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Fletcher CME, Trenerry C, Wilson C, Gunn KM. 'Being a farmer, I mostly always think there is something more important to do': A mixed methods analysis of the skin cancer detection practices of Australian farmers. Health Promot J Austr 2024; 35:672-682. [PMID: 37611617 DOI: 10.1002/hpja.796] [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: 01/11/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
ISSUE ADDRESSED Farmers experience skin cancer and die from melanoma at significantly higher rates than the general Australian population. This study examined Australian farmers' engagement with self-skin examinations (SSE), participation in clinical skin examinations (CSE) by a health professional, and self-reported barriers to engagement with these important skin cancer detection practices. METHODS A cross-sectional, mixed-methods design was used. Australian farmers were recruited through an industry-based organisation representing livestock farmers. Farmers (N = 498; 22-89 years; 83.1% male) responded to a paper-based survey that included closed- and open-ended questions. RESULTS Farmers reported engagement with self-conducted SSE and routine CSE that was comparable to findings in the general population, but 29.4% of farmers reported that they had not sought a CSE as soon as possible after noticing changes to their skin. Farmers reported a range of barriers to SSE, including physical difficulties examining their skin, difficulties identifying changes in their skin, forgetfulness, and lack of motivation. Barriers to CSE included accessibility, cost, difficulties finding the right doctor, and avoidance and complacency. CONCLUSIONS There is a need to make clinical skin cancer detection more accessible to farmers, in addition to promoting self-skin examination and help-seeking behaviours within this at risk population. SO WHAT?: Novel approaches are needed to address systemic barriers faced by Australian farmers. These may include the use of teledermatology or artificial intelligence to assist with CSE. Remote training delivery methods may be also utilised to teach SSE skills to farmers who may be otherwise unable to access such opportunities.
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Affiliation(s)
- Chloe M E Fletcher
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Camilla Trenerry
- Freemasons Foundation Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, South Australia, Australia
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carlene Wilson
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
- Olivia Newton John Cancer Wellness Research Centre, Austin Health, Melbourne, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kate M Gunn
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, South Australia, Australia
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Moreno A, Pulido J, Cea-Soriano L, Mateo A, Pezzotti P, Regidor E. Differences urban versus non-urban trends in mortality from ischemic heart disease and diabetes in Italy and Spain, 2003-2019. Eur J Prev Cardiol 2024:zwae197. [PMID: 38857174 DOI: 10.1093/eurjpc/zwae197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/23/2024] [Accepted: 06/05/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND AND AIMS In recent years, mortality from ischemic heart disease and diabetes has decreased. There is an inequality in mortality reduction between urban and non-urban areas. This study aims to estimate the trend in mortality from ischemic heart disease and diabetes mellitus in urban and non-urban areas in Italy and Spain, throughout the first two decades of the 21st century. METHODS Deaths and population data by age and sex, according to the area de residence, were obtained from the National Institutes of Statistics. Annual age-standardized mortality rates from ischemic heart disease and diabetes mellitus were calculated from 2003 to 2019, in each of the two areas of residence in both countries. The average annual percentage change (APC) in the mortality rate in each area was estimated using linear regression models and taking age-standardized mortality rates as dependent variable. RESULTS Mortality rates from both causes of death decreased between the beginning and the end of the period analysed. In Italy, the APC in was -4.0% and -3.6% in mortality rate from ischemic heart disease and -1.5% and -1.3% in mortality rate from diabetes mellitus, in urban and non-urban areas, respectively. In Spain, the APC in was -4.4% and -3.7% in mortality rate from ischemic heart disease and -3.3% and -2.0% in mortality rate from diabetes mellitus, in urban and non-urban areas, respectively. CONCLUSION Mortality from ischemic heart disease and mortality from diabetes have shown a greater reduction in urban than in non-urban areas since the first years of the 21st century in Spain and Italy.
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Affiliation(s)
- Almudena Moreno
- Department of Sociology, Universidad Pública de Navarra
- I-COMMUNITAS - Institute for Advanced Social Research, Universidad Pública de Navarra, Pamplona, Spain
| | - José Pulido
- Department of Public Health and Maternal & Child Health, Faculty of Medecine, Universidad Complutense de Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lucía Cea-Soriano
- Department of Public Health and Maternal & Child Health, Faculty of Medecine, Universidad Complutense de Madrid, Spain
| | - Alberto Mateo
- Infectious Diseases Department, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Infectious Diseases Department, Istituto Superiore di Sanità, Rome, Italy
| | - Enrique Regidor
- Department of Public Health and Maternal & Child Health, Faculty of Medecine, Universidad Complutense de Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Zhang C, Shen Y, Wang A, Wang D, Cao L, Yue W. Cardiovascular Disease in China: Socioeconomic Status Variation in Prevalence. Risk Manag Healthc Policy 2023; 16:2077-2084. [PMID: 37841077 PMCID: PMC10575027 DOI: 10.2147/rmhp.s429224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Cardiovascular disease is the single largest contributor to global mortality and the leading cause of both death and premature death in China. Data on the association between cardiovascular disease and socioeconomic status are sparse, especially for Asian countries. Our study collected data to describe the socioeconomic status variation across cardiovascular disease using a large nationwide cross-sectional study. Methods We chose participants using the cluster sampling method, prepared a face-to-face questionnaire interview for the selected community residents, and collected information on health conditions, socioeconomic status, demographics, and comorbidities. All collected data were reported as frequencies and corresponding percentages. Linear regression and simple and multivariable logistic regression were performed to identify the prevalence variation. All statistical analyses were performed using SPSS version 26 software. Results Socioeconomic information was available for 394,688 participants (covering most provincial districts). The prevalence of cardiovascular disease was 7.9%. The prevalence was higher in rural areas than that in urban areas (rural, 8.4%; urban, 7.5%). There was a negative relationship between urbanization and cardiovascular disease prevalence. Furthermore, cardiovascular disease prevalence had a negative relationship with average earnings. Conclusion This cross-sectional analysis of socioeconomic status variation in the prevalence of cardiovascular disease in China showed a significant negative relationship between regional and individual socioeconomic status and cardiovascular disease. The results imply that governments would benefit communities by focusing on effective and targeted interventions for prevention, screening, and treatment in individuals who may be in the socioeconomic status with a high risk for cardiovascular disease.
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Affiliation(s)
- Chao Zhang
- Department of Neurology, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin University, Tianjin, People’s Republic of China
| | - Ying Shen
- Department of Traditional Chinese Medicine, Beijing Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Anxin Wang
- Department of Epidemiology, National Clinical Research Center for Neurological Diseases, Beijing TianTan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Da Wang
- Department of Medical Administration, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, People’s Republic of China
| | - Lei Cao
- Department of Neurology, Nation Project Office of Stroke Prevention and Control, Beijing, People’s Republic of China
| | - Wei Yue
- Department of Neurology, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin University, Tianjin, People’s Republic of China
- Department of Medical Administration, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, People’s Republic of China
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Fantin R, Delpierre C, Barboza-Solís C. Health inequalities in cause-specific mortality in Costa Rica: a population-based cohort study. Rev Saude Publica 2023; 57:3. [PMID: 36820682 PMCID: PMC9933644 DOI: 10.11606/s1518-8787.2023057004331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/13/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To analyze health inequalities in cause-specific mortality in Costa Rica from 2010 to 2018, observing the main causes for inequality in the country. METHODS The National Electoral Rolls were used to follow-up all Costa Rican adults aged 20 years or older from 2010 to 2018 (n = 2,739,733) in an ecological study. A parametric survival model based on the Gompertz distribution was performed and the event death was classified according to the ICD-10. RESULTS After adjustment for urbanicity, the poorest districts had a higher mortality than the wealthier districts for most causes of death except neoplasms, mental and behavioral disorders, and diseases of the nervous system. Urban districts showed significantly higher mortality than mixed and rural districts after adjustment for wealth for most causes except mental and behavioral disorders, diseases of the nervous system, and diseases of the respiratory system. Differences according to wealth were more frequent in women than men, whereas differences according to urbanicity were more frequent in men than in women. CONCLUSIONS The study's findings were consistent, but not fully similar, to the international literature.
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Affiliation(s)
- Romain Fantin
- Universidad de Costa RicaCentro Centroamericano de PoblaciónSan JoséCosta Rica Universidad de Costa Rica. Centro Centroamericano de Población. San José, Costa Rica.,Universidad de Costa RicaFacultad de MedicinaEscuela de Salud PúblicaSan JoséCosta Rica Universidad de Costa Rica. Facultad de Medicina. Escuela de Salud Pública. San José, Costa Rica,Universidad de Costa RicaFacultad de OdontologíaSan JoséCosta Rica Universidad de Costa Rica. Facultad de Odontología. San José, Costa Rica
| | - Cyrille Delpierre
- Inserm-University Toulouse III Paul SabatierCenter for Epidemiology and Research in Population healthToulouseFranceInserm-University Toulouse III Paul Sabatier. Center for Epidemiology and Research in Population health. Toulouse, France
| | - Cristina Barboza-Solís
- Universidad de Costa RicaFacultad de OdontologíaSan JoséCosta Rica Universidad de Costa Rica. Facultad de Odontología. San José, Costa Rica
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Sharma D, Kiran T, Goel K, Junaid KP, Rajagopal V, Gupta M, Kaundal H, Sharma S, Bahl A. Comprehensive assessment of age-specific mortality rate and its incremental changes using a composite measure: A sub-national analysis of rural Indian women. Front Med (Lausanne) 2022; 9:1046072. [PMID: 36523773 PMCID: PMC9745315 DOI: 10.3389/fmed.2022.1046072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/07/2022] [Indexed: 09/19/2023] Open
Abstract
Background Diverse socio-economic and cultural issues contribute to adverse health outcomes and increased mortality rates among rural Indian women across different age categories. The present study aims to comprehensively assess age-specific mortality rates (ASMR) and their temporal trends using a composite measure at the sub-national level for rural Indian females to capture cross-state differences. Materials and methods A total of 19 states were included in the study to construct a composite age-specific mortality index for 2011 (base year) and 2018 (reference year) and examine the incremental changes in the index values across these years at the sub-national level in India. Sub-index values were calculated for each component age group and were subsequently used to compute the composite ASMR index using the geometric mean method. Based on the incremental changes, the performance of states was categorized into four different typologies. Results Improvement in mortality index scores in the 0-4 years age group was documented for all states. The mortality rates for the 60+ age group were recorded to be high for all states. Kerala emerged as the overall top performer in terms of mortality index scores, while Bihar and Jharkhand were at the bottom of the mortality index table. The overall mortality composite score has shown minor improvement from base year to reference year at all India level. Conclusion An overall reduction in the mortality rates of rural Indian women has been observed over the years in India. However, in states like Bihar and Jharkhand, mortality is high and has considerable scope for improvement. The success of public health interventions to reduce the under-five mortality rate is evident as the female rural mortality rates have reduced sizably for all states. Nevertheless, there is still sizable scope for reducing mortality rates for other component age groups. Additionally, there is a need to divert attention toward the female geriatric (60+ years) population as the mortality rates are still high.
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Affiliation(s)
- Divya Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvi Kiran
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kapil Goel
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K. P. Junaid
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vineeth Rajagopal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhu Gupta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Himika Kaundal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Saraswati Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankit Bahl
- Plan India, Community Center 1, New Delhi, India
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Abbas SS, Majeed T, Weaver N, Nair BR, Forder PM, Byles JE. Utility estimations of health states of older Australian women with atrial fibrillation using SF-6D. Qual Life Res 2021; 30:1457-1466. [PMID: 33550542 DOI: 10.1007/s11136-020-02748-3] [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] [Accepted: 12/23/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To estimate SF-6D utility scores for older women with atrial fibrillation (AF); calculate and compare mean utility scores for women with AF with various demographic, health behaviours, and clinical characteristics; and develop a multivariable regression model to determine factors associated with SF-6D utility scores. METHODS This study evaluated N = 1432 women diagnosed with AF from 2000 to 2015 of the old cohort (born 1921-26) of the Australian Longitudinal Study on Women's Health (ALSWH) who remained alive for at least 12 months post first recorded AF diagnosis. Self-reported data on demographics, health behaviours, health conditions, and SF-36 were obtained from the ALSWH surveys, corresponding to within three years of the date of the first record of AF diagnosis. Linked Pharmaceutical Benefits Scheme (PBS) data determined the use of oral anticoagulants and comorbid conditions, included in CHA2DS2-VA (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, Stroke or TIA, Vascular disease and Age 65-74 years) score calculation, were assessed using state-based hospital admissions data. Utility scores were calculated for every woman from their SF-36 responses using the SF-6D algorithm with Australian population norms. Mean utility scores were then calculated for women with various demographic, health behaviours, and clinical characteristics. Ordinary Least Square (OLS) regression modelling was performed to determine factors associated with these utility scores. Two different scenarios were used for the analysis: (1) complete-case, for women with complete data on all the SF-36 items required to estimate SF-6D (N = 584 women), and (2) Multiple Imputation (MI) for missing data, applied to missing values on SF-36 items (N = 1432 women). MI scenario was included to gauge the potential bias when using complete data only. RESULTS The mean health utility was estimated to be 0.638 ± 0.119 for the complete dataset and 0.642 ± 0.120 for the dataset where missing values were handled using MI. Using the MI technique, living in regional and remote areas ([Formula: see text]) and the use of oral anticoagulants ([Formula: see text] were positively associated with health utility compared to living in major cities and no use of anticoagulants, respectively. Difficulty to manage on available income [Formula: see text], no/low physical activity [Formula: see text], disability [Formula: see text], history of stroke ([Formula: see text] and history of arthritis [Formula: see text] were negatively associated with health utility. CONCLUSION This study presents health utility estimates for older women with AF. These estimates can be used in future clinical and economic research. The study also highlights better health utilities for women living in regional and remote areas, which requires further exploration.
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Affiliation(s)
- Shazia S Abbas
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
| | - Tazeen Majeed
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Natasha Weaver
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Balakrishnan R Nair
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Peta M Forder
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Julie E Byles
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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Choukou MA, Maddahi A, Polyvyana A, Monnin C. Digital health technology for Indigenous older adults: A scoping review. Int J Med Inform 2021; 148:104408. [PMID: 33609927 DOI: 10.1016/j.ijmedinf.2021.104408] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/15/2021] [Accepted: 02/01/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Telehealth implementation is a great solution for Indigenous older adults (OAs) due to the rise of chronic disease and other age-related health disorders. Telehealth is a promising option to increase quality of life, decrease healthcare costs, and offer more independent living. OBJECTIVES This scoping review investigated existing telehealth solutions that have been implemented to serve Indigenous OAs. METHODS A structured search strategy was performed on 6 electronic databases: Ovid Medline, Ovid PsycINFO, Ovid Embase, EBSCOhost, Scopus and Cochrane. Studies were included in the review if they contained information on telehealth technologies for Indigenous OAs (aged 65 years and older). Grey literature was also explored in ProQuest Theses and Dissertations, ERIC, Google Advanced and various government websites from Canada, Australia/New Zealand and the USA. RESULTS Twenty six articles were included and reviewed by two assessors. Analysis of the results from five countries revealed eight different types of telehealth solutions for Indigenous OAs. No documented telerehabilitation technologies were available to OAs in Indigenous Communities. Analysis of a broad range of Indigenous OAs with different chronic diseases revealed that they are seeking telehealth technologies for ease of access to health care, increased health equity and cost-effectiveness. Results revealed various advantages of telehealth for Indigenous OAs and barriers for implementing such technologies in Indigenous communities. CONCLUSION The use of telehealth technologies among OAs is expected to rise, but effective implementation will be successful only if the patient's acceptance and culture are kept at the forefront, and if healthcare services are provided by telehealth-trained healthcare professionals.
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Affiliation(s)
- Mohamed-Amine Choukou
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0T6, Canada; Centre on Aging, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada.
| | - Ali Maddahi
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0T6, Canada; Tactile Robotics Ltd., 100-135 Innovation Dr, Winnipeg, MB, R3T 6A8, Canada
| | - Anna Polyvyana
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Caroline Monnin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada
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Padilla CM, Foucault A, Grimaud O, Nowak E, Timsit S. Gender difference of geographic distribution of the stroke incidence affected by socioeconomic, clinical and urban-rural factors: an ecological study based on data from the Brest stroke registry in France. BMC Public Health 2021; 21:39. [PMID: 33407274 PMCID: PMC7788878 DOI: 10.1186/s12889-020-10026-7] [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: 02/24/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Mapping the spatial distribution of disease occurrence is a strategy to identify contextual factors that could be useful for public health policies. The purpose of this ecological study was to examine to which extent the socioeconomic deprivation and the urbanization level can explain gender difference of geographic distribution in stroke incidence in Pays de Brest, France between 2008 and 2013. Methods Stroke cases aged 60 years or more were extracted from the Brest stroke registry and combined at the census block level. Contextual socioeconomic, demographic, and geographic variables at the census block level come from the 2013 national census. We used spatial and non-spatial regression models to study the geographic correlation between socioeconomic deprivation, degree or urbanization and stroke incidence. We generated maps using spatial geographically weighted models, after longitude and latitude smoothing and adjustment for covariates. Results Stroke incidence was comparable in women and men (6.26 ± 3.5 vs 6.91 ± 3.3 per 1000 inhabitants-year, respectively). Results showed different patterns of the distribution of stroke risk and its association with deprivation or urbanisation across gender. For women, stroke incidence was spatially homogeneous over the entire study area, but was associated with deprivation level in urban census blocks: age adjusted risk ratio of high versus low deprivation = 1.24, [95%CI 1.04–1.46]. For men, three geographic clusters were identified. One located in the northern rural and deprived census blocks with a 9–14% increase in the risk of stroke. Two others clusters located in the south-eastern (mostly urban part) and south-western (suburban and rural part) with low deprivation level and associated with higher risk of stroke incidence between (3 and 8%) and (8.5 and 19%) respectively. There were no differences in profile of cardiovascular risk factors, stroke type and stroke severity between clusters, or when comparing clusters cases to the rest of the study population. Conclusions Understanding whether and how neighborhood and patient’s characteristics influence stroke risk may be useful for both epidemiological research and healthcare service planning.
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Affiliation(s)
- Cindy M Padilla
- Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, 15, Avenue du Professeur Léon Bernard, 35043, Rennes, France.
| | - Anais Foucault
- Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, 15, Avenue du Professeur Léon Bernard, 35043, Rennes, France
| | - Olivier Grimaud
- Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, 15, Avenue du Professeur Léon Bernard, 35043, Rennes, France
| | - Emmanuel Nowak
- Centre d'Investigation Clinique-INSERM CIC 1412, CHRU, Brest, France
| | - Serge Timsit
- Univ Brest, Inserm, EFS, UMR 1078, GGB, Neurology and Stroke unit Department, CHRU de Brest, Université de Bretagne Occidentale, Inserm 1078, Brest, F-29200, France
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Castrillon CIM, Beckenkamp PR, Ferreira ML, Michell JA, de Aguiar Mendes VA, Luscombe GM, Stamatakis E, Ferreira PH. Are people in the bush really physically active? A systematic review and meta-analysis of physical activity and sedentary behaviour in rural Australians populations. J Glob Health 2020; 10:010410. [PMID: 32373329 PMCID: PMC7182355 DOI: 10.7189/jogh.10.010410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Physical inactivity is a major risk factor for non-communicable disease and premature mortality. People who live in rural settings are usually regarded as more physically active than those living in urban areas, however, direct comparisons between these populations are scarce. We aimed to summarise the prevalence of physical inactivity and sedentary behaviour in rural settings in Australia, compared to urban counterparts. Methods We searched six databases (AMED, Embase, Medline; CINAHL, SPORTDiscus; and RURAL) and identified 28 observational studies that investigated the levels of physical inactivity and/or sedentary behaviour in adults aged 18 years and over in rural Australia. Random effects meta-analysis was used to generate pooled prevalence estimates. Results Physical inactivity was four percentage points (95% confidence interval (CI) = 0.4 to 8) higher in rural populations compared to urban populations. There was a one percentage point (95% CI = -3 to 5) prevalence difference of physical activity in the rural populations. Rural populations reported on average 7.8 hours of sedentary time per day (95% CI = 5 to 10) and the prevalence of high levels of sedentary behaviour (≥to 8 hours per day) was 7% (95% CI = -8 to -7) greater in urban areas compared to rural areas. Conclusions People living in rural areas are just as physically inactive as people who live in urban areas. Our findings challenge the popular views that rural lifestyles result in people engaging more frequently in physical activity. Public health campaigns promoting physical activity in rural settings are just as necessary as in urban settings.
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Affiliation(s)
| | - Paula R Beckenkamp
- The University of Sydney, Discipline of Physiotherapy, Faculty of Medicine and Health, Sydney, Australia
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jose A Michell
- The University of Sydney, Discipline of Physiotherapy, Faculty of Medicine and Health, Sydney, Australia.,Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,University of Sao Paulo, Department of Neuroscience and Behavioral Sciences, Sao Paulo, Brazil.,The University of Sydney, School of Rural Health, Faculty of Medicine and Health, Orange, Australia.,The University of Sydney, Charles Perkins Centre, Faculty of Medicine and Health, School of Health Sciences, Sydney, Australia
| | | | - Georgina M Luscombe
- The University of Sydney, School of Rural Health, Faculty of Medicine and Health, Orange, Australia
| | - Emmanuel Stamatakis
- The University of Sydney, Charles Perkins Centre, Faculty of Medicine and Health, School of Health Sciences, Sydney, Australia
| | - Paulo Henrique Ferreira
- The University of Sydney, Discipline of Physiotherapy, Faculty of Medicine and Health, Sydney, Australia
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Terry DR, Nguyen H, Kim JA, Islam MR. Factors contributing to COPD hospitalisations from 2010 to 2015: Variation among rural and metropolitan Australians. CLINICAL RESPIRATORY JOURNAL 2019; 13:306-313. [PMID: 30816003 DOI: 10.1111/crj.13012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 01/21/2019] [Accepted: 02/24/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Rural and remote populations experience the greatest burden of chronic obstructive pulmonary disease (COPD), the fifth leading cause of death in Australia. Currently there is a need to prioritise health services to improve health outcomes among those at higher risk of COPD. OBJECTIVES To investigate the differences in COPD hospitalisation between rural and urban populations and determine predictive factors contributing to COPD hospitalisation. METHODS Statewide hospitalisation data from 2010 to 2015 were obtained through the Victorian Admitted Episodes Dataset and other key data sets. The rates of hospitalisation were analysed using hierarchical multiple regression to examine the association between COPD hospitalisations and a number of predictor variables. RESULTS The highest COPD incidence occurred in metropolitan males aged 85 years of age and older (35.092 hospitalisations per 1000 population). Among metropolitan residents, smoking, population density and household income had a significant association with COPD hospitalisations for both sexes. Among rural males, smoking rates, household income and rural land use (farming) were significant predictors of COPD hospitalisations. There was an overall stability in statewide COPD hospitalisation over the 5 years to 2015, P = 0.420. CONCLUSION This investigation highlights many rural and regional areas have much lower COPD hospitalisation rates than metropolitan areas. Between males and females, there are heterogenetic factors that contribute to the significant variation associated with COPD hospitalisation in metropolitan and rural areas, such as rural land use among rural males. This indicates that risk factor assessments, beyond smoking alone, need to be individualised and prioritised in practice to optimise care.
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Affiliation(s)
- Daniel R Terry
- School of Nursing and Healthcare Professions, Federation University Australia, Ballarat, Victoria, Australia
| | - Hoang Nguyen
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Jeong-Ah Kim
- School of Nursing and Healthcare Professions, Federation University Australia, Ballarat, Victoria, Australia
| | - Md Rafiqul Islam
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia.,Goulburn Valley Health, Shepparton, Victoria, Australia.,School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
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11
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Jacobs J, Peterson KL, Allender S, Alston LV, Nichols M. Regional variation in cardiovascular mortality in Australia 2009–2012: the impact of remoteness and socioeconomic status. Aust N Z J Public Health 2018; 42:467-473. [DOI: 10.1111/1753-6405.12807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/01/2018] [Accepted: 05/01/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jane Jacobs
- Global Obesity Centre, Centre for Population Health ResearchDeakin University Victoria
| | - Karen Louise Peterson
- Wardliparingga Aboriginal Research UnitSouth Australian Health and Medical Research Institute Adelaide South Australia
| | - Steven Allender
- Global Obesity Centre, Centre for Population Health ResearchDeakin University Victoria
| | - Laura Veronica Alston
- Global Obesity Centre, Centre for Population Health ResearchDeakin University Victoria
| | - Melanie Nichols
- Global Obesity Centre, Centre for Population Health ResearchDeakin University Victoria
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12
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Warburton J, Winterton R. A far greater sense of community: The impact of volunteer behaviour on the wellness of rural older Australians. Health Place 2017; 48:132-138. [PMID: 29121536 DOI: 10.1016/j.healthplace.2017.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/20/2017] [Accepted: 10/23/2017] [Indexed: 11/15/2022]
Abstract
This paper builds on place-based research investigating the transformative potential of volunteering for service-deprived, ageing rural communities. Here, we critically explore the relationship between communities of place, voluntarism and wellness for rural older Australians. We draw on data from a large qualitative multi-site study, and utilise Ryan et al.'s (2005) systemic model of community attachment. Findings support the dual perspective of strong community sentiments through social embeddedness in rural communities; and personal interests, associated with rational choice theory, through healthy ageing practices. Both aspects have demonstrated positive impact on wellness, but also risks to wellness associated with over-expectations of volunteers.
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Affiliation(s)
- Jeni Warburton
- John Richards Initiative, College of Science, Health and Engineering, La Trobe University, P O Box 821, Wodonga, VIC 3689, Australia.
| | - Rachel Winterton
- John Richards Initiative, College of Science, Health and Engineering, La Trobe University, P O Box 821, Wodonga, VIC 3689, Australia.
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13
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Alston L, Peterson KL, Jacobs JP, Allender S, Nichols M. Quantifying the role of modifiable risk factors in the differences in cardiovascular disease mortality rates between metropolitan and rural populations in Australia: a macrosimulation modelling study. BMJ Open 2017; 7:e018307. [PMID: 29101149 PMCID: PMC5695309 DOI: 10.1136/bmjopen-2017-018307] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The study aimed (1) to quantify differences in modifiable risk factors between urban and rural populations, and (2) to determine the number of rural cardiovascular disease (CVD) and ischaemic heart disease (IHD) deaths that could be averted or delayed if risk factor levels in rural areas were equivalent to metropolitan areas. SETTING National population estimates, risk factor prevalence, CVD and IHD deaths data were analysed by rurality using a macrosimulation Preventable Risk Integrated Model for chronic disease risk. Uncertainty analysis was conducted using a Monte Carlo simulation of 10 000 iterations to calculate 95% credible intervals (CIs). PARTICIPANTS National data sets of men and women over the age of 18 years living in urban and rural Australia. RESULTS If people living in rural Australia had the same levels of risk factors as those in metropolitan areas, approximately 1461 (95% CI 1107 to 1791) deaths could be delayed from CVD annually. Of these CVD deaths, 793 (95% CI 506 to 1065) would be from IHD. The IHD mortality gap between metropolitan and rural populations would be reduced by 38.2% (95% CI 24.4% to 50.6%). CONCLUSIONS A significant portion of deaths from CVD and IHD could be averted with improvements in risk factors; more than one-third of the excess IHD deaths in rural Australia were attributed to differences in risk factors. As much as two-thirds of the increased IHD mortality rate in rural areas could not be accounted for by modifiable risk factors, however, and this requires further investigation.
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Affiliation(s)
- Laura Alston
- Faculty of Health, Global Obesity Centre, Deakin University, Geelong, Victoria, Australia
| | - Karen Louise Peterson
- Faculty of Health, Global Obesity Centre, Deakin University, Geelong, Victoria, Australia
| | - Jane P Jacobs
- Faculty of Health, Global Obesity Centre, Deakin University, Geelong, Victoria, Australia
| | - Steven Allender
- Faculty of Health, Global Obesity Centre, Deakin University, Geelong, Victoria, Australia
| | - Melanie Nichols
- Faculty of Health, Global Obesity Centre, Deakin University, Geelong, Victoria, Australia
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14
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Rural Inequalities in the Australian Burden of Ischaemic Heart Disease: A Systematic Review. Heart Lung Circ 2017; 26:122-133. [DOI: 10.1016/j.hlc.2016.06.1213] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/17/2016] [Accepted: 06/21/2016] [Indexed: 11/16/2022]
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15
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Cleland V, Hughes C, Thornton L, Squibb K, Venn A, Ball K. Environmental barriers and enablers to physical activity participation among rural adults: a qualitative study. Health Promot J Austr 2016; 26:99-104. [PMID: 26169296 DOI: 10.1071/he14115] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/26/2015] [Indexed: 11/23/2022] Open
Abstract
ISSUE ADDRESSED Social-ecological models of health behaviour acknowledge environmental influences, but research examining how the environment shapes physical activity in rural settings is limited. This study aimed to explore the environmental factors that act as barriers or facilitators to physical activity participation among rural adults. METHODS Forty-nine adults from three regions of rural Tasmania, Australia, participated in semi-structured interviews that explored features of the environment that supported or hindered physical activity. Interviews were digitally recorded, transcribed verbatim and analysed thematically. RESULTS Four key themes emerged: functionality, diversity, spaces and places for all and realistic expectations. 'Functionality' included connectivity with other destinations, distance, safety, continuity, supporting infrastructure and surfacing. While there was limited 'diversity' of structured activities and recreational facilities, the importance of easy and convenient access to a natural environment that accommodated physical activity was highlighted. 'Spaces and places for all' highlighted the importance of shared-use areas, particularly those that were family- and dog-friendly. Despite desires for more physical activity opportunities, many participants had 'realistic expectations' of what was feasible in rural settings. CONCLUSIONS Functionality, diversity, spaces and places for all and realistic expectations were identified as considerations important for physical activity among rural adults. Further research using quantitative approaches in larger samples is needed to confirm these findings. SO WHAT? Urban-centric views of environmental influences on physical activity are unlikely to be entirely appropriate for rural areas. Evidence-based recommendations are provided for creating new or modifying existing infrastructure to support active living in rural settings.
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Affiliation(s)
- Verity Cleland
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia
| | - Clarissa Hughes
- School of Health Sciences, University of Tasmania, Private Bag 135, Hobart, Tasmania 7000, Australia
| | - Lukar Thornton
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Kathryn Squibb
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia
| | - Kylie Ball
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
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16
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Leung J, Martin J, McLaughlin D. Rural-urban disparities in stage of breast cancer at diagnosis in Australian women. Aust J Rural Health 2016; 24:326-332. [PMID: 26798970 DOI: 10.1111/ajr.12271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To examine urban-rural differences and individual risk factors for a late stage of breast cancer at diagnosis in Australian women. DESIGN Individual-level longitudinal data were linked with cancer registry data from New South Wales (New South Wales Cancer Registry linked by the Centre for Health Record Linkage (CHeReL)), Queensland (Queensland Cancer Registry) and Victoria (The Cancer Council Victoria). SETTING Participants were drawn from the Australian Longitudinal Study on Women's Health 1946-1951 cohort (n = 13 715). PARTICIPANTS The sample included 195 women identified from the linked cancer registry data with a breast cancer diagnosis. INTERVENTIONS Rural or urban residence was measured using Accessibility/Remoteness Index of Australia Plus (ARIA+). Individual characteristics and socio-demographic variables examined included survey year, menopausal status, country of birth, education and marital status. MAIN OUTCOME MEASURES A late stage of breast cancer at diagnosis was defined based on the TNM Classification of Malignant Tumours. RESULTS A late stage of breast cancer diagnosis was observed in 36% of women residing in urban areas and 40% of women residing in rural areas. After adjusting for individual characteristics, we found that obesity was the strongest risk factor for a late stage of breast cancer at diagnosis. CONCLUSIONS Given that women are becoming increasingly obese, and that the rate of obesity is higher in the Australian rural population, this paper provides further evidence for targeting interventions for obesity, particularly in rural Australia, as a public health priority.
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Affiliation(s)
- Janni Leung
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia. .,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia.
| | - Jennifer Martin
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Deirdre McLaughlin
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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17
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A Qualitative Study of Environmental Factors Important for Physical Activity in Rural Adults. PLoS One 2015; 10:e0140659. [PMID: 26554376 PMCID: PMC4640845 DOI: 10.1371/journal.pone.0140659] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 09/29/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Despite increasing evidence that the physical environment impacts on physical activity among urban-dwellers, little attention has been devoted to understanding this relationship in rural populations. Work in this area is further hindered by a lack of environmental measures specifically designed for rural settings. This qualitative study aimed to explore the salience of urban physical activity environment constructs among rural adults. METHODS In 2011, 49 rural men and women from three distinct areas (coastal, animal-based farming, forestry/plant-based farming) of rural Tasmania, Australia, were purposively recruited to participate in semi-structured interviews. Interviews explored features of the built and social environment commonly examined in studies of urban adults, including functional characteristics (eg, lighting, footpaths, roads/verges), road and personal safety, availability and accessibility of places to be active, destinations, and aesthetics. Interviews were recorded, transcribed verbatim and analysed using a content-thematic approach using QSR NVivo software. FINDINGS While some urban environmental constructs were salient to these rural adults, such as availability of and accessibility to places to be active, some constructs were operationalised differently, such as road safety (where large trucks and winding roads rather than traffic density was of concern), or were not considered relevant (eg, personal safety related to crime, availability of walkable destinations, aesthetics). CONCLUSIONS The measurement of the physical environment in rural populations may require reconsideration and/or modification to ensure salience and appropriate quantification of associations with physical activity in future studies.
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18
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Ward J. Improving health equity in Australia: practical advice for those ready to act. Med J Aust 2015; 203:317-8. [PMID: 26465686 DOI: 10.5694/mja15.00415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/04/2015] [Indexed: 11/17/2022]
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19
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Akinyemiju TF, Genkinger JM, Farhat M, Wilson A, Gary-Webb TL, Tehranifar P. Residential environment and breast cancer incidence and mortality: a systematic review and meta-analysis. BMC Cancer 2015; 15:191. [PMID: 25885593 PMCID: PMC4396806 DOI: 10.1186/s12885-015-1098-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 02/20/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Factors beyond the individual level such as those characterizing the residential environment may be important to breast cancer outcomes. We provide a systematic review and results of meta-analysis of the published empirical literature on the associations between breast cancer risk and mortality and features of the residential environment. METHODS Using PRISMA guidelines, we searched four electronic databases and manually searched the references of selected articles for studies that were published before June 2013. We selected English language articles that presented data on adult breast cancer incidence or mortality in relation to at least one area-based residential (ABR) independent variable. RESULTS We reviewed 31 eligible studies, and observed variations in ABR construct definition and measurement, study design, and analytic approach. The most common ABR measures were indicators of socioeconomic status (SES) (e.g., income, education, summary measures of several SES indicators or composite SES). We observed positive associations between breast cancer incidence and urbanization (Pooled RR for urban vs. rural: 1.09. 95% CI: 1.01, 1.19), ABR income (Pooled RR for highest vs. lowest ABR income: 1.17, 95% CI: 1.15, 1.19) and ABR composite SES (Pooled RR for highest vs. lowest ABR composite SES: 1.25, 95% CI: 1.08, 1.44). We did not observe consistent associations between any ABR measures and breast cancer mortality. CONCLUSIONS The findings suggest modest positive associations between urbanization and residential area socioeconomic environment and breast cancer incidence. Further studies should address conceptual and methodological gaps in the current publications to enable inference regarding the influence of the residential environment on breast cancer.
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Affiliation(s)
- Tomi F Akinyemiju
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Jeanine M Genkinger
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
| | - Maggie Farhat
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Adrienne Wilson
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Tiffany L Gary-Webb
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Departments of Community and Behavioral Sciences and Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
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20
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Hocking C, Broadbridge VT, Karapetis C, Beeke C, Padbury R, Maddern GJ, Roder DM, Price TJ. Equivalence of outcomes for rural and metropolitan patients with metastatic colorectal cancer in South Australia. Med J Aust 2015; 201:462-6. [PMID: 25332033 DOI: 10.5694/mja14.00046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 05/06/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the management and outcome of rural and metropolitan patients with metastatic colorectal cancer (mCRC) in South Australia. DESIGN, SETTING AND PATIENTS Retrospective cohort study of patients with mCRC submitted to the South Australian mCRC registry between 2 February 2006 and a cut-off date of 28 May 2012. MAIN OUTCOME MEASURES Differences in oncological and surgical management and overall survival (calculated using the Kaplan-Meier method) between city and rural patients. RESULTS Of 2289 patients, 624 (27.3%) were rural. There was a higher proportion of male patients in the rural cohort, but other patient characteristics did not significantly differ between the cohorts. Equivalent rates of chemotherapy administration between city and rural patients were observed across each line of treatment (first line: 56.0% v 58.3%, P = 0.32; second line: 23.3% v 22.5%, P = 0.78; and third line: 10.1% v 9.3%, P = 0.69). A higher proportion of city patients received combination chemotherapy in the first-line setting (67.4% v 59.9%; P = 0.01). When an oxaliplatin combination was prescribed, oral capecitabine was used more frequently in rural patients (22.9% v 8.4%; P < 0.001). No significant difference was seen in rates of hepatic resection or other non-chemotherapy treatments between cohorts. Median overall survival was equivalent between city and rural patients (14.6 v 14.9 months, P = 0.18). CONCLUSION Patterns of chemotherapy and surgical management of rural patients with mCRC in SA are equivalent to their metropolitan counterparts and lead to comparable overall survival. The centralised model of oncological care in SA may ensure rural patients gain access to optimal care.
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Affiliation(s)
| | | | - Christos Karapetis
- Flinders Cancer Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
| | - Carol Beeke
- Division of Surgery, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - Robert Padbury
- Division of Surgery, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - Guy J Maddern
- Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - David M Roder
- School of Population Health, University of South Australia, Adelaide, SA, Australia
| | - Timothy J Price
- Medical Oncology, The Queen Elizabeth Hospital, Adelaide, SA, Australia
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21
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Patterson KAE, Cleland V, Venn A, Blizzard L, Gall S. A cross-sectional study of geographic differences in health risk factors among young Australian adults: the role of socioeconomic position. BMC Public Health 2014; 14:1278. [PMID: 25512127 PMCID: PMC4300821 DOI: 10.1186/1471-2458-14-1278] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/11/2014] [Indexed: 12/02/2022] Open
Abstract
Background It remains unclear why living outside of an urban environment affects aspects of health, particularly whether these differences can be explained by other factors such as socioeconomic position (SEP). The aim of this study was to compare health risk factors between metropolitan and non-metropolitan young Australian adults and examine whether socioeconomic position (SEP) mediates any differences. Methods Cross-sectional data came from an Australia-wide sample of 26–36 year-olds (n = 2567). Information on demographic characteristics, smoking, alcohol consumption, diet, physical activity (PA, mins/week) and mental health were collected by questionnaire, BMI from measured height and weight and daily steps using pedometers. Metropolitan versus non-metropolitan residence was classified from addresses. SEP included individual-level (education, occupation) and area-level measures. Prevalence ratios and ratio of means were calculated using log binomial, log multinomial and linear regression techniques. Results Non-metropolitan residents were less likely to meet 2 or more dietary guidelines, reported less leisure-time PA and active commuting but more occupational and domestic PA than metropolitan residents. Non-metropolitan women were more likely to smoke and be obese. No differences in mental health were found. After adjusting for SEP, differences remained significant except for leisure-time PA (men and women) and smoking (women). Conclusions Living outside metropolitan areas was associated with more risk factors in these young adults. Individual SEP and area-level disadvantage generally did not explain these differences, suggesting that a focus on geographic location as its own social determinant of health, beyond SEP, is warranted.
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Affiliation(s)
- Kira A E Patterson
- Menzies Research Institute Tasmania, Private Bag 23, Hobart 7001, Tasmania, Australia.
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22
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Hauenstein EJ, Glick DF, Kane C, Kulbok P, Barbero E, Cox K. A Model to Develop Nurse Leaders for Rural Practice. J Prof Nurs 2014; 30:463-73. [DOI: 10.1016/j.profnurs.2014.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Indexed: 12/29/2022]
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23
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Satasivam P, O'Neill S, Sivarajah G, Sliwinski A, Kaiser C, Niall O, Goad J, Brennan J. The dilemma of distance: patients with kidney cancer from regional Australia present at a more advanced stage. BJU Int 2014; 113 Suppl 2:57-63. [PMID: 24053545 DOI: 10.1111/bju.12459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether patients from regional areas undergoing surgery for kidney cancer present with more advanced disease as a result of geographic isolation. PATIENTS AND METHODS Retrospective analysis of 221 patients undergoing surgery for renal cell carcinoma (RCC) from January 2004 to June 2012, from both a metropolitan centre and a large inner regional hospital. Data was collected on age, gender, presentation (incidental or symptomatic), clinical stage and pathological features. The Australian Standard Geographical Classification-Remoteness Area (ASGC-RA) is a system developed to allow quantitative comparisons between metropolitan and rural Australia. A score was assigned to each patient based on their location of residence at the time of surgery: metropolitan, RA1; inner regional, RA2; outer regional, RA3. Statistical significance was specified as P < 0.05 on Pearson's chi-square tests. RESULTS Patients in each ASGC-RA group did not differ significantly in age, sex or mode of presentation. Pathological T stage on presentation increased with increasing ASGC-RA and thus distance from tertiary centres (P = 0.004). The proportion of patients with ≥T3 disease rose from 30% of RA1 to 73% of RA3 patients (P = 0.016) treated at our tertiary centre. Similarly, our regional centre had a larger proportion of patients presenting with ≥T3 disease from RA3 (31% vs 5%, P = 0.003). When the 221 patients with RCC were analysed as a group, clinical T stage was significantly associated with ASGC-RA (P < 0.001), symptomatic presentation (P < 0.001), N stage (P < 0.001), M stage (P < 0.001) and Fuhrman grade (P < 0.001). CONCLUSIONS Our data quantifies the detrimental effect of physical distance on the health outcomes of regional Australians with kidney cancer. Australia's unique geography and rural culture may preclude any attempts to centralise cancer care to specialised metropolitan units, as has occurred in other countries.
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Hearn L, Miller M, Lester L. Reaching perinatal women online: the Healthy You, Healthy Baby website and app. J Obes 2014; 2014:573928. [PMID: 24872891 PMCID: PMC4020447 DOI: 10.1155/2014/573928] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 02/09/2014] [Accepted: 03/16/2014] [Indexed: 11/18/2022] Open
Abstract
Overwhelming evidence reveals the close link between unwarranted weight gain among childbearing women and childhood adiposity. Yet current barriers limit the capacity of perinatal health care providers (PHCPs) to offer healthy lifestyle counselling. In response, today's Internet savvy women are turning to online resources to access health information, with the potential of revolutionising health services by enabling PHCPs to guide women to appropriate online resources. This paper presents the findings of a project designed to develop an online resource to promote healthy lifestyles during the perinatal period. The methodology involved focus groups and interviews with perinatal women and PHCPs to determine what online information was needed, in what form, and how best it should be presented. The outcome was the development of the Healthy You, Healthy Baby website and smartphone app. This clinically-endorsed, interactive online resource provides perinatal women with a personalised tool to track their weight, diet, physical activity, emotional wellbeing, and sleep patterns based on the developmental stage of their child with links to quality-assured information. One year since the launch of the online resource, data indicates it provides a low-cost intervention delivered across most geographic and socioeconomic strata without additional demands on health service staff.
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Affiliation(s)
- Lydia Hearn
- School of Dentistry, University of Western Australia, Perth, WA 6009, Australia
- School of Exercise and Health Science, Edith Cowan University, Joondalup, WA 6027, Australia
- *Lydia Hearn:
| | - Margaret Miller
- Child Health Promotion Research Centre, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Leanne Lester
- Health Promotion Evaluation Unit, University of Western Australia, Perth, WA 6009, Australia
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25
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Chondur R, Li SQ, Guthridge S, Lawton P. Does relative remoteness affect chronic disease outcomes? Geographic variation in chronic disease mortality in Australia, 2002-2006. Aust N Z J Public Health 2013; 38:117-21. [DOI: 10.1111/1753-6405.12126] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Shu Qin Li
- Health Gains Planning Branch, Department of Health, Northern Territory
| | - Steven Guthridge
- Health Gains Planning Branch, Department of Health, Northern Territory
- Centre for Remote Health, Flinders University and Charles Darwin University
- Centre of Research Excellence in Rural and Remote Primary Health Care
| | - Paul Lawton
- Menzies School of Health Research, Northern Territory
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Johnston CL, Maxwell LJ, Maguire GP, Alison JA. How prepared are rural and remote health care practitioners to provide evidence-based management for people with chronic lung disease? Aust J Rural Health 2012; 20:200-7. [PMID: 22827428 DOI: 10.1111/j.1440-1584.2012.01288.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the existing experience, training, confidence and knowledge of rural/remote health care practitioners in providing management for people with chronic obstructive pulmonary disease (COPD). DESIGN Descriptive cross-sectional, observational survey design using a written anonymous questionnaire. This study formed part of a larger project evaluating the impact of breathe easy walk easy (BEWE), an interactive education and training program for rural and remote health care practitioners. SETTING Rural (n = 1, New South Wales) and remote (n = 1, Northern Territory) Australian health care services. PARTICIPANTS Health care practitioners who registered to attend the BEWE training program (n = 31). MAIN OUTCOME MEASURES Participant attitudes, objective knowledge and self-rated experience, training and confidence related to providing components of management for people with COPD. RESULTS Participants were from a variety of professional backgrounds (medical, nursing, allied health) but were predominantly nurses (n = 13) or physiotherapists (n = 9). Most participants reported that they had minimal or no experience or training in providing components of management for people with COPD. Confidence was also commonly rated by participants as low. Mean knowledge score (number of correct answers out of 19) was 8.5 (SD = 4.5). Questions relating to disease pathophysiology and diagnosis had higher correct response rates than those relating more specifically to pulmonary rehabilitation. CONCLUSION The results of this study indicate that some rural and remote health care practitioners have low levels of experience, knowledge and confidence related to providing components of management for people with COPD and that education and training with an emphasis on pulmonary rehabilitation would be beneficial.
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Affiliation(s)
- Catherine Louise Johnston
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, Australia.
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Salcedo N, Saez M, Bragulat B, Saurina C. Does the effect of gender modify the relationship between deprivation and mortality? BMC Public Health 2012; 12:574. [PMID: 22846597 PMCID: PMC3778847 DOI: 10.1186/1471-2458-12-574] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 07/13/2012] [Indexed: 11/10/2022] Open
Abstract
Background In this study we propose improvements to the method of elaborating deprivation indexes. First, in the selection of the variables, we incorporated a wider range of both objective and subjective measures. Second, in the statistical methodology, we used a distance indicator instead of the standard aggregating method principal component analysis. Third, we propose another methodological improvement, which consists in the use of a more robust statistical method to assess the relationship between deprivation and health responses in ecological regressions. Methods We conducted an ecological small-area analysis based on the residents of the Metropolitan region of Barcelona in the period 1994–2007. Standardized mortality rates, stratified by sex, were studied for four mortality causes: tumor of the bronquial, lung and trachea, diabetes mellitus type II, breast cancer, and prostate cancer. Socioeconomic conditions were summarized using a deprivation index. Sixteen socio-demographic variables available in the Spanish Census of Population and Housing were included. The deprivation index was constructed by aggregating the above-mentioned variables using the distance indicator, DP2. For the estimation of the ecological regression we used hierarchical Bayesian models with some improvements. Results At greater deprivation, there is an increased risk of dying from diabetes for both sexes and of dying from lung cancer for men. On the other hand, at greater deprivation, there is a decreased risk of dying from breast cancer and lung cancer for women. We did not find a clear relationship in the case of prostate cancer (presenting an increased risk but only in the second quintile of deprivation). Conclusions We believe our results were obtained using a more robust methodology. First off, we have built a better index that allows us to directly collect the variability of contextual variables without having to use arbitrary weights. Secondly, we have solved two major problems that are present in spatial ecological regressions, i.e. those that use spatial data and, consequently, perform a spatial adjustment in order to obtain consistent estimators.
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Affiliation(s)
- Natalia Salcedo
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
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Ward J. Responses to ‘From Norm to Eric’. Aust N Z J Public Health 2012; 36:91-2; author reply 93. [DOI: 10.1111/j.1753-6405.2012.00835.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Jordan S, Wilson A, Dobson A. Management of heart conditions in older rural and urban Australian women. Intern Med J 2011; 41:722-9. [DOI: 10.1111/j.1445-5994.2011.02536.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Youl PH, Baade PD, Aitken JF, Chambers SK, Turrell G, Pyke C, Dunn J. A multilevel investigation of inequalities in clinical and psychosocial outcomes for women after breast cancer. BMC Cancer 2011; 11:415. [PMID: 21951320 PMCID: PMC3195770 DOI: 10.1186/1471-2407-11-415] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 09/28/2011] [Indexed: 12/02/2022] Open
Abstract
Background In Australia, breast cancer is the most common cancer affecting Australian women. Inequalities in clinical and psychosocial outcomes have existed for some time, affecting particularly women from rural areas and from areas of disadvantage. We have a limited understanding of how individual and area-level factors are related to each other, and their associations with survival and other clinical and psychosocial outcomes. Methods/Design This study will examine associations between breast cancer recurrence, survival and psychosocial outcomes (e.g. distress, unmet supportive care needs, quality of life). The study will use an innovative multilevel approach using area-level factors simultaneously with detailed individual-level factors to assess the relative importance of remoteness, socioeconomic and demographic factors, diagnostic and treatment pathways and processes, and supportive care utilization to clinical and psychosocial outcomes. The study will use telephone and self-administered questionnaires to collect individual-level data from approximately 3, 300 women ascertained from the Queensland Cancer Registry diagnosed with invasive breast cancer residing in 478 Statistical Local Areas Queensland in 2011 and 2012. Area-level data will be sourced from the Australian Bureau of Statistics census data. Geo-coding and spatial technology will be used to calculate road travel distances from patients' residence to diagnostic and treatment centres. Data analysis will include a combination of standard empirical procedures and multilevel modelling. Discussion The study will address the critical question of: what are the individual- or area-level factors associated with inequalities in outcomes from breast cancer? The findings will provide health care providers and policy makers with targeted information to improve the management of women with breast cancer, and inform the development of strategies to improve psychosocial care for women with breast cancer.
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Affiliation(s)
- Philippa H Youl
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, QLD, Australia.
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