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Casey C, Buckley CM, Kearney PM, Griffin MD, Dinneen SF, Griffin TP. Social deprivation and diabetic kidney disease: A European view. J Diabetes Investig 2024; 15:541-556. [PMID: 38279774 PMCID: PMC11060165 DOI: 10.1111/jdi.14156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024] Open
Abstract
There is a large body of literature demonstrating a social gradient in health and increasing evidence of an association between social deprivation and diabetes complications. Diabetic kidney disease (DKD) increases mortality in people with diabetes. Socioeconomic deprivation is increasingly recognized as a modifier of risk factors for kidney disease but also an independent risk factor itself for kidney disease. This may not be truly appreciated by clinicians and warrants further attention and exploration. In this review we explore the literature to date from Europe on the relationship between social deprivation and DKD. The majority of the studies showed at least an association with microalbuminuria, an early marker of DKD, while many showed an association with overt nephropathy. This was seen across many countries in Europe using a variety of different measures of deprivation. We reviewed and considered the mechanisms by which deprivation may lead to DKD. Health related behaviors such as smoking and suboptimal control of risk factors such as hypertension, hyperglycemia and elevated body mass index (BMI) accounts for some but not all of the association. Poorer access to healthcare, health literacy, and stress are also discussed as potential mediators of the association. Addressing deprivation is difficult but starting points include targeted interventions for people living in deprived circumstances, equitable roll out of diabetes technology, and flexible outpatient clinic arrangements including virtual and community-based care.
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Affiliation(s)
- Caoimhe Casey
- Centre for Diabetes, Endocrinology and MetabolismGalway University HospitalsGalwayIreland
- School of Public HealthUniversity College CorkCorkIreland
| | | | | | - Matthew D Griffin
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Research Centre for Medical Devices, School of MedicineUniversity of GalwayGalwayIreland
- Department of NephrologyGalway University HospitalGalwayIreland
| | - Sean F Dinneen
- Centre for Diabetes, Endocrinology and MetabolismGalway University HospitalsGalwayIreland
- School of MedicineUniversity of GalwayGalwayIreland
| | - Tomás P Griffin
- Centre for Diabetes, Endocrinology and MetabolismGalway University HospitalsGalwayIreland
- School of MedicineUniversity of GalwayGalwayIreland
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Social mobility across the lifecourse and DNA methylation age acceleration in adults in the UK. Sci Rep 2022; 12:22284. [PMID: 36566336 PMCID: PMC9790005 DOI: 10.1038/s41598-022-26433-2] [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: 10/11/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022] Open
Abstract
Disadvantaged socio-economic position (SEP) is associated with greater biological age, relative to chronological age, measured by DNA methylation (positive 'age acceleration', AA). Social mobility has been proposed to ameliorate health inequalities. This study aimed to understand the association of social mobility with positive AA. Diagonal reference modelling and ordinary least square regression techniques were applied to explore social mobility and four measures of age acceleration (first-generation: 'Horvath', 'Hannum' and second-generation: 'Phenoage', DunedinPoAm) in n = 3140 participants of the UK Household Longitudinal Study. Disadvantaged SEP in early life is associated with positive AA for three (Hannum, Phenoage and DunedinPoAm) of the four measures examined while the second generation biomarkers are associated with SEP in adulthood (p < 0.01). Social mobility was associated with AA measured with Hannum only such that compared to no mobility, upward mobility was associated with greater age independently of origin and destination SEP. Compared to continuously advantaged groups, downward mobility was associated with positive Phenoage (1.06y [- 0.03, 2.14]) and DunedinPoAm assessed AA (0.96y [0.24, 1.68]). For these two measures, upward mobility was associated with negative AA (Phenoage, - 0.65y [- 1.30, - 0.002]; DunedinPoAm, - 0.96y [- 1.47, - 0.46]) compared to continually disadvantaged groups. While we find some support for three models of lifecourse epidemiology with early life as a sensitive period, SEP across the lifecourse and social mobility for age acceleration measured with DNA methylation, our findings suggest that disadvantaged SEP across the lifecourse is most consistently associated with positive AA.
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Shaw S, Jana A, Kundu S. An analytical pathway of consumption expenditure with neighborhood deprivation and depression on cognitive health among elderly in India: A moderated mediation approach. J Affect Disord 2022; 308:249-258. [PMID: 35429519 DOI: 10.1016/j.jad.2022.04.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 01/22/2022] [Accepted: 04/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aims to find the linkage between neighborhood deprivation and cognition with depression as a mediating factor while economic condition as a moderator. METHODS We have used the recent baseline wave-1 data of Longitudinal Aging Study in India (LASI), 2017-2018. The study was restricted to 60 and above population, consisting of males (14,931) and females (16,533). We have used moderated mediating model to understand the relationship between deprivation (X), cognition (Y) mediated through depression (M), moderated by economic condition (W), while controlling all possible confounders. RESULTS Neighborhood deprivation was positively associated with depression (β: 0.12; SE: 0.01) and inversely linked to cognition (β: -0.4; SE: 0.02). Deprivation had a strong indirect effect on cognition that was mediated by depression. Further, interaction of depression (M) and economic condition (W) was negatively associated (β = -0.03; SE: 0.01) with cognition (Y), indicating that lower economic section being more depressed with lower cognitive function. LIMITATIONS The study failed to capture other mental health aspects like stress and anxiety using the Depression, Anxiety and Stress Scale-21 items (DASS-21). CONCLUSIONS This study has found a link between higher economic condition with low deprivation and depression. Older individuals with better financial situation have improved cognitive level than their counterparts, who are also depressed. This study provides an opportunity to conduct future research on cognitive health in the face of population aging in India.
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Affiliation(s)
- Subhojit Shaw
- Department of Population and Development, International Institute for Population Sciences, Deonar, Mumbai 400088, India
| | - Arup Jana
- Department of Population and Development, International Institute for Population Sciences, Deonar, Mumbai 400088, India
| | - Sampurna Kundu
- Center of Social Medicine and Community Health, Jawaharlal Nehru University, Delhi 110067, India.
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Andersén H, Kankaanranta H, Tuomisto LE, Piirilä P, Sovijärvi A, Langhammer A, Backman H, Lundbäck B, Rönmark E, Lehtimäki L, Ilmarinen P. Multimorbidity in Finnish and Swedish speaking Finns; association with daily habits and socioeconomic status - Nordic EpiLung cross-sectional study. Prev Med Rep 2021; 22:101338. [PMID: 33732608 PMCID: PMC7937573 DOI: 10.1016/j.pmedr.2021.101338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/12/2021] [Accepted: 02/09/2021] [Indexed: 12/23/2022] Open
Abstract
Multimorbidity is an emerging public health priority. This study aims to assess the role of lifestyle and socioeconomic status in the prevalence of multimorbidity and chronic diseases by using two language groups that are part of the same genetic subgroup but differ by daily habits. We conducted a cross-sectional survey in 2016 with randomly selected population sample with 4173 responders (52.3%) aged 20-69 years in Western Finland. We included 3864 Finnish participants with Swedish (28.1%) or Finnish (71.9%) as a native language. We used a questionnaire to assess participants' chronic diseases and lifestyle. We determined multimorbidity as a disease count ≥ 2. Finnish speakers were more likely to have a diagnosis of COPD, heart failure, diabetes, reflux disease, chronic kidney failure, and painful conditions than Swedish speakers. The prevalence of multimorbidity was higher for Finnish speakers in the age group of 60-69 years (41.0% vs. 32.0%, p = 0.018) than Swedish speakers. A higher proportion of Finnish speakers smoked, were obese, inactive, and had lower socioeconomic status compared to Swedish speakers. All these factors, in addition to age and female sex, were significant risk factors for multimorbidity. Prevalence of multimorbidity was different in two language groups living in the same area and was associated with differences in lifestyle factors such as smoking, physical inactivity and obesity.
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Affiliation(s)
- Heidi Andersén
- Karolinska University Hospital, Thoracic Oncology Unit, Tema Cancer, Stockholm, Sweden
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Päivi Piirilä
- Unit of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital, Finland
- University of Helsinki, Helsinki, Finland
| | - Anssi Sovijärvi
- Unit of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital, Finland
- University of Helsinki, Helsinki, Finland
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Pinja Ilmarinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Kashem T, Al Sayah F, Tawiah A, Ohinmaa A, Johnson JA. The relationship between individual-level deprivation and health-related quality of life. Health Qual Life Outcomes 2019; 17:176. [PMID: 31783859 PMCID: PMC6883516 DOI: 10.1186/s12955-019-1243-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To examine the association between individual-level deprivation and health-related quality of life (HRQL) in the general population. METHODS Data from a population-based survey in the Canadian province of Alberta were used. Individual-level deprivation was assessed using the Canadian Deprivation Index (CDI) and the Ontario Deprivation Index (ODI). HRQL was assessed using the EQ-5D-5 L. Differences in problems in the EQ-5D-5 L dimensions, index and visual analogue scale (VAS) scores across levels of deprivation were examined. Multivariate logistic and linear regression models adjusted for socio-demographic and other characteristics were used to examine the independent association between deprivation and HRQL. RESULTS Of the 6314 respondents, 39% were aged between 18 and 44 years and 38% between 45 and 64 years; 60% were female. Mean EQ-5D-5 L index and VAS scores were 0.85 (standard deviation [SD] 0.14) and 79.6 (SD 17.7), respectively. Almost one-third (30.6%) of respondents reported no problems on all EQ-5D-5 L dimensions. Few participants reported some problems with mobility (23.8%), self-care (6.2%) and usual activities (25.2%), while 59.3 and 35.5% reported some levels of pain/discomfort and anxiety/depression, respectively. Differences between the most and least deprived in reporting problems in EQ-5D-5 L dimensions, index and VAS scores were statistically significant and clinically important. In adjusted regression models for both deprivation indices, the least well-off, compared to the most well-off, had higher likelihood of reporting problems in all EQ-5D-5 L dimensions. Compared to the most well-off, the least well-off had an EQ-5D-5 L index score decrement of 0.18 (p < 0.01) and 0.17 (p < 0.01) for the CDI and ODI, respectively. Similarly, an inverse association was found between the VAS score and the CDI (β = - 17.3, p < 0.01) as well as the ODI (β = - 13.3, p < 0.01). CONCLUSION Individual-level deprivation is associated with worse HRQL. Poverty reduction strategies should consider the effects of not only neighbourhood-level deprivation, but also that of individual-level deprivation to improve overall health.
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Affiliation(s)
- Tahmid Kashem
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada.
| | - Fatima Al Sayah
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Andrews Tawiah
- Faculty of Rehabilitation Medicine, University of Alberta, 3-44 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Jeffery A Johnson
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
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Tatulashvili S, Fagherazzi G, Dow C, Cohen R, Fosse S, Bihan H. Socioeconomic inequalities and type 2 diabetes complications: A systematic review. DIABETES & METABOLISM 2019; 46:89-99. [PMID: 31759171 DOI: 10.1016/j.diabet.2019.11.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/19/2019] [Accepted: 11/06/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES A socioeconomic gradient related to type 2 diabetes (T2D) prevalence has been demonstrated in high-income countries. However, there is no evidence of such a socioeconomic gradient regarding diabetes complications. Thus, the aim of this systematic review was to collect data on risk of complications according to socioeconomic status in patients with T2D. METHODS PubMed and EMBASE were searched for English-language observational studies evaluating the prevalence or incidence of micro- and macrovascular complications according to individual and geographical socioeconomic status (SES). Observational studies reporting the prevalence and risk of micro- and macrovascular diabetes complications, according to an individual or geographical index of deprivation, were selected, and estimated crude and adjusted risks for each complication were reported. RESULTS Among the 28 included studies, most described a clear relationship between SES and diabetes complications, especially retinopathy (in 9 of 14 studies) and cardiopathy (in 8 of 9 studies). Both individual and area-based low SES was associated with an increased risk of complications. However, very few studies adjusted their analyses according to HbA1c level. CONCLUSION Evaluation of SES is necessary for every T2D patient, as it appears to be a risk factor for diabetes complications. However, the available studies are insufficient for gradation of the impact of low socioeconomic level on each of these complications. Regardless, strategies for the improved screening, follow-up and care of high-risk patients should now be implemented.
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Affiliation(s)
- S Tatulashvili
- Department of Endocrinology, Diabetology, Metabolic Disease, Avicenne Hospital, Sorbonne Paris Cité, CRNH-IdF, Paris 13 University, AP-HP, 93000 Bobigny, France
| | - G Fagherazzi
- Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP), Paris-Sud Paris-Saclay University, 94800 Villejuif, France
| | - C Dow
- Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP), Paris-Sud Paris-Saclay University, 94800 Villejuif, France
| | - R Cohen
- Department of Endocrinology, Diabetology, Delafontaine Hospital, 93205 Saint-Denis, France
| | - S Fosse
- French National Public Health Agency, 94410 Saint-Maurice, France
| | - H Bihan
- Department of Endocrinology, Diabetology, Metabolic Disease, Avicenne Hospital, Sorbonne Paris Cité, CRNH-IdF, Paris 13 University, AP-HP, 93000 Bobigny, France; Health Education and Practice Laboratory, EA 3412, UFR SMBH Léonard de Vinci, Paris 13 University, 93017 Bobigny, France.
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Cassell A, Edwards D, Harshfield A, Rhodes K, Brimicombe J, Payne R, Griffin S. The epidemiology of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract 2018; 68:e245-e251. [PMID: 29530918 PMCID: PMC5863678 DOI: 10.3399/bjgp18x695465] [Citation(s) in RCA: 290] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/09/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Multimorbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available. AIM To describe the epidemiology of multimorbidity in adults in England, and quantify associations between multimorbidity and health service utilisation. DESIGN AND SETTING Retrospective cohort study, undertaken in England. METHOD The study used a random sample of 403 985 adult patients (aged ≥18 years), who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Multimorbidity was defined as having two or more of 36 long-term conditions recorded in patients' medical records, and associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over 4 years were quantified. RESULTS In total, 27.2% of the patients involved in the study had multimorbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). The prevalence of multimorbidity was higher in females than males (30.0% versus 24.4% respectively) and among those with lower socioeconomic status (30.0% in the quintile with the greatest levels of deprivation versus 25.8% in that with the lowest). Physical-mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients (18-44 years) and those patients with a lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Patients with multimorbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions. CONCLUSION Multimorbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.
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Affiliation(s)
- Anna Cassell
- School of Medicine, University of Utah, Salt Lake City, US
| | - Duncan Edwards
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Amelia Harshfield
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kirsty Rhodes
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rupert Payne
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Axelsson Fisk S, Mulinari S, Wemrell M, Leckie G, Perez Vicente R, Merlo J. Chronic Obstructive Pulmonary Disease in Sweden: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy. SSM Popul Health 2018; 4:334-346. [PMID: 29854918 PMCID: PMC5976844 DOI: 10.1016/j.ssmph.2018.03.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 12/13/2022] Open
Abstract
Socioeconomic, ethnic and gender disparities in Chronic Obstructive Pulmonary Disease (COPD) risk are well established but no studies have applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) within an intersectional framework to study this outcome. We study individuals at the first level of analysis and combinations of multiple social and demographic categorizations (i.e., intersectional strata) at the second level of analysis. Here we used MAIHDA to assess to what extent individual differences in the propensity of developing COPD are at the intersectional strata level. We also used MAIHDA to determine the degree of similarity in COPD incidence of individuals in the same intersectional stratum. This leads to an improved understanding of risk heterogeneity and of the social dynamics driving socioeconomic and demographic disparities in COPD incidence. Using data from 2,445,501 residents in Sweden aged 45–65, we constructed 96 intersectional strata combining categories of age, gender, income, education, civil- and migration status. The incidences of COPD ranged from 0.02% for young, native males with high income and high education who cohabited to 0.98% for older native females with low income and low education who lived alone. We calculated the intra-class correlation coefficient (ICC) that informs on the discriminatory accuracy of the categorizations. In a model that conflated additive and interaction effects, the ICC was good (20.0%). In contrast, in a model that measured only interaction effects, the ICC was poor (1.1%) suggesting that most of the observed differences in COPD incidence across strata are due to the main effects of the categories used to construct the intersectional matrix while only a minor share of the differences are attributable to intersectional interactions. We found conclusive interaction effects. The intersectional MAIHDA approach offers improved information to guide public health policies in COPD prevention, and such policies should adopt an intersectional perspective. We use multilevel analysis of individual heterogeneity and discriminatory accuracy. There is a clear difference in COPD incidence between intersectional strata. Intersectionality improves mapping of socioeconomic differences in COPD incidence. Preventive measures should be based on intersectional rather than classic analyses.
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Affiliation(s)
- Sten Axelsson Fisk
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Sweden
| | - Shai Mulinari
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Sweden
| | - Maria Wemrell
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Sweden
| | - George Leckie
- Centre for Multilevel Modelling, University of Bristol, UK
| | | | - Juan Merlo
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Sweden.,Center for Primary Health Research, Region Skåne, Malmö, Sweden
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McNamara CL, Balaj M, Thomson KH, Eikemo TA, Bambra C. The contribution of housing and neighbourhood conditions to educational inequalities in non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health. Eur J Public Health 2018; 27:102-106. [PMID: 28355640 DOI: 10.1093/eurpub/ckw224] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Social gradients have been found across European populations, where less affluent groups are more often affected by poor housing and neighbourhood conditions. While poor housing and neighbourhood quality have been associated with a range of non-communicable diseases (NCDs), these conditions have rarely been applied to the examination of socioeconomic differences in NCDs. This study therefore asks ‘to what extent does adjusting for poor housing and neighbourhood conditions reduce inequalities in NCDs among men and women in Europe’? Methods Our analysis used pooled-data from 20 European countries for women (n= 12 794) and men (n= 11 974), aged 25–75, from round 7 of the European Social Survey. Fourteen NCDs were investigated: heart/circulatory problems, high blood pressure, back pain, arm/hand pain, foot/leg pain, allergies, breathing problems, stomach/digestion problems, skin conditions, diabetes, severe headaches, cancer, obesity and depression. We used binary logistic regression models, stratified by gender, and adjusted rate ratios to examine whether educational inequalities in NCDs were reduced after controlling for poor housing and neighbourhood quality. Results Overall, we find that adjusting for poor housing and neighbourhood quality reduces inequalities in NCDs. While reductions were relatively small for some NCDs–for high blood pressure, reductions were found in the range of 0–4.27% among women—for other conditions reductions were more considerable. Controlling for both housing and neighbourhood conditions for example, reduced inequalities by 16–24% for severe headaches and 14–30% for breathing problems. Conclusions Social gradients in poor housing and neighbourhood quality could be an important contributor to educational inequalities in some NCDs.
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Affiliation(s)
- Courtney L McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mirza Balaj
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Katie H Thomson
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, UK
| | - Terje A Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Clare Bambra
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, UK
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Dreassi E. Lung Cancer Mortality in Tuscany from 1971 to 2010 and Its Connections with Silicosis: A Space-Cohort Analysis Based on Shared Models. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:4964569. [PMID: 29796059 PMCID: PMC5896287 DOI: 10.1155/2018/4964569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/13/2017] [Accepted: 12/28/2017] [Indexed: 11/18/2022]
Abstract
Lung cancer mortality in Tuscany (Italy) for males, from 1971 and 2010, is investigated. A hierarchical Bayesian model for space-time disease mapping is introduced. Such a model belongs to the class of shared random effect models and exploits the birth-cohort as the relevant time dimension. It allows for highlighting common and specific patterns of risk for each birth-cohort. The results show that different birth-cohorts exhibit quite different spatial patterns, even if the socioeconomic status is taken into account. In fact, there were different occupational exposures before and after the Second World War. The birth-cohort 1930-35 exhibits high relative risks related to particular areas. This fact could be connected with occupational exposure to risk factors for silicosis, perhaps a prognostic status for lung cancer.
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Affiliation(s)
- Emanuela Dreassi
- Dipartimento di Statistica, Informatica, Applicazioni “G. Parenti”, Università di Firenze, Viale Morgagni 59, 50134 Firenze, Italy
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Kim GR, Nam CM. Temporal trends in educational inequalities in non-communicable diseases in Korea, 2007-2015. PLoS One 2017; 12:e0190143. [PMID: 29284021 PMCID: PMC5746222 DOI: 10.1371/journal.pone.0190143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 12/09/2017] [Indexed: 11/19/2022] Open
Abstract
Background Socioeconomic inequalities in non-communicable diseases are known to exist; however there is a paucity of research describing the secular trends in these inequalities. To this end, the current study aims to explore the recent time trends in social patterning of selected non-communicable diseases among Korean adults between 2007 and 2015. Methods Using data from the Korea National Health and Nutrition Examination Survey (KNHANES), temporal trends in socioeconomic inequalities in diabetes, arthritis, asthma and depressive symptoms were assessed across three time points. Respondents were adults aged 20 years or over (N = 47,091, 20,180 men and 26,911 women). Socioeconomic circumstance was assessed based on highest level of educational attainment. We estimated prevalence ratios with 95% confidence intervals using Poisson regression with robust variance estimation (adjusted for age, smoking status, alcohol consumption, obesity, and physical activity) separately for men and women. The magnitude of the inequalities was computed using the relative index of inequality (RII). Results In men, diabetes was not associated with educational attainment, while there was evidence of a negative association in women across surveys. Similar inverse associations were found with arthritis and depressive symptoms, but these associations were less clear for asthma. RII showed a non-significant increasing trend in educational disparities in depressive symptoms. Meanwhile, relative inequalities in diabetes, arthritis and asthma have narrowed. These trends were, in general, more pronounced in women. Conclusions The findings of this study indicate higher burden of selected NCDs among the lower educational groups, particularly among women. In addition, our results indicated some improvements in inequalities in diabetes, arthritis and asthma in recent years. These findings have important implications for understanding the causes of social patterning of NCDs and for the targeting of effective interventions.
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Affiliation(s)
- Gyu Ri Kim
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea
- * E-mail:
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Noh JW, Park H, Kim M, Kwon YD. Gender Differences and Socioeconomic Factors Related to Osteoporosis: A Cross-Sectional Analysis of Nationally Representative Data. J Womens Health (Larchmt) 2017; 27:196-202. [PMID: 28832241 DOI: 10.1089/jwh.2016.6244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Osteoporosis has been considered a disease that primarily affects women, but recently male osteoporosis is also attracting attention. This study aims to comparatively analyze socioeconomic and other factors that are related to the prevalence of osteoporosis in both men and women. MATERIALS AND METHODS This study used data from the Korean Community Health Survey conducted in 2013. To determine factors related to osteoporosis prevalence, researchers applied a binary logistic regression model, first for all research participants, then separately for male and female participants. RESULTS Women were more likely than men to have osteoporosis (odds ratio 12.33, 95% confidence interval 11.55-13.17). Factors related to osteoporosis prevalence included age, education level, region, economic activity, alcohol consumption, salt intake, depression, and body mass index in both genders. Low education and income levels were more highly associated with osteoporosis prevalence in women than in men. CONCLUSIONS Most of the factors were not gender specific, but some socioeconomic determinants varied by gender. Future studies that will focus on the effects of socioeconomic factors on osteoporosis, as well as gender-related differences in prevention and control of osteoporosis, are needed.
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Affiliation(s)
- Jin-Won Noh
- 1 Department of Healthcare Management, Eulji University , Seongnam, Korea.,2 University Medical Centre Groningen, University of Groningen , Groningen, The Netherlands
| | - Hyunchun Park
- 1 Department of Healthcare Management, Eulji University , Seongnam, Korea
| | - Minji Kim
- 1 Department of Healthcare Management, Eulji University , Seongnam, Korea
| | - Young Dae Kwon
- 3 Department of Humanities and Social Medicine, College of Medicine and Catholic Institute for Healthcare Management, The Catholic University of Korea , Seoul, Korea
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Cookson R, Dusheiko M, Hardman G. Socioeconomic inequality in small area use of elective total hip replacement in the English National Health Service in 1991 and 2001. J Health Serv Res Policy 2016; 12 Suppl 1:S1-10-7. [PMID: 17411502 DOI: 10.1258/135581907780318365] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives To compare socioeconomic inequality in small area use of elective total hip replacement in the English National Health Service (NHS) in 1991 and 2001. Methods Hospital Episode Statistics and Census data were aggregated to a common geography of ‘frozen’ 1991 English electoral wards. The Townsend deprivation score was used as the primary indicator of socioeconomic status for each ward, and the sensitivity analysis used other Census indicators. Two main measures of inequality were examined: the indirectly age-sex standardized utilization rate ratio between most and least deprived quintile groups, and the concentration index of deprivation-related inequality in age-sex standardized utilization ratios between small areas. Each standardized utilization ratio is the observed use divided by the expected use, if each age and sex group in the study population had the same use rate as the national population. Results In both years, observed use was below expected use for the bottom third of areas by socioeconomic status. The standardized utilization rate ratio between top and bottom Townsend quintiles fell from 1.41 (95% confidence interval [CI] 1.36-1.47) in 1991 to 1.27 (95% CI 1.23-1.32) in 2001. The proportionate increase in use required to bring the bottom quintile to the level of top thus fell significantly from 41% to 27%. The Town-send-based concentration index also fell from 0.069 (95% CI 0.059-0.079) in 1991 to 0.060 (95% CI 0.050-0.071) in 2001, although this fall was not statistically significant (P=0.085). Other socioeconomic indicators yielded a similar pattern. Conclusions Socioeconomic small area inequality in use of total hip replacement appears to have fallen between 1991 and 2001. One possible explanation is that increased hip replacement rates in the 1990s may have lowered barriers to access, thus allowing this health technology to diffuse further among lower socio-economic groups.
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Affiliation(s)
- Richard Cookson
- Department of Social Policy and Social Work, Centre for Health Economics, University of York, York YO10 5DD, UK.
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Pleasants RA, Riley IL, Mannino DM. Defining and targeting health disparities in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2016; 11:2475-2496. [PMID: 27785005 PMCID: PMC5065167 DOI: 10.2147/copd.s79077] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The global burden of chronic obstructive pulmonary disease (COPD) continues to grow in part due to better outcomes in other major diseases and in part because a substantial portion of the worldwide population continues to be exposed to inhalant toxins. However, a disproportionate burden of COPD occurs in people of low socioeconomic status (SES) due to differences in health behaviors, sociopolitical factors, and social and structural environmental exposures. Tobacco use, occupations with exposure to inhalant toxins, and indoor biomass fuel (BF) exposure are more common in low SES populations. Not only does SES affect the risk of developing COPD and etiologies, it is also associated with worsened COPD health outcomes. Effective interventions in these people are needed to decrease these disparities. Efforts that may help lessen these health inequities in low SES include 1) better surveillance targeting diagnosed and undiagnosed COPD in disadvantaged people, 2) educating the public and those involved in health care provision about the disease, 3) improving access to cost-effective and affordable health care, and 4) markedly increasing the efforts to prevent disease through smoking cessation, minimizing use and exposure to BF, and decreasing occupational exposures. COPD is considered to be one the most preventable major causes of death from a chronic disease in the world; therefore, effective interventions could have a major impact on reducing the global burden of the disease, especially in socioeconomically disadvantaged populations.
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Affiliation(s)
- Roy A Pleasants
- Duke Asthma, Allergy, and Airways Center
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine
- Durham VA Medical Center, Durham, NC
| | - Isaretta L Riley
- Duke Asthma, Allergy, and Airways Center
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine
- Durham VA Medical Center, Durham, NC
| | - David M Mannino
- Division of Pulmonary, Critical Care, and Sleep Medicine, Pulmonary Epidemiology Research Laboratory, University of Kentucky, Lexington, KY, USA
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Abstract
The first Whitehall Study of British civil servants demonstrated an inverse gradient in mortality. The lower the grade the higher was the mortality risk. This higher mortality risk applies to most but not all causes of death. The Whitehall II Study, set up to investigate causes of this social gradient shows similarly marked gradients in morbidity. A review of potential causes of the gradient suggests that it is due neither to health selection nor simply to differences in lifestyle, but that relative deprivation—a psychosocial concept—and the accumulation of socially-patterned exposures over the life course, must be important. Whitehall II suggests that the operation of these factors is to be found in the specific circumstances under which people grow, live and work.
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Prescribing of nicotine replacement therapy in and around pregnancy: a population-based study using primary care data. Br J Gen Pract 2015; 64:e554-60. [PMID: 25179069 PMCID: PMC4141612 DOI: 10.3399/bjgp14x681361] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Licensing arrangements for nicotine replacement therapy (NRT) in the UK were broadened in 2005 to allow prescribing to pregnant smokers. However, estimates of NRT prescribing in pregnant females in the UK are currently lacking. AIM To assess trends in NRT prescribing around pregnancy, and variation in prescribing by maternal characteristics. DESIGN AND SETTING Population-based descriptive study using pregnancy data from The Health Improvement Network primary care database, 2001-2012. METHOD NRT prescriptions were identified during pregnancy and in the 9 months before and after. Annual prescribing prevalence was calculated. Logistic regression was used to assess females' likelihood of receiving prescriptions by maternal characteristics. RESULTS Of 388 142 pregnancies studied, NRT was prescribed in 7551 for an average duration of 2 weeks. The prescribing prevalence of NRT increased from 0.03% (0.7% in smokers) in 2001 to 2.6% (11.4% in smokers) in 2005, after which it remained stable. Prescribing prevalence of NRT before and after pregnancy was half the prevalence during pregnancy. The odds of prescribing NRT during pregnancy in smokers increased with socioeconomic deprivation (OR = 1.29, 95% CI = 1.15 to 1.45 in the most compared with the least deprived group). Prescribing was 33% higher in pregnant smokers with asthma (OR = 1.33, 95% CI = 1.22 to 1.45) and mental illness (OR = 1.33, 95% CI = 1.23 to 1.44) compared with smokers without these diagnoses. CONCLUSION NRT prescribing is higher during pregnancy compared with before and after, and is higher in smokers from more socioeconomically deprived groups, those with asthma or those diagnosed mental illness.
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Hilfiker R, Jüni P, Nüesch E, Dieppe PA, Reichenbach S. Association of radiographic osteoarthritis, pain on passive movement and knee range of motion: A cross-sectional study. ACTA ACUST UNITED AC 2015; 20:361-5. [DOI: 10.1016/j.math.2014.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 11/04/2014] [Accepted: 11/10/2014] [Indexed: 01/28/2023]
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Nwanyanwu KH, Newman-Casey PA, Gardner TW, Lim JI. Beyond HbA 1c: Environmental Risk Factors for Diabetic Retinopathy. ACTA ACUST UNITED AC 2015; 6. [PMID: 26973797 PMCID: PMC4785841 DOI: 10.4172/2155-9570.1000405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diabetic retinopathy affects 4.2 million people in the United States and is the leading cause of blindness in working-aged people. As the prevalence of diabetes continues to rise, cost-effective interventions to decrease blindness from diabetic retinopathy will be paramount. While HbA1c and duration of disease are known risk factors, they account for only 11% of the risk of developing microvascular complications from the disease. The assessment of environmental risk factors for diabetic eye disease allows for the determination of modifiable population-level challenges that may be addressed to facilitate the end of blindness from diabetes.
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Affiliation(s)
| | | | | | - Jennifer I Lim
- University of Illinois at Chicago, Chicago, Illinois, USA
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Pickrell WO, Lacey AS, Bodger OG, Demmler JC, Thomas RH, Lyons RA, Smith PEM, Rees MI, Kerr MP. Epilepsy and deprivation, a data linkage study. Epilepsia 2015; 56:585-91. [PMID: 25873180 DOI: 10.1111/epi.12942] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether the link between epilepsy and deprivation is due to factors associated with deprivation (social causation) or factors associated with a diagnosis of epilepsy (social drift). METHODS We reviewed electronic primary health care records from 2004 to 2010, identifying prevalent and incident cases of epilepsy and recording linked deprivation scores. Logistic and Poisson regression models were used to calculate odds ratios and incidence rate ratios. The change in deprivation was measured 10 years after the initial diagnosis of epilepsy for a cohort of people. RESULTS Between 2004 and 2010, 8.1 million patient-years of records were reviewed. Epilepsy prevalence and incidence were significantly associated with deprivation. Epilepsy prevalence ranged from 1.13% (1.07-1.19%) in the most deprived decile to 0.49% (0.45-0.53%) in the least deprived decile (adjusted odds ratio 0.92, p < 0.001). Epilepsy incidence ranged from 40/100,000 per year in the most deprived decile to 19/100,000 per year in the least deprived decile (adjusted incidence rate ratio 0.94, p < 0.001). There was no statistically significant change in deprivation index decile 10 years after a new diagnosis of epilepsy (mean difference -0.04, p = 0.85). SIGNIFICANCE Epilepsy prevalence and incidence are strongly associated with deprivation; the deprivation score remains unchanged 10 years after a diagnosis of epilepsy. These findings suggest that increasing rates of epilepsy in deprived areas are more likely explained by social causation than by social drift. The nature of the association between incident epilepsy and social deprivation needs further exploration.
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Affiliation(s)
- William O Pickrell
- Wales Epilepsy Research Network, Neurology and Molecular Neuroscience Research Group, College of Medicine, Swansea University, Swansea, United Kingdom
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Uphoff E, Cabieses B, Pinart M, Valdés M, Antó JM, Wright J. A systematic review of socioeconomic position in relation to asthma and allergic diseases. Eur Respir J 2014; 46:364-74. [PMID: 25537562 DOI: 10.1183/09031936.00114514] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/24/2014] [Indexed: 01/11/2023]
Abstract
The role of socioeconomic position (SEP) in the development of asthma and allergies is unclear, with some pointing to the risks of low SEP and other research pointing in the direction of higher SEP being associated with higher prevalence rates. The aim of this systematic review is to clarify associations between SEP and the prevalence of asthma and allergies. Out of 4407 records identified, 183 were included in the analysis. Low SEP was associated with a higher prevalence of asthma in 63% of the studies. Research on allergies, however, showed a positive association between higher SEP and illness in 66% of studies. Pooled estimates for the odds ratio of disease for the highest compared with the lowest SEP confirmed these results for asthma (unadjusted OR 1.38, 95% CI 1.37-1.39), allergies in general (OR 0.67, 95% CI 0.62-0.72), atopic dermatitis (unadjusted OR 0.72, 95% CI 0.61-0.83) and allergic rhinoconjunctivitis (unadjusted OR 0.52, 95% CI 0.46-0.59). Sensitivity analyses with a subsample of high-quality studies led to the same conclusion. Evidence from this systematic review suggests that asthma is associated with lower SEP, whereas the prevalence of allergies is associated with higher SEP.
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Affiliation(s)
- Eleonora Uphoff
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK. Dept of Health Sciences, University of York, York, UK.
| | - Báltica Cabieses
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK. Dept of Health Sciences, University of York, York, UK. Universidad del Desarrollo, Clínica Alemana, Santiago, Chile
| | - Mariona Pinart
- Centre for Research in Environmental Epidemiology, Barcelona, Spain. IMIM (Hospital del Mar Research Institute), Barcelona, Spain. CIBER Epidemiología y Salud Pública, Barcelona, Spain. Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Macarena Valdés
- PhD in Public Health Programme, Universidad de Chile, Santiago, Chile
| | - Josep Maria Antó
- Centre for Research in Environmental Epidemiology, Barcelona, Spain. IMIM (Hospital del Mar Research Institute), Barcelona, Spain. CIBER Epidemiología y Salud Pública, Barcelona, Spain. Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
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Garcia-Gil M, Elorza JM, Banque M, Comas-Cufí M, Blanch J, Ramos R, Méndez-Boo L, Hermosilla E, Bolibar B, Prieto-Alhambra D. Linking of primary care records to census data to study the association between socioeconomic status and cancer incidence in Southern Europe: a nation-wide ecological study. PLoS One 2014; 9:e109706. [PMID: 25329578 PMCID: PMC4203762 DOI: 10.1371/journal.pone.0109706] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 09/05/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Area-based measures of economic deprivation are seldom applied to large medical records databases to establish population-scale associations between deprivation and disease. OBJECTIVE To study the association between deprivation and incidence of common cancer types in a Southern European region. METHODS Retrospective ecological study using the SIDIAP (Information System for the Development of Research in Primary Care) database of longitudinal electronic medical records for a representative population of Catalonia (Spain) and the MEDEA index based on urban socioeconomic indicators in the Spanish census. Study outcomes were incident cervical, breast, colorectal, prostate, and lung cancer in 2009-2012. The completeness of SIDIAP cancer recording was evaluated through linkage of a geographic data subset to a hospital cancer registry. Associations between MEDEA quintiles and cancer incidence was evaluated using zero-inflated Poisson regression adjusted for sex, age, smoking, alcoholism, obesity, hypertension, and diabetes. RESULTS SIDIAP sensitivity was 63% to 92% for the five cancers studied. There was direct association between deprivation and lung, colorectal, and cervical cancer: incidence rate ratios (IRR) 1.82 [1.64-2.01], IRR 1.60 [1.34-1.90], IRR 1.22 [1.07-1.38], respectively, comparing the most deprived to most affluent areas. In wealthy areas, prostate and breast cancers were more common: IRR 0.92 [0.80-1.00], IRR 0.91 [0.78-1.06]. Adjustment for confounders attenuated the association with lung cancer risk (fully adjusted IRR 1.16 [1.08-1.25]), reversed the direction of the association with colorectal cancer (IRR 0.90 [0.84-0.95]), and did not modify the associations with cervical (IRR 1.27 [1.11-1.45]), prostate (0.74 [0.69-0.80]), and breast (0.76 [0.71-0.81]) cancer. CONCLUSIONS Deprivation is associated differently with the occurrence of various cancer types. These results provide evidence that MEDEA is a useful, area-based deprivation index for analyses of the SIDIAP database. This information will be useful to improve screening programs, cancer prevention and management strategies, to reach patients more effectively, particularly in deprived urban areas.
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Affiliation(s)
- Maria Garcia-Gil
- Research Unit, Family Medicine, Girona, Spain, and Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
- Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Catalunya, Spain
| | - Josep-Maria Elorza
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Marta Banque
- Cancer Prevention Unit and Cancer Registry, Department of Epidemiology and Evaluation, Hospital del Mar, Barcelona, Catalunya, Spain
| | - Marc Comas-Cufí
- Research Unit, Family Medicine, Girona, Spain, and Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Jordi Blanch
- Research Unit, Family Medicine, Girona, Spain, and Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Rafel Ramos
- Primary Care Services, Girona, Spain, and Catalan Institute of Health (ICS), Catalunya, Spain
| | - Leonardo Méndez-Boo
- Primary Care Information System, Catalan Institute of Health (ICS), Catalunya, Spain
| | - Eduardo Hermosilla
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Bonaventura Bolibar
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Daniel Prieto-Alhambra
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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Bhattacharyya M, Marston L, Walters K, D'Costa G, King M, Nazareth I. Psychological distress, gender and dietary factors in South Asians: a cross-sectional survey. Public Health Nutr 2014; 17:1538-46. [PMID: 23768422 PMCID: PMC10282352 DOI: 10.1017/s136898001300147x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 03/25/2013] [Accepted: 04/19/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Psychological distress, defined as symptoms of depression and anxiety, is an increasingly important public health issue in developing countries. Little is known about the extent to which adverse dietary factors are associated with psychological distress in South Asians. Our aim was to compare the associations of diet and psychological distress in men and women in Goa, India. DESIGN Cross-sectional study of consecutive attendees in nine urban and rural general practices in Goa, India in 2004-2005. All participants completed an FFQ on their dietary intake in a typical week. Psychological distress was measured using the Kessler Psychological Distress Scale (K10), a WHO-validated screening instrument. RESULTS Consecutive attendees (n 1512; 601 men and 911 women) aged 30 to 75 years participated. Moderate and high scores of psychological distress were detected in significantly more women than men (eighty-eight men v. 264 women, unadjusted OR = 0·39; 95 % CI 0·29, 0·52). Those who ate one or more portions of fish weekly had nearly half the prevalence of distress in both sexes (women, OR = 0·52; 95 % CI 0·29, 0·91; men, OR = 0·50; 95 % CI 0·25, 0·99) and this was independent of age, marital status, education, income, religion and living alone. CONCLUSIONS Psychological distress is significantly lower with fish intake in both sexes. Further longitudinal work is needed to establish temporal relationships. Addressing psychological distress is becoming an increasingly significant public health priority in both high- and low-income countries.
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Affiliation(s)
- Mimi Bhattacharyya
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | | | - Michael King
- Research Department of Mental Health Sciences, University College London, London, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
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Banjare P, Pradhan J. Socio-economic inequalities in the prevalence of multi-morbidity among the rural elderly in Bargarh District of Odisha (India). PLoS One 2014; 9:e97832. [PMID: 24902041 PMCID: PMC4046974 DOI: 10.1371/journal.pone.0097832] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 04/25/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Multi-morbidity among elderly is increasingly recognized as a major public health challenge in most of the developing countries. However, information on the size of population suffering from multi-morbidity and socio-economic differentials of multi-morbidity is scarce. The objectives of this paper are twofold; first, to assess the prevalence of various chronic conditions and morbidity among rural elderly and second, to examine the socio-economic and demographic factors that have a significant effect on the morbidity. METHODS A cross-sectional survey has been done using multi-stage random sampling procedure that was conducted among elderly (60+ years) in Bargarh District of Odisha during October 2011-February 2012. The survey was conducted among 310 respondents including 153 males and 157 females. Descriptive analyses were performed to assess the pattern of multi-morbidity. Logistic regression analyses were used to see the adjusted effect of various socio-economic and demographic covariates of multi-morbidity. RESULTS The overall prevalence of multi-morbidity is 57% among rural elderly in Bargarh District of Odisha. The most common diseases in rural areas are: Arthritis, Chronic Obstructive Pulmonary Disease (COPD), High Blood Pressure and Cataract. Results from the logistic regression analyses show that age, state of economic independence and life style indicators are the most important measured predictors of multi-morbidity. Unlike earlier studies, wealth index and education have a marginal impact on multi-morbidity rate. Moreover, the occurrence of multi-morbidity is higher for elderly males compared to their female counterparts, though the difference is not significant. CONCLUSION The high prevalence of morbidity observed in the present study suggests that there is an urgent need to develop geriatric health care services in a developing country like India. Any effort to reorganize primary care for elderly people should also consider the high prevalence of multi-morbidity among rural elderly in India.
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Affiliation(s)
- Pallavi Banjare
- Department of Humanities & Social Sciences, National Institute of Technology (NIT), Rourkela, Odisha, India
| | - Jalandhar Pradhan
- Department of Humanities & Social Sciences, National Institute of Technology (NIT), Rourkela, Odisha, India
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Mashru M, Galib R, Shukla VJ, Ravishankar B, Prajapati PK. Effect of Sameera Pannaga Rasa (arsenomercurial formulation) in the management of Tamaka Shwasa (bronchial asthma) - Randomized double blind clinical study. Ayu 2014; 34:346-51. [PMID: 24696570 PMCID: PMC3968694 DOI: 10.4103/0974-8520.127692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Asthma represents a profound world-wide public health problem. The most effective anti-asthmatic drugs currently available include β2-agonists and glucocorticoids which can controls asthma in about 90-95% of patients. In Ayurveda, this miserable condition is comparable with Tamaka Shwasa type of Shwasa Roga. In the present study, 52 patients were treated with Sameera Pannaga Rasa at a dose of 30 mg twice a day for 4 weeks along with Nagavallidala (leaf of Piper betel Linn.) The results were assessed in terms of clinical recovery, symptomatic relief, pulmonary function improvement and on subjective and objective parameters. A significant improvement in subjective parameters, control on asthma, recurrence of asthma, increase in peak expiratory flow rate, considerable decrease in total and absolute, acute eosinophil count and erythrocyte sedimentation rate were observed. Overall marked improvement was found in 33.33%, moderate improvement in 44.44% and mild improvement in 20.00% was observed. The study reveals that Sameera Pannaga Rasa can be used as an effective drug in bronchial asthma.
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Affiliation(s)
- Mayur Mashru
- Superintendent, Government Ayurved Hospital Popatpura, Godhra, India
| | - R Galib
- Assistant Professor, Department of Rasashastra and Bhaishajya Kalpana, Institute for Post Graduate Teaching and Research in Ayurveda, Jamnagar, Gujarat, India
| | - Vinay J Shukla
- Head, Pharmaceutical Chemistry Laboratory, Institute for Post Graduate Teaching and Research in Ayurveda, Jamnagar, Gujarat, India
| | - B Ravishankar
- Director, Research and Development, S.D.M. Research Center for Ayurveda and Allied Sciences, Udupi, Karnataka, India
| | - Pradeep Kumar Prajapati
- Professor and Head, Department of Rasashastra and Bhaishajya Kalpana Including Drug Research, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
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Lowe A, Campbell L, Ramaswamy B, Horobin H, McLean S. Does deprivation influence treatment outcome in physiotherapy? PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x13y.0000000132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pollard B, Johnston M, Dixon D. Exploring differential item functioning in the SF-36 by demographic, clinical, psychological and social factors in an osteoarthritis population. BMC Musculoskelet Disord 2013; 14:346. [PMID: 24330385 PMCID: PMC4029744 DOI: 10.1186/1471-2474-14-346] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 12/07/2013] [Indexed: 11/29/2022] Open
Abstract
Background The SF-36 is a very commonly used generic measure of health outcome in osteoarthritis (OA). An important, but frequently overlooked, aspect of validating health outcome measures is to establish if items work in the same way across subgroup of a population. That is, if respondents have the same ‘true’ level of outcome, does the item give the same score in different subgroups or is it biased towards one subgroup or another. Differential item functioning (DIF) can identify items that may be biased for one group or another and has been applied to measuring patient reported outcomes. Items may show DIF for different conditions and between cultures, however the SF-36 has not been specifically examined in an osteoarthritis population nor in a UK population. Hence, the aim of the study was to apply the DIF method to the SF-36 for a UK OA population. Methods The sample comprised a community sample of 763 people with OA who participated in the Somerset and Avon Survey of Health. The SF-36 was explored for DIF with respect to demographic, social, clinical and psychological factors. Well developed ordinal regression models were used to identify DIF items. Results DIF items were found by age (6 items), employment status (6 items), social class (2 items), mood (2 items), hip v knee (2 items), social deprivation (1 item) and body mass index (1 item). Although the impact of the DIF items rarely had a significant effect on the conclusions of group comparisons, in most cases there was a significant change in effect size. Conclusions Overall, the SF-36 performed well with only a small number of DIF items identified, a reassuring finding in view of the frequent use of the SF-36 in OA. Nevertheless, where DIF items were identified it would be advisable to analyse data taking account of DIF items, especially when age effects are the focus of interest.
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Affiliation(s)
- Beth Pollard
- Aberdeen Health Psychology Group, University of Aberdeen, 2nd Floor, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK.
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Pollard B, Dixon D, Johnston M. Does the impact of osteoarthritis vary by age, gender and social deprivation? A community study using the International Classification of Functioning, Disability and Health. Disabil Rehabil 2013; 36:1445-51. [PMID: 24164585 PMCID: PMC4196505 DOI: 10.3109/09638288.2013.847123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/10/2013] [Accepted: 09/17/2013] [Indexed: 11/14/2022]
Abstract
UNLABELLED Abstract Purpose: The aim of the study was to explore if the impact of osteoarthritis varies with respect to age, gender and social deprivation. Impact was defined as impairment, activity limitations and participation restriction (International Classification of Functioning, Disability and Health (ICF)). Investigating the functioning of the ICF model for subgroups is important both practically and theoretically. METHOD The sample comprised a community sample of 763 people diagnosed with osteoarthritis. Uncontaminated measures of the ICF constructs were developed using discriminant content validity from a pool of 134 items, including the WOMAC and SF-36. Multigroup Structural Equation Modelling was used to explore if the same pathways exist for subgroups of gender, age and social deprivation. RESULTS Different significant paths were found for gender and social deprivation: impairment did not predict participation restriction for women and those most deprived, whereas these paths were significant for men and those less deprived. No difference in the paths was found for age. CONCLUSIONS The impact of osteoarthritis appears to vary with respect to gender and social deprivation but not age. This suggests both that osteoarthritis per se does not adequately explain the health outcomes observed and that different clinical approaches may be appropriate for people of different gender and levels of deprivation. Implications of Rehabilitation The ICF model appears to vary with respect to gender and social deprivation for people with osteoarthritis. The ICF model did not appear to vary with respect to age for people with osteoarthritis. Different treatments and interventions for osteoarthritis may need to be targeted for specific gender and social deprivation groups.
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Affiliation(s)
- Beth Pollard
- Aberdeen Health Psychology Group, University of AberdeenAberdeenUK
| | - Diane Dixon
- School of Psychological Sciences and Health, University of StrathclydeGlasgowUK
| | - Marie Johnston
- Aberdeen Health Psychology Group, University of AberdeenAberdeenUK
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Dhalwani NN, Tata LJ, Coleman T, Fleming KM, Szatkowski L. Completeness of maternal smoking status recording during pregnancy in United Kingdom primary care data. PLoS One 2013; 8:e72218. [PMID: 24069143 PMCID: PMC3777944 DOI: 10.1371/journal.pone.0072218] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 07/08/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Given the health impacts of smoking during pregnancy and the opportunity for primary healthcare teams to encourage pregnant smokers to quit, our primary aim was to assess the completeness of gestational smoking status recording in primary care data and investigate whether completeness varied with women's characteristics. As a secondary aim we assessed whether completeness of recording varied before and after the introduction of the Quality and Outcomes Framework (QOF). METHODS In The Health Improvement Network (THIN) database we calculated the proportion of pregnancies ending in live births or stillbirths where there was a recording of maternal smoking status for each year from 2000 to 2009. Logistic regression was used to assess variation in the completeness of maternal smoking recording by maternal characteristics, before and after the introduction of QOF. RESULTS Women had a record of smoking status during the gestational period in 28% of the 277,552 pregnancies identified. In 2000, smoking status was recorded in 9% of pregnancies, rising to 43% in 2009. Pregnant women from the most deprived group were 17% more likely to have their smoking status recorded than pregnant women from the least deprived group before QOF implementation (OR 1.17, 95% CI 1.10-1.25) and 42% more likely afterwards (OR 1.42, 95% CI 1.37-1.47). A diagnosis of asthma was related to recording of smoking status during pregnancy in both the pre-QOF (OR 1.63, 95% CI 1.53-1.74) and post-QOF periods (OR 2.08, 95% CI 2.02-2.15). There was no association between having a diagnosis of diabetes and recording of smoking status during pregnancy pre-QOF however, post-QOF diagnosis of diabetes was associated with a 12% increase in recording of smoking status (OR 1.12, 95% CI 1.05-1.19). CONCLUSION Recording of smoking status during pregnancy in primary care data is incomplete though has improved over time, especially after the implementation of the QOF, and varies by maternal characteristics and QOF-incentivised morbidities.
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Affiliation(s)
- Nafeesa N. Dhalwani
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
- Division of Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Laila J. Tata
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Kate M. Fleming
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Lisa Szatkowski
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
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Pollard B, Johnston M, Dixon D. Exploring differential item functioning in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). BMC Musculoskelet Disord 2012; 13:265. [PMID: 23273389 PMCID: PMC3582585 DOI: 10.1186/1471-2474-13-265] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 12/20/2012] [Indexed: 12/13/2022] Open
Abstract
Background The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a widely used patient reported outcome in osteoarthritis. An important, but frequently overlooked, aspect of validating health outcome measures is to establish if items exhibit differential item functioning (DIF). That is, if respondents have the same underlying level of an attribute, does the item give the same score in different subgroups or is it biased towards one subgroup or another. The aim of the study was to explore DIF in the Likert format WOMAC for the first time in a UK osteoarthritis population with respect to demographic, social, clinical and psychological factors. Methods The sample comprised a community sample of 763 people with osteoarthritis who participated in the Somerset and Avon Survey of Health. The WOMAC was explored for DIF by gender, age, social deprivation, social class, employment status, distress, body mass index and clinical factors. Ordinal regression models were used to identify DIF items. Results After adjusting for age, two items were identified for the physical functioning subscale as having DIF with age identified as the DIF factor for 2 items, gender for 1 item and body mass index for 1 item. For the WOMAC pain subscale, for people with hip osteoarthritis one item was identified with age-related DIF. The impact of the DIF items rarely had a significant effect on the conclusions of group comparisons. Conclusions Overall, the WOMAC performed well with only a small number of DIF items identified. However, as DIF items were identified in for the WOMAC physical functioning subscale it would be advisable to analyse data taking into account the possible impact of the DIF items when weight, gender or especially age effects, are the focus of interest in UK-based osteoarthritis studies. Similarly for the WOMAC pain subscale in people with hip osteoarthritis it would be worthwhile to analyse data taking into account the possible impact of the DIF item when age comparisons are of primary interest.
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Affiliation(s)
- Beth Pollard
- Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, UK.
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Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012; 380:37-43. [PMID: 22579043 DOI: 10.1016/s0140-6736(12)60240-2] [Citation(s) in RCA: 4123] [Impact Index Per Article: 343.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation. METHODS In a cross-sectional study we extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders. FINDINGS 42·2% (95% CI 42·1-42·3) of all patients had one or more morbidities, and 23·2% (23·08-23·21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210,500 vs 194,996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11·0%, 95% CI 10·9-11·2% in most deprived area vs 5·9%, 5·8%-6·0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6·74, 95% CI 6·59-6·90 for five or more disorders vs 1·95, 1·93-1·98 for one disorder), and was much greater in more deprived than in less deprived people (2·28, 2·21-2·32 vs 1·08, 1·05-1·11). INTERPRETATION Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas. FUNDING Scottish Government Chief Scientist Office.
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Affiliation(s)
- Karen Barnett
- Quality, Safety and Informatics Research Group, Population Health Sciences Division, University of Dundee, Dundee, UK
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Sun VK, Stijacic Cenzer I, Kao H, Ahalt C, Williams BA. How safe is your neighborhood? Perceived neighborhood safety and functional decline in older adults. J Gen Intern Med 2012; 27:541-7. [PMID: 22160889 PMCID: PMC3326109 DOI: 10.1007/s11606-011-1943-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 09/14/2011] [Accepted: 11/04/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neighborhood characteristics are associated with health and the perception of safety is particularly important to exercise and health among older adults. Little is known about the relationship between perception of neighborhood safety and functional decline in older adults. OBJECTIVE To determine the relationship between perceived neighborhood safety and functional decline in older adults. DESIGN/SETTING Longitudinal, community-based. PARTICIPANTS 18,043 persons, 50 years or older, who participated in the 1998 and 2008 Health and Retirement Study. MAIN MEASURES The primary outcome was 10-year functional decline (new difficulty or dependence in any Activity of Daily Living, new mobility difficulty, and/or death). The primary predictor was perceived neighborhood safety categorized into three groups: "very safe", "moderately safe", and "unsafe." We evaluated the association between perceived neighborhood safety and 10-year functional decline using a modified Poisson regression to generate unadjusted and adjusted relative risks (ARR). KEY RESULTS At baseline 11,742 (68.0%) participants perceived their neighborhood to be very safe, 4,477 (23.3%) moderately safe, and 1,824 (8.7%) unsafe. Over 10 years, 10,338 (53.9%) participants experienced functional decline, including 6,266 (50.2%) who had perceived their neighborhood to be very safe, 2,839 (61.2%) moderately safe, and 1,233 (63.6%) unsafe, P < 0.001. For the 11,496 (63.3%) of participants who were functionally independent at baseline, perceived neighborhood safety was associated with 10-year functional decline (moderately safe ARR 1.15 95% CI 1.09-1.20; unsafe ARR 1.21 95% CI: 1.03-1.31 compared to very safe group). The relationship between perceived neighborhood safety and 10-year functional decline was not statistically significant for participants who had baseline functional impairment. CONCLUSION Asking older adults about their perceived neighborhood safety may provide important information about their risk of future functional decline. These findings also suggest that future studies might focus on assessing whether interventions that promote physical activity while addressing safety concerns help reduce functional decline in older adults.
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Affiliation(s)
- Vivien K Sun
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Gershon AS, Dolmage TE, Stephenson A, Jackson B. Chronic obstructive pulmonary disease and socioeconomic status: a systematic review. COPD 2012; 9:216-26. [PMID: 22497534 DOI: 10.3109/15412555.2011.648030] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Along with age and sex, socioeconomic status is one of the most powerful determinants of health. We conducted a systematic review to examine the consistency and magnitude of the association between socioeconomic status and COPD health outcomes to determine the potential impact of SES disparity on the COPD population. METHODS Electronic databases to October 2011 were searched for studies of adults who had or were at risk for COPD that quantified an association between a measure of socioeconomic status and at least one COPD health outcome. Two authors independently reviewed studies, assessed study quality, and for eligible studies, extracted data. RESULTS Regardless of the population, socioeconomic status measure or COPD outcome examined, with few exceptions, consistent significant inverse associations between socioeconomic status and COPD outcomes were found. Most studies found that individuals of the lowest socioeconomic strata were at least twice as likely to have poor outcomes as those of the highest (range from no difference to 10-fold difference). CONCLUSIONS Social and economic disadvantage appears to have a significant consistent impact on COPD mortality and morbidity. These findings point to the need for public health strategies and research to address socioeconomic status disparity in individuals with COPD.
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Affiliation(s)
- Andrea S Gershon
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
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Varga S. Evolutionary psychiatry and depression: testing two hypotheses. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2012; 15:41-52. [PMID: 21221814 DOI: 10.1007/s11019-010-9305-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In the last few decades, there has been a genuine 'adaptive turn' in psychiatry, resulting in evolutionary accounts for an increasing number of psychopathologies. In this paper, I explore the advantages and problems with the two main evolutionary approaches to depression, namely the mismatch and persistence accounts. I will argue that while both evolutionary theories of depression might provide some helpful perspectives, the accounts also harbor significant flaws that might question their authority and usefulness as explanations.
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Affiliation(s)
- Somogy Varga
- Institute of Cognitive Science, University of Osnabrück, Albrechtstraße 28, 49069 Osnabrück, Germany.
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Tello JE, Bonizzato P. Social economic inequalities and mental health II. Methodological aspects and literature review. Epidemiol Psychiatr Sci 2011; 12:253-71. [PMID: 14968484 DOI: 10.1017/s1121189x00003079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SummaryObjective - This study provides a framework for mental health inequalities beginners. It describes the methods used to measure socio economic inequalities and the inter-relations with different aspects of mental health: residence, mental health services organisation and main diagnostic categories. Method - Literature electronic-search on Medline, Psyclit, Econlit, Social Science Index and SocioSearch usingand relating the key-words inequalities, deprivation, poverty, socio-economic status, social class, occupational class, mental health for the period 1965-2002 (June). The articles selected were integrated with manual search (publications of the same authors, cross-references, working documents and reports of international andregional organisations). Results - Inequality is not an absolute concept and, mainly, it has been changing during the last years. For example, the integration and re-definition of variables that capture, in simple indices, a complex reality; the accent on social more than on economic aspects; the geo-validity and time-reference of the inequality's indices. Moreover, the inequalities could be the result of individual preferences, in this case, the social selectionand social causation issues will raise the suitability for a public intervention. Conclusions - Up to now, research has been mainly concentrated in describing and measuring health inequalities. For designing effective interventions, policy makers need to ground decisions on health-socioeconomic inequalities explanatory models.Declaration of Interestthis work was partly funded by the Department of the Public Health Sciences “G. Sanarelli” of the University of Rome “La Sapienza” and the Department of Medicine and Public Health of the University of Verona.
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Affiliation(s)
- Juan Eduardo Tello
- Istituto Superiore di Sanità, Aula Missiroli, Segreteria per le Attività Culturali, Viale Regina Elena 299, 00161 Roma.
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Le C, Jun D, Zhankun S, Yichun L, Jie T. Socioeconomic differences in diabetes prevalence, awareness, and treatment in rural southwest China. Trop Med Int Health 2011; 16:1070-6. [DOI: 10.1111/j.1365-3156.2011.02805.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Nüesch E, Dieppe P, Reichenbach S, Williams S, Iff S, Jüni P. All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study. BMJ 2011; 342:d1165. [PMID: 21385807 PMCID: PMC3050438 DOI: 10.1136/bmj.d1165] [Citation(s) in RCA: 484] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine all cause and disease specific mortality in patients with osteoarthritis of the knee or hip. DESIGN Population based cohort study. SETTING General practices in the southwest of England. PARTICIPANTS 1163 patients aged 35 years or over with symptoms and radiological confirmation of osteoarthritis of the knee or hip. MAIN OUTCOME MEASURES Age and sex standardised mortality ratios and multivariable hazard ratios of death after a median of 14 years' follow-up. RESULTS Patients with osteoarthritis had excess all cause mortality compared with the general population (standardised mortality ratio 1.55, 95% confidence interval 1.41 to 1.70). Excess mortality was observed for all disease specific causes of death but was particularly pronounced for cardiovascular (standardised mortality ratio 1.71, 1.49 to 1.98) and dementia associated mortality (1.99, 1.22 to 3.25). Mortality increased with increasing age (P for trend <0.001), male sex (adjusted hazard ratio 1.59, 1.30 to 1.96), self reported history of diabetes (1.95, 1.31 to 2.90), cancer (2.28, 1.50 to 3.47), cardiovascular disease (1.38, 1.12 to 1.71), and walking disability (1.48, 1.17 to 1.86). However, little evidence existed for increased mortality associated with previous joint replacement, obesity, depression, chronic inflammatory disease, eye disease, or presence of pain at baseline. The more severe the walking disability, the higher was the risk of death (P for trend <0.001). CONCLUSION Patients with osteoarthritis are at higher risk of death compared with the general population. History of diabetes, cancer, or cardiovascular disease and the presence of walking disability are major risk factors. Management of patients with osteoarthritis and walking disability should focus on effective treatment of cardiovascular risk factors and comorbidities, as well as on increasing physical activity.
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Affiliation(s)
- Eveline Nüesch
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
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Searle A, Norman P, Thompson R, Vedhara K. A prospective examination of illness beliefs and coping in patients with type 2 diabetes. Br J Health Psychol 2010; 12:621-38. [DOI: 10.1348/135910706x164935] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Jüni P, Low N, Reichenbach S, Villiger PM, Williams S, Dieppe PA. Gender inequity in the provision of care for hip disease: population-based cross-sectional study. Osteoarthritis Cartilage 2010; 18:640-5. [PMID: 20167302 DOI: 10.1016/j.joca.2009.12.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 12/10/2009] [Accepted: 12/21/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine gender differences along the care pathway to total hip replacement. METHODS We conducted a population-based cross-sectional study of 26,046 individuals aged 35 years and over in Avon and Somerset. Participants completed a questionnaire asking about care provision at five milestones on the pathway to total hip replacement. Those reporting hip disease were invited to a clinical examination. We estimated odds ratios (ORs) [95% confidence intervals (CI)] for provision of care to women compared with men. RESULTS 3169 people reported hip pain, 2018 were invited for clinical examination, and 1405 attended (69.6%). After adjustment for age and disease severity, women were less likely than men to have consulted their general practitioner (OR 0.78, 95%-CI 0.61-1.00), as likely as men to have received drug therapy for hip pain in the previous year (OR 0.96, 95%-CI 0.74-1.24), but less likely to have been referred to specialist care (OR 0.53, 95%-CI 0.40-0.70), to have consulted an orthopaedic surgeon (OR 0.50, 95%-CI 0.32-0.78), or to be on a waiting list for total hip replacement (OR 0.41, 95%-CI 0.20-0.87). Differences remained in the 746 people who had sought care from their general practitioner, and after adjustment for willingness and fitness for surgery. CONCLUSIONS There are gender inequalities in provision of care for hip disease in England, which are not fully accounted for by gender differences in care seeking and treatment preferences. Differences in referral to specialist care by general practitioners might unwittingly contribute to this inequity. Accurate information about availability, benefits and risks of hip replacement for providers and patients, and continuing education to ensure that clinicians interpret and correct patients' assumptions could help reduce inequalities.
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Affiliation(s)
- P Jüni
- Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
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Virtanen M, Kivimäki M, Pentti J, Oksanen T, Ahola K, Linna A, Kouvonen A, Salo P, Vahtera J. School neighborhood disadvantage as a predictor of long-term sick leave among teachers: prospective cohort study. Am J Epidemiol 2010; 171:785-92. [PMID: 20179159 DOI: 10.1093/aje/kwp459] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This ongoing prospective study examined characteristics of school neighborhood and neighborhood of residence as predictors of sick leave among school teachers. School neighborhood income data for 226 lower-level comprehensive schools in 10 towns in Finland were derived from Statistics Finland and were linked to register-based data on 3,063 teachers with no long-term sick leave at study entry. Outcome was medically certified (>9 days) sick leave spells during a mean follow-up of 4.3 years from data collection in 2000-2001. A multilevel, cross-classified Poisson regression model, adjusted for age, type of teaching job, length and type of job contract, school size, baseline health status, and income level of the teacher's residential area, showed a rate ratio of 1.30 (95% confidence interval: 1.03, 1.63) for sick leave among female teachers working in schools located in low-income neighborhoods compared with those working in high-income neighborhoods. A low income level of the teacher's residential area was also independently associated with sick leave among female teachers (rate ratio = 1.50, 95% confidence interval: 1.18, 1.91). Exposure to both low-income school neighborhoods and low-income residential neighborhoods was associated with the greatest risk of sick leave (rate ratio = 1.71, 95% confidence interval: 1.27, 2.30). This study indicates that working and living in a socioeconomically disadvantaged neighborhood is associated with increased risk of sick leave among female teachers.
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Affiliation(s)
- Marianna Virtanen
- Finnish Institute of Occupational Health, Work, and Organizations, Helsinki, Finland.
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Thorstensson CA, Gooberman-Hill R, Adamson J, Williams S, Dieppe P. Help-seeking behaviour among people living with chronic hip or knee pain in the community. BMC Musculoskelet Disord 2009; 10:153. [PMID: 19968876 PMCID: PMC2793247 DOI: 10.1186/1471-2474-10-153] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 12/07/2009] [Indexed: 12/21/2022] Open
Abstract
Background A large proportion of people living with hip or knee pain do not consult health care professionals. Pain severity is often believed to be the main reason for help seeking in this population; however the evidence for this is contradictory. This study explores the importance of several potential risk factors on help seeking across different practitioner groups, among adults living with chronic hip or knee pain in a large community sample. Methods Health care utilization, defined as having seen a family doctor (GP) during the past 12 months; or an allied health professional (AHP) or alternative therapist during the past 3 months, was assessed in a community based sample aged 35 or over and reporting pain in hip or knee. Adjusted odds ratios were determined for social deprivation, rurality, pain severity, mobility, anxiety/depression, co-morbidities, and body mass index. Results Of 1119 persons reporting hip or knee pain, 52% had pain in both sites. Twenty-five percent of them had seen a doctor only, 3% an AHP only, and 4% an alternative therapist only. Thirteen percent had seen more than one category of health care professionals, and 55% had not seen any health care professional. In the multivariate model, factors associated with consulting a GP were mobility problems (OR 2.62 (1.64-4.17)), urban living (OR 2.40 (1.14-5.04) and pain severity (1.28 (1.13-1.44)). There was also some evidence that obesity was associated with increased consultation (OR 1.72 (1.00-2.93)). Factors were similar for consultation with a combination of several health care professionals. In contrast, seeing an alternative therapist was negatively associated with pain severity, anxiety and mobility problems (adjusting for age and sex). Conclusion Disability appears to be a more important determinant of help-seeking than pain severity or anxiety and depression, for adults with chronic pain in hip or knee. The determinants of seeking help from alternative practitioners are different from determinants of consulting GPs, AHPs or a combination of different health care providers.
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Affiliation(s)
- Carina A Thorstensson
- Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
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Klaber Moffett JA, Underwood MR, Gardiner ED. Socioeconomic status predicts functional disability in patients participating in a back pain trial. Disabil Rehabil 2009; 31:783-90. [DOI: 10.1080/09638280802309327] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gender inequality in health among elderly people in a combined framework of socioeconomic position, family characteristics and social support. AGEING & SOCIETY 2009. [DOI: 10.1017/s0144686x08008349] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTThis study analyses gender inequalities in health among elderly people in Catalonia (Spain) by adopting a conceptual framework that globally considers three dimensions of health determinants: socio-economic position, family characteristics and social support. Data came from the 2006Catalonian Health Survey. For the purposes of this study a sub-sample of people aged 65–85 years with no paid job was selected (1,113 men and 1,484 women). The health outcomes analysed were self-perceived health status, poor mental health status and long-standing limiting illness. Multiple logistic regression models separated by sex were fitted and a hierarchical model was fitted in three steps. Health status among elderly women was poorer than among the men for the three outcomes analysed. Whereas living with disabled people was positively related to the three health outcomes and confidant social support was negatively associated with all of them in both sexes, there were gender differences in other social determinants of health. Our results emphasise the importance of using an integrated approach for the analysis of health inequalities among elderly people, simultaneously considering socio-economic position, family characteristics and social support, as well as different health indicators, in order fully to understand the social determinants of the health status of older men and women.
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Ayis S, Dieppe P. The natural history of disability and its determinants in adults with lower limb musculoskeletal pain. J Rheumatol 2009; 36:583-91. [PMID: 19208591 DOI: 10.3899/jrheum.080455] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate determinants of deterioration or improvement in disability in people with chronic hip and knee pain. METHODS We analyzed data from the Somerset and Avon Survey of Health, a longitudinal, community-based cohort study containing data collected in 1994-95 and again in 2002-03. The Medical Outcomes Study Short-Form 36 was completed by subjects at both timepoints, and used to categorize people as disabled or not. Baseline data were used to explore possible determinants of change in functional status over the 8-year time period. Adjusted odds ratios (OR) were derived from a multivariate, multinomial logistic model. RESULTS Data were available on 1072 subjects, all of whom reported chronic hip and/or knee pain at baseline. At baseline, 56.8% of women and 42.0% of men were disabled. Of 545 people with disabilities at baseline, 107 (19.6%) reported no disability at followup; of 527 with no disability at baseline, 177 (33.6%) became disabled. The development of disability was significantly associated with older age (OR 2.1), living in the most deprived areas (2.4), the presence of 3 or more comorbidities (3.6), more problems with physical function at baseline (2.0), and more severe pain (2.4). The determinants of improvement mirrored those of deterioration. The data suggest a "threshold effect" at which recovery becomes unlikely. CONCLUSION Of people presenting with hip or knee pain, healthcare professionals should be most concerned about those who are older, of lower socioeconomic status, with comorbidities, and who have more severe pain. Much longstanding disability might be preventable.
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Affiliation(s)
- Salma Ayis
- Department of Social Medicine, University of Bristol, Bristol BS8 2PR, UK.
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Ebrahim S, Adamson J, Ayis S, Beswick A, Gooberman-Hill R. Locomotor disability: meaning, causes and effects of interventions. J Health Serv Res Policy 2009; 13 Suppl 3:38-46. [PMID: 18806191 DOI: 10.1258/jhsrp.2008.008013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper provides a synopsis of a long-term programme of MRC-funded work on locomotor disability in older people. Specifically it describes the meaning and experience of disability, examines the risk factors for disability and systematically reviews the evidence from randomized trials of complex interventions for disability. We undertook a national prospective study of a representative sample of 999 people aged 65 years or more plus in-depth interviews with a small subsample and a selected sample obtained from hospital sources. Secondary analysis of several large prospective studies was carried out and a systematic review and meta-analysis of published randomized controlled trials of the effects of complex interventions for disability. Very few participants subscribed to the constructs of longstanding illness, disability or infirmity that surveys often use. A wide range of social and psychological factors, independently of chronic diseases, were strongly associated with disability. People with greater functional reserve capacity and those with greater self-efficacy were generally less likely to suffer from catastrophic decline in ability and had better quality of life in the face of disability. In reviewing 89 trials (over 97,000 participants) of complex interventions for disability, evidence of benefits was found although no relationship with intensity of intervention was apparent. Our findings on the meaning and experience of disability suggest the need for modifications to routinely used survey questions and for different ways of understanding the need for and receipt of care among older people with disabilities. The diverse risk factors for disability suggest that novel approaches across social, psychological as well as more traditional rehabilitation and behavioural risk factor modification would be worth exploring. Complex interventions appeared to help older people to live independently and limit functional decline irrespective of age and health status.
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Affiliation(s)
- Shah Ebrahim
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Searle A, Wetherell MA, Campbell R, Dayan C, Weinman J, Vedhara K. Do patients' beliefs about type 2 diabetes differ in accordance with complications: an investigation into diabetic foot ulceration and retinopathy. Int J Behav Med 2008; 15:173-9. [PMID: 18696310 DOI: 10.1080/10705500802212940] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previous research has examined patients' beliefs in diabetes and how these beliefs may affect patient outcomes. However, changes in symptoms and complications are a common feature of diabetes, and these can significantly alter the patient's "disease experience." However, no consideration has been given to how beliefs about diabetes vary according to the complications patients have. PURPOSE The present study was designed to compare the beliefs of 22 patients with diabetic foot ulcers and 22 age-and gender-matched patients with diabetic retinopathy, and 22 age-and gender-matched controls with type 2 diabetes but without either complication. METHODS Beliefs about diabetes were assessed with the Revised Illness Perception Questionnaire (IPQ-R; Moss-Morris et al., 2002). RESULTS Patients with foot ulcers held a greater belief in personal control of diabetes, but perceived treatment control was lower than that of diabetic controls without serious complications (p < .05). Patients with foot ulcers also demonstrated less illness coherence than patients with retinopathy and diabetic controls (p < .01) and also perceived their diabetes to be more cyclical in nature (p < .01). CONCLUSION Differences were found in diabetic patients' beliefs according to their complications. Future interventions should consider how the complications associated with diabetes may affect patients' beliefs and subsequent emotional and behavioral responses to the disease.
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Affiliation(s)
- Aidan Searle
- Department of Social Medicine, University of Bristol, Bristol, UK
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Long-chain omega-3 polyunsaturated fatty acids in the blood of children and adolescents with juvenile bipolar disorder. Lipids 2008; 43:1031-8. [PMID: 18781353 DOI: 10.1007/s11745-008-3224-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 08/05/2008] [Indexed: 10/21/2022]
Abstract
Reduced long-chain omega-3 polyunsaturated fatty acids (LCn-3PUFA), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been reported in adult patients suffering from depression and bipolar disorder (BD). LCn-3PUFA status has not previously been examined in children and adolescents with BD compared with healthy controls. Fifteen children and adolescents (9-18 years, M +/- SD = 14.4 +/- 3.48) diagnosed with juvenile bipolar disorder (JBD) and fifteen healthy age and sex-matched controls were assessed for dietary intake and fasting red blood cell (RBC) membrane concentrations of LCn-3PUFA. Fatty acid concentrations were compared between participants diagnosed with JBD and controls after controlling for dietary intake. RBC membrane concentrations of EPA and DHA were not significantly lower in participants diagnosed with JBD compared with healthy controls (M +/- sem EPA = 3.37 +/- 0.26 vs. 3.69 +/- 0.27 microg/mL, P = 0.458; M +/- sem DHA = 22.08 +/- 2.23 vs. 24.61 +/- 2.38 microg/mL, P = 0.528) after controlling for intake. Red blood cell DHA was negatively (r = -0.55; P = 0.044) related to clinician ratings of depression. Although lower RBC concentrations of LCn-3PUFA were explained by lower intakes in the current study, previous evidence has linked reduced LCn-3PUFA to the aetiology of BD. As RBC DHA was also negatively related to symptoms of depression, a randomised placebo-controlled study examining supplementation with LCn-3PUFA as an adjunct to standard pharmacotherapy appears warranted in this patient population.
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Briggs D, Abellan JJ, Fecht D. Environmental inequity in England: small area associations between socio-economic status and environmental pollution. Soc Sci Med 2008; 67:1612-29. [PMID: 18786752 DOI: 10.1016/j.socscimed.2008.06.040] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Indexed: 11/17/2022]
Abstract
Recent studies have suggested that more deprived people tend to live in areas characterised by higher levels of environmental pollution. If generally true, these environmental inequities may combine to cause adverse effects on health and also exacerbate problems of confounding in epidemiological studies. Previous studies of environmental inequity have nevertheless indicated considerable complexity in the associations involved, which merit further investigation using more detailed data and more advanced analytical methods. This study investigates the ways in which environmental inequity in England varies in relation to: (a) different environmental pollutants (measured in different ways); (b) different aspects of socio-economic status; and (c) different geographical scales and contexts (urban vs. rural). Associations were analysed between the Index of Multiple Deprivation (IMD2004) and its domains and five sets of environmental pollutants (relating to road traffic, industry, electro-magnetic frequency radiation, disinfection by-products in drinking water and radon), measured in terms of proximity, emission intensity and environmental concentration. Associations were assessed using bivariate and multivariate correlation, and by comparing the highest and lowest quintiles of deprivation using Student's t-test and Hotelling's T2. Associations are generally weak (R(2) < 0.10), and vary depending on the specific measures used. Strongest associations occur with what can be regarded as contingent components of deprivation (e.g. crime, living environment, health) rather than causative factors such as income, employment or education. Associations also become stronger with increasing level of spatial aggregation. Overall, the results suggest that any triple jeopardy for health, and problems of confounding, associated with environmental inequities are likely to be limited.
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Affiliation(s)
- David Briggs
- Imperial College London, Department of Epidemiology and Public Health, Norfolk Place, London W2 1PG, United Kingdom.
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Kvaal K, McDougall FA, Brayne C, Matthews FE, Dewey ME. Co-occurrence of anxiety and depressive disorders in a community sample of older people: results from the MRC CFAS (Medical Research Council Cognitive Function and Ageing Study). Int J Geriatr Psychiatry 2008; 23:229-37. [PMID: 17631679 DOI: 10.1002/gps.1867] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Few population-based studies have examined the whole range of subthreshold syndromes and disorders of anxiety and depression in older people. AIMS To investigate the co-occurrence of anxiety and depressive syndromes in older people. Associations between these conditions and personal and environmental factors are examined. METHOD MRC CFAS included 13,004, age 65 years and above, who completed the initial screening interview. A stratified random subsample of 2,640 participated in the assessment interview where the Geriatric Mental State Examination (GMS) was administered. The AGECAT diagnostic system was used to generate subthreshold and disorder-level of anxiety and depression as well as the combination of these into eight syndromes categories plus a group without any of the syndromes categories. Prevalences, unadjusted and adjusted odds ratios are calculated for the syndrome categories in relation to cross-sectional personal and environmental factors, and odds ratios of subthreshold and disorders level are estimated. RESULTS The overall prevalence of anxiety and depressive disorders are 3.1% and 9.7% respectively. The overall prevalence of either anxiety or depressive disorder (anxiety disorder with subthreshold depression, mixed anxiety and depressive disorder with subthreshold anxiety) where they overlapped is 8.4%. The highest Odds Ratios unadjusted and adjusted for age and gender, of anxiety and depressive disorders and significant for trend are found for increasing disability. Disability has a strong relationship with all the co-morbid syndrome categories. In all analyses women showed significant higher estimates than men. CONCLUSIONS Our study demonstrated high estimates where anxiety and depression occurred in parallel both as disorders and as subthreshold syndromes.
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Affiliation(s)
- Kari Kvaal
- University Unit, Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway.
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Searle A, Norman P, Thompson R, Vedhara K. Illness representations among patients with type 2 diabetes and their partners: relationships with self-management behaviors. J Psychosom Res 2007; 63:175-84. [PMID: 17662754 DOI: 10.1016/j.jpsychores.2007.02.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 01/25/2007] [Accepted: 02/06/2007] [Indexed: 01/21/2023]
Abstract
OBJECTIVE There is accumulating evidence to indicate that the illness representations of significant others are important for understanding patients' responses to chronic disease. The aims of the present study were to (a) assess the illness representations of patients with type 2 diabetes and their partners, (b) determine the extent of agreement between patient and partner representations, and (c) examine whether partners' representations mediate the relationships between patients' representations and their prospective self-management behaviors. METHODS Patients' and partners' representations of diabetes were assessed with the Revised Illness Perception Questionnaire [Moss-Morris R, Weinman J, Petrie K, Horne R, Cameron LD, Buick, D. The revised illness perception questionnaire (IPQ-R). Psychol Health 2002;17:116] at baseline (n=164). Self-management behaviors were assessed 12 months later with self-report measures of physical activity, medication, and a food frequency questionnaire. RESULTS Patients scored lower on the illness coherence dimension, indicating that they reported a poorer understanding of the condition (t=-2.66, df=163, P=.009) relative to their partners. Patients demonstrated higher scores for personal control than their partners (t=2.01, df=163, P=.046). Mediational analyses indicated that partners' perceived timeline of diabetes partially mediated the relationship between patients' representations and their self-management behaviors including physical activity and dietary intake. In addition, partners' personal control representations partially mediated the relationship between patients' representations and physical activity. CONCLUSION It was demonstrated that patient-partner dyads generally share similar representations of type 2 diabetes and perceived control over the condition. Furthermore, there was evidence that partners' representations partially mediated the relationships between patients' representations and their prospective self-management behaviors.
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Affiliation(s)
- Aidan Searle
- MRC Health Services Research Collaboration, University of Bristol, United Kingdom.
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