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Kalip K, Burdorf A. Health Status, Type of Contract and Labour Force Participation. JOURNAL OF PREVENTION (2022) 2024; 45:107-121. [PMID: 38017294 DOI: 10.1007/s10935-023-00759-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Health status, type of contract, education and age might affect labour force participation (LFP). We investigated possible factors associated with LFP among European countries. METHODS European Union Statistics on Income and Living Conditions (EU-SILC) data of 149,798 individuals were used and the odds ratios were calculated in logistic regression analyses. RESULTS LFP rates were higher among those in good health. Self-perceived poor health frequencies were higher in people with temporary contracts than in those with permanent contracts in Bulgaria, Finland, and Hungary, while they were lower in Republic of Serbia. Multivariate analyses revealed that having temporary contract, poor health, oldest age group, and lower educational level were associated with lower probability of being in paid employment in the total study population. Poor health was stronger driver of lower LFP than temporary contracts in Austria, Hungary, Iceland, Netherlands. Temporary contracts were stronger driver of lower LFP than poor health in Greece, Spain, Finland, Portugal, Serbia, Slovenia and total study population. CONCLUSION Both poor health and temporary contracts were associated with lower LFP. The magnitude of these associations varied among countries. Worker's health status differed by type of contract in Bulgaria, Hungary, Finland and Serbia.
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Affiliation(s)
- Kamer Kalip
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, Rotterdam, 3000 CA, Netherlands.
| | - Alex Burdorf
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, Rotterdam, 3000 CA, Netherlands
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Oude Groeniger J, Houweling TAJ, Jansen PW, Horoz N, Buil JM, van Lier PAC, van Lenthe FJ. Social inequalities in child development: the role of differential exposure and susceptibility to stressful family conditions. J Epidemiol Community Health 2023; 77:74-80. [PMID: 36428086 PMCID: PMC9872228 DOI: 10.1136/jech-2022-219548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stressful family conditions may contribute to inequalities in child development because they are more common among disadvantaged groups (ie, differential exposure) and/or because their negative effects are stronger among disadvantaged groups (ie, differential impact/susceptibility). We used counterfactual mediation analysis to investigate to what extent stressful family conditions contribute to inequalities in child development via differential exposure and susceptibility. METHODS We used data from the Generation R Study, a population-based birth cohort in the Netherlands (n=6842). Mother's education was used as the exposure. Developmental outcomes, measured at age 13 years, were emotional and behavioural problems (Youth Self-Report), cognitive development (Wechsler Intelligence Scale for Children) and secondary education entry level. Financial and social stress at age 9 years were the putative mediators. RESULTS Differential exposure to financial stress caused a 0.07 (95% CI -0.12 to -0.01) SD worse emotional and behavioural problem -score, a 0.05 (95% CI -0.08 to -0.02) SD lower intelligence score and a 0.05 (95% CI -0.05 to -0.01) SD lower secondary educational level, respectively, among children of less-educated mothers compared with children of more-educated mothers. This corresponds to a relative contribution of 54%, 9% and 6% of the total effect of mother's education on these outcomes, respectively. Estimates for differential exposure to social stress, and differential susceptibility to financial or social stress, were much less pronounced. CONCLUSION Among children of less-educated mothers, higher exposure to financial stress in the family substantially contributes to inequalities in socioemotional development, but less so for cognitive development and educational attainment.
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Affiliation(s)
- Joost Oude Groeniger
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands .,Department of Public Administration and Sociology, Erasmus University, Rotterdam, Netherlands
| | - Tanja AJ Houweling
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Pauline W Jansen
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Nil Horoz
- Dept of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - J. Marieke Buil
- Dept of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Amsterdam, Netherlands,Research Centre Urban Talent, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | - Pol AC van Lier
- Dept of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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Lu C, Wiersma R, Corpeleijn E. The association among SES, screen time, and outdoor play in children at different ages: The GECKO Drenthe study. Front Public Health 2023; 10:1042822. [PMID: 36703855 PMCID: PMC9872556 DOI: 10.3389/fpubh.2022.1042822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction This study examined the association among socioeconomic status (SES), screen time, and outdoor play in children at different ages in the GECKO Drenthe birth cohort study. Methods Valid data were obtained from two surveys at ages 3-4 years and 10-11 years. Screen time (TV watching and computer use) and outdoor play were reported by parents. Childhood SES was derived by a synthetic "Equivalized Household Income Indicator," an estimated disposable income. Quantile regression models (cross-sectional analysis) and linear regression models (change between 3-4 and 10-11 years) were used. Results In general, screen time increased strongly from a median of 51 min/day at 3-4 years (n = 888) to 122 min/day at 10-11 years (n = 1023), whereas time spent on outdoor play remained stable over age (77 min/day at 3-4 years and 81 min/day at 10-11 years). More time spent on outdoor play (50th quantile) was found in children with low SES families at 3-4 years, while at 10-11 years, more outdoor play was found in the high SES group. At 10-11 years, in the higher ranges of screen time, children from high SES had relatively lower screen time [50th quantile: -10.7 (-20.8; -0.6); 75th quantile: -13.6 (-24.4; -2.8)]. In the longitudinal analysis (n = 536), high SES was associated with an increasing time spent on outdoor play [11.7 (2.7; 20.8)]. Conclusion Socioeconomic disparities in children's outdoor play and screen behavior may be more obvious with increasing age. Low SES may facilitate both outdoor play (at 3-4 years) and screen time (at 10-11 years); however, children from high SES families develop slightly more favorable behavior patterns with age.
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Affiliation(s)
- Congchao Lu
- School of Public Health, Tianjin Medical University, Tianjin, China,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China,Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China,*Correspondence: Congchao Lu ✉
| | - Rikstje Wiersma
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Unintentional injuries and potential determinants of falls in young children: Results from the Piccolipiù Italian birth cohort. PLoS One 2022; 17:e0275521. [PMID: 36191030 PMCID: PMC9529104 DOI: 10.1371/journal.pone.0275521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 09/19/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Unintentional injuries such as falls, are particularly frequent in early childhood. To date, epidemiological studies in this field have been carried out using routine data sources or registries and many studies were observational studies with a cross-sectional design. The aims of the study are to describe unintentional injuries in the first two years of life in the Piccolipiù birth cohort, and to investigate the association between mother and children characteristics and the First Event of Raised surface Fall (FERF). METHODS This longitudinal observational study included 3038 children from an Italian birth cohort. Data on socio-demographic factors, socio-economic indicators, maternal health and lifestyle characteristics and child's sleeping behavior, obtained from questionnaires completed at birth, 12 and 24 months of age, were considered in the analyses as potential risk factors of FERF. Time of occurrence of FERF was analyzed using the Kaplan-Meier method. The multivariable analysis for time to event was carried out using a Cox proportional hazards model. RESULTS Falls from raised surfaces are the leading cause of unintentional injuries in the cohort with 610 (21.1%) and 577 (20.0%) cases among children during the first and second year of life, respectively. An increased risk of FERF was associated with several risk factors: maternal psychological distress (HR 1.41, 95%CI 1.10-1.81), maternal alcohol intake (HR 1.26, 95%CI 1.10-1.45), and child's sleeping problems (HR 1.28, 95%CI 1.09-1.51). Children with older aged mothers (HR 0.98, 95%CI 0.96-0.99) and living in northern Italy (HR 0.64, 95%CI 0.55-0.75) had a lower risk of FERF. CONCLUSION The results of the study suggest that a higher risk of FERF is associated with socio-demographic factors, maternal characteristics and child sleeping behavior that could hinder parent empowerment.
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Boelens M, Raat H, Wijtzes AI, Schouten GM, Windhorst DA, Jansen W. Associations of socioeconomic status indicators and migrant status with risk of a low vegetable and fruit consumption in children. SSM Popul Health 2022; 17:101039. [PMID: 35198723 PMCID: PMC8841774 DOI: 10.1016/j.ssmph.2022.101039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/18/2021] [Accepted: 01/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background It is important to provide insight in potential target groups for interventions to reduce socioeconomic inequalities in children's vegetable/fruit consumption. In earlier studies often single indicators of socioeconomic status (SES) or migrant status have been used. However, SES is a multidimensional concept and different indicators may measure different SES dimensions. Our objective is to explore multiple associations of SES indicators and migrant status with risk of a low vegetable/fruit consumption in a large multi-ethnic and socioeconomically diverse sample of children. Methods We included 5,010 parents of 4- to 12-year-olds from a Dutch public health survey administered in 2018. Cross-sectional associations of parental education, material deprivation, perceived financial difficulties, neighbourhood socioeconomic status (NSES) and migrant status with low (≤4 days a week) vegetable and fruit consumption in children were assessed using multilevel multivariable logistic regression models. Results are displayed as odds ratios (OR) with 95% confidence intervals (CI). Results Of the 4- to 12-year-olds, 22.1% had a low vegetable consumption and 11.9% a low fruit consumption. Low (OR 2.51; 95%CI: 2.05, 3.07) and intermediate (OR 1.83; 95%CI: 1.54, 2.17) parental education, material deprivation (OR 1.45; 95%CI: 1.19, 1.76), low NSES (OR 1.28; 95%CI: 1.04, 1.58) and a non-Western migrant status (OR 1.94; 95%CI: 1.66, 2.26) were associated with a higher risk of a low vegetable consumption. Low (OR 1.68; 95%CI: 1.31, 2.17) and intermediate (OR 1.39; 95%CI: 1.12, 1.72) parental education and material deprivation (OR 1.63; 95%CI: 11.27, 2.08) were also associated with a higher risk of a low fruit consumption. Conclusion Our findings indicate associations of multiple SES indicators and migrant status with a higher risk of a low vegetable/fruit consumption in children and thus help to identify potential target groups. Vegetable and fruit consumptions on 4 days or less a week is reported for respectively 22.1% and 11.9% of children. Children's vegetable but not fruit consumption differs between neighbourhoods. A non-Western migrant status and a low socio-economic status of the neighbourhood are associated with low vegetable consumption. Low/intermediate education and material deprivation are associated with low vegetable and fruit consumption. This study provides clues to potential entry points for reducing inequalities in vegetable and fruit consumption.
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Costa C, Santana P. Trends of amenable deaths due to healthcare within the European Union countries. Exploring the association with the economic crisis and education. SSM Popul Health 2021; 16:100982. [PMID: 34926783 PMCID: PMC8648806 DOI: 10.1016/j.ssmph.2021.100982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 02/03/2023] Open
Abstract
The study of premature deaths from causes that are generally preventable given the current availability of healthcare - called amenable deaths due to healthcare - provides information on the quality of services. However, they are not only impacted by healthcare characteristics: other factors are also likely to influence. Therefore, identifying the association between amenable deaths due to healthcare and health determinants, such as education, might be the key to preventing these deaths in the future. Still unclear however, is how this works and how amenable deaths due to healthcare are distributed and evolve within the European Union (EU) below the national level. We therefore studied the geographical and temporal patterns of amenable deaths due to healthcare in the 259 EU regions from 1999 to 2016, including the 2007-2008 financial crisis and the post-2008 economic downturn, and identified whether any association with education exists. A cross-sectional ecological study was carried out. Using a hierarchical Bayesian model, we estimated the average smoothed Standardized Mortality Ratios (sSMR). A regression model was also applied to measure the relative risks (RR) at 95% credible intervals for cause-specific mortality association with education. Results show that amenable deaths due to healthcare decreased globally. Nevertheless, the decrease is not the same across all regions, and inequalities within countries do persist, with lower mortality ratios seen in regions from Central European countries and higher mortality ratios in regions from Eastern European countries. Also, the evolution trend reveals that after the financial crisis, the number of these deaths increased in regions across almost all EU countries. Moreover, educational disparities in mortality emerged, and a statistical association was found between amenable deaths due to healthcare and early exit from education and training. These results confirm that identifying and understanding the background of regional differences may lead to a better understanding of the amenable deaths due to healthcare and allow for the application of more effective policies.
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Affiliation(s)
- Claudia Costa
- Centre of Studies in Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, Portugal
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, Portugal
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Social Deprivation Is Associated With Lower Access to Pre-emptive Kidney Transplantation and More Urgent-Start Dialysis in the Pediatric Population. Kidney Int Rep 2021; 7:741-751. [PMID: 35497781 PMCID: PMC9039898 DOI: 10.1016/j.ekir.2021.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/06/2021] [Indexed: 11/22/2022] Open
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Koltai J, Varchetta FM, McKee M, Stuckler D. The softer they fall: a natural experiment examining the health effects of job loss before and after Fornero's unemployment benefit reforms in Italy. Eur J Public Health 2021; 31:724-730. [PMID: 34491345 DOI: 10.1093/eurpub/ckab092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Job loss is a well-established social determinant of health. Recent research has taken an 'institutional turn', asking whether unemployment support could buffer the health consequences of job loss. Here, we exploit a quasi-natural experiment based on the Fornero reforms in Italy, which increased wage replacement rates from 60% to 75% on 1 January 2013. METHODS We employed difference-in-difference models using longitudinal data covering 202 incidents of job loss from the EU-Survey on Income and Living Conditions to quantify the impact of job loss on changes in self-reported health prior to and after the Fornero reforms (2011-14). RESULTS Job loss pre-Fornero was associated with health declines -0.342 [95% confidence interval (CI): -0.588 to -0.096] but did not significantly influence health post-Fornero 0.031 (95% CI: -0.101 to 0.164). The difference-in-difference estimate was 0.373 (95% CI: 0.107-0.639), or a -0.51 standard deviation in self-reported health, consistent with the buffering hypothesis. To put the magnitude of this estimate in perspective, the incidence of a chronic illness, such as diabetes, results in a similar magnitude decline in self-reported health. CONCLUSIONS Our analysis contributes to a growing body of evidence that the impact of job loss on health depends critically on the strength of social protection systems and, in some cases, could be eliminated completely.
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Affiliation(s)
- Jonathan Koltai
- Sociology Department, University of New Hampshire, Durham, NH, USA
| | - Francesco Maria Varchetta
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - David Stuckler
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
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Zhao Q, Wigmann C, Areal AT, Altug H, Schikowski T. Effect of non-optimum ambient temperature on cognitive function of elderly women in Germany. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 285:117474. [PMID: 34087635 DOI: 10.1016/j.envpol.2021.117474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/19/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
Non-optimum ambient temperature has been associated with a variety of health outcomes in the elderly population. However, few studies have examined its adverse effects on neurocognitive function. In this study, we explored the temperature-cognition association in elderly women. We investigated 777 elderly women from the German SALIA cohort during the 2007-2010 follow-up. Cognitive function was evaluated using the CERAD-Plus test battery. Modelled data on daily weather conditions were assigned to the residential addresses. The temperature-cognition association over lag 0-10 days was estimated using multivariable regression with distributed lag non-linear model. The daily mean temperature ranged between -6.7 and 26.0 °C during the study period for the 777 participants. We observed an inverse U-shaped association in elderly women, with the optimum temperature (15.3 °C) located at the 68th percentile of the temperature range. The average z-score of global cognitive function declined by -0.31 (95%CI: 0.73, 0.11) for extreme cold (the 2.5th percentile of temperature range) and -0.92 (95%CI: 1.50, -0.33) for extreme heat (the 97.5th percentile of temperature range), in comparison to the optimum temperature. Episodic memory was more sensitive to heat exposure, while semantic memory and executive function were the two cognitive domains sensitive to cold exposure. Individuals living in an urban area and those with a low educational level were particularly sensitive to extreme heat. In summary, non-optimum temperature was inversely associated with cognitive function in elderly women, with the effect size for heat exposure particularly substantial. The strength of association varied by cognitive domains and individual characteristics.
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Affiliation(s)
- Qi Zhao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Claudia Wigmann
- Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Ashtyn Tracey Areal
- Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Hicran Altug
- Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Tamara Schikowski
- Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
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Moran V, Suhrcke M, Ruiz-Castell M, Barré J, Huiart L. Investigating unmet need for healthcare using the European Health Interview Survey: a cross-sectional survey study of Luxembourg. BMJ Open 2021; 11:e048860. [PMID: 34344682 PMCID: PMC8336210 DOI: 10.1136/bmjopen-2021-048860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We investigate the prevalence of unmet need arising from wait times, distance/transportation and financial affordability using the European Health Interview Survey. We explore associations between individual characteristics and the probability of reporting unmet need. DESIGN Cross-sectional survey conducted between February and December 2014. SETTING AND PARTICIPANTS 4004 members of the resident population in private households registered with the health insurance fund in Luxembourg aged 15 years and over. OUTCOME MEASURES Six binary variables that measured unmet need arising from wait time, distance/transportation and affordability of medical, dental and mental healthcare and prescribed medicines among those who reported a need for care. RESULTS The most common barrier to access arose from wait times (32%) and the least common from distance/transportation (4%). Dental care (12%) was most often reported as unaffordable, followed by prescribed medicines (6%), medical (5%) and mental health (5%) care. Respondents who reported bad/very bad health were associated with a higher risk of unmet need compared with those with good/very good health (wait: OR 2.41, 95% CI 1.53 to 3.80, distance/transportation: OR 7.12, 95% CI 2.91 to 17.44, afford medical care: OR 5.35, 95% CI 2.39 to 11.95, afford dental care: OR 3.26, 95% CI 1.86 to 5.71, afford prescribed medicines: OR 2.22, 95% CI 1.04 to 4.71, afford mental healthcare: OR 3.58, 95% CI 1.25 to 10.30). Income between the fourth and fifth quintiles was associated with a lower risk of unmet need for dental care (OR 0.29, 95% CI 0.16 to 0.53), prescribed medicines (OR 0.38, 95% CI 0.17 to 0.82) and mental healthcare (OR 0.17, 95% CI 0.05 to 0.61) compared with income between the first and second quintiles. CONCLUSIONS Recent and planned reforms to address waiting times and financial barriers to accessing healthcare may help to address unmet need. In addition, policy-makers should consider additional policies targeted at high-risk groups with poor health and low incomes.
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Affiliation(s)
- Valerie Moran
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
- Living Conditions department, Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette/Belval, Luxembourg
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York, UK
- Health and Health Systems, Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette/Belval, Luxembourg
| | - Maria Ruiz-Castell
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Jessica Barré
- Service Nomenclature, conventions, analyse et prospective, Caisse nationale de santé, Luxembourg, Luxembourg
| | - Laetitia Huiart
- Direction générale, Santé publique France, Saint-Maurice, France
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Rajan S, Ricciardi W, McKee M. The SDGs and health systems: the last step on the long and unfinished journey to universal health care? Eur J Public Health 2021; 30:i28-i31. [PMID: 32391906 PMCID: PMC7213413 DOI: 10.1093/eurpub/ckaa035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In 2015, the world’s governments committed, in the Sustainable Development Goals (SDGs), to achieve universal health coverage by 2030, something they will be held accountable for. We examine progress in the WHO European Region using data from several sources. We assess effective coverage using data from the Global Burden of Disease Programme, including access to 9 key interventions for maternal and child health and communicable and non-communicable diseases and mortality from 32 conditions amenable to health care. Progress is mixed; while Finland and Iceland have already achieved the 2030 target already, other countries, including in the Caucasus and Central Asia have not yet, and are unlikely to by 2030. We then examine financial protection, where progress lags in Central and South East Europe and the former Soviet Union, where high out-of-pocket healthcare payments and catastrophic spending are still common. We stress the need to consider inequalities within countries, with the most vulnerable groups, such as Roma or newly arrived migrants (from the Middle East and Africa) often underserved, while their needs are frequently undocumented. To make progress on the SDGs, governments must invest more heavily in health services research and support the infrastructure and capacity required to enable it.
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Affiliation(s)
- Selina Rajan
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, UK
| | - Walter Ricciardi
- Department of Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Martin McKee
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, UK.,European Observatory on Health Systems and Policies, Brussels, Belgium
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Baranowska-Rataj A, Strandh M. When things go wrong with you, it hurts me too: The effects of partner's employment status on health in comparative perspective. JOURNAL OF EUROPEAN SOCIAL POLICY 2021; 31:143-160. [PMID: 34012221 PMCID: PMC8107445 DOI: 10.1177/0958928720963330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The effects of changes in employment status on health within couples have attracted increasing attention. This paper contributes to this emerging research by investigating whether the impact of a partner's employment status on individual self-rated health varies systematically across countries with varying decommodification levels. We use longitudinal data from the European Union Statistics on Income and Living Conditions (EU-SILC) and hybrid models. We find that a change in an individual's employment status may affect the health not just of the person who experiences this transition, but that of his or her partner. The likelihood that such a spillover will occur varies across countries with different decommodification levels. The negative effects of a partner's employment status on self-rated health are observed when the generosity of welfare state support is limited. The moderating effects of financial support from the state are not very strong, though. They are not robust across all our models and do not extend to all the dimensions of the generosity of welfare state support.
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Affiliation(s)
- Anna Baranowska-Rataj
- Anna Baranowska-Rataj, Department of
Sociology and Centre for Demographic and Ageing Research, Umeå University,
Mediagränd 14, 901 87 Umeå, Sweden.
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Senaratne N, Stubbs B, Werneck AO, Stamatakis E, Hamer M. Device-measured physical activity and sedentary behaviour in relation to mental wellbeing: An analysis of the 1970 British cohort study. Prev Med 2021; 145:106434. [PMID: 33485998 DOI: 10.1016/j.ypmed.2021.106434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/03/2021] [Accepted: 01/17/2021] [Indexed: 11/25/2022]
Abstract
Although physical activity and sedentary behaviour have established associations with mental illness, the extent to which they impact on mental wellbeing is not well understood. We examined associations between moderate to vigorous physical activity (MVPA), sitting time (ST) and mental wellbeing in 4526 participants from the 1970 British Cohort Study (UK) in the age 46 survey (2016-18). MVPA and ST were measured using a thigh mounted accelerometer device (activPAL 3 micro) worn continuously for 7 days and participants completed the 14-item Warwick-Edinburg Mental Wellbeing Scale (WEMWBS) to assess mental wellbeing. In linear regression models MVPA (per hr) was associated with an additional 0.57 points on the WEMWBS (95% CI 0.03-1.12) regardless of gender, wear time, education, socioeconomic status, smoking, body mass index, disability and psychological distress. ST was not associated with WEMWBS in the adjusted models (B = -0.11, -0.23, 0.02). In MVPA stratified analyses, ST showed a linear trend with WEMBS in participants with low levels of MVPA but not in medium and high MVPA categories. In this large, nationally representative cohort, device-measured MVPA showed an association with higher mental wellbeing whilst ST was only associated with reduced mental wellbeing in participants with low levels of MVPA. Our main limitation was the cross-sectional design which precludes any inference of direction of association or causality. Nevertheless, interventions to promote MVPA may be an effective public health policy to promote mental wellbeing. Further investigation of the effect different sitting behaviours has on mental wellbeing is warranted.
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Affiliation(s)
- Nipuna Senaratne
- The Institute of Sport, Exercise & Health, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom.
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; South London Maudsley NHS Foundation Trust, London, United Kingdom
| | - André O Werneck
- Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, Brazil
| | - Emmanuel Stamatakis
- Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Mark Hamer
- The Institute of Sport, Exercise & Health, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom
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14
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Rubio Valverde JR, Mackenbach JP, Nusselder WJ. Trends in inequalities in disability in Europe between 2002 and 2017. J Epidemiol Community Health 2021; 75:712-720. [PMID: 33674458 PMCID: PMC8292565 DOI: 10.1136/jech-2020-216141] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/18/2021] [Accepted: 02/26/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Monitoring socioeconomic inequalities in population health is important in order to reduce them. We aim to determine if educational inequalities in Global Activity Limitation Indicator (GALI) disability have changed between 2002 and 2017 in Europe (26 countries). METHODS We used logistic regression to quantify the annual change in disability prevalence by education, as well as the annual change in prevalence difference and ratio, both for the pooled sample and each country, as reported in the European Union Statistics on Income and Living Conditions (EU-SILC) and the European Social Survey (ESS) for individuals aged 30-79 years. RESULTS In EU-SILC, disability prevalence tended to decrease among the high educated. As a result, both the prevalence difference and the prevalence ratio between the low and high educated increased over time. There were no discernible trends in the ESS. However, there was substantial heterogeneity between countries in the magnitude and direction of these changes, but without clear geographical patterns and without consistency between surveys. CONCLUSIONS Socioeconomic inequalities in disability appear to have increased over time in Europe between 2002 and 2017 as per EU-SILC, and have persisted as measured by the ESS. Efforts to further harmonise disability instruments in international surveys are important, and so are studies to better understand international differences in disability trends and inequalities.
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Affiliation(s)
- Jose R Rubio Valverde
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wilma J Nusselder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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15
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Santos JV, Viana J, Devleesschauwer B, Haagsma JA, Santos CC, Ricciardi W, Freitas A. Health expectancies in the European Union: same concept, different methods, different results. J Epidemiol Community Health 2021; 75:764-771. [PMID: 33452161 DOI: 10.1136/jech-2020-213791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 11/15/2020] [Accepted: 12/20/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Healthy life expectancy (HLE) is a population health measure that combines mortality and morbidity, which can be calculated using different methods. In this study, we aimed to assess the correlation, reliability and (dis)agreement between two estimates monitored in the European Union (EU), that is, the European Commission's HLE based on self-perceived health (SPH-HLE) and the Institute for Health Metrics and Evaluation's HLE based on disability weight (DW-HLE), by sex, and comparing these results with LE and proportion of life spent in good health (%GH). METHODS We performed a retrospective study in the EU28 countries, between 2010 and 2017. The HLE methods differ in definition, measurement and valuation of health states. While SPH-HLE relies directly on one question, DW-HLE relies on epidemiological data adjusted for DW. Spearman's r, intraclass correlation coefficient, information-based measure of disagreement and Bland-Altman plots were used to assess reliability, correlation and disagreement in HLE resulting from both methods and in LE or %GH measured by both institutions. RESULTS Correlation and reliability between SPH-HLE and DW-HLE were good (better for males), with low disagreement, and were even better for LE between both institutions. The HLE Bland-Altman plots suggest a variability range of approximately 6 years for both sexes, higher for females. There was also an increasing HLE difference between methods with higher average HLE for both sexes. CONCLUSION We showed wide variations between both methods with a clear and different high impact on female and male HLE, showing a tendency for countries with higher health expectancies to yield larger gaps between SPH-HLE and DW-HLE.
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Affiliation(s)
- João Vasco Santos
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal .,CINTESIS-Centre for Health Technology and Services Research, Porto, Portugal.,Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Espinho/Gaia, Portugal
| | - João Viana
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS-Centre for Health Technology and Services Research, Porto, Portugal
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Juanita A Haagsma
- Erasmus MC, University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Cristina Costa Santos
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS-Centre for Health Technology and Services Research, Porto, Portugal
| | - Walter Ricciardi
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | - Alberto Freitas
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS-Centre for Health Technology and Services Research, Porto, Portugal
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16
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Gaps in coverage and access in the European Union. Health Policy 2020; 125:341-350. [PMID: 33431257 DOI: 10.1016/j.healthpol.2020.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/04/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022]
Abstract
This study identifies gaps in universal health coverage in the European Union, using a questionnaire sent to the Health Systems and Policy Monitor network of the European Observatory on Health Systems and Policies. The questionnaire was based on a conceptual framework with four access dimensions: population coverage, service coverage, cost coverage, and service access. With respect to population coverage, groups often excluded from statutory coverage include asylum seekers and irregular residents. Some countries exclude certain social-professional groups (e.g. civil servants) from statutory coverage but cover these groups under alternative schemes. In terms of service coverage, excluded or restricted services include optical treatments, dental care, physiotherapy, reproductive health services, and psychotherapy. Early access to new and expensive pharmaceuticals is a concern, especially for rare diseases and cancers. As to cost coverage, some countries introduced protective measures for vulnerable patients in the form of exemptions or ceilings from user chargers, especially for deprived groups or patients with accumulation of out-of-pocket spending. For service access, common issues are low perceived quality and long waiting times, which are exacerbated for rural residents who also face barriers from physical distance. Some groups may lack physical or mental ability to properly formulate their request for care. Currently, available indicators fail to capture the underlying causes of gaps in coverage and access.
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17
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Boelens M, Raat H, Yang-Huang J, Schouten GM, van Grieken A, Jansen W. Independent contributions of family and neighbourhood indicators of socioeconomic status and migrant status to risk of mental health problems in 4-12 year old children. SSM Popul Health 2020; 12:100675. [PMID: 33072844 PMCID: PMC7548441 DOI: 10.1016/j.ssmph.2020.100675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/24/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022] Open
Abstract
Rationale A range of family and neighbourhood indicators of socioeconomic status and migrant status have been shown to be associated with risk of mental health l problems (MHP) in children. In this study we determined the independent contributions of these indicators. Objectives The main objective is to examine independent associations of family and neighbourhood socioeconomic status indicators and migrant status with risk of MHP in children. Methods We analyzed data from an anonymous public health survey among 5010 parents/caretakers of children aged 4–12 years living in Rotterdam, The Netherlands, gathered in 2018. Outcome of interest was risk of MHP measured using the total difficulties score of the Strengths and Difficulties Questionnaire. Associations of parent-reported perceived financial difficulties, material deprivation (not being able to provide certain goods, or leisure, educational or cultural activities or care use for children due to financial restrictions), parental educational level, child's migrant status and neighbourhood socioeconomic status with risk of MHP and with the total difficulties score were assessed using multilevel multivariable logistic and linear regression models. Results In total, 473 (9.5%) children had a high risk of MHP. We observed independent associations of perceived financial difficulties, material deprivation and parental educational level with risk of MHP and with an increase in total difficulties score (P < 0.05). Migrant status and neighbourhood socioeconomic status were not independently associated with risk of MHP or a change in total difficulties score. Conclusions Already in early life, perceived financial difficulties by parents, material deprivation reported by parents and lower parental education appeared to be independently associated with the risk of MHP in 4–12 year olds. Health professionals should be aware of the relatively higher risks in these subgroups and consider policies address this. Uses multilevel models to examine associations with child mental health problems. Mat erial deprivation increases risk of child mental health problems. Lower parental education increases risk of child mental health problems. Studies risk of SES indicators and migrant status on child mental health problems.
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Affiliation(s)
- Mirte Boelens
- Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Junwen Yang-Huang
- Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Gea M Schouten
- Department of Research and Business Intelligence, Municipality of Rotterdam, P O Box 3001, Rotterdam, AH, the Netherlands
| | - Amy van Grieken
- Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Wilma Jansen
- Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.,Department of Social Development, Municipality of Rotterdam, PO Box 70032, LP, Rotterdam, the Netherlands
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18
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Roxo L, Bambra C, Perelman J. Gender Equality and Gender Inequalities in Self-Reported Health: A Longitudinal Study of 27 European Countries 2004 to 2016. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 51:146-154. [PMID: 33019863 PMCID: PMC8114429 DOI: 10.1177/0020731420960344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Significant gender-based health inequalities have been observed across Europe, with women reporting worse health than men. Still, there has been little examination of how the gender–health gap has changed over time, and how it has been shaped by societal gender equality. We used data from the Statistics on Income and Living Conditions Eurostat database (EU-SILC), involving 2,931,081 participants aged 25–64, for 27 European countries. Logistic regressions were performed to model the association between self-reported bad health and gender, in general and over time. Analyses were stratified by employment, education, and clusters of countries according to levels of Gender Equality Index (GEI). Adjusting for age, year, and country, bad health was 17% more likely among women, but this disadvantage ceased after accounting for education and employment. Gender–health inequalities were larger among countries with higher GEI scores and among low-educated groups. The gender–health gap did not reduce significantly between 2004 and 2016, in general and within subgroups. Although societies are becoming more equal, persistent inequalities in employment and income still lead to sustained health differences between men and women.
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Affiliation(s)
- Luis Roxo
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Clare Bambra
- Faculty of Medical Sciences, Institute for Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Julian Perelman
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal.,Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal
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19
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Bayesian analysis of Turkish Income and Living Conditions data, using clustered longitudinal ordinal modelling with Bridge distributed random effects. STAT MODEL 2020. [DOI: 10.1177/1471082x20920122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article is motivated by the panel surveys, called Statistics on Income and Living Conditions (SILC), conducted annually on (randomly selected) country representative households to monitor EU 2020 aims on poverty reduction. We particularly consider the surveys conducted in Turkey within the scope of integration to the EU. Our main interests are on health aspects of economic and living conditions. The outcome is self-reported health that is clustered longitudinal ordinal, since repeated measures of it are nested within individuals and individuals are nested within families. Economic and living conditions have been measured through a number of individual- and family-level explanatory variables. The questions of interest are on the marginal relationships between the outcome and covariates that we address using a polytomous logistic regression with Bridge distributed random effects. This choice of distribution allows us to directly obtain marginal inferences in the presence of random effects. Widely used Normal distribution is also considered as the random effects distribution. Samples from the joint posterior densities of parameters and random effects are drawn using Markov Chain Monte Carlo. Interesting findings from the public health point of view are that differences were found between the subgroups of employment status, income level and panel year in terms of odds of reporting better health.
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20
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Calocer F, Dejardin O, Kwiatkowski A, Bourre B, Vermersch P, Hautecoeur P, Launoy G, Defer G. Socioeconomic deprivation increases the risk of disability in multiple sclerosis patients. Mult Scler Relat Disord 2020; 40:101930. [DOI: 10.1016/j.msard.2020.101930] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/25/2019] [Accepted: 01/02/2020] [Indexed: 11/16/2022]
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21
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Measuring Child Socio-Economic Position in Birth Cohort Research: The Development of a Novel Standardized Household Income Indicator. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051700. [PMID: 32150940 PMCID: PMC7084936 DOI: 10.3390/ijerph17051700] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
The assessment of early life socioeconomic position (SEP) is essential to the tackling of social inequalities in health. Although different indicators capture different SEP dimensions, maternal education is often used as the only indicator in birth cohort research, especially in multi-cohort analyses. Household income, as a direct measure of material resources, is one of the most important indicators, but one that is underused because it is difficult to measure through questionnaires. We propose a method to construct a standardized, cross-cohort comparable income indicator, the “Equivalized Household Income Indicator (EHII)”, which measures the equivalized disposable household income, using external data from the pan-European Union Statistics on Income and Living Conditions (EUSILC) surveys, and data from the cohorts. We apply this method to four studies, Piccolipiù and NINFEA from Italy and ELFE and EDEN from France, comparing the distribution of EHII with other SEP-related variables available in the cohorts, and estimating the association between EHII and child body mass index (BMI). We found that basic parental and household characteristics may be used, with a fairly good performance, to predict the household income. We observed a strong correlation between EHII and both the self-reported income, whenever available, and other individual socioeconomic-related variables, and an inverse association with child BMI. EHII could contribute to improving research on social inequalities in health, in particular in the context of European birth cohort collaborative studies.
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22
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Mezzetti M, Palli D, Dominici F. Combining individual and aggregated data to investigate the role of socioeconomic disparities on cancer burden in Italy. Stat Med 2020; 39:26-44. [PMID: 31746020 DOI: 10.1002/sim.8392] [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: 07/02/2018] [Revised: 07/19/2019] [Accepted: 09/18/2019] [Indexed: 11/06/2022]
Abstract
Quantifying socioeconomic disparities and understanding the roots of inequalities are growing topics in cancer research. However, socioeconomic differences are challenging to investigate mainly due to the lack of accurate data at individual-level, while aggregate indicators are only partially informative. We implemented a multiple imputation algorithm within a statistical matching framework that combines diverse sources of data to estimate individual-level associations between income and risk of breast and lung cancer, adjusting for potential confounding factors in Italy. The framework is computationally flexible and can be adapted to similar contexts.
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Affiliation(s)
- Maura Mezzetti
- Department of Economics and Finance, Università "Tor Vergata", Rome, Italy
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute, ISPRO, Florence, Italy
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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23
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Barlow P, Reeves A, McKee M, Stuckler D. Employment relations and dismissal regulations: Does employment legislation protect the health of workers? SOCIAL POLICY & ADMINISTRATION 2019; 53:939-957. [PMID: 33776168 PMCID: PMC7983177 DOI: 10.1111/spol.12487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 06/12/2023]
Abstract
Sociologists have long acknowledged that being in a precarious labour market position, whether employed or unemployed, can harm peoples' health. However, scholars have yet to fully investigate the possible contextual, institutional determinants of this relationship. Two institutions that were overlooked in previous empirical studies are the regulations that set minimum compensation for dismissal, severance payments, and entitlements to a period of notice before dismissal, notice periods. These institutions may be important for workers' health as they influence the degree of insecurity that workers are exposed to. Here, we test this hypothesis by examining whether longer notice periods and greater severance payments protect the health of labour market participants, both employed and unemployed. We constructed two cohorts of panel data before and during the European recession using data from 22 countries in the European Union Statistics on Income and Living Conditions (person years = 338,000). We find more generous severance payments significantly reduce the probability that labour market participants, especially the unemployed, will experience declines in self-reported health, with a slightly weaker relationship for longer notice periods.
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Affiliation(s)
- Pepita Barlow
- Bennett Institute for Public Policy, Department of Politics and International StudiesUniversity of CambridgeCambridgeUK
| | - Aaron Reeves
- International Inequalities InstituteLondon School of Economics and Political ScienceLondonUK
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Martin McKee
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - David Stuckler
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Department of Social and Political SciencesBocconi UniversityMilanItaly
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24
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Social deprivation is associated with poor kidney transplantation outcome in children. Kidney Int 2019; 96:769-776. [DOI: 10.1016/j.kint.2019.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/19/2022]
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25
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Karanikolos M, Mackenbach JP, Nolte E, Stuckler D, McKee M. Amenable mortality in the EU-has the crisis changed its course? Eur J Public Health 2019; 28:864-869. [PMID: 29982338 DOI: 10.1093/eurpub/cky116] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Did the global financial crisis and its aftermath impact upon the performance of health systems in Europe? We investigated trends in amenable and other mortality in the EU since 2000 across 28 EU countries. Methods We use WHO detailed mortality files from 28 EU countries to calculate age-standardized deaths rates from amenable and other causes. We then use joinpoint regression to analyse trends in mortality before and after the onset of the economic crisis in Europe in 2008. Results Amenable and other mortality have declined in the EU since 2000, albeit faster for amenable mortality. We observed increases in amenable mortality following the global financial crisis for females in Estonia [from -4.53 annual percentage change (APC) in 2005-12 to 0.03 APC in 2012-14] and Slovenia (from -4.22 APC in 2000-13 to 0.73 in 2013-15) as well as males and females in Greece(males: from -2.93 APC in 2000-10 to 0.01 APC in 2010-13; females: from -3.48 APC in 2000-10 to 0.06 APC in 2010-13). Other mortality continued to decline for these populations. Increases in deaths from infectious diseases before and after the crisis played a substantial part in reversals in Estonia, Slovenia and Greece. Conclusion There is evidence that amenable mortality rose in Greece and, among females in Estonia and Slovenia. However, in most countries, trends in amenable mortality rates appeared to be unaffected by the crisis.
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Affiliation(s)
- M Karanikolos
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK
| | - J P Mackenbach
- Department of Public Health, Erasmus University Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - E Nolte
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK
| | - D Stuckler
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - M McKee
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK
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26
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Zack R, Okunade O, Olson E, Salt M, Amodeo C, Anchala R, Berwanger O, Campbell N, Chia YC, Damasceno A, Phuong Do TN, Tamdja Dzudie A, Fiuza M, Mirza F, Nitsch D, Ogedegbe G, Podpalov V, Schiffrin EL, Vaz Carneiro A, Lamptey P. Improving Hypertension Outcome Measurement in Low- and Middle-Income Countries. Hypertension 2019; 73:990-997. [DOI: 10.1161/hypertensionaha.118.11916] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rachel Zack
- From the International Consortium for Health Outcomes Measurement (ICHOM) (O.O., E.O., M.S., R.Z.)
| | - Oluwakemi Okunade
- From the International Consortium for Health Outcomes Measurement (ICHOM) (O.O., E.O., M.S., R.Z.)
| | - Elizabeth Olson
- From the International Consortium for Health Outcomes Measurement (ICHOM) (O.O., E.O., M.S., R.Z.)
| | - Matthew Salt
- From the International Consortium for Health Outcomes Measurement (ICHOM) (O.O., E.O., M.S., R.Z.)
| | | | - Raghupathy Anchala
- The Public Health Foundation of India, Indian Institute of Public Health, Hyderabad (R.A.)
| | | | | | - Yook-Chin Chia
- Sunway University; University of Malaya; and Malaysian Society of Hypertension (Y.-C.C.)
| | | | | | | | - Manuela Fiuza
- CCUL, Faculdade de Medicina da Universidade de Lisboa (M.F.)
| | | | | | | | - Vladislav Podpalov
- Belarusian Hypertension Society, Vitebsk State Medical University (V.P.)
| | | | - António Vaz Carneiro
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina da Universidade de Lisboa, Portugal (A.V.C.)
| | - Peter Lamptey
- FHI360, London School of Hygiene & Tropical Medicine (P.L.)
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27
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Freigoun MT, Rivera DE, Guo P, Hohman EE, Gernand AD, Downs DS, Savage JS. A Dynamical Systems Model of Intrauterine Fetal Growth. MATHEMATICAL AND COMPUTER MODELLING OF DYNAMICAL SYSTEMS 2018; 24:661-687. [PMID: 30498392 PMCID: PMC6258009 DOI: 10.1080/13873954.2018.1524387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 09/12/2018] [Indexed: 06/09/2023]
Abstract
The underlying mechanisms for how maternal perinatal obesity and intrauterine environment influence fetal development are not well understood and thus require further understanding. In this paper, energy balance concepts are used to develop a comprehensive dynamical systems model for fetal growth that illustrates how maternal factors (energy intake and physical activity) influence fetal weight and related components (fat mass, fat-free mass, and placental volume) over time. The model is estimated from intensive measurements of fetal weight and placental volume obtained as part of Healthy Mom Zone (HMZ), a novel intervention for managing gestational weight gain in obese/overweight women. The overall result of the modeling procedure is a parsimonious system of equations that reliably predicts fetal weight gain and birth weight based on a sensible number of assessments. This model can inform clinical care recommendations as well as how adaptive interventions, such as HMZ, can influence fetal growth and birth outcomes.
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Affiliation(s)
- Mohammad T. Freigoun
- Control Systems Engineering Laboratory, School for the Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ, USA
| | - Daniel E. Rivera
- Control Systems Engineering Laboratory, School for the Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ, USA
| | - Penghong Guo
- Control Systems Engineering Laboratory, School for the Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ, USA
| | - Emily E. Hohman
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
| | - Alison D. Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Danielle Symons Downs
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer S. Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
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Zhou Y, Yao X, Jian W. Improving health equity: changes in self-assessed health across income groups in China. Int J Equity Health 2018; 17:94. [PMID: 29970088 PMCID: PMC6029271 DOI: 10.1186/s12939-018-0808-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Beginning in 2010, China has endeavoured to expand health coverage and provide residents with fair access to primary health care with the intention of improving health equity. This study aims to measure changes in income-related health inequity in China between 2010 and 2014. METHODS Data were extracted from the nationally representative annual survey of the China Family Panel Studies in 2010 and 2014 with a first wave of 31,743 respondents and a second wave of 32,006 respondents over age 15. In both years, subjects were stratified into the following five categories of income: poorest 20%, lower 20%, medium 20%, higher 20% and richest 20%. The concentration curve and index was used to compare the distribution of health status in income quintiles, and a logistic model was used to examine the relationship between health and socioeconomic indicators with self-assessed health as the primary outcome of interest. RESULTS Income was significantly associated with self-assessed health in China. The concentration curve was above the line of equality in both years, while the self-assessed health line in 2014 was closer to the equality line. The concentration index (CIN) displayed the similar result of decreasing inequality, with the CIN in 2014 (- 0.157) closer to zero (the line of equality) than that of 2010 (- 0.167). In 2010, there was a decreasing trend of people reporting poor health from the poorest to the richest, while in 2014, there was no significant difference between the poorest and lower 20% or between the higher 20% and the medium 20%. The odds ratio of the prevalence of self-reporting poor health between the poorest and richest increased from 0.555 (95% CI: 0.484-0.636) in 2010 to 0.598 (95% CI: 0.513-0.696) in 2014. CONCLUSIONS From 2010 to 2014, the self-assessed health gap between income groups in China decreased, and health equity improved. However, health differences remain. In order to achieve better health for all, China should further strengthen the role of primary care in reducing health inequity.
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Affiliation(s)
- Yuqi Zhou
- Department of Health Policy and Management, Peking University School of Public Health, Xueyuan Road 38, Haidian District, Beijing, 100191, China
| | - Xi Yao
- Department of Health Policy and Management, Peking University School of Public Health, Xueyuan Road 38, Haidian District, Beijing, 100191, China
| | - Weiyan Jian
- Department of Health Policy and Management, Peking University School of Public Health, Xueyuan Road 38, Haidian District, Beijing, 100191, China.
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Van der Heyden J, De Bacquer D, Gisle L, Demarest S, Charafeddine R, Drieskens S, Tafforeau J, Van Oyen H, Van Herck K. Additional weighting for education affects estimates from a National Health Interview Survey. Eur J Public Health 2018; 27:892-897. [PMID: 28204447 DOI: 10.1093/eurpub/ckx005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background National Health Interview Surveys are used to produce country-wide results for a substantial number of health indicators. However, if some educational groups are underrepresented in the sample, estimates may be biased. This study investigated the impact of the use of post-stratification weights that adjust for the population distribution by education on estimates from the Belgian Health Interview Survey 2013. Methods For 25 health-related indicators that match the European Core Health Indicator shortlist, estimates were computed using two different sets of post-stratification weights: one based on age group, gender and province only and the other one including also education. The Census 2011 was used as auxiliary data source. Statistical differences between the two estimates were assessed with the Delta method. Results If education is not included as post-stratification weighting factor, low educational groups (ISCED 0-2) represent 31.1% of the total study population aged 25 years and older. If education is taken into account this proportion rises to 40.3%. The use of post-stratification weights adjusting for the population distribution by education has an impact on several survey estimates. The most pronounced effect is an increase in the estimated proportion of people with diabetes (+0.73%; 95% CI 0.19-1.27; relative increase +11.6%), asthma (+0.52%; 95% CI, 0.06-0.98; relative increase +12.4%) and difficulties to cover their health expenses (+2.31%; 95% CI, 1.52-3.10; relative increase +9.4%). Conclusions Including education in the calculation of post-stratification weights reduces bias due to educational differences in survey participation. Auxiliary information used to calculate post-stratification weights for national health surveys should include education.
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Affiliation(s)
- Johan Van der Heyden
- Department of Public Health and Surveillance Brussels, Scientific Institute of Public Health, Belgium.,Department of Public Health Ghent, University Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health Ghent, University Ghent, Belgium
| | - Lydia Gisle
- Department of Public Health and Surveillance Brussels, Scientific Institute of Public Health, Belgium
| | - Stefaan Demarest
- Department of Public Health and Surveillance Brussels, Scientific Institute of Public Health, Belgium
| | - Rana Charafeddine
- Department of Public Health and Surveillance Brussels, Scientific Institute of Public Health, Belgium
| | - Sabine Drieskens
- Department of Public Health and Surveillance Brussels, Scientific Institute of Public Health, Belgium
| | - Jean Tafforeau
- Department of Public Health and Surveillance Brussels, Scientific Institute of Public Health, Belgium
| | - Herman Van Oyen
- Department of Public Health and Surveillance Brussels, Scientific Institute of Public Health, Belgium.,Department of Public Health Ghent, University Ghent, Belgium
| | - Koen Van Herck
- Department of Public Health Ghent, University Ghent, Belgium
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Zurlo MC, Vallone F, Smith AP. Effects of Individual Differences and Job Characteristics on the Psychological Health of Italian Nurses. EUROPES JOURNAL OF PSYCHOLOGY 2018; 14:159-175. [PMID: 29899804 PMCID: PMC5973523 DOI: 10.5964/ejop.v14i1.1478] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/02/2017] [Indexed: 11/20/2022]
Abstract
The Demand Resources and Individual Effects Model (DRIVE Model) is a transactional model that integrates Demands- Control-Support and Effort-Reward Imbalance models emphasising the role of individual (Coping Strategies; Overcommitment) and job characteristics (Job Demands, Social Support, Decision Latitude, Skill Discretion, Effort, Rewards) in the work-related stress process. The present study aimed to test the DRIVE Model in a sample of 450 Italian nurses and to compare findings with those of a study conducted in a sample of UK nurses. A questionnaire composed of Ways of Coping Checklist-Revised (WCCL-R); Job Content Questionnaire (JCQ); ERI Test; Hospital Anxiety and Depression Scale (HADS) was used. Data supported the application of the DRIVE Model to the Italian context, showing significant associations of the individual characteristics of Problem-focused, Seek Advice and Wishful Thinking coping strategies and the job characteristics of Job Demands, Skill Discretion, Decision Latitude, and Effort with perceived levels of Anxiety and Depression. Effort represented the best predictor for psychological health conditions among Italian nurses, and Social Support significantly moderated the effects of Job Demands on perceived levels of Anxiety. The comparison study showed significant differences in the risk profiles of Italian and UK nurses. Findings were discussed in order to define focused interventions to promote nurses’ wellbeing.
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Affiliation(s)
- Maria Clelia Zurlo
- Department of Political Sciences, University of Naples Federico II, Naples, Italy
| | - Federica Vallone
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Andrew P Smith
- Centre for Occupational and Health Psychology, Cardiff University, Cardiff, Wales, United Kingdom
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Dimitrovová K, Perelman J. Changes in access to primary care in Europe and its patterning, 2007–12: a repeated cross-sectional study. Eur J Public Health 2018; 28:398-404. [DOI: 10.1093/eurpub/cky019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Klára Dimitrovová
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Julian Perelman
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
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Smith D, Thompson C, Harland K, Parker S, Shelton N. Identifying populations and areas at greatest risk of household food insecurity in England. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2018; 91:21-31. [PMID: 29915447 PMCID: PMC6003598 DOI: 10.1016/j.apgeog.2017.12.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite the increasing recognition of household food insecurity as a policy issue, there is currently no routine measurement of food insecurity in the UK. There is nothing to suggest that Government will address this in the near future for all parts of the UK. In which case, policy makers and campaigners might instead seek out consistent and robust measures of the population-level factors which are known to contribute to food insecurity. However, no systematic measures exist, meaning that resources may not be targeted at those areas most in need. This paper presents the first objective estimate of high population-level risk of household food insecurity in English neighbourhoods (4.09% of the population, 95%CI 4.08-4.10) using public data. Estimated geographic distribution of factors contributing to household food insecurity is customisable to local pressures and is adaptable to settings outside of England.
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Socioeconomic status and biomedical risk factors in migrants and native tuberculosis patients in Italy. PLoS One 2017; 12:e0189425. [PMID: 29253014 PMCID: PMC5734730 DOI: 10.1371/journal.pone.0189425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/26/2017] [Indexed: 11/19/2022] Open
Abstract
Action on social determinants is a main component of the World Health Organization End Tuberculosis (TB) Strategy. The aim of the study was to collect information on socioeconomic characteristics and biomedical risk factors in migrant TB patients in Italy and compare it with data collected among Italian TB patients. A cross-sectional study was conducted among TB patients aged ≥18 years over a 12-months enrolment period in 12 major Italian hospitals. Information on education, employment, housing and income was collected, and European Union Statistics on Income and Living Conditions index was used to assess material deprivation. Among migrants, we also analyzed factors associated with severe material deprivation. Migrants were compared with younger (18-64 years) and older (65+ years) Italians patients. Out of 755 patients enrolled (with a median age of 42 years, interquartile range: 31-53), 65% were migrants. Pulmonary, microbiologically confirmed, and new cases were 80%, 73%, and 87% respectively. Prevalence of co-morbidities (i.e. diabetes, chronic kidney disease, neoplastic diseases and use of immunosuppressive drugs) was lower among migrants compared to Italian TB patients, while indicators of socioeconomic status, income and housing conditions were worst in migrants. Forty-six percent of migrants were severely deprived vs. 9% of Italians (p<0.0001, 11.3% and 5.5% among younger and older Italians, respectively). Among migrants, being male, older, irregular, unemployed, with a shorter time spent in Italy, a lower education level, and without a co-morbidity diagnosis were factors associated with severe material deprivation at multi-variable logistic regression. Moreover, socioeconomic indicators for Italian patients did not differ from those reported for the general Italian population, while migrant TB patients seem to have a higher prevalence of severe material deprivation than other migrants residing in Italy. Intervention to address the needs of this population are urgent.
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Geiger BB, van der Wel KA, Tøge AG. Success and failure in narrowing the disability employment gap: comparing levels and trends across Europe 2002-2014. BMC Public Health 2017; 17:928. [PMID: 29197367 PMCID: PMC5712075 DOI: 10.1186/s12889-017-4938-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/22/2017] [Indexed: 11/11/2022] Open
Abstract
Background International comparisons of the disability employment gap are an important driver of policy change. However, previous comparisons have used the European Union Statistics on Income and Living Conditions (EU-SILC), despite known comparability issues. We present new results from the higher-quality European Social Survey (ESS), compare these to EU-SILC and the EU Labour Force Survey (EU-LFS), and also examine trends in the disability employment gap in Europe over the financial crisis for the first time. Methods For cross-sectional comparisons of 25 countries, we use micro-data for ESS and EU-SILC for 2012 and compare these to published EU-LFS 2011 estimates. For trend analyses, we use seven biannual waves of ESS (2002–2014) with a total sample size of 182,195, and annual waves of EU-SILC (2004–2014) with a total sample size of 2,412,791. Results (i) Cross-sectional: countries that have smaller disability employment gaps in one survey tend to have smaller gaps in the other surveys. Nevertheless, there are some countries that perform badly on the lower-quality surveys but better in the higher-quality ESS. (ii) Trends: the disability employment gap appears to have declined in ESS by 4.9%, while no trend is observed in EU-SILC – but this has come alongside a rise in disability in ESS. Conclusions There is a need for investment in disability measures that are more comparable over time/space. Nevertheless, it is clear to policymakers there are some countries that do consistently well across surveys and measures (Switzerland), and others that do badly (Hungary). Electronic supplementary material The online version of this article (10.1186/s12889-017-4938-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ben Baumberg Geiger
- School of Social Policy, Sociology and Social Research (SSPSSR), University of Kent, Canterbury, Kent, CT2 7NZ, UK.
| | - Kjetil A van der Wel
- Department of Social Work, Child Welfare and Social Policy, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Anne Grete Tøge
- Work Research Institute (AFI), Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Agrrawal P, Waggle D, Sandweiss DH. Suicides as a response to adverse market sentiment (1980-2016). PLoS One 2017; 12:e0186913. [PMID: 29095894 PMCID: PMC5667934 DOI: 10.1371/journal.pone.0186913] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 10/10/2017] [Indexed: 12/02/2022] Open
Abstract
Financial crises inflict significant human as well as economic hardship. This paper focuses on the human fallout of capital market stress. Financial stress-induced behavioral changes can manifest in higher suicide and murder-suicide rates. We find that these rates also correlate with the Gross Domestic Product (GDP) growth rate (negatively associated; a -0.25% drop [in the rate of change in annual suicides for a +1% change in the independent variable]), unemployment rate (positive link; 0.298% increase), inflation rate (positive link; 0.169% increase in suicide rate levels) and stock market returns adjusted for the risk-free T-Bill rate (negative link; -0.047% drop). Suicides tend to rise during periods of economic turmoil, such as the recent Great Recession of 2008. An analysis of Centers for Disease Control and Prevention (CDC) data of more than 2 million non-natural deaths in the US since 1980 reveals a positive correlation with unemployment levels. We find that suicides and murder-suicides associated with adverse market sentiment lag the initial stressor by up to two years, thus opening a policy window for government/public health intervention to reduce these negative outcomes. Both our models explain about 73 to 76% of the variance in suicide rates and rate of change in suicide rates, and deploy a total of four widely available independent variables (lagged and/or transformed). The results are invariant to the inclusion/exclusion of 2008 data over the 1980-2016 time series, the period of our study. The disconnect between rational decision making, induced by cognitive dissonance and severe financial stress can lead to suboptimal outcomes, not only in the area of investing, but in a direct loss of human capital. No economic system can afford such losses. Finance journal articles focus on monetary alpha, which is the return on a portfolio in excess of the benchmark; we think it is important to be aware of the loss of human capital as a consequence of market instability. This study makes one such an attempt.
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Affiliation(s)
- Pankaj Agrrawal
- MaineBusiness School, University of Maine, Orono, Maine, United States of America
| | - Doug Waggle
- Department of Accounting and Finance, University of West Florida, Pensacola, Florida, United States of America
| | - Daniel H. Sandweiss
- Department of Anthropology, University of Maine, Orono, Maine, United States of America
- Climate Change Institute, Bryand Global Sciences Center, University of Maine, Orono, Maine, United States of America
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Scherbov S, Weber D. Future trends in the prevalence of severe activity limitations among older adults in Europe: a cross-national population study using EU-SILC. BMJ Open 2017; 7:e017654. [PMID: 29061570 PMCID: PMC5722100 DOI: 10.1136/bmjopen-2017-017654] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To project the proportion of population 65+ years with severe long-term activity limitations from 2017 to 2047. DESIGN Large population study. SETTING Population living in private households of the European Union (EU) and neighbouring countries. PARTICIPANTS Participants from the EU Statistics on Income and Living Conditions aged 55 years and older and living in one of 26 EU and neighbouring countries, who answered the health section of the questionnaire. OUTCOME MEASURES Prevalence of severe long-term activity limitations of particular subpopulations (ie, 55+, 65+, 75+ and 85+ years) by sex and country. RESULTS We find a huge variation in the prevalence of self-reported severe long-term limitations across Europe for both sexes. However, in 2017, about 20% of the female population aged 65 years and above and about 16% of their male counterparts are expected to report severe long-term activity limitations after accounting for differences in reporting. Accounting for cultural differences in reporting, we expect that European countries will have about 21% (decile 1: 19.5%; decile 9: 22.9%) of female and about 16.8% (decile 1: 15.4%; decile 9: 18.1%) of male 65+ years population with severe long-term activity limitations by 2047. CONCLUSIONS Overall, despite the expected increase of life expectancy in European countries, our results suggest almost constant shares of older adults with severe long-term activity limitations within the next 30 years.
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Affiliation(s)
- Sergei Scherbov
- Wittgenstein Centre (IIASA, VID/ÖAW, WU), International Institute for Applied Systems Analysis, Laxenburg, Austria
- Russian Presidential Academy of National Economyand Public Administration (RANEPA), Moscow, Russian Federation
- Vienna Institute of Demography, Austrian Academy of Science, Vienna, Austria
| | - Daniela Weber
- Wittgenstein Centre (IIASA, VID/ÖAW, WU), International Institute for Applied Systems Analysis, Laxenburg, Austria
- Health Economics and Policy Division, Vienna University of Economics and Business, Vienna, Austria
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37
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Unmet healthcare needs in Ireland: Analysis using the EU-SILC survey. Health Policy 2017; 121:434-441. [DOI: 10.1016/j.healthpol.2017.02.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/15/2016] [Accepted: 02/06/2017] [Indexed: 11/20/2022]
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38
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The growing disconnect between food prices and wages in Europe: cross-national analysis of food deprivation and welfare regimes in twenty-one EU countries, 2004-2012. Public Health Nutr 2017; 20:1414-1422. [PMID: 28318474 DOI: 10.1017/s1368980017000167] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Food insecurity has been rising across Europe following the Great Recession, but to varying degrees across countries and over time. The reasons for this increase are not well understood, nor are what factors might protect people's access to food. Here we test the hypothesis that an emerging gap between food prices and wages can explain increases in reported inability to afford protein-rich foods and whether welfare regimes can mitigate its impact. DESIGN We collected data in twenty-one countries from 2004 to 2012 using two databases: (i) on food prices and deprivation related to food (denoted by reported inability to afford to eat meat, chicken, fish or a vegetarian equivalent every second day) from EuroStat 2015 edition; and (ii) on wages from the Organisation for Economic Co-operation and Development 2015 edition. RESULTS After adjusting for macroeconomic factors, we found that each 1 % rise in the price of food over and above wages was associated with greater self-reported food deprivation (β=0·060, 95 % CI 0·030, 0·090), particularly among impoverished groups. However, this association also varied across welfare regimes. In Eastern European welfare regimes, a 1 % rise in the price of food over wages was associated with a 0·076 percentage point rise in food deprivation (95 % CI 0·047, 0·105) while in Social Democratic welfare regimes we found no clear association (P=0·864). CONCLUSIONS Rising prices of food coupled with stagnating wages are a major factor driving food deprivation, especially in deprived groups; however, our evidence indicates that more generous welfare systems can mitigate this impact.
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McKee M, Reeves A, Clair A, Stuckler D. Living on the edge: precariousness and why it matters for health. Arch Public Health 2017; 75:13. [PMID: 28270912 PMCID: PMC5335798 DOI: 10.1186/s13690-017-0183-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/23/2017] [Indexed: 11/10/2022] Open
Abstract
The post-war period in Europe, between the late 1940s and the 1970s, was characterised by an expansion of the role of by the state, protecting its citizens from risks of unemployment, poverty, homelessness, and food insecurity. This security began to erode in the 1980s as a result of privatisation and deregulation. The withdrawal of the state further accelerated after the 2008 financial crisis, as countries began pursuing deep austerity. The result has been a rise in what has been termed 'precariousness'. Here we review the development of the concept of precariousness and related phenomena of vulnerability and resilience, before reviewing evidence of growing precariousness in European countries. It describes a series of studies of the impact on precariousness on health in domains of employment, housing, and food, as well as natural experiments of policies that either alleviate or worsen these impacts. It concludes with a warning, drawn from the history of the 1930s, of the political consequences of increasing precariousness in Europe and North America.
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Affiliation(s)
- Martin McKee
- ECOHOST, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Aaron Reeves
- London School of Economics and Political Science, London, UK
| | - Amy Clair
- Department of Sociology, University of Oxford, Oxford, UK
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK
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Kooijman MN, Kruithof CJ, van Duijn CM, Duijts L, Franco OH, van IJzendoorn MH, de Jongste JC, Klaver CCW, van der Lugt A, Mackenbach JP, Moll HA, Peeters RP, Raat H, Rings EHHM, Rivadeneira F, van der Schroeff MP, Steegers EAP, Tiemeier H, Uitterlinden AG, Verhulst FC, Wolvius E, Felix JF, Jaddoe VWV. The Generation R Study: design and cohort update 2017. Eur J Epidemiol 2017. [PMID: 28070760 DOI: 10.1007/s10654‐016‐0224‐9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Generation R Study is a population-based prospective cohort study from fetal life until adulthood. The study is designed to identify early environmental and genetic causes and causal pathways leading to normal and abnormal growth, development and health from fetal life, childhood and young adulthood. This multidisciplinary study focuses on several health outcomes including behaviour and cognition, body composition, eye development, growth, hearing, heart and vascular development, infectious disease and immunity, oral health and facial growth, respiratory health, allergy and skin disorders of children and their parents. Main exposures of interest include environmental, endocrine, genomic (genetic, epigenetic, microbiome), lifestyle related, nutritional and socio-demographic determinants. In total, 9778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. Response at baseline was 61%, and general follow-up rates until the age of 10 years were around 80%. Data collection in children and their parents includes questionnaires, interviews, detailed physical and ultrasound examinations, behavioural observations, lung function, Magnetic Resonance Imaging and biological sampling. Genome and epigenome wide association screens are available. Eventually, results from the Generation R Study contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.
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Affiliation(s)
- Marjolein N Kooijman
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Claudia J Kruithof
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marinus H van IJzendoorn
- Center for Child and Family Studies, Leiden University, Leiden, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Edmond H H M Rings
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marc P van der Schroeff
- Department of Otolaryngology, Head and Neck Surgery, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eppo Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Janine F Felix
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Kooijman MN, Kruithof CJ, van Duijn CM, Duijts L, Franco OH, van IJzendoorn MH, de Jongste JC, Klaver CCW, van der Lugt A, Mackenbach JP, Moll HA, Peeters RP, Raat H, Rings EHHM, Rivadeneira F, van der Schroeff MP, Steegers EAP, Tiemeier H, Uitterlinden AG, Verhulst FC, Wolvius E, Felix JF, Jaddoe VWV. The Generation R Study: design and cohort update 2017. Eur J Epidemiol 2017; 31:1243-1264. [PMID: 28070760 PMCID: PMC5233749 DOI: 10.1007/s10654-016-0224-9] [Citation(s) in RCA: 559] [Impact Index Per Article: 79.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/30/2016] [Indexed: 12/31/2022]
Abstract
The Generation R Study is a population-based prospective cohort study from fetal life until adulthood. The study is designed to identify early environmental and genetic causes and causal pathways leading to normal and abnormal growth, development and health from fetal life, childhood and young adulthood. This multidisciplinary study focuses on several health outcomes including behaviour and cognition, body composition, eye development, growth, hearing, heart and vascular development, infectious disease and immunity, oral health and facial growth, respiratory health, allergy and skin disorders of children and their parents. Main exposures of interest include environmental, endocrine, genomic (genetic, epigenetic, microbiome), lifestyle related, nutritional and socio-demographic determinants. In total, 9778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. Response at baseline was 61%, and general follow-up rates until the age of 10 years were around 80%. Data collection in children and their parents includes questionnaires, interviews, detailed physical and ultrasound examinations, behavioural observations, lung function, Magnetic Resonance Imaging and biological sampling. Genome and epigenome wide association screens are available. Eventually, results from the Generation R Study contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.
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Affiliation(s)
- Marjolein N Kooijman
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Claudia J Kruithof
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marinus H van IJzendoorn
- Center for Child and Family Studies, Leiden University, Leiden, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Edmond H H M Rings
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marc P van der Schroeff
- Department of Otolaryngology, Head and Neck Surgery, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eppo Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Janine F Felix
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group (NA-2915), Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Pediatrics, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Clair A, Loopstra R, Reeves A, McKee M, Dorling D, Stuckler D. The impact of housing payment problems on health status during economic recession: A comparative analysis of longitudinal EU SILC data of 27 European states, 2008-2010. SSM Popul Health 2016; 2:306-316. [PMID: 28018958 PMCID: PMC5165046 DOI: 10.1016/j.ssmph.2016.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/13/2016] [Accepted: 05/11/2016] [Indexed: 11/27/2022] Open
Abstract
Although the recent Great Recession had its origins in the housing sector, the short-term health impact of the housing crisis is not well understood. We used longitudinal data to evaluate the impact of housing payment problems on health status among home-owners and renters in 27 European states. Multi-level and fixed-effects models were applied to a retrospective cohort drawn from the EU Statistics on Income and Living Conditions survey of employed persons, comprising those without housing arrears in the base year 2008 and followed through to 2010 (n=45,457 persons, 136,371 person-years). Multi-variate models tested the impact of transitioning into housing payment arrears on self-reported health (0-worst to 4-best), adjusting for confounders including age, sex, baseline health, and individual fixed effects. Transitioning into housing arrears was associated with a significant deterioration in the health of renters (−0.09 units, 95% CI −0.05 to −0.13), but not owners (0.00, 95% CI −0.05 to 0.06), after adjusting for individual fixed effects. This effect was independent of and greater than the impact of job loss for the full sample (−0.05, 95% CI −0.002 to −0.09). The magnitude of this association varied across countries; the largest adverse associations were observed for renters in Belgium, Austria, and Italy. There was no observed protective association of differing categories of social protection or of the housing regulatory structure for renters. Women aged 30 and over who rented appeared to have worse self-reported health when transitioning into arrears than other groups. Renters also fared worse in those countries where house prices were escalating. We therefore find that housing payment problems are a significant risk factor for worse-self reported health in persons who are renting their homes. Future research is needed to understand potential sources of health resilience among renters, especially at a time when housing prices are rising in many European states. Falling into housing arrears is detrimental to health for renters, but not owners. The impact of housing arrears on health varies considerably across countries. Similarly, tenure differences in health vary across European countries. The health of home owners in Poland suffers considerably if they fall into arrears. House price increases exacerbate health effects.
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Affiliation(s)
- Amy Clair
- Department of Sociology, University of Oxford, Manor Road Building, Manor Road, Oxford OX1 3UQ, UK
| | - Rachel Loopstra
- Department of Sociology, University of Oxford, Manor Road Building, Manor Road, Oxford OX1 3UQ, UK
| | - Aaron Reeves
- Department of Sociology, University of Oxford, Manor Road Building, Manor Road, Oxford OX1 3UQ, UK
| | - Martin McKee
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Danny Dorling
- School of Geography and the Environment, University of Oxford, Oxford, Oxford University Centre for the Environment, University of Oxford, South Parks Road, Oxford OX1 3QY, UK
| | - David Stuckler
- Department of Sociology, University of Oxford, Manor Road Building, Manor Road, Oxford OX1 3UQ, UK
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Van der Heyden J, Charafeddine R, De Bacquer D, Tafforeau J, Van Herck K. Regional differences in the validity of self-reported use of health care in Belgium: selection versus reporting bias. BMC Med Res Methodol 2016; 16:98. [PMID: 27528010 PMCID: PMC4986374 DOI: 10.1186/s12874-016-0198-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/28/2016] [Indexed: 11/24/2022] Open
Abstract
Background The Health Care Module of the European Health Interview Survey (EHIS) is aimed to obtain comparable information on the use of inpatient and ambulatory care in all EU member states. In this study we assessed the validity of self-reported information on the use of health care, collected through this instrument, in the Belgian Health Interview Survey (BHIS), and explored the impact of selection and reporting bias on the validity of regional differences in health care use observed in the BHIS. Methods To assess reporting bias, self-reported BHIS 2008 data were linked with register-based data from the Belgian compulsory health insurance (BCHI). The latter were compared with similar estimates from a random sample of the BCHI to investigate the selection bias. Outcome indicators included the prevalence of a contact with a GP, specialist, dentist and a physiotherapist, as well as inpatient and day patient hospitalisation. The validity of the estimates and the regional differences were explored through measures of agreement and logistic regression analyses. Results Validity of self-reported health care use varies by type of health service and is more affected by reporting than by selection bias. Compared to health insurance estimates, self-reported results underestimate the percentage of people with a specialist contact in the past year (50.5 % versus 65.0 %) and a day patient hospitalisation (7.8 % versus 13.9 %). Inversely, survey results overestimated the percentage of people having visited a dentist in the past year: 58.3 % versus 48.6 %. The best concordance was obtained for an inpatient hospitalisation (kappa 0.75). Survey data overestimate the higher prevalence of a contact with a specialist [OR 1.51 (95 % CI 1.33–1.72) for self-report and 1.08 (95 % CI 1.05–1.15) for register] and underestimate the lower prevalence of a contact with a GP [ORs 0.59 (95 % CI 0.51–0.70) and 0.41 (95 % CI 0.39–0.42) respectively] in Brussels compared to Flanders. Conclusion Cautiousness is needed to interpret self-reported use of health care, especially for ambulatory care. Regional differences in self-reported health care use may be influenced by regional differences in the validity of the self-reported information. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0198-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Van der Heyden
- Department of Public Health and Surveillance, Scientific Institute of Public Health, 14, Juliette Wytsmanstraat, 1050, Brussels, Belgium. .,Department of Public Health, Ghent University, 185, De Pintelaan, 9000, Ghent, Belgium.
| | - R Charafeddine
- Department of Public Health and Surveillance, Scientific Institute of Public Health, 14, Juliette Wytsmanstraat, 1050, Brussels, Belgium
| | - D De Bacquer
- Department of Public Health, Ghent University, 185, De Pintelaan, 9000, Ghent, Belgium
| | - J Tafforeau
- Department of Public Health and Surveillance, Scientific Institute of Public Health, 14, Juliette Wytsmanstraat, 1050, Brussels, Belgium
| | - K Van Herck
- Department of Public Health, Ghent University, 185, De Pintelaan, 9000, Ghent, Belgium
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Irdam D, King L, Gugushvili A, Azarova A, Fazekas M, Scheiring G, Stefler D, Doniec K, Horvat P, Kolesnikova I, Popov V, Szelenyi I, Marmot M, Murphy M, McKee M, Bobak M. Mortality in Transition: Study Protocol of the PrivMort Project, a multilevel convenience cohort study. BMC Public Health 2016; 16:672. [PMID: 27473198 PMCID: PMC4967292 DOI: 10.1186/s12889-016-3249-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/01/2016] [Indexed: 11/26/2022] Open
Abstract
Background Previous research using routine data identified rapid mass privatisation as an important driver of mortality crisis following the collapse of Communism in Central and Eastern Europe. However, existing studies on the mortality crisis relying on individual level or routine data cannot assess both distal (societal) and proximal (individual) causes of mortality simultaneously. The aim of the PrivMort Project is to overcome these limitations and to investigate the role of societal factors (particularly rapid mass privatisation) and individual-level factors (e.g. alcohol consumption) in the mortality changes in post-communist countries. Methods The PrivMort conducts large-sample surveys in Russia, Belarus and Hungary. The approach is unique in comparing towns that have undergone rapid privatisation of their key industrial enterprises with those that experienced more gradual forms of privatisation, employing a multi-level retrospective cohort design that combines data on the industrial characteristics of the towns, socio-economic descriptions of the communities, settlement-level data, individual socio-economic characteristics, and individuals’ health behaviour. It then incorporates data on mortality of different types of relatives of survey respondents, employing a retrospective demographic approach, which enables linkage of historical patterns of mortality to exposures, based on experiences of family members. By May 2016, 63,073 respondents provided information on themselves and 205,607 relatives, of whom 102,971 had died. The settlement-level dataset contains information on 539 settlements and 12,082 enterprises in these settlements in Russia, 96 settlements and 271 enterprises in Belarus, and 52 settlement and 148 enterprises in Hungary. Discussion In addition to reinforcing existing evidence linking smoking, hazardous drinking and unemployment to mortality, the PrivMort dataset will investigate the variation in transition experiences for individual respondents and their families across settlements characterized by differing contextual factors, including industrial characteristics, simultaneously providing information about how excess mortality is distributed across settlements with various privatization strategies. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3249-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | - Denes Stefler
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | | | - Pia Horvat
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Irina Kolesnikova
- Institute of Economics of the National Academy of Sciences of Belarus, Minsk, Belarus
| | | | | | - Michael Marmot
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
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Elstad JI. Income inequality and foregone medical care in Europe during The Great Recession: multilevel analyses of EU-SILC surveys 2008-2013. Int J Equity Health 2016; 15:101. [PMID: 27388561 PMCID: PMC4936318 DOI: 10.1186/s12939-016-0389-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/28/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The association between income inequality and societal performance has been intensely debated in recent decades. This paper reports how unmet need for medical care has changed in Europe during The Great Recession, and investigates whether countries with smaller income differences have been more successful than inegalitarian countries in protecting access to medical care during an economic crisis. METHODS Six waves of EU-SILC surveys (2008-2013) from 30 European countries were analyzed. Foregone medical care, defined as self-reported unmet need for medical care due to costs, waiting lists, or travel difficulties, was examined among respondents aged 30-59 years (N = 1.24 million). Countries' macro-economic situation was measured by Real Gross Domestic Product (GDP) per capita. The S80/S20 ratio indicated the country's level of income inequality. Equity issues were highlighted by separate analyses of disadvantaged respondents with limited economic resources and relatively poor health. Cross-tabulations and multilevel linear probability regression models were utilized. RESULTS Foregone medical care increased 2008-2013 in the majority of the 30 countries, especially among the disadvantaged parts of the population. For the disadvantaged, unmet need for medical care tended to be higher in countries with larger income inequalities, regardless of the average economic standard in terms of GDP per capita. Both for disadvantaged and for other parts of the samples, a decline in GDP had more severe effects on access in inegalitarian countries than in countries with less income inequality. CONCLUSIONS During The Great Recession, unmet need for medical care increased in Europe, and social inequalities in foregone medical care widened. Overall, countries with a more egalitarian income distribution have been more able to protect their populations, and especially disadvantaged groups, against deteriorated access to medical care when the country is confronted with an economic crisis.
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Affiliation(s)
- Jon Ivar Elstad
- NOVA, Centre for Welfare and Labour Research, Oslo and Akershus University College of Applied Sciences, P.O.B. 4, St. Olavs Plass, 0130, Oslo, Norway.
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Giannoni M, Franzini L, Masiero G. Migrant integration policies and health inequalities in Europe. BMC Public Health 2016; 16:463. [PMID: 27250252 PMCID: PMC4888480 DOI: 10.1186/s12889-016-3095-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 05/11/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Research on socio-economic determinants of migrant health inequalities has produced a large body of evidence. There is lack of evidence on the influence of structural factors on lives of fragile groups, frequently exposed to health inequalities. The role of poor socio-economic status and country level structural factors, such as migrant integration policies, in explaining migrant health inequalities is unclear. The objective of this paper is to examine the role of migrant socio-economic status and the impact of migrant integration policies on health inequalities during the recent economic crisis in Europe. METHODS Using the 2012 wave of Eurostat EU-SILC data for a set of 23 European countries, we estimate multilevel mixed-effects ordered logit models for self-assessed poor health (SAH) and self-reported limiting long-standing illnesses (LLS), and multilevel mixed-effects logit models for self-reported chronic illness (SC). We estimate two-level models with individuals nested within countries, allowing for both individual socio-economic determinants of health and country-level characteristics (healthy life years expectancy, proportion of health care expenditure over the GDP, and problems in migrant integration policies, derived from the Migrant Integration Policy Index (MIPEX). RESULTS Being a non-European citizen or born outside Europe does not increase the odds of reporting poor health conditions, in accordance with the "healthy migrant effect". However, the country context in terms of problems in migrant integration policies influences negatively all of the three measures of health (self-reported health status, limiting long-standing illnesses, and self-reported chronic illness) in foreign people living in European countries, and partially offsets the "healthy migrant effect". CONCLUSIONS Policies for migrant integration can reduce migrant health disparities.
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Affiliation(s)
- Margherita Giannoni
- Institute of Economics, Università della Svizzera Italiana, via Buffi 13, Lugano, 6900, Switzerland.
- Department of Economics, Università degli Studi di Perugia, via Pascoli 20, Perugia, 06123, Italy.
| | - Luisa Franzini
- School of Public Health, University of Maryland, College Park, MD, 20742, USA
| | - Giuliano Masiero
- Institute of Economics, Università della Svizzera Italiana, via Buffi 13, Lugano, 6900, Switzerland
- Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio 7b, Dalmine (BG), 24044, Italy
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Clair A, Reeves A, Loopstra R, McKee M, Dorling D, Stuckler D. The impact of the housing crisis on self-reported health in Europe: multilevel longitudinal modelling of 27 EU countries. Eur J Public Health 2016; 26:788-793. [PMID: 27221606 PMCID: PMC5054274 DOI: 10.1093/eurpub/ckw071] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Many EU nations experienced a significant housing crisis during the Great Recession of 2008–10. We evaluated the consequences of housing payment problems for people’s self-reported overall health. Methods: We used longitudinal data from the EU Statistics on Income and Living Conditions survey covering 27 countries from 2008 to 2010 to follow a baseline sample of persons who did not have housing debt and who were employed (45 457 persons, 136 371 person–years). Multivariate linear regression and multilevel models were used to evaluate the impact of transitions into housing arrears on self-reported health, correcting for the presence of chronic illness, health limitations, and other potential socio-demographic confounders. Results: Persons who transitioned into housing arrears experienced a significant deterioration in self-reported overall health by − 0.03 U (95% CI − 0.01 to − 0.04), even after correcting for chronic illness, disposable income and employment status, and individual fixed effects. This association was independent and similar in magnitude to that for job loss (−0.02, 95% CI: −0.01 to − 0.04). We also found that the impact of housing arrears was significantly worse among renters, corresponding to a mean 0.11 unit additional drop in health as compared with owner-occupiers. These adverse associations were only evident in persons below the 75th percentile of disposable income. Discussion: Our analysis demonstrates that persons who suffer housing arrears experience increased risk of worsening self-reported health, especially among those who rent. Future research is needed to understand the role of alternative housing support systems and available strategies for preventing the health consequences of housing insecurity.
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Affiliation(s)
- Amy Clair
- Department of Sociology, University of Oxford, United Kingdom
| | - Aaron Reeves
- Department of Sociology, University of Oxford, United Kingdom
| | - Rachel Loopstra
- Department of Sociology, University of Oxford, United Kingdom
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Danny Dorling
- School of Geography and the Environment, University of Oxford, United Kingdom
| | - David Stuckler
- Department of Sociology, University of Oxford, United Kingdom
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McKee M, Azzopardi-Muscat N, Jakab Z, Andriukaitis V, Barnhoorn F. European Public Health NewsEUPHA President's ColumnEUPHA Office ColumnMessage from the WHO Regional Director for EuropeMessage from Vytenis Andriukaitis, EU Commissioner for Health and Food Safety9th European Public Health Conference—‘All for Health—Health for All’. Eur J Public Health 2016; 26:364-7. [DOI: 10.1093/eurpub/ckw024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Córdoba-Doña JA, Escolar-Pujolar A, San Sebastián M, Gustafsson PE. How are the employed and unemployed affected by the economic crisis in Spain? Educational inequalities, life conditions and mental health in a context of high unemployment. BMC Public Health 2016; 16:267. [PMID: 26979336 PMCID: PMC4791891 DOI: 10.1186/s12889-016-2934-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 03/08/2016] [Indexed: 04/03/2023] Open
Abstract
Background Despite an increasing number of studies on the factors mediating the impact of the economic recession on mental health, research beyond the individual employment status is scarce. Our objectives were to investigate in which ways the mental health of employed and unemployed populations is differently affected by the current economic recession along the educational scale and to examine whether financial strain and social support explain these effects of the crisis. Methods A repeated cross-sectional study, using two waves of the Andalusian Health Survey in 2007 (pre-crisis) and 2011–2012 (crisis). A population aged between 19 and 64 years was selected. The dependent variable was the Mental Component Summary of the SF-12 questionnaire. We performed Poisson regression models stratified by working status, with period, educational level, financial strain and social support as independent variables. We examined interactions between period and educational level. Age, sex, main earner, cohabitation and partner's working status were considered as covariates. Results The study included 3210 individuals (1185 women) in 2007 and 3633 individuals (1486 women) in 2011–2012. In working individuals the prevalence of poor mental health increased for secondary and complete primary studies groups during crisis compared to the pre-crisis period, while it decreased significantly in the university study group (PR = 0.76, 95 % CI: 0.58–0.99). However, in unemployed individuals prevalence ratios for poor mental health increased significantly only in the secondary studies group (PR = 1.73, 95 % CI: 1.06–2.83). Financial strain and social support yielded consistent associations with mental health in all subgroups. Only financial strain could partly explain the crisis effect on mental health among the unemployed. Conclusions Our study supports the finding that current economic recession is associated with poorer mental health differentially according to labour market status and educational level. Those with secondary studies may be at risk in times of economic recession. In connection with this, emerging educational inequalities in mental health among the employed population were observed. Our research also suggests a partial mediating role of financial strain for the effects of crisis on poor mental health among the unemployed. Good social support appears to buffer poor mental health in all subgroups but not specifically during crisis period. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2934-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juan Antonio Córdoba-Doña
- Delegación Territorial de Igualdad, Salud y Políticas Sociales de Andalucía, Avda María Auxiliadora 2, 11009, Cádiz, Spain. .,Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 85, Umeå, Sweden.
| | - Antonio Escolar-Pujolar
- Delegación Territorial de Igualdad, Salud y Políticas Sociales de Andalucía, Avda María Auxiliadora 2, 11009, Cádiz, Spain
| | - Miguel San Sebastián
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 85, Umeå, Sweden
| | - Per E Gustafsson
- Department of Public Health and Clinical Medicine, Social Medicine, Umeå University, SE-901 85, Umeå, Sweden
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Austerity, precariousness, and the health status of Greek labour market participants: Retrospective cohort analysis of employed and unemployed persons in 2008–2009 and 2010–2011. J Public Health Policy 2015; 36:452-68. [DOI: 10.1057/jphp.2015.25] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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