Spatial inequalities in life expectancy within postindustrial regions of Europe: a cross-sectional observational study

Spatiotemporal trends in life expectancy and impacts of economic growth and air pollution in 134 countries: A Bayesian modeling study

Life expectancy (LE) varies across countries in space and time, and economic growth and air pollution are two important influence factors to LE. This study mainly aims to investigate spatiotemporal trends in LE in 134 countries from 1960 to 2016 by using Bayesian spatiotemporal modeling. Further, the relations between per capita gross domestic product (GDP_pc) and population-weighted fine particulate matter (pwPM_2.5) and LE are investigated from a global perspective from 1998 to 2016 by using the Bayesian regression model. The results illustrated the heterogeneity of spatiotemporal trends in LE globally. Specifically, Africa and South-East Asia show much lower LE levels, and the Americas, European, and Western Pacific exhibit a relatively higher LE level compared to the overall level. The countries with low overall levels of LE show a relatively stronger upward trend than the overall upward trend and vice versa. In addition, this study demonstrates that the spatial differences in effects of influence factors on LE in the six WHO regions in the 134 countries. Africa shows the highest positive regression coefficient of GDP_pc and lowest negative regression coefficient of pwPM_2.5 on LE than other regions in the world. Furthermore, it shows the complexity of the interaction between economic growth and air pollution on LE across six WHO regions. Our findings suggest the public policies to reduce the health damage caused by air pollution, especially in Africa, Eastern Mediterranean, and Europe where the pwPM_2.5 negatively affect the LE benefits from economic growth.

Spatial and temporal inequalities in mortality in the USA, 1968-2016

Previous UK and European research has highlighted important variations in mortality between populations after adjustment for key determinants such as poverty and deprivation. The aim here was to establish whether similar populations could be identified in the US, and to examine changes over time. We employed Poisson regression models to compare county-level mortality with national rates between 1968 and 2016, adjusting for poverty, education, race (a proxy for exposure to racism), population change and deindustrialisation. Results are presented by means of population-weighted cartograms, and highlight widening spatial inequalities in mortality over time, including an urban to rural, and south-westward, shift in areas with the highest levels of such unexplained 'excess' mortality. There is a need to understand the causes of the excess in affected communities, given that it persists after adjustment for such a broad range of important health determinants.

Prescribing patterns for medical treatment of suspected prostatic obstruction: a longitudinal register-based study of the Scottish Health and Social Care Open Data

BACKGROUND

The diagnosis of lower urinary tract symptoms related to suspected bladder outflow obstruction from benign prostate hyperplasia/enlargement in men is increasing. This is leading to high demand on healthcare services; however, there is limited knowledge of differences in pharmacotherapy prescribing for this condition based on geography.

OBJECTIVE

To investigate potential variation in drug prescribing for suspected bladder outflow obstruction in Scotland, based on analysis of publicly available data, to identify trends and inform future prescribing.

STUDY DESIGN

A longitudinal register-based data study of prescribing and patient data publicly available from Scottish registries. All information is available as monthly aggregates at the level of single general practices.

SETTING AND PARTICIPANTS

903 (97%) general practices in Scotland, over a 50-month period (October 2015 to November 2019).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

We analysed numbers of daily doses of drugs for suspected bladder outflow obstruction prescribed per month using a Bayesian Poisson regression analysis, incorporating random effects to account for spatial and temporal elements.

RESULTS

Prescriptions for suspected bladder outflow obstruction medications increased during the observation period (overall average rate of change 1.24±0.28, ranging from 0.893 in Orkney to 1.95 in Lanarkshire). While some determinants of health inequality regarding prescribing practices across health boards are consistent with those known from the literature, other inequalities remain unexplained after accounting for practice-specific and patient-specific characteristics such as deprivation and rurality.

CONCLUSIONS

Inequalities in prescribing for suspected bladder outflow obstruction medications exist in Scotland, partially ascribable to accepted sociodemographic and geographic factors.

Estimating the changing nature of Scotland's health inequalities by using a multivariate spatiotemporal model

Health inequalities are the unfair and avoidable differences in people's health between different social groups. These inequalities have a huge influence on people's lives, particularly those who live at the poorer end of the socio-economic spectrum, as they result in prolonged ill health and shorter lives. Most studies estimate health inequalities for a single disease, but this will give an incomplete picture of the overall inequality in population health. Here we propose a novel multivariate spatiotemporal model for quantifying health inequalities in Scotland across multiple diseases, which will enable us to understand better how these inequalities vary across disease and have changed over time. In developing this model we are interested in estimating health inequalities between Scotland's 14 regional health boards, who are responsible for the protection and improvement of their population's health. The methodology is applied to hospital admissions data for cerebrovascular disease, coronary heart disease and respiratory disease, which are three of the leading causes of death, from 2003 to 2012 across Scotland.

Association between the General Practitioner Workforce Crisis and Premature Mortality in Hungary: Cross-Sectional Evaluation of Health Insurance Data from 2006 to 2014

The workforce crisis of primary care is reflected in the increasing number of general medical practices (GMP) with vacant general practitioner (GP) positions, and the GPs’ ageing. Our study aimed to describe the association between this crisis and premature mortality. Age-sex-standardized mortality for 18–64 years old adults was calculated for all Hungarian GMPs annually in the period from 2006 to 2014. The relationship of premature mortality with GPs’ age and vacant GP positions was evaluated by standardized linear regression controlled for list size, urbanization, geographical location, clients’ education, and type of the GMP. The clients’ education was the strongest protective factor (beta = −0175; p < 0.001), followed by urban residence (beta = −0.149; p < 0.001), and bigger list size (beta_1601–2000 = −0.054; p < 0.001; beta_2001−X = −0.096; p < 0.001). The geographical localization also significantly influenced the risk. Although GMPs with a GP aged older than 65 years (beta = 0; p = 0.995) did not affect the risk, GP vacancy was associated with higher risk (beta = 0.010; p = 0.033), although the corresponding number of attributable cases was 23.54 over 9 years. The vacant GP position is associated with a significant but hardly detectable increased risk of premature mortality without considerable public health importance. Nevertheless, employment of GPs aged more than 65 does not impose premature mortality risk elevation.

Does community deprivation determine longevity after the age of 75? A cross-national analysis

OBJECTIVES

Analyze the association between socioeconomic deprivation and old-age survival in Europe, and investigate whether it varies by country and gender.

METHODS

Our study incorporated five countries (Portugal, Spain, France, Italy, and England). A 10-year survival rate expressing the proportion of population aged 75-84 years who reached 85-94 years old was calculated at area-level for 2001-11. To estimate associations, we used Bayesian spatial models and a transnational measure of deprivation. Attributable/prevention fractions were calculated.

RESULTS

Overall, there was a significant association between deprivation and survival in both genders. In England that association was stronger, following a dose-response relation. Although lesser in magnitude, significant associations were observed in Spain and Italy, whereas in France and Portugal these were even weaker. The elimination of socioeconomic differences between areas would increase survival by 7.1%, and even a small reduction in socioeconomic differences would lead to a 1.6% increase.

CONCLUSIONS

Socioeconomic deprivation was associated with survival among older adults at ecological-level, although with varying magnitude across countries. Reasons for such cross-country differences should be sought. Our results emphasize the importance of reducing socioeconomic differences between areas.

Mechanical induction of bi-directional orientation of primary porcine bladder smooth muscle cells in tubular fibrin-poly(vinylidene fluoride) scaffolds for ureteral and urethral repair using cyclic and focal balloon catheter stimulation

To restore damaged organ function or to investigate organ mechanisms, it is necessary to prepare replicates that follow the biological role model as faithfully as possible. The interdisciplinary field of tissue engineering has great potential in regenerative medicine and might overcome negative side effects in the replacement of damaged organs. In particular, tubular organ structures of the genitourinary tract, such as the ureter and urethra, are challenging because of their complexity and special milieu that gives rise to incrustation, inflammation and stricture formation. Tubular biohybrids were prepared from primary porcine smooth muscle cells embedded in a fibrin gel with a stabilising poly(vinylidene fluoride) mesh. A mechanotransduction was performed automatically with a balloon kyphoplasty catheter. Diffusion of urea and creatinine, as well as the bursting pressure, were measured. Light and electron microscopy were used to visualise cellular distribution and orientation. Histological evaluation revealed a uniform cellular distribution in the fibrin gel. Mechanical stimulation with a stretch of 20% leads to a circumferential orientation of smooth muscle cells inside the matrix and a longitudinal alignment on the outer surface of the tubular structure. Urea and creatinine permeability and bursting pressure showed a non-statistically significant trend towards stimulated tissue constructs. In this proof of concept study, an innovative technique of intraluminal pressure for mechanical stimulation of tubular biohybrids prepared from autologous cells and a composite material induce bi-directional orientation of smooth muscle cells by locally and cyclically applied mechanical tension. Such geometrically driven patterns of cell growth within a scaffold may represent a key stage in the future tissue engineering of implantable ureter replacements that will allow the active transportation of urine from the renal pelvis into the bladder.

History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow

OBJECTIVES

High levels of excess mortality (i.e. that not explained by deprivation) have been observed for Scotland compared with England & Wales, and especially for Glasgow in comparison with similar post-industrial cities such as Liverpool and Manchester. Many potential explanations have been suggested. Based on an assessment of these, the aim was to develop an understanding of the most likely underlying causes. Note that this paper distils a larger research report, with the aim of reaching wider audiences beyond Scotland, as the important lessons learnt are relevant to other populations.

STUDY DESIGN

Review and dialectical synthesis of evidence.

METHODS

Forty hypotheses were examined, including those identified from a systematic review. The relevance of each was assessed by means of Bradford Hill's criteria for causality alongside-for hypotheses deemed causally linked to mortality-comparisons of exposures between Glasgow and Liverpool/Manchester, and between Scotland and the rest of Great Britain. Where gaps in the evidence base were identified, new research was undertaken. Causal chains of relevant hypotheses were created, each tested in terms of its ability to explain the many different aspects of excess mortality. The models were further tested with key informants from public health and other disciplines.

RESULTS

In Glasgow's case, the city was made more vulnerable to important socioeconomic (deprivation, deindustrialisation) and political (detrimental economic and social policies) exposures, resulting in worse outcomes. This vulnerability was generated by a series of historical factors, processes and decisions: the lagged effects of historical overcrowding; post-war regional policy including the socially selective relocation of population to outside the city; more detrimental processes of urban change which impacted on living conditions; and differences in local government responses to UK government policy in the 1980s which both impacted in negative terms in Glasgow and also conferred protective effects on comparator cities. Further resulting protective factors were identified (e.g. greater 'social capital' in Liverpool) which placed Glasgow at a further relative disadvantage. Other contributory factors were highlighted, including the inadequate measurement of deprivation. A similar 'explanatory model' resulted for Scotland as a whole. This included: the components of the Glasgow model, given their impact on nationally measured outcomes; inadequate measurement of deprivation; the lagged effects of deprivation (in particular higher levels of overcrowding historically); and additional key vulnerabilities.

CONCLUSIONS

The work has helped to further understanding of the underlying causes of Glasgow's and Scotland's high levels of excess mortality. The implications for policy include the need to address three issues simultaneously: to protect against key exposures (e.g. poverty) which impact detrimentally across all parts of the UK; to address the existing consequences of Glasgow's and Scotland's vulnerability; and to mitigate against the effects of future vulnerabilities which are likely to emerge from policy responses to contemporary problems which fail sufficiently to consider and to prevent long-term, unintended social consequences.

Perspectives on differing health outcomes by city: accounting for Glasgow's excess mortality

Several health outcomes (including mortality) and health-related behaviors are known to be worse in Scotland than in comparable areas of Europe and the United Kingdom. Within Scotland, Greater Glasgow (in West Central Scotland) experiences disproportionately poorer outcomes independent of measurable variation in socioeconomic status and other important determinants. Many reasons for this have been proposed, particularly related to deprivation, inequalities, and variation in health behaviors. The use of models (such as the application of Bradford Hill's viewpoints on causality to the different hypotheses) has provided useful insights on potentially causal mechanisms, with health behaviors and inequalities likely to represent the strongest individual candidates. This review describes the evolution of our understanding of Glasgow's excess mortality, summarizes some of the key work in this area, and provides some suggestions for future areas of exploration. In the context of demographic change, the experience in Glasgow is an important example of the complexity that frequently lies behind observed variations in health outcomes within and between populations. A comprehensive explanation of Glasgow's excess mortality may continue to remain elusive, but is likely to lie in a complex and difficult-to-measure interplay of health determinants acting at different levels in society throughout the life course. Lessons learned from the detailed examination of different potentially causative determinants in Scotland may provide useful methodological insights that may be applied in other settings. Ongoing efforts to unravel the causal mechanisms are needed to inform public health efforts to reduce health inequalities and improve outcomes in Scotland.