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Petrelli A, Ventura M, Di Napoli A, Pappagallo M, Simeoni S, Frova L. Socioeconomic inequalities in avoidable mortality in Italy: results from a nationwide longitudinal cohort. BMC Public Health 2024; 24:757. [PMID: 38468229 DOI: 10.1186/s12889-024-18205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/24/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Disparities in avoidable mortality have never been evaluated in Italy at the national level. The present study aimed to assess the association between socioeconomic status and avoidable mortality. METHODS The nationwide closed cohort of the 2011 Census of Population and Housing was followed up for 2012-2019 mortality. Outcomes of preventable and of treatable mortality were separately evaluated among people aged 30-74. Education level (elementary school or less, middle school, high school diploma, university degree or more) and residence macro area (North-West, North-East, Center, South-Islands) were the exposures, for which adjusted mortality rate ratios (MRRs) were calculated through multivariate quasi-Poisson regression models, adjusted for age at death. Relative index of inequalities was estimated for preventable, treatable, and non-avoidable mortality and for some specific causes. RESULTS The cohort consisted of 35,708,459 residents (48.8% men, 17.5% aged 65-74), 34% with a high school diploma, 33.5% living in the South-Islands; 1,127,760 deaths were observed, of which 65.2% for avoidable causes (40.4% preventable and 24.9% treatable). Inverse trends between education level and mortality were observed for all causes; comparing the least with the most educated groups, a strong association was observed for preventable (males MRR = 2.39; females MRR = 1.65) and for treatable causes of death (males MRR = 1.93; females MRR = 1.45). The greatest inequalities were observed for HIV/AIDS and alcohol-related diseases (both sexes), drug-related diseases and tuberculosis (males), and diabetes mellitus, cardiovascular diseases, and renal failure (females). Excess risk of preventable and of treatable mortality were observed for the South-Islands. CONCLUSIONS Socioeconomic inequalities in mortality persist in Italy, with an extremely varied response to policies at the regional level, representing a possible missed gain in health and suggesting a reassessment of priorities and definition of health targets.
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Affiliation(s)
- Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy.
| | - Martina Ventura
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy
| | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy
| | - Marilena Pappagallo
- National Institute of Statistics (Istat), Viale Liegi 13, 00198, Rome, Italy
| | - Silvia Simeoni
- National Institute of Statistics (Istat), Viale Liegi 13, 00198, Rome, Italy
| | - Luisa Frova
- National Institute of Statistics (Istat), Viale Liegi 13, 00198, Rome, Italy
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Donat M, Regidor E, Barrio G, Ambrosio E, Sordo L, Guerras JM, Politi J, Belza MJ. Increase in educational inequalities in alcohol-related mortality in Spain during a period of economic growth. Addiction 2023; 118:1920-1931. [PMID: 37203875 DOI: 10.1111/add.16264] [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: 06/15/2022] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND AIMS Alcohol-related mortality risk is almost always greater in lower than higher socio-economic positions (SEPs). There is little information on the evolution of this SEP gradient and its relationship with the economic cycle. Some results suggest that during economic expansions, there is a hypersensitivity of low-SEP people to harmful drinking. The main objective of this study was to measure the evolution of educational inequality in alcohol-related and non-alcohol related mortality by sex and age group in Spain during 2012-19. DESIGN, SETTING AND MEASUREMENTS This is a repeated cross-sectional study. This study includes all residents in Spain aged 25 years and over from 2012 to 2019. (1) We calculated age-standardized mortality rates (ASMRs) from strongly/moderately alcohol-related causes (directly alcohol-attributable, unspecified liver cirrhosis, liver and upper aerodigestive tract cancers and moderately alcohol-related), weakly alcohol-related causes and other causes by educational level. (2) We used age-adjusted relative index of inequality (RII) and slope index of inequality (SII) to measure relative and absolute educational inequality in mortality, respectively. (3) Age-adjusted annual percentage change (APC) was also used to measure linear trends in mortality by educational level. RII, SII and APC were obtained from negative binomial regression. FINDINGS Between 2012-15 and 2016-19, economic growth accelerated, the RII in mortality from strongly/moderately alcohol-related causes increased from 2.0 to 2.2 among men and from 1.1 to 1.3 among women, and the SII in deaths/100 000 person-years from 181.4 to 190.9 among men and from 18.9 to 46.5 among women. It also increased relative and absolute inequality in mortality from weakly alcohol-related and other causes of death in both men and women. These increases in inequality were due primarily to a flattening or even reversal of the downward mortality trend among low- and medium-educated people. CONCLUSIONS During the economic expansion of 2012-19 in Spain, changes in mortality risk from strongly/moderately alcohol-related causes were especially unfavourable among low- and medium-educated people.
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Affiliation(s)
- Marta Donat
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Enrique Regidor
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense, Madrid, Spain
- Health Research Institute of San Carlos (IdISSC), Madrid, Spain
| | - Gregorio Barrio
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Emilio Ambrosio
- Department of Psychobiology, Faculty of Psychology, National University of Distance Education (UNED), Madrid, Spain
| | - Luis Sordo
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense, Madrid, Spain
| | - Juan Miguel Guerras
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Julieta Politi
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
| | - María J Belza
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Ivankova V, Gavurova B, Khouri S. Understanding the relationships between health spending, treatable mortality and economic productivity in OECD countries. Front Public Health 2022; 10:1036058. [PMID: 36620274 PMCID: PMC9810629 DOI: 10.3389/fpubh.2022.1036058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Population health is one of the highest priorities for countries, which can translate into increased economic prosperity. This encourages research on health in an economic context. Methods The objective was to assess the relationships between health spending, treatable respiratory mortality, and gross domestic product (GDP) in countries of the Organization for Economic Co-operation and Development (OECD). The research was conducted with respect to health systems (tax-based, insurance-based) and gender differentiation of the productive population (aged 25-64 years). Descriptive analysis, regression analysis, and cluster analysis were used to achieve the main objective. The data covered the period from 1994 to 2016. Results The results of the regression analysis revealed negative relationships between health spending and treatable respiratory mortality in countries with a tax-based health system for male and female working-age populations, as well as in countries with an insurance-based health system for male population. This means that higher health spending was associated with lower treatable respiratory mortality. Also, lower treatable mortality was associated with higher GDP, especially in the male productive population from countries with an insurance-based health system. In this study, countries with a tax-based health system were characterized by higher health spending, lower rates of treatable mortality from respiratory system diseases, and higher GDP compared to countries with an insurance-based health system. Males reported a higher mortality rate than females. Among the countries with a tax-based health system, the United Kingdom and Latvia showed less positive outcomes, while Italy and Iceland were the countries with the most positive outcomes. Among the countries with an insurance-based health system, Hungary and Slovakia reported poor outcomes, while France, Switzerland and Luxembourg were characterized by very positive outcomes. The United States showed a high mortality rate despite its high economic outcomes, i.e., health spending and GDP. Discussion Health care financing in particular is one of the instruments of health policy. It seems that the leaders of countries should ensure a sufficient level of health financing, as higher health spending can contribute to lower mortality rates in a country. This may translate into higher productivity. Especially countries with underfunded health systems should increase their health spending.
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Affiliation(s)
- Viera Ivankova
- Institute of Earth Resources, Faculty of Mining, Ecology, Process Control and Geotechnologies, Technical University of Košice, Košice, Slovakia
| | - Beata Gavurova
- Center for Applied Economic Research, Faculty of Management and Economics, Tomas Bata University in Zlín, Zlín, Czechia,*Correspondence: Beata Gavurova ✉
| | - Samer Khouri
- Institute of Earth Resources, Faculty of Mining, Ecology, Process Control and Geotechnologies, Technical University of Košice, Košice, Slovakia
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Eklund Karlsson L, Balkfors A, Gunnarsdottir H, Povlsen L, Regber S, Buch Mejsner S, Leena Ikonen A, Fosse E. Are universal measures sufficient in reducing child poverty in the Nordic countries? An analysis of policies and political commitments. Scand J Public Health 2022; 50:892-902. [PMID: 35815562 DOI: 10.1177/14034948221109694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) have long traditions of social welfare policies that have eradicated poverty as part of their goals. The purpose of this study was to increase our understanding of why child poverty is still significant in the Nordic countries despite existing strategies. METHODS A qualitative analysis of Nordic government documents and reports between 2007 and 2019 was carried out to track changes in public health priorities and political measures and to determine the similarities and differences between the five countries. RESULTS In all countries, most of the measures were universal, such as benefits during pregnancy, paid parental leave before and after the child was born, paid parental leave related to children's sickness, child allowances, day care, free health care for children and support for disabled children. National policies aimed to reduce social inequalities and child poverty exist in all five countries, but unaffordable housing, unequal disposable family income distribution and unequal income distribution at local municipality levels seem to be obstacles to reaching national policy goals. CONCLUSIONS Despite comprehensive universal measures to eradicate child poverty, inequalities are significant and increasing in some of the Nordic countries. This might be due to a lack of proportional universalism, where universal measures are in place in all Nordic countries, but with a lack of scale and intensity proportional to the children and families at risk. The significance of eliminating social inequalities needs to be emphasised at the local level.
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Affiliation(s)
- Leena Eklund Karlsson
- Unit for Health Promotion Research, Public Health Institute, University of Southern Denmark, Denmark
| | | | | | - Lene Povlsen
- Unit for Health Promotion Research, Public Health Institute, University of Southern Denmark, Denmark
| | - Susann Regber
- School of Health and Welfare, Halmstad University, Sweden
| | - Sofie Buch Mejsner
- Unit for Health Promotion Research, Public Health Institute, University of Southern Denmark, Denmark
| | - Anne Leena Ikonen
- Faculty of Education and Psychology, University of Jyväskylä, Finland
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Educational Gradients in Drinking Amount and Heavy Episodic Drinking among Working-Age Men and Women in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074371. [PMID: 35410052 PMCID: PMC8998990 DOI: 10.3390/ijerph19074371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 02/04/2023]
Abstract
Alcohol-related harm decreases as socioeconomic position increases, although sometimes the opposite happens with alcohol intake. The objective was to know the educational gradient in monthly measures of drinking amount and heavy episodic drinking (HED) among people aged 25−64 years in Spain from 1997−2017. Such gradient was characterized with the relative percent change (PC) in drinking measures per year of education from generalized linear regression models after adjusting for age, year, region, marital status and immigration status. Among men, the PCs were significantly positive (p < 0.05) for prevalence of <21 g alcohol/day (2.9%) and 1−3 HED days (1.4%), and they were negative for prevalences of 21−40 g/day (−1.1%), >40 g/day (−6.0%) and ≥4 HED days (−3.2%), while among women they ranged from 3.6% to 5.7%. The gradient in prevalences of >40 g/day (men) and >20 g/day (women) was greatly attenuated after additionally adjusting for HED, while that of ≥4 HED days was only slightly attenuated after additionally adjusting for drinking amount. Among women, the gradients, especially in HED measures, seem steeper in 2009−2017 than in 1997−2007. Educational inequality remained after additional adjustment for income and occupation, although it decreased among women. These results can guide preventive interventions and help explain socioeconomic inequalities in alcohol-related harm.
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McMinn MA, Seaman R, Dundas R, Pell JP, Leyland AH. Socio-economic inequalities in rates of amenable mortality in Scotland: Analyses of the fundamental causes using the Scottish Longitudinal Study, 1991-2010. POPULATION, SPACE AND PLACE 2022; 28:psp.2385. [PMID: 35411206 PMCID: PMC7612592 DOI: 10.1002/psp.2385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/02/2020] [Indexed: 05/29/2023]
Abstract
Socio-economic inequalities in amenable mortality rates are increasing across Europe, which is an affront to universal healthcare systems where the numbers of, and inequalities in, amenable deaths should be minimal and declining over time. However, the fundamental causes theory proposes that inequalities in health will be largest across preventable causes, where unequally distributed resources can be used to gain an advantage. Information on individual-level inequalities that may better reflect the fundamental causes remains limited. We used the Scottish Longitudinal Study, with follow-up to 2010 to examine trends in amenable mortality by a range of socioeconomic position measures. Large inequalities were found for all measures of socioeconomic position and were lowest for educational attainment, higher for social class and highest for social connection. To reduce inequalities, amenable mortality needs to be interpreted both as an indicator of healthcare quality and as a reflection of the unequal distribution of socio-economic resources.
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Affiliation(s)
- Megan A. McMinn
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Usher Institute, University of Edinburgh, Edinburgh,UK
| | - Rosie Seaman
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alastair H. Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Toffol E, Heikinheimo O, But A, Latvala A, Partonen T, Haukka J. Population-level indicators associated with hormonal contraception use: a register-based matched case-control study. BMC Public Health 2021; 21:465. [PMID: 33678190 PMCID: PMC7938490 DOI: 10.1186/s12889-021-10512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Monitoring factors related to hormonal contraception (HC) use is essential to evaluating public health strategies and promoting access to contraception. We aimed to examine municipal social and health indicators of HC use at the population level, and to identify patterns of inequality across Finnish municipalities. Methods We identified all women (15–49 years) with a redeemed HC prescription in Finland in 2017 (n = 294,445), and a control group of non-users. Municipal social and health indicators at the population level were retrieved from the nationwide Statistics and Indicator Bank. Differences between the groups across 309 municipalities were calculated, and associations of municipal-specific proportions of HC users with municipal-specific indicators were studied using LASSO (Least Absolute Shrinkage and Selection Operator) models. Results Sociodemographic differences between HC users and non-users were non-homogenous across municipalities. Indicators positively associated with HC use included: larger population and higher proportions of population aged 16–24 years, of household-dwelling units with one person, of persons with higher education, and of divorces among those aged 25–64. Lower HC use was associated with higher proportions of Swedish-speaking population, of those aged 7–15 years, of young people not in education/training, and of household-dwelling units in overcrowded conditions. Lower HC use was also associated with indicators of outpatient and inpatient healthcare, and of municipal finances in welfare and healthcare. Conclusions Sociodemographic differences in relation to HC use exist across Finnish municipalities. Municipal indicators of social structure, health and welfare, and investment in and use of healthcare services are related to HC use. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10512-6.
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Affiliation(s)
- Elena Toffol
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna But
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
| | - Timo Partonen
- Mental Health Unit, Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Çilenti K, Rask S, Elovainio M, Lilja E, Kuusio H, Koskinen S, Koponen P, Castaneda AE. Use of Health Services and Unmet Need among Adults of Russian, Somali, and Kurdish Origin in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2229. [PMID: 33668241 PMCID: PMC7956472 DOI: 10.3390/ijerph18052229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 01/03/2023]
Abstract
Equal access to health care is one of the key policy priorities in many European societies. Previous findings suggest that there may be wide differences in the use of health services between people of migrant origin and the general population. We analyzed cross-sectional data from a random sample of persons of Russian (n = 692), Somali (n = 489), and Kurdish (n = 614) origin and the Health 2011 survey data (n = 1406) representing the general population in Finland. Having at least one outpatient visit to any medical doctor during the previous 12 months was at the same level for groups of Russian and Kurdish origin, but lower for people of Somali origin, compared with the general population. Clear differences were found when examining where health care services were sought: people of migrant origin predominantly visited a doctor at municipal health centers whereas the general population also used private and occupational health care. Self-reported need for doctor's treatment was especially high among Russian women and Kurdish men and women. Compared to the general population, all migrant origin groups reported much higher levels of unmet medical need and were less satisfied with the treatment they had received. Improving basic-level health services would serve besides the population at large, the wellbeing of the population of migrant origin.
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Affiliation(s)
- Katja Çilenti
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland
| | - Shadia Rask
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Marko Elovainio
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland
| | - Eero Lilja
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Hannamaria Kuusio
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Seppo Koskinen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Päivikki Koponen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Anu E. Castaneda
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland
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Ding Y, Chen D, Ding X, Wang G, Wan Y, Shen Q. A bibliometric analysis of income and cardiovascular disease: Status, Hotspots, Trends and Outlook. Medicine (Baltimore) 2020; 99:e21828. [PMID: 32846827 PMCID: PMC7447358 DOI: 10.1097/md.0000000000021828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Income is 1 of the socio-economic indicators and could directly influence the health outcomes of cardiovascular disease (CVD). The relationship between income and CVD has attracted more and more scholars' attention in the past 20 years. METHODS To study the current research dynamics of this field, a bibliometric analysis was conducted to evaluate the publications from 1990 to 2018 based on the Science Citation Index Expanded database. By using the Derwent Date Analyzer software, the following aspects were explored: RESULTS:: The USA ranked first in this field, followed by UK and Canada in terms of number of publications. As for institutions, Harvard University took the leading place in the number of publications, as well as the h-index. Plos One had the most publications and "health" was the most frequent used keyword. The leading research area was "public environmental occupational health". CONCLUSIONS In conclusion, the elderly, the children and the puerpera were the main study population in this field and "disease prevention" was the main study direction. The most concerned health issues in this field were "obesity" and "diet". There might be a lack of articles that explore the associations between income and CVD with a global perspective. Articles on this content are urgently warranted.
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Affiliation(s)
- Ye Ding
- School of Public Health, Hangzhou Medical College
| | - Dingwan Chen
- School of Public Health, Hangzhou Medical College
| | - Xufen Ding
- Institute of Information Resources, Zhejiang University of Technology
- Library, Zhejiang University of Technology, Hangzhou, China
| | - Guan Wang
- School of Public Health, Hangzhou Medical College
| | - Yuehua Wan
- Institute of Information Resources, Zhejiang University of Technology
- Library, Zhejiang University of Technology, Hangzhou, China
| | - Qing Shen
- School of Public Health, Hangzhou Medical College
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Raissadati A, Knihtilä H, Pätilä T, Nieminen H, Jokinen E. Long-term Social Outcomes After Congenital Heart Surgery. Pediatrics 2020; 146:peds.2019-3745. [PMID: 32503936 DOI: 10.1542/peds.2019-3745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patients are surviving decades after congenital heart surgery (CHS), raising the importance of postoperative quality of life as an outcome measure. We determined the long-term social outcomes after CHS performed during childhood. METHODS Between 1953 and 2009, 10 635 patients underwent surgery for congenital heart defects at <15 years of age in Finland. We obtained 4 control subjects per patient, matched by age, sex, birth time, and hospital district, from Statistics Finland, which also provided data on the highest education level, employment status, marital status, and progeny for both patients and control subjects. We included patients who were alive and ≥18 years of age at the end of the follow-up on December 31, 2017. RESULTS A total of 7308 patients met inclusion criteria. Patients had on average similar high school or vocational education rates as the general population but lower undergraduate or higher education rates (female patients: risk ratio [RR] 0.8 [95% confidence interval (CI) 0.8-0.9]; male patients: RR 0.8 [95% CI 0.7-0.9]). Patients were less likely to be married or have progeny compared with the general population. The rate of employment was significantly lower (female patients: RR 0.8 [95% CI 0.8-0.9]; male patients: RR 0.8 [95% CI 0.8-0.9]) and the rate of retirement (female patients: RR 2.1 [95% CI 2.0-2.3]; male patients RR 3.1 [95% CI 2.9-3.5]) significantly higher among patients. CONCLUSIONS Patients who undergo CHS at childhood age are, on average, more disadvantaged from both an educational and professional standpoint compared with the general population, regardless of the severity of the defect.
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Affiliation(s)
- Alireza Raissadati
- Department of Surgery and Cardiology, University of Helsinki and New Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland; .,Boston Children's Hospital, Boston, Massachusetts
| | - Hanna Knihtilä
- Department of Allergy, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; and.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Tommi Pätilä
- Department of Surgery and Cardiology, University of Helsinki and New Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Heta Nieminen
- Department of Surgery and Cardiology, University of Helsinki and New Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Eero Jokinen
- Department of Surgery and Cardiology, University of Helsinki and New Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
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Paalanen L, Härkänen T, Kontto J, Tolonen H. Inequalities by education and marital status in the co-occurrence of cardiovascular risk factors in Finland persisted between 1997-2017. Sci Rep 2020; 10:9123. [PMID: 32499541 PMCID: PMC7272447 DOI: 10.1038/s41598-020-65959-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/12/2020] [Indexed: 11/15/2022] Open
Abstract
Understanding on sociodemographic variation of the co-occurrence of cardiovascular disease risk factors is crucial for planning future prevention strategies. We aimed at examining (1) the co-occurrence of smoking, obesity, hypertension and elevated serum cholesterol by education and marital status, and (2) its trends in different sociodemographic groups in Finland. We used data from cross-sectional health examination surveys among the general population (25-64 years): for 1997-2012 the National FINRISK Study and for 2017 the FinHealth 2017 Survey (n = 25036). A risk factor accumulation score with categories (1) zero, (2) one, (3) two, and (4) three or four elevated risk factors was the outcome in multinomial logistic regression. The risk factor score was more favourable among women, among high education groups, and slightly among participants living with a spouse. Among men, the lowest risk factor score class became more prevalent especially in the intermediate education group, which approached the highest education group over time. Our results indicate an overall transition towards a more favourable risk factor distribution. However, risk factor accumulation among the least educated remained emphasizing the need to develop and implement more targeted prevention interventions and public health policies to decrease the risk factor burden particularly in this group.
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Affiliation(s)
- Laura Paalanen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271, Helsinki, Finland.
| | - Tommi Härkänen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271, Helsinki, Finland
| | - Jukka Kontto
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271, Helsinki, Finland
| | - Hanna Tolonen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271, Helsinki, Finland
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Gender Inequalities in Health and Their Effect on the Economic Prosperity Represented by the GDP of Selected Developed Countries-Empirical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103555. [PMID: 32438655 PMCID: PMC7277572 DOI: 10.3390/ijerph17103555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022]
Abstract
The objective is to evaluate the relations between gender health inequalities and economic prosperity in the Organisation for Economic Co-operation and Development (OECD) countries. The groups included health indicators in the specification of men, women and gender inequalities: life expectancy, causes of mortality and avoidable mortality. The variable determining the economic prosperity was represented by the Gross Domestic Product (GDP). The analytical processing included descriptive analysis, analysis of differences and analysis of relationships. The regression analysis was presented as the main output of the research. Most of the significant gender differences in health showed a more positive outcome for women. It is possible to identify a certain relation between gender health inequalities and economic prosperity. If there is some reduction in gender inequalities in health, the economic prosperity will increase. The reduction seems to be more effective on the part of men than women. The output of the cluster analysis showed the relations of indicators evaluating the inequalities and the prosperity. The countries such as Luxembourg, Norway or Switzerland showed very positive outputs, on the other hand, the countries with a potential for the improvement are Lithuania, Latvia or Estonia. Overall, the policies should focus on reducing the inequalities in avoidable mortality as well as reducing the frequent diseases in younger people.
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