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Hahm S, Altweck L, Schmidt S, Fleischer T, Helmert C, Ulke C, Speerforck S, Schomerus G, Klinger-König J, Grabe HJ, Schmidt CO, Beutel ME, Brähler E, Muehlan H. How socio-political change is associated with the number of individually reported negative life events: a population-based study using the German reunification 1989/1990 as an example. J Epidemiol Community Health 2024; 78:311-318. [PMID: 38331562 DOI: 10.1136/jech-2023-221549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Socio-political change often leads to disruptions in employment and social networks, which can exacerbate health issues and increase mortality rates. These consequences are likely observed as an increase in negative life events (NLEs), serving as indicators of the broader social and health impacts. Using the German reunification in 1989/1990 as an example, this study investigates changes in reported numbers of NLEs and differences regarding sociodemographic characteristics. METHODS We used data from the population-based Study of Health in Pomerania (SHIP-START-0, SHIP-Life-Events and Gene-Environment Interaction in Depression; N=1932). Numbers of NLEs in different categories (work/financial, social/interpersonal, illness (own) and illness/death (others)) were measured retrospectively in 5-year intervals (1980-2004) using a semistructured interview. Pre-reunification and post-reunification changes were modelled using piecewise mixed-effects Poisson regressions with the 1990-1994 interval (reunification) as change point. Interactions with age, sex and education were examined. RESULTS The number of most NLE categories, except social/interpersonal NLEs, increased at reunification. Whereas work/financial NLEs slightly decreased post-reunification, illness-related NLEs continued to increase. Higher numbers of social/interpersonal NLEs were found with younger age. More illness-related NLEs were reported with older age, lower education (illness (own)) and by women (illness/death (others)). However, the majority reported no NLEs at reunification (68.2%-80.7%, varying by category). CONCLUSION Our findings suggest that although some individuals experience a marked increase in NLEs due to socio-political changes, many remain unaffected, emphasising the need for a differentiated understanding of these effects. This increase in NLEs may partly account for ongoing health and well-being disparities among countries with differing transformation histories.
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Affiliation(s)
- Stefanie Hahm
- Department Health and Prevention, University of Greifswald, Greifswald, Germany
| | - Laura Altweck
- Department Health and Prevention, University of Greifswald, Greifswald, Germany
| | - Silke Schmidt
- Department Health and Prevention, University of Greifswald, Greifswald, Germany
| | - Toni Fleischer
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Claudia Helmert
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Christine Ulke
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Sven Speerforck
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases Site Rostock/Greifswald, Rostock, Germany
| | | | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Holger Muehlan
- Department Health and Prevention, University of Greifswald, Greifswald, Germany
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Tavares AI. Treatable mortality and health care related factors across European countries. Front Public Health 2024; 12:1301825. [PMID: 38435289 PMCID: PMC10904533 DOI: 10.3389/fpubh.2024.1301825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/25/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Despite the improvements in European health systems, a large number of premature deaths are attributable to treatable mortality. Men make up the majority of these deaths, with a significant gap existing between women and men's treatable mortality rate in the EU. Aim This study aims to identify the healthcare-related factors, including health expenditures, human and physical resources, and hospital services use associated with treatable mortality in women and men across European countries during the period 2011-2019. Methods We use Eurostat data for 28 EU countries in the period 2011-2019. We estimate a panel data linear regression with country fixed effects and quantile linear regression for men and women. Results The results found (i) differences in drivers for male and female treatable mortality, but common drivers hold the same direction for both sexes; (ii) favorable drivers are GDP per capita, health expenditures, number of physicians per capita, and (only for men) the average length of a hospital stay, (iii) unfavorable drivers are nurses and beds per capita, although nurses are not significant for explaining female mortality. Conclusion Policy recommendations may arise that involve an improvement in hospital bed management and the design of more specific policies aimed at healthcare professionals.
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Affiliation(s)
- Aida Isabel Tavares
- CEISUC - Centre for Health Studies and Research, University of Coimbra, Coimbra, Portugal
- ISEG, UL - Lisbon School of Economics and Management, University of Lisbon, Lisbon, Portugal
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Gugushvili A, Reeves A. How democracy alters our view of inequality - and what it means for our health. Soc Sci Med 2021; 283:114190. [PMID: 34242889 DOI: 10.1016/j.socscimed.2021.114190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Income inequality is associated with poor health when economic disparities are especially salient. Yet, political institutions may alter this relationship because democracies (as opposed to autocracies) may be more inclined to frame inequalities in negative rather than positive ways. Living in a particular political system potentially alters the messages individuals receive about whether inequality is large or small, good or bad, and this, in turn, might affect whether beliefs about inequality influence health. Further, media coverage of economic inequality may negatively affect health if it contributes toward the general perception that the gap between rich and poor has gone up, even if there has been no change in income differentials. METHODS In this study, we explore the relationship between democracy, perceptions of inequality, and self-rated health across 28 post-communist countries using survey and macro-level data, multilevel regression models, and inverse probability weighting to estimate the average treatment effect on the treated. RESULTS We find that self-rated health is higher in more democratic countries and lower among people who believe that inequality has risen in the last few years. Moreover, we observe that people in democracies are more likely to learn about rising inequality through watching television and that when they do it has a more harmful effect on their health than when people in autocracies learn about rising inequality through the same channel, suggesting that in countries where there is less trust in the television media learning about rising inequality is not as harmful for health. CONCLUSIONS Our results indicate that while democracies are generally good for well-being, they may not be unambiguously positive for health. This does not mean, of course, that inequality is good for health nor that, on average, autocracies have better health than democracies; but rather that being more aware of inequality can negatively affect self-rated health.
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Affiliation(s)
- Alexi Gugushvili
- Department of Sociology and Human Geography, University of Oslo, Postboks 1096 Blindern, 0317, Oslo, Norway.
| | - Aaron Reeves
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, OX1 2ER, Oxford, United Kingdom.
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Clark-Cutaia MN, Rivera E, Iroegbu C, Squires A. Disparities in chronic kidney disease-the state of the evidence. Curr Opin Nephrol Hypertens 2021; 30:208-214. [PMID: 33464006 DOI: 10.1097/mnh.0000000000000688] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review was to assess the prevalence of United States chronic kidney disease (CKD) health disparities, focusing on racial/ethnic groups, immigrants and refugees, sex or gender, and older adults. RECENT FINDINGS There are major racial/ethnic disparities in CKD, with possible contributions from the social determinants of health, socioeconomics, and racial discrimination. Racial/ethnic minority patients experience faster progression to end-stage kidney disease (ESKD) and higher mortality predialysis, however, once on dialysis, appear to live longer. Similarly, men are quicker to progress to ESKD than women, with potential biological, behavioral, and measurement error factors. There is a lack of substantial evidence for intersex, nonbinary, or transgender patients. There are also strikingly few studies about US immigrants or older adults with CKD despite the fact that they are at high risk for CKD due to a variety of factors. SUMMARY As providers and scientists, we must combat both conscious and unconscious biases, advocate for minority patient populations, and be inclusive and diverse in our treatment regimens and provision of care. We need to acknowledge that sufficient evidence exists to change treatment guidelines, and that more is required to support the diversity of our patient population.
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Affiliation(s)
| | - Eleanor Rivera
- Assistant Professor, University of Illinois Chicago College of Nursing, Chicago, Illinois
| | - Christin Iroegbu
- Doctoral Student, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Allison Squires
- Associate Professor, NYU Meyers College of Nursing, New York, New York, USA
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Bíró A, Hajdu T, Kertesi G, Prinz D. Life expectancy inequalities in Hungary over 25 years: The role of avoidable deaths. Population Studies 2021; 75:443-455. [PMID: 33527888 DOI: 10.1080/00324728.2021.1877332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Using mortality registers and administrative data on income and population, we develop new evidence on the magnitude of life expectancy inequality in Hungary and the scope for health policy in mitigating this. We document considerable inequalities in life expectancy at age 45 across settlement-level income groups, and show that these inequalities have increased between 1991-96 and 2011-16 for both men and women. We show that avoidable deaths play a large role in life expectancy inequality. Income-related inequalities in health behaviours, access to care, and healthcare use are all closely linked to the inequality in life expectancy.Supplementary material for this article is available at: https://doi.org/10.1080/00324728.2021.1877332.
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Affiliation(s)
- Anikó Bíró
- Centre for Economic and Regional Studies
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Bíró A, Branyiczki R. Transition shocks during adulthood and health a few decades later in post-socialist Central and Eastern Europe. BMC Public Health 2020; 20:698. [PMID: 32414350 PMCID: PMC7227088 DOI: 10.1186/s12889-020-08839-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background Health of the population of post-socialist Central and Eastern European (CEE) countries lags behind the European Union average. Our aim in this paper is to analyse the link between transition shocks and health two-three decades later. Methods We use retrospective data from the Survey of Health, Ageing and Retirement in Europe. We estimate the implications of stressful periods, financial hardships and job loss occurring around the transition (1987–1993) on subjective and objective measures of health in 2017. We compare these implications across groups of CEE countries and with the health implications of similar difficulties reported by individuals from Western Europe. We also compare the health implications of difficulties occurring around the transition to difficulties occurring before or after the transition. Results In the CEE region there is a peak in the timing of difficulties around the transition. Stressful periods, financial difficulties and job loss around the period of transition are generally associated with worse subjective and objective health at older ages in all groups of CEE countries, even after netting out the effect of childhood health and demographic factors. However, the consequences of hardships due to the transition are not specific, health implications of these difficulties seem to be similar to the implications of other shocks possibly unrelated to the transition. Conclusions The high fraction of individuals experiencing stress, financial difficulties and job loss around the transition contributed to the current health disadvantage in the CEE region. As similar shocks in the West and before or after the transition had similar health implications, our results draw the attention to the long-lasting impacts of psychosocial stress and financial hardship during adulthood on later health over the life course.
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Affiliation(s)
- Anikó Bíró
- Health and Population "Lendület" Research Group at the Centre for Economic and Regional Studies, Tóth Kálmán utca 4, Budapest, 1097, Hungary.
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Shkolnikov VM, Andreev EM, Tursun-Zade R, Leon DA. Patterns in the relationship between life expectancy and gross domestic product in Russia in 2005-15: a cross-sectional analysis. Lancet Public Health 2019; 4:e181-e188. [PMID: 30954143 PMCID: PMC6506569 DOI: 10.1016/s2468-2667(19)30036-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/04/2019] [Accepted: 02/13/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since 2005, Russia has made substantial progress, experiencing an almost doubling of per-capita gross domestic product by purchasing power parity (GDP [PPP]) to US$24 800 and witnessing a 6-year increase in life expectancy, reaching 71·4 years by 2015. Even greater gains in GDP (PPP) were seen for Moscow, the Russian capital, reaching $43 000 in 2015 and with a life expectancy of 75·5 years. We aimed to investigate whether mortality levels now seen in Russia are consistent with what would be expected given this new level of per-capita wealth. METHODS We used per-capita GDP (PPP) and life expectancy from 61 countries in 2014-15, plus those of Russia as a whole and its capital Moscow, to construct a Preston curve expressing the relationship between mortality and national wealth and to examine the positions of Russia and other populations relative to this curve. We adjusted life expectancy values for Moscow for underestimation of mortality at older ages. For comparison, we constructed another Preston curve based on the same set of countries for the year 2005. We used the stepwise replacement algorithm to decompose mortality differences between Russia or Moscow and comparator countries with similar incomes into age and cause-of-death components. FINDINGS Life expectancy in 2015 for both Russia and Moscow lay below the Preston-curve-based expectations by 6·5 years and 4·9 years, respectively. In 2015, Russia had a lower per-capita income than 36 of the comparator countries but lower life expectancy than 60 comparator countries. However, the gaps between the observed and the Preston-expected life expectancy values for Russia have diminished by about 25% since 2005, when the life expectancy gap was 8·9 years for Russia and 6·6 years for Moscow. When compared with countries with similar level of income, the largest part of the life expectancy deficit was produced by working-age mortality from external causes for Russia and cardiovascular disease at older ages for Moscow. INTERPRETATION Given the economic wealth of Russia, its life expectancy could be substantially higher. Sustaining the progress seen over the past decade depends on the ability of the Russian Government and society to devote adequate resources to people's health. FUNDING This work was partly funded through the International Project on Cardiovascular Disease in Russia supported by a Wellcome Trust Strategic Award (100217) and was supported by the Russian Academic Excellence Project 5-100.
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Affiliation(s)
- Vladimir M Shkolnikov
- Laboratory for Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany; International Laboratory for Population and Health, Research University Higher School of Economics, Moscow, Russia.
| | - Evgeny M Andreev
- International Laboratory for Population and Health, Research University Higher School of Economics, Moscow, Russia
| | - Rustam Tursun-Zade
- International Laboratory for Population and Health, Research University Higher School of Economics, Moscow, Russia
| | - David A Leon
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
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