current smoking were calculated. RESULTS Between 1999 and 2013, the proportion of smokers in the working population fell from 39.9 to 34.4% (men) and from 30.6 to 26.8% (women). Differences between occupational status groups increased significantly: while the prevalence of smoking among employees with high occupational status decreased, it remained largely stable in the low status group. In 2013, the occupations with the highest proportion of smokers were waste disposal workers, cleaning staff, unskilled workers, truck and bus drivers, salespeople and cashiers, and employees in the catering industry. CONCLUSION Since the beginning of the 2000s, the prevalence of smoking in the working population has declined. The strengthened tobacco control policy - e. g. the establishment of smoke-free workplace laws - might have contributed to this trend. In the context of workplace health promotion, tobacco prevention and cessation measures should be targeted at those professions in which smoking is still particularly common.
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Affiliation(s)
- Benjamin Kuntz
- FG 28 Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland.
| | - Lars Eric Kroll
- FG 28 Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Jens Hoebel
- FG 28 Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Maria Schumann
- FG 28 Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Johannes Zeiher
- FG 27 Gesundheitsverhalten, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Anne Starker
- FG 27 Gesundheitsverhalten, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Thomas Lampert
- FG 28 Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
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Oshio T, Kan M. Educational level as a predictor of the incidences of non-communicable diseases among middle-aged Japanese: a hazards-model analysis. BMC Public Health 2019; 19:852. [PMID: 31262277 PMCID: PMC6604183 DOI: 10.1186/s12889-019-7182-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 06/17/2019] [Indexed: 01/12/2023] Open
Abstract
Background It is well known that there are educational inequalities in incidences of non-communicable diseases (NCDs). Unlike most preceding studies, this study examined this issue using a hazards model analysis, with specific reference to the potential mediating effects of socioeconomic status (SES), other than educational level, and health behaviour as well as gender differences. Methods Data were obtained from a 12-wave longitudinal nationwide survey conducted from 2005 to 2016 with middle-aged individuals in Japan. Participants included 31,210 individuals (15,127 men and 16,083 women) who were aged 50–59 years at wave 1. Incidences of six NCDs (diabetes, heart disease, stroke, hypertension, hyperlipidaemia, and cancer), initially diagnosed between waves 2 and 12, were considered. Cox proportional hazards models were estimated to examine their associations with educational level, adjusted for baseline SES and health behaviour. Educational inequalities were measured by the relative indices of inequality (RII). Results Lower educational level was associated with higher incidences of diabetes and stroke among both men and women, and with hypertension only among women. After controlling for baseline SES, health behaviour, and regional areas, the RII ranged from 1.37 (95% confidence interval [CI]: 1.02–1.85) for stroke among men to 2.65 (95% CI, 2.09–3.36) for diabetes among women. Small to moderate parts (0.0–32.7%) of the RII were explained by baseline SES and health behaviour. A negative association with education was observed for diabetes and hypertension among women. Conclusions Results underscored the importance of educational level as a predictor of the incidences of selected NCDs, especially among women, with limited mediating effects of other SES and health behaviour.
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Affiliation(s)
- Takashi Oshio
- Institute of Economic Research, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, 186-8603, Japan.
| | - Mari Kan
- School of Economics, University of Hyogo, 8-2-1 Gakuen-Nishi-machi, Nishi-ku, Kobe, Hyogo, 651-2197, Japan
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Franconi F, Campesi I, Colombo D, Antonini P. Sex-Gender Variable: Methodological Recommendations for Increasing Scientific Value of Clinical Studies. Cells 2019; 8:E476. [PMID: 31109006 PMCID: PMC6562815 DOI: 10.3390/cells8050476] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 02/08/2023] Open
Abstract
There is a clear sex-gender gap in the prevention and occurrence of diseases, and in the outcomes and treatments, which is relevant to women in the majority of cases. Attitudes concerning the enrollment of women in randomized clinical trials have changed over recent years. Despite this change, a gap still exists. This gap is linked to biological factors (sex) and psycho-social, cultural, and environmental factors (gender). These multidimensional, entangled, and interactive factors may influence the pharmacological response. Despite the fact that regulatory authorities recognize the importance of sex and gender, there is a paucity of research focusing on the racial/ethnic, socio-economic, psycho-social, and environmental factors that perpetuate disparities. Research and clinical practice must incorporate all of these factors to arrive at an intersectional and system-scenario perspective. We advocate for scientifically rigorous evaluations of the interplay between sex and gender as key factors in performing clinical trials, which are more adherent to real-life. This review proposes a set of 12 rules to improve clinical research for integrating sex-gender into clinical trials.
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Affiliation(s)
- Flavia Franconi
- Laboratory of Sex-gender Medicine, National Institute of Biostructures and Biosystems, 07100 Sassari, Italy.
| | - Ilaria Campesi
- Laboratory of Sex-gender Medicine, National Institute of Biostructures and Biosystems, 07100 Sassari, Italy.
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy.
| | - Delia Colombo
- Value and Access Head, Novartis Italia, 21040 Origgio, Italy.
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Hoebel J, Kuntz B, Kroll LE, Schienkiewitz A, Finger JD, Lange C, Lampert T. Socioeconomic Inequalities in the Rise of Adult Obesity: A Time-Trend Analysis of National Examination Data from Germany, 1990-2011. Obes Facts 2019; 12:344-356. [PMID: 31167203 PMCID: PMC6696774 DOI: 10.1159/000499718] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/16/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Despite extensive study of the obesity epidemic, research on whether obesity has risen faster in lower or in higher socioeconomic groups is inconsistent. This study examined secular trends in obesity prevalence by socioeconomic position and the resulting obesity inequalities in the German adult population. METHODS Data were drawn from three national examination surveys conducted in 1990-1992, 1997-1999 and 2008-2011 (n = 18,541; age range: 25-69 years). Obesity was defined by a body mass index ≥30 kg/m2 using standardised measurements of body height and weight. Education and equivalised household disposable income were used as indicators of socioeconomic position. Time trends in socioeconomic inequalities in obesity were examined using linear probability and log-binomial regression models. RESULTS In each survey period, the highest socioeconomic groups had the lowest prevalence of obesity. The low and medium socioeconomic groups showed increases in obesity prevalence, whereas no such trend was observed in the high socioeconomic groups. Absolute inequalities in obesity by income increased by an average of 0.53 percentage points per year (95% confidence interval [CI] 0.01-1.05, p = 0.047) among men and 0.47 percentage points per year (95% CI 0.05-0.90, p = 0.029) among women. Absolute inequalities in obesity by education increased on average by 0.64 percentage points per year (95% CI 0.19-1.08, p = 0.005) among women but not among men (0.33 percentage points, 95% CI -0.27 to 0.92, p = 0.283). CONCLUSIONS These findings suggest a widening obesity gap between the top and the bottom of the socioeconomic spectrum. This has the potential to have adverse consequences for population health and health inequalities in coming decades. Interventions that are effective in preventing and reducing obesity in socially disadvantaged groups are needed.
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Affiliation(s)
- Jens Hoebel
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany,
| | - Benjamin Kuntz
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Lars E Kroll
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anja Schienkiewitz
- Division of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jonas D Finger
- Division of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Cornelia Lange
- Division of Health Behaviour, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Thomas Lampert
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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