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Iakunchykova O, Lange T, Leon DA. Multiplicative and additive interactions between risk factors for coronary heart disease. Ann Epidemiol 2024; 91:82-84. [PMID: 38043838 DOI: 10.1016/j.annepidem.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Olena Iakunchykova
- Department of Psychology, University of Oslo, Norway; Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Theis Lange
- Department of Public Health, University of Copenhagen, Denmark
| | - David A Leon
- Department of Psychology, University of Oslo, Norway; Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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2
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Hahad O, Gilan DA, Chalabi J, Al-Kindi S, Schuster AK, Wicke F, Büttner M, Tüscher O, Lackner KJ, Galle PR, Konstantinides S, Daiber A, Wild PS, Münzel T. Cumulative social disadvantage and cardiovascular disease burden and mortality. Eur J Prev Cardiol 2024; 31:40-48. [PMID: 37721449 DOI: 10.1093/eurjpc/zwad264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 09/19/2023]
Abstract
AIMS To investigate the association between cumulative social disadvantage and cardiovascular burden and mortality in a large cohort of the general population. METHODS AND RESULTS Cross-sectional (n = 15 010, aged 35 to 74 years, baseline investigation period 2007 to 2012) and longitudinal data (5- and 10-year follow-ups from 2012 to 2022) from the Gutenberg Health Study were used to investigate the association between individual socioeconomic status (SES, measured via a validated questionnaire) and cardiovascular disease (CVD, composite of atrial fibrillation, coronary artery disease, myocardial infarction, stroke, chronic heart failure, peripheral artery disease, and/or venous thromboembolism) risk and mortality. Subjects with prevalent CVD had a lower SES sum score, as well as lower education, occupation, and household net-income scores (all P < 0.0001). Logistic regression analysis showed that a low SES (vs. high, defined by validated cut-offs) was associated with 19% higher odds of prevalent CVD [odds ratio (OR) 1.19, 95% CI 1.01; 1.40] in the fully adjusted model. At 5-year follow-up, low SES was associated with both increased cardiovascular [hazard ratio (HR) 5.36, 2.24; 12.82] and all-cause mortality (HR 2.23, 1.51; 3.31). At 10-year follow-up, low SES was associated with a 68% higher risk of incident CVD (OR 1.68, 1.12; 2.47) as well as 86% higher all-cause mortality (HR 1.86, 1.55; 2.24). In general, the education and occupation scores were stronger related to risk of CVD and death than the household net-income score. Low SES was estimated to account for 451.45 disability-adjusted life years per 1000 people (years lived with disability 373.41/1000 and years of life lost 78.03/1000) and an incidence rate of 11 CVD cases and 3.47 CVD deaths per 1000 people per year. The population attributable fraction for CVD incidence after 5 years was 4% due to low SES. CONCLUSION Despite universal healthcare access, cumulative social disadvantage remains associated with higher risk of CVD and mortality. Dimensions of education and occupation, but not household net income, are associated with outcomes of interest.
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Affiliation(s)
- Omar Hahad
- Department of Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Donya A Gilan
- Leibniz Institute for Resilience Research (LIR), Wallstraße 7, 55122 Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Julian Chalabi
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Sadeer Al-Kindi
- Department of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Alexander K Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Felix Wicke
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Matthias Büttner
- Institute of Medical Biostatistics, Epidemiology & Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Rhabanusstraße 3/Tower A, 55118 Mainz, Germany
| | - Oliver Tüscher
- Leibniz Institute for Resilience Research (LIR), Wallstraße 7, 55122 Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Peter R Galle
- Department of Internal Medicine, Gastroenterology and Hepatology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Andreas Daiber
- Department of Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Philipp S Wild
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstraße 1, 55131 Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Institute for Molecular Biology, Ackermannweg 4, 55128 Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
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Sanchez Rico M, Plessz M, Airagnes G, Wiernik E, Hoertel N, Goldberg M, Zins M, Meneton P. Lifetime exposure to unemployment and prior working conditions are associated with retiree's health: A retrospective study in a large population-based French cohort. Soc Sci Med 2024; 341:116550. [PMID: 38160610 DOI: 10.1016/j.socscimed.2023.116550] [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: 08/24/2023] [Revised: 12/05/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
It is unclear whether unemployment exposure, as well as working conditions, can have sustained effects on the health of retirees who are no longer exposed. The aim of the present study is to investigate this issue in 29,281 French retirees from the CONSTANCES cohort in whom the prevalence of suboptimal self-rated health, disability for routine tasks, cardiovascular diseases and cancers is assessed according to lifetime exposure to unemployment and prior working conditions. The analyses are performed retrospectively using multivariable logistic regression models with adjustment for potential confounders such as sex, birth year, parental histories of cardiovascular disease and cancer, social position, retirement age and duration. High lifetime exposure to unemployment is associated with an increased prevalence of suboptimal self-rated health (adjusted odds ratio (95% CI), 1.39 (1.23-1.57)), disability for routine tasks (1.41 (1.26-1.57)) and several cardiovascular diseases including stroke (1.66 (1.19-2.31)), myocardial infarction (1.65 (1.18-2.31)) and peripheral arterial disease (2.38 (1.46-3.90)). Bad prior working conditions are associated with an increased prevalence of disability for routine tasks (1.17 (1.04-1.33)) and cancers (1.27 (1.04-1.54)), notably prostate cancer (1.60 (1.01-2.64)). These findings suggest that unemployment and working conditions have long-term health effects that may cumulate over lifetime, emphasizing that risk evaluation and preventive strategies in retirees, as in workers, should take into account the life-course of individuals in addition to traditional risk factors.
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Affiliation(s)
- Marina Sanchez Rico
- AP-HP, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
| | - Marie Plessz
- Centre Maurice Halbwachs, INRAE, EHESS, ENS-PSL, CNRS, Paris, France
| | - Guillaume Airagnes
- AP-HP, DMU Psychiatrie et Addictologie, Hôpital européen Georges-Pompidou, Paris, France; Université Paris Cité, Faculté de Médecine, Paris, France
| | - Emmanuel Wiernik
- Université Paris Cité, Université Paris-Saclay, UVSQ, UMS_011 INSERM, Villejuif, France
| | - Nicolas Hoertel
- AP-HP, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Issy-les-Moulineaux, France; Université Paris Cité, Faculté de Médecine, Paris, France; UMR_1266, INSERM, Paris, France
| | - Marcel Goldberg
- Université Paris Cité, Université Paris-Saclay, UVSQ, UMS_011 INSERM, Villejuif, France
| | - Marie Zins
- Université Paris Cité, Faculté de Médecine, Paris, France; Université Paris Cité, Université Paris-Saclay, UVSQ, UMS_011 INSERM, Villejuif, France
| | - Pierre Meneton
- UMR_1142 INSERM, Sorbonne Université, Université Paris 13, Paris, France.
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4
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O'Neill KN, Bell JA, Smith GD, Fraser A, Howe LD, Kearney PM, Robinson O, Tilling K, Willeit P, O'Keeffe LM. Childhood socioeconomic position and sex-specific trajectories of metabolic traits across early life: prospective cohort study. EBioMedicine 2023; 98:104884. [PMID: 37989036 PMCID: PMC10700592 DOI: 10.1016/j.ebiom.2023.104884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Socioeconomic inequalities in cardiovascular disease risk begin early in life and are more pronounced in females than males later in life. Causal atherogenic traits explaining this are not well understood. We explored sex-specific associations between childhood socioeconomic position (SEP) and molecular measures of systemic metabolism across early life. METHODS Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based birth cohort in southwest England. Pregnant women with an expected delivery date between 1991 and 1992 were invited to participate. Maternal education was the primary indicator of SEP. Concentrations of 148 metabolic traits from targeted metabolomics (nuclear magnetic resonance spectroscopy) from research clinics at ages 7, 15, 18 and 25 years were analysed. The sex-specific slope index of inequality (SII) in trajectories of metabolic traits was estimated using multilevel models. FINDINGS Total number of participants included was 6537 (12,543 repeated measures). Lower maternal education was associated with more adverse levels of several atherogenic lipids and key metabolic traits among females at age 7 years, but not males. For instance, SII for very small very-low-density lipoprotein (VLDL) concentrations was 0.16SD (95% CI: 0.01, 0.30) among females and -0.02SD (95% CI: -0.16, 0.13) among males. Between 7 and 25 years, inequalities widened among females and emerged among males particularly for VLDL particle concentrations, apolipoprotein-B concentrations, and inflammatory glycoprotein acetyls. For instance, at 25 years, SII for very small VLDL concentrations was 0.36SD (95% CI: 0.20, 0.52) and 0.22SD (95% CI: 0.04, 0.40) among females and males respectively. INTERPRETATION Prevention of socioeconomic inequalities in cardiovascular disease risk requires a life course approach beginning at the earliest opportunity, especially among females. FUNDING The UK Medical Research Council and Wellcome (grant ref: 217065/Z/19/Z) and the University of Bristol provide core support for ALSPAC. A comprehensive list of grants funding is available on the ALSPAC website (http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf). KON is supported by a Health Research Board (HRB) of Ireland Investigator Led Award (ILP-PHR-2022-008). JB, GDS and KT work in a unit funded by the UK MRC (MC_UU_00011/1 and MC UU 00011/3) and the University of Bristol. OR is supported by a UKRI Future Leaders Fellowship (MR/S03532X/1). These funding sources had no role in the design and conduct of this study. This publication is the work of the authors and KON will serve as guarantor for the contents of this paper.
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Affiliation(s)
- Kate N O'Neill
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.
| | - Joshua A Bell
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Patricia M Kearney
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland
| | - Oliver Robinson
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Peter Willeit
- Clinical Epidemiology Team, Medical University of Innsbruck, Austria; Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Linda M O'Keeffe
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland; MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
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5
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Sanchez Rico M, Plessz M, Airagnes G, Ribet C, Hoertel N, Goldberg M, Zins M, Meneton P. Distinct cardiovascular and cancer burdens associated with social position, work environment and unemployment: a cross-sectional and retrospective study in a large population-based French cohort. BMJ Open 2023; 13:e074835. [PMID: 37524560 PMCID: PMC10391792 DOI: 10.1136/bmjopen-2023-074835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES Distinguish the respective effects of social position, work environment and unemployment on cardiovascular and cancer risks. DESIGN A cross-sectional and retrospective observational study. SETTING A population-based French cohort (CONSTANCES). PARTICIPANTS 130 197 adults enrolled between 2012 and 2021 without missing values. PRIMARY OUTCOME MEASURES The associations of social position, work environment and unemployment exposure with the prevalence of cardiovascular events and cancers simultaneously tested using logistic regression models adjusting for common risk factors. RESULTS While social position, work environment and unemployment exposure are strongly inter-related with each other, they are not linked to the same cardiovascular and cancer outcomes. Low social position and long unemployment duration are significantly associated with an increased prevalence of angina pectoris, myocardial infarction and peripheral arterial disease (OR=1.22 to 1.90, p<0.04 to p<0.0001) but not of stroke. In contrast, a bad work environment is associated with an increased prevalence of stroke (OR=1.29, p<0.01) but not of angina pectoris, myocardial infarction and peripheral arterial disease. Low social position is associated with an increased prevalence of cervical and lung cancers (OR=1.73 and 1.95, p<0.002 and p<0.03) and a decreased prevalence of skin cancer (OR=0.70, p<0.0001) while a bad work environment is associated with an increased prevalence of breast, skin, prostate and colon cancers (OR=1.31 to 2.91, p<0.0002 to p<0.0001). Unemployment exposure is not associated with the prevalence of any type of cancers. CONCLUSIONS Social position, work environment and unemployment are associated with distinct cardiovascular and cancerous diseases that could add up during lifetime, they should therefore be considered all together in any preventive strategy.
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Affiliation(s)
- Marina Sanchez Rico
- DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, AP-HP, Issy-les-Moulineaux, France
| | - Marie Plessz
- Centre Maurice Halbwachs, EHESS, ENS-PSL, CNRS, INRAE, Paris, France
| | - Guillaume Airagnes
- DMU Psychiatrie et Addictologie, Hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - Céline Ribet
- UMS_011, Université Paris-Saclay, INSERM, Villejuif, France
| | - Nicolas Hoertel
- DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, AP-HP, Issy-les-Moulineaux, France
| | | | - Marie Zins
- UMS_011, Université Paris-Saclay, INSERM, Villejuif, France
| | - Pierre Meneton
- UMR_1142, Sorbonne Université, Université Paris 13, INSERM, Paris, France
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Sanchez Rico M, Plessz M, Airagnes G, Ribet C, Hoertel N, Goldberg M, Zins M, Meneton P. Cardiovascular burden and unemployment: A retrospective study in a large population-based French cohort. PLoS One 2023; 18:e0288747. [PMID: 37459323 PMCID: PMC10351739 DOI: 10.1371/journal.pone.0288747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023] Open
Abstract
The specific effect of unemployment on cardiovascular health relatively to the effects of social position and work environment is still unclear. To clarify this effect, the associations between current or past unemployment and the prevalence of common cardiovascular risk factor and events were tested using multiple logistic regression models with adjustment for both social position and prior work environment. The analyses were performed in a population-based French cohort (CONSTANCES) that included 131,186 adults enrolled between 2012 and 2021. Participants who were unemployed at inclusion (n = 8278) were overexposed to non-moderate alcohol consumption, smoking, leisure-time physical inactivity and depression (odds ratios (ORs) from 1.19 to 1.58) whereas those who have been unemployed at least once in the past (n = 19,015) were additionally overexposed not only to the previous risk factors but also to obesity, diabetes and sleep disorders (ORs from 1.10 to 1.35). These latter were also more exposed to non-fatal myocardial infarction and peripheral arterial disease (ORs of 1.44 and 1.47 respectively), overexposures that persisted after further adjustment for cardiovascular risk factors (ORs of 1.36 and 1.33). The overexposures to risk factors and cardiovascular events were both dependent on the duration of past unemployment. They were equally observed in participants with low social position or bad work environment. These results suggest that unemployment increases cardiovascular risk independently from social position and work environment with a cumulative effect over time. The effect of unemployment could add up to those of low social position and bad work environment during lifetime to further increase cardiovascular risk. They also suggest that long-term unemployment increases the prevalence of cardiovascular events through pathways including but not limited to overexposure to common risk factors.
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Affiliation(s)
- Marina Sanchez Rico
- AP-HP, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
| | - Marie Plessz
- Centre Maurice Halbwachs, INRAE, EHESS, ENS-PSL, CNRS, Paris, France
| | - Guillaume Airagnes
- AP-HP, DMU Psychiatrie et Addictologie, Hôpital Européen Georges-Pompidou, Paris, France
- Université Paris Cité, Faculté de Médecine, Paris, France
| | - Céline Ribet
- UMS_011, INSERM, Université Paris-Saclay, Villejuif, France
| | - Nicolas Hoertel
- AP-HP, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
- Université Paris Cité, Faculté de Médecine, Paris, France
- UMR_1266, INSERM, Paris, France
| | | | - Marie Zins
- Université Paris Cité, Faculté de Médecine, Paris, France
- UMS_011, INSERM, Université Paris-Saclay, Villejuif, France
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7
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Kolden MØ, Nymo SH, Øie E. Impact of neighbourhood-level socioeconomic status, traditional coronary risk factors, and ancestry on age at myocardial infarction onset: A population-based register study. BMC Cardiovasc Disord 2022; 22:447. [PMID: 36289452 PMCID: PMC9608887 DOI: 10.1186/s12872-022-02880-7] [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: 04/05/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is consensus that low socioeconomic status (SES) is associated with an increased risk of acute myocardial infarction (AMI), but the extent to which traditional coronary risk factors and other characteristics of low SES mediate this effect remains uncertain. This study examined AMI patients residing in neighbouring city districts with the same local hospital despite having among the most considerable differences in mean SES in Norway. Our purpose was to assess low SES as a coronary risk factor and examine whether traditional coronary risk factors or ancestry mediate this effect. Methods Six hundred six patients (215 and 391 with a low and high neighbourhood-level SES, respectively) admitted to Diakonhjemmet Hospital with non-ST-elevation myocardial infarction (NSTEMI) between 2014 and 2017, entered analysis. Data from the Norwegian Myocardial Infarction Register were used to identify patient characteristics, and the STATA/SE 15.1 software was used to perform the statistical analyses. Results Patients from socioeconomically disadvantaged city-districts had a 4.9 years earlier onset of AMI (68.99 vs. 73.89 years; p < 0.001) and a higher prevalence of previous AMI, known diabetes, and current smokers (36% vs. 27%, 25% vs. 12%, and 33% vs. 17%, respectively; all p ≤ 0.05). When only comparing patients with a first time AMI, an even greater difference in the age at AMI onset was found (6.1 yrs; p < 0.001). The difference in age at AMI onset remained statistically significant when adjusting for traditional coronary risk factors (3.28 yrs; 95% confidence interval (CI) 1.11−5.44; p = 0.003), but not when adjusting for presumed non-Northwest-European ancestry (1.81 yrs; 95% CI −0.55 to 4.17; p = 0.132). Conclusion This study supports earlier research showing an increased risk of AMI in socioeconomically disadvantaged individuals. In our population, presumed non-Northwest-European ancestry could entirely explain the increased risk, whereas traditional coronary risk factors could only partly explain the increased risk.
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Affiliation(s)
- Mathias Øie Kolden
- grid.413684.c0000 0004 0512 8628Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Ståle H. Nymo
- grid.413684.c0000 0004 0512 8628Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Erik Øie
- grid.413684.c0000 0004 0512 8628Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
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Tesli M, Degerud E, Plana‐Ripoll O, Gustavson K, Torvik FA, Ystrom E, Ask H, Tesli N, Høye A, Stoltenberg C, Reichborn‐Kjennerud T, Nesvåg R, Næss Ø. Educational attainment and mortality in schizophrenia. Acta Psychiatr Scand 2022; 145:481-493. [PMID: 35152418 PMCID: PMC9305099 DOI: 10.1111/acps.13407] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Individuals suffering from schizophrenia have a reduced life expectancy with cardiovascular disease (CVD) as a major contributor. Low educational attainment is associated with schizophrenia, as well as with all-cause and CVD mortality. However, it is unknown to what extent low educational attainment can explain the increased mortality in individuals with schizophrenia. AIM Here, we quantify associations between educational attainment and all-cause and CVD mortality in individuals with schizophrenia, and compare them with the corresponding associations in the general population. METHOD All Norwegian citizens born between January 1, 1925, and December 31, 1959, were followed up from January 1, 1990, to December 31, 2014. The total sample included 1,852,113 individuals, of which 6548 were registered with schizophrenia. We estimated hazard ratios (HR) for all-cause and CVD mortality with Cox models, in addition to life years lost. Educational attainment for index persons and their parents were included in the models. RESULTS In the general population individuals with low educational attainment had higher risk of all-cause (HR: 1.48 [95% CI: 1.47-1.49]) and CVD (HR: 1.59 [95% CI: 1.57-1.61]) mortality. In individuals with schizophrenia these estimates were substantially lower (all-cause: HR: 1.13 [95% CI: 1.05-1.21] and CVD: HR: 1.12 [95% CI: 0.98-1.27]). Low educational attainment accounted for 3.28 (3.21-3.35) life years lost in males and 2.48 (2.42-2.55) years in females in the general population, but was not significantly associated with life years lost in individuals with schizophrenia. Results were similar for parental educational attainment. CONCLUSIONS Our results indicate that while individuals with schizophrenia in general have lower educational attainment and higher mortality rates compared with the general population, the association between educational attainment and mortality is smaller in schizophrenia subjects than in the general population.
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Affiliation(s)
- Martin Tesli
- Norwegian Institute of Public HealthOsloNorway,Norwegian Centre for Mental Disorders ResearchOslo University HospitalOsloNorway
| | | | - Oleguer Plana‐Ripoll
- Department of Economics and Business EconomicsNational Centre for Register‐Based ResearchAarhus UniversityAarhus VDenmark,Department of Clinical EpidemiologyAarhus University and Aarhus University HospitalAarhus NDenmark
| | - Kristin Gustavson
- Norwegian Institute of Public HealthOsloNorway,Department of PsychologyUniversity of OsloOsloNorway
| | - Fartein Ask Torvik
- Norwegian Institute of Public HealthOsloNorway,Department of PsychologyUniversity of OsloOsloNorway
| | - Eivind Ystrom
- Norwegian Institute of Public HealthOsloNorway,Department of PsychologyUniversity of OsloOsloNorway,PharmacoEpidemiology and Drug Safety Research GroupSchool of PharmacyUniversity of OsloOsloNorway
| | - Helga Ask
- Norwegian Institute of Public HealthOsloNorway
| | - Natalia Tesli
- Norwegian Centre for Mental Disorders ResearchOslo University HospitalOsloNorway
| | - Anne Høye
- Division of Mental Health and Substance AbuseUniversity Hospital of North NorwayTromsøNorway,Department of Clinical MedicineThe Arctic University of NorwayTromsøNorway
| | - Camilla Stoltenberg
- Norwegian Institute of Public HealthOsloNorway,Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
| | - Ted Reichborn‐Kjennerud
- Norwegian Institute of Public HealthOsloNorway,Institute of Clinical MedicineUniversity of OsloOsloNorway
| | | | - Øyvind Næss
- Norwegian Institute of Public HealthOsloNorway,Institute of Health and SocietyUniversity of OsloOsloNorway
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Kyprianidou M, Panagiotakos D, Makris KC, Kambanaros M, Christophi CA, Giannakou K. The Lifestyle Profile of Individuals with Cardiovascular and Endocrine Diseases in Cyprus: A Hierarchical, Classification Analysis. Nutrients 2022; 14:nu14081559. [PMID: 35458120 PMCID: PMC9027605 DOI: 10.3390/nu14081559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 02/01/2023] Open
Abstract
The study aims to explore the lifestyle profile of adult individuals with cardiovascular and endocrine diseases in Cyprus. Age and sex-specific analyses were applied. A representative sample of the general adult population was recruited during 2018–2019 using stratified sampling among the five government-controlled municipalities of the Republic of Cyprus. Data on Mediterranean diet adherence, quality of sleep, smoking status, physical activity, Body Mass Index, and the presence of cardiovascular and endocrine diseases were collected using a validated questionnaire. Diseases were classified according to the International Classification of Diseases, Tenth Revision (ICD-10). A total of 1140 men and women over 18 years old (range: 18–94) participated in the study. The prevalence of cardiovascular and endocrine diseases among the adult general population of Cyprus was 24.8% and 17.2%, respectively, with a higher prevalence of cardiovascular diseases in men, and a higher prevalence of endocrine diseases in women. Among individuals with cardiovascular disease, 23.3% were aged between 18–44 years old, while the corresponding percentage among endocrine disease individuals was 48%. The prevalence of smoking, physical activity, a low adherence to the Mediterranean diet, poor quality of sleep and obesity among the study population was 35.5%, 48.0%, 32.9%, 39.0% and 13.6%, respectively. Individuals with cardiovascular and endocrine diseases were characterized by poor quality of sleep, inadequate physical activity, and a higher BMI. This is the first study in Cyprus exploring the profile of individuals with cardiovascular and endocrine diseases in Cyprus. Health promotion and educational programs focusing on the importance of sleep quality, healthier dietary habits, physical activity, and lower BMIs among people with cardiovascular and endocrine diseases should be developed.
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Affiliation(s)
- Maria Kyprianidou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3036, Cyprus; (M.K.); (K.C.M.); (C.A.C.)
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece;
| | - Konstantinos C. Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3036, Cyprus; (M.K.); (K.C.M.); (C.A.C.)
| | - Maria Kambanaros
- Department of Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia;
| | - Costas A. Christophi
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3036, Cyprus; (M.K.); (K.C.M.); (C.A.C.)
| | - Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus
- Correspondence: ; Tel.: +357-2255-9656
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10
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Hoertel N, Sanchez Rico M, Limosin F, Ménard J, Ribet C, Bonenfant S, Goldberg M, Zins M, Meneton P. Respective Mediating Effects of Social Position and Work Environment on the Incidence of Common Cardiovascular Risk Factors. J Am Heart Assoc 2022; 11:e021373. [PMID: 35023345 PMCID: PMC9238532 DOI: 10.1161/jaha.121.021373] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Social position and work environment are highly interrelated and their respective contribution to cardiovascular risk is still debated. Methods and Results In a cohort of 20 625 French workers followed for 25 years, discrete‐time survival analysis with reciprocal mediating effects, adjusted for sex, age, and parental history of early coronary heart disease, was performed using Bayesian structural equation modeling to simultaneously investigate the extent to which social position mediates the effect of work environment and, inversely, the extent to which work environment mediates the effect of social position on the incidence of common cardiovascular risk factors. Depending on the factor, social position mediates 2% to 53% of the effect of work environment and work environment mediates 9% to 87% of the effect of social position. The mediation by work environment is larger than that by social position for the incidence of obesity, hypertension, dyslipidemia, diabetes, sleep complaints, and depression (mediation ratios 1.32–41.5, 6.67 when modeling the 6 factors together). In contrast, the mediation by social position is larger than that by work environment for the incidence of nonmoderate alcohol consumption, smoking, and leisure‐time physical inactivity (mediation ratios 0.16–0.69, 0.26 when modeling the 3 factors together). Conclusions The incidence of behavioral risk factors seems strongly dependent on social position whereas that of clinical risk factors seems closely related to work environment, suggesting that preventive strategies should be based on education and general practice for the former and on work organization and occupational medicine for the latter.
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Affiliation(s)
- Nicolas Hoertel
- Département de Psychiatrie Institut de Psychiatrie et Neurosciences de Paris Faculté de Médecine Hôpital Corentin-Celton INSERM UMR_S1266 AP-HPUniversité de Paris Issy-les-Moulineaux France
| | - Marina Sanchez Rico
- Département de Psychiatrie Institut de Psychiatrie et Neurosciences de Paris Faculté de Médecine Hôpital Corentin-Celton INSERM UMR_S1266 AP-HPUniversité de Paris Issy-les-Moulineaux France
| | - Frédéric Limosin
- Département de Psychiatrie Institut de Psychiatrie et Neurosciences de Paris Faculté de Médecine Hôpital Corentin-Celton INSERM UMR_S1266 AP-HPUniversité de Paris Issy-les-Moulineaux France
| | - Joël Ménard
- UMR_1142 INSERM Sorbonne UniversitéUniversité Paris 13 Paris France
| | - Céline Ribet
- UMS_011 INSERM Université Paris-Saclay Villejuif France
| | | | | | - Marie Zins
- UMS_011 INSERM Université Paris-Saclay Villejuif France
| | - Pierre Meneton
- UMR_1142 INSERM Sorbonne UniversitéUniversité Paris 13 Paris France
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11
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Ryan M, Muldoon OT, Gallagher S, Jetten J. Physiological stress responses to inequality across income groups in a virtual society. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1111/jasp.12807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Megan Ryan
- Department of Psychology Centre for Social Issues Research University of Limerick Limerick Ireland
- Department of Psychology Centre for Social Issues Research Study of Anxiety, Stress and Health Laboratory University of Limerick Limerick Ireland
| | - Orla T. Muldoon
- Department of Psychology Centre for Social Issues Research University of Limerick Limerick Ireland
| | - Stephen Gallagher
- Department of Psychology Centre for Social Issues Research University of Limerick Limerick Ireland
- Department of Psychology Centre for Social Issues Research Study of Anxiety, Stress and Health Laboratory University of Limerick Limerick Ireland
| | - Jolanda Jetten
- School of Psychology University of Queensland Brisbane QLD Australia
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12
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Jamieson L, Hedges J, Peres MA, Guarnizo-Herreño CC, Bastos JL. Challenges in identifying indigenous peoples in population oral health surveys: a commentary. BMC Oral Health 2021; 21:216. [PMID: 33910554 PMCID: PMC8082663 DOI: 10.1186/s12903-021-01455-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/22/2021] [Indexed: 12/31/2022] Open
Abstract
There are currently 370 million persons identifying as indigenous across 90 countries globally. Indigenous peoples generally face substantial exclusion/marginalization and poorer health status compared with non-indigenous majority populations; this includes poorer oral health status and reduced access to dental services. Population-level oral health surveys provide data to set priorities, inform policies, and monitor progress in dental disease experience/dental service utilisation over time. Rigorously and comprehensively measuring the oral health burden of indigenous populations is an ethical issue, though, given that survey instruments and sampling procedures are usually not sufficiently inclusive. This results in substantial underestimation or even biased estimation of dental disease rates and severity among indigenous peoples, making it difficult for policy makers to prioritise resources in this area. The methodological challenges identified include: (1) suboptimal identification of indigenous populations; (2) numerator-denominator bias and; (3) statistical analytic considerations. We suggest solutions that can be implemented to strengthen the visibility of indigenous peoples around the world in an oral health context. These include acknowledgment of the need to engage indigenous peoples with all data-related processes, encouraging the use of indigenous identifiers in national and regional data sets, and mitigating and/or carefully assessing biases inherent in population oral health methodologies for indigenous peoples.
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Affiliation(s)
- Lisa Jamieson
- Australian Research Centre for Population Oral Health, University of Adelaide Dental School, Adelaide, SA 5005 Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, University of Adelaide Dental School, Adelaide, SA 5005 Australia
| | - Marco A. Peres
- National Dental Research Institute Singapore, 5 Second Hospital Ave, Singapore, 168938 Singapore
| | - Carol C. Guarnizo-Herreño
- Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - João L. Bastos
- Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
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13
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Mahar AL, Davis LE, Kurdyak P, Hanna TP, Coburn NG, Groome PA. Using additive and relative hazards to quantify colorectal survival inequalities for patients with a severe psychiatric illness. Ann Epidemiol 2020; 56:70-74. [PMID: 33239182 DOI: 10.1016/j.annepidem.2020.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We examine colorectal cancer (CRC) survival for patients with and without severe psychiatric illness (SPI) to demonstrate the use of relative and absolute effects. METHODS This included a retrospective cohort study of patients with CRC diagnosed between 01/04/2007 and 31/12/2012. SPI was defined as major depression, bipolar disorder, schizophrenia, and other psychotic illnesses occurring six months to five years preceding cancer diagnosis and categorized as inpatient, outpatient, or none. Associations between SPI history and death were examined using Cox proportional hazards regression (hazard ratios (HRs)) and Aalen's semiparametric additive hazards regression (absolute differences). RESULTS A total of 24,507 patients with CRC were included. A total of 58.1% of patients with inpatient SPI history died, and 47.1% of patients with outpatient SPI history died. Patients with an outpatient SPI history had a 40% (HR 1.40, 95% confidence interval: 1.22-1.59) increased hazard of death, and patients with an inpatient SPI history had a 91% increased hazard of death (HR 1.91, 95% confidence interval: 1.63-2.25), relative to no history of a mental illness. Outpatient SPI history was associated with additional 33 deaths per 1000 person years, and inpatient SPI was associated with additional 82 deaths per 1000 person years. CONCLUSIONS We encourage future studies examining inequities with time-to-event data to use this method addressing both relative and absolute effect.
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Affiliation(s)
- Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Laura E Davis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Natalie G Coburn
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Patti A Groome
- Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
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Kino S, Kawachi I. How much do preventive health behaviors explain education- and income-related inequalities in health? Results of Oaxaca–Blinder decomposition analysis. Ann Epidemiol 2020; 43:44-50. [DOI: 10.1016/j.annepidem.2020.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/09/2020] [Accepted: 01/16/2020] [Indexed: 11/17/2022]
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15
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Bartoll X, Gotsens M, Marí-Dell’Olmo M, Palència L, Calvo M, Esnaola S, Borrell C. Stable socioeconomic inequalities in ischaemic heart disease mortality during the economic crisis: a time trend analysis in 2 Spanish settings. Arch Public Health 2019; 77:12. [PMID: 30918659 PMCID: PMC6419419 DOI: 10.1186/s13690-019-0339-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/20/2019] [Indexed: 12/03/2022] Open
Abstract
Background Prior studies have identified a decrease in ischaemic heart disease mortality during the recent economic recession. The Spanish population was severely affected by the Great Recession, however, there is little evidence on its effects on socioeconomic inequalities in ischaemic heart disease mortality. This study examines trends in socioeconomic inequalities in mortality due to ischaemic heart disease (IHD). Methods We used linked census records with mortality registers available from the Basque Country and Barcelona city for population above 25 years, between 2001 and 04, the accelerated economic growth period of 2005–08, and 2009–12, with the last period coinciding with the Great Recession. Applying Poisson models, we calculated relative and absolute indexes of inequalities by education level for each period, age group, gender, and site. Results We found moderate age-adjusted inequalities in IHD with a gradient of increasing rates through less educational level, but no significant evidence of increasing trends in socioeconomic inequalities in IHD mortality, rather an inverted U-shape time trend in some groups below 75 years in relative inequalities. Absolute inequalities decrease in the last period except for women from 50 to 64 years. Conclusions This study shows that the economic crisis has not increased socioeconomic inequalities in IHD mortality in two geographical settings in Spain.
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16
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Editorial commentary: What drives trends in inequalities of cardiovascular disease? Trends Cardiovasc Med 2019; 29:304-305. [DOI: 10.1016/j.tcm.2018.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/19/2018] [Indexed: 11/19/2022]
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17
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Ward JB, Feinstein L, Vines AI, Robinson WR, Haan MN, Aiello AE. Perceived discrimination and depressive symptoms among US Latinos: the modifying role of educational attainment. ETHNICITY & HEALTH 2019; 24:271-286. [PMID: 28399649 PMCID: PMC5683937 DOI: 10.1080/13557858.2017.1315378] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Despite growing evidence that discrimination may contribute to poor mental health, few studies have assessed this association among US Latinos. Furthermore, the interaction between discrimination and educational attainment in shaping Latino mental health is virtually unexplored. This study aims to examine the association between perceived discrimination and depressive symptoms and the modifying role of education among a population of Mexican-origin adults. DESIGN We utilized population-based data from 629 Mexican-origin adults (mean age = 52.8 years) participating the Niños Lifestyle and Diabetes Study (2013-2014). Perceived discrimination was defined as responding 'sometimes' or 'often' to at least one item on the 9-item Everyday Discrimination Scale. High depressive symptoms were defined as scoring ≥10 on the CESD-10. We used log-binomial and linear-binomial models to estimate prevalence ratios (PR) and prevalence differences (PD), respectively, of high depressive symptoms for levels of perceived discrimination. Final models were adjusted for age, sex, education, cultural orientation, and nativity. General estimating equations were employed to account for within-family clustering. RESULTS Prevalence of perceived discrimination and high depressive symptoms were 49.5% and 29.2%, respectively. Participants experiencing discrimination had higher depressive symptom prevalence than those never or rarely experiencing discrimination [PR = 1.94, 95% confidence interval (CI): 1.46-2.58; PD = 0.19, 95% CI: 0.12-0.27]. The strength of this association varied by education level. The association between discrimination and depressive symptoms was stronger among those with >12 years of education (PR = 2.69; PD = 0.24) compared to those with ≤12 years of education (PR = 1.36; PD = 0.09). CONCLUSION US Latinos suffer a high burden of depressive symptoms, and discrimination may be an important driver of this burden. Our results suggest that effortful coping strategies, such as achieving high education despite high perceived discrimination, may magnify discrimination's adverse effect on Latino mental health.
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Affiliation(s)
- Julia B Ward
- a Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , USA
- b Carolina Population Center , University of North Carolina , Chapel Hill , USA
| | - Lydia Feinstein
- a Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , USA
- c Social & Scientific Systems, Inc. , Durham , USA
| | - Anissa I Vines
- a Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , USA
| | - Whitney R Robinson
- a Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , USA
- b Carolina Population Center , University of North Carolina , Chapel Hill , USA
| | - Mary N Haan
- d Department of Epidemiology and Biostatistics , University of California , San Francisco , USA
| | - Allison E Aiello
- a Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , USA
- b Carolina Population Center , University of North Carolina , Chapel Hill , USA
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Quantifying the impact of reducing socioeconomic inequalities in modifiable risk factors on mortality and mortality inequalities in South Korea. Int J Public Health 2019; 64:585-594. [PMID: 30887061 DOI: 10.1007/s00038-019-01231-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES We quantified the impact of reducing socioeconomic inequalities in risk factors on mortality and mortality inequalities in South Korea. METHODS The mortality risk function from the 12-year mortality follow-up data of the National Health Insurance Service-National Health Screening Cohort, the prevalence of major risk factors from the Korea National Health and Nutrition Examination Survey 2013-2015, and the Health Plan 2020 (HP2020) goals for major risk factors were used to estimate the magnitude of reduction in mortality inequalities by changing the magnitude of income-based inequalities in risk factors in various scenarios under gender-specific models among participants aged 40-79 years. RESULTS The greatest reduction in absolute and relative inequalities in mortality would occur if the low-income group achieved the HP2020 goals earlier than the high-income group. A 10-20% reduction in all-cause mortality inequalities was expected if absolute gaps between income groups in risk factors were halved. CONCLUSIONS With the practical goal halving the socioeconomic gaps in modifiable risk factors, reducing inequalities in all-cause mortality by 10-20% would be possible. Further reduction in mortality inequalities would need more aggressive policies on social determinants of health.
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Rusiecki L, Zdrojowy R, Gebala J, Sobieszczańska M, Smoliński R, Pilecki W, Piestrak P, Janocha A, Kawałko W, Womperski M, Kałka D. The Influence of Socioeconomic Status on the Presence and Degree of Erectile Dysfunction in Men With Coronary Artery Disease—A Cross-Sectional Study. Am J Mens Health 2019. [PMCID: PMC6872924 DOI: 10.1177/1557988319834378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Impairment of social functioning and low economic status may lead to the development of cardiovascular disease (CVD). This study aimed to evaluate the relationship between socioeconomic status (SES) and erectile dysfunction (ED) in patients with clinically significant CVD. A total of 808 male patients with ischemic heart disease (IHD) were recruited. Socioeconomic and demographic data as well as occupational data and the presence of modifiable risk factors were collected. Erection quality was assessed using the International Index of Erectile Function 5 (IIEF-5), while physical activity was evaluated using a modified Framingham questionnaire. Relationships among the presence of socioeconomic factors (marital status, education, income, occupational status, nature of work conducted, and demographic data), intensity of ED, and time from diagnosis of IHD were assessed. ED was diagnosed in 618 men (76.49% overall; severe in 23.14%, moderate to severe in 13.11%, moderate in 32.20%, mild in 31.55%). Patients with ED were older (61 ± 8.6 vs. 53 ± 9.1 years; p < .0001), were less active (6.97 ± 2.18 vs. 8.31 ± 2.34 Metabolic Equivalent [METs]; p < .0001), and had more modifiable risk factors (3.4 ± 1.1 vs. 3.2 ± 1.0; p < .0300). Higher education was associated with a lower probability of the occurrence of ED (OR = 0.7546; 95% CI [0.6221, 0.9153]). In patients with newly diagnosed IHD, SES correlated significantly with the presence of ED (p = .009). Education in patients suffering from CVD has a significant relationship with both the occurrence and degree of ED. Economic status was significantly linked to the presence and degree of ED only in patients with IHD diagnosed less than 2 months before entering the study.
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Affiliation(s)
- Lesław Rusiecki
- Department of Pathophysiology, Wrocław Medical University, Poland
| | - Romuald Zdrojowy
- Department and Clinic of Urology, Wrocław Medical University, Poland
| | - Jana Gebala
- Cardiosexology Students’ Scientific Club, Wrocław Medical University, Poland
| | | | | | - Witold Pilecki
- Department of Pathophysiology, Wrocław Medical University, Poland
| | - Piotr Piestrak
- Department of Track and Field, University School of Physical Education, Wroclaw, Poland
| | - Anna Janocha
- Department of Pathophysiology, Wrocław Medical University, Poland
| | - Wiktor Kawałko
- Department of Geriatrics, Wrocław Medical University, Poland
| | | | - Dariusz Kałka
- Department of Pathophysiology, Wrocław Medical University, Poland
- Centre for Men’s Health in Wroclaw, Poland
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20
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Bae S, Massie AB, Thomas AG, Bahn G, Luo X, Jackson KR, Ottmann SE, Brennan DC, Desai NM, Coresh J, Segev DL, Garonzik Wang JM. Who can tolerate a marginal kidney? Predicting survival after deceased donor kidney transplant by donor-recipient combination. Am J Transplant 2019; 19:425-433. [PMID: 29935051 PMCID: PMC6309666 DOI: 10.1111/ajt.14978] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/07/2018] [Accepted: 06/15/2018] [Indexed: 01/25/2023]
Abstract
The impact of donor quality on post-kidney transplant (KT) survival may vary by candidate condition. Characterizing this variation would increase access to KT without sacrificing outcomes. We developed a tool to estimate post-KT survival for combinations of donor quality and candidate condition. We studied deceased donor KT recipients (n = 120 818) and waitlisted candidates (n = 376 272) between 2005 and 2016 by using the Scientific Registry of Transplant Recipients. Donor quality and candidate condition were measured by using the Kidney Donor Profile Index (KDPI) and the Estimated Post Transplant Survival (EPTS) score. We estimated 5-year post-KT survival based on combinations of KDPI and EPTS score using random forest algorithms and waitlist survival by EPTS score using Weibull regressions. Survival benefit was defined as absolute reduction in mortality risk with KT. For candidates with an EPTS score of 80, 5-year waitlist survival was 47.6%, and 5-year post-KT survival was 78.9% after receiving kidneys with a KDPI of 20 and was 70.7% after receiving kidneys with a KDPI of 80. The impact of KDPI on survival benefit varied greatly by EPTS score. For candidates with low EPTS scores (eg, <40), the KDPI had limited impact on survival benefit. For candidates with middle or high EPTS scores (eg, >40), survival benefit decreased with higher KDPI but was still substantial even with a KDPI of 100 (>16 percentage points). Our prediction tool (www.transplantmodels.com/kdpi-epts) can support individualized decision-making on kidney offers in clinical practice.
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Affiliation(s)
- Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gahyun Bahn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kyle R. Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shane E. Ottmann
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel C. Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Niraj M. Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Ward JB, Vines AI, Haan MN, Fernández-Rhodes L, Miller E, Aiello AE. Spanish Language Use Across Generations and Depressive Symptoms Among US Latinos. Child Psychiatry Hum Dev 2019; 50:61-71. [PMID: 29943348 PMCID: PMC6309758 DOI: 10.1007/s10578-018-0820-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Acculturation markers, such as language use, have been associated with Latino depression. Language use may change between generations; however, few studies have collected intergenerational data to assess how language differences between generations impact depression. Using the Niños Lifestyle and Diabetes Study (2013-2014), we assessed how changes in Spanish language use across two generations of Mexican-origin participants in Sacramento, California, influenced offspring depressive symptoms (N = 603). High depressive symptoms were defined as CESD-10 scores ≥ 10. We used log-binomial and linear-binomial models to calculate prevalence ratios and differences, respectively, for depressive symptoms by language use, adjusting for identified confounders and within-family clustering. Decreased Spanish use and stable-equal English/Spanish use across generations protected against depressive symptoms, compared to stable-high Spanish use. Stable-low Spanish use was not associated with fewer depressive symptoms compared to stable-high Spanish use. Exposure to multiple languages cross-generationally may improve resource access and social networks that protect against depression.
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Affiliation(s)
- Julia B. Ward
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill 135 Dauer Drive, 2101 McGavran-Greenberg Hall Chapel Hill, NC 27599-7435 USA, Carolina Population Center, University of North Carolina, Chapel Hill 206 West Franklin St., Rm. 208 Chapel Hill, NC 27516 USA
| | - Anissa I. Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill 135 Dauer Drive, 2101 McGavran-Greenberg Hall Chapel Hill, NC 27599-7435 USA
| | - Mary N. Haan
- Department of Epidemiology and Biostatistics, University of California, San Francisco 550 16th Street, 2nd Floor San Francisco, CA 94158-2549 USA
| | - Lindsay Fernández-Rhodes
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill 135 Dauer Drive, 2101 McGavran-Greenberg Hall Chapel Hill, NC 27599-7435 USA, Carolina Population Center, University of North Carolina, Chapel Hill 206 West Franklin St., Rm. 208 Chapel Hill, NC 27516 USA
| | - Erline Miller
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill 135 Dauer Drive, 2101 McGavran-Greenberg Hall Chapel Hill, NC 27599-7435 USA
| | - Allison E. Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill 135 Dauer Drive, 2101 McGavran-Greenberg Hall Chapel Hill, NC 27599-7435 USA, Carolina Population Center, University of North Carolina, Chapel Hill 206 West Franklin St., Rm. 208 Chapel Hill, NC 27516 USA
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Liu W, Wang T, Sun P, Zhou Y. Expression of Hcy and blood lipid levels in serum of CHD patients and analysis of risk factors for CHD. Exp Ther Med 2018; 17:1756-1760. [PMID: 30783445 PMCID: PMC6364198 DOI: 10.3892/etm.2018.7111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/15/2018] [Indexed: 11/25/2022] Open
Abstract
Expression of homocysteine (Hcy) and blood lipid levels in serum of atherosclerotic coronary heart disease (CHD) patients was investigated and the related risk factors were analyzed. A total of 148 CHD patients were selected as study group and another 120 healthy people attending Weifang People's Hospital for physical examination in the same period as control group. Hcy and blood lipid levels in serum were measured in the two groups, including total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). At the same time, analysis of risk factors for CHD was performed. The levels of Hcy, TC, TG and LDL-C in patients in the study group were significantly higher than that in control group, while the HDL-C level was significantly lower than that in control group, and the differences were statistically significant (P<0.001). The difference was statistically significant in the levels of Hcy, TC, TG and LDL-C between acute and old myocardial infarction and angina pectoris group (P<0.05), and the difference was statistically significant in the levels of Hcy, TC, TG and LDL-C between old and acute myocardial infarction group (P<0.05). Analysis of risk factors for the disease was performed using logistic regression. The results of univariate analysis showed that CHD was associated with Hcy, hyperlipidemia, smoking, hypertension and diabetes (P<0.05), but had no relationship with drinking and obesity (P>0.05). The results of multivariate analysis showed that Hcy, hyperlipidemia, hypertension and diabetes were independent risk factors for CHD, and the difference was statistically significant (P<0.05). The Hcy level increased and the HDL-C level decreased in serum of CHD patients. Hcy, hyperlipidemia, hypertension and diabetes are independent risk factors for CHD, which can provide practical basis for the diagnosis, treatment and prevention.
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Affiliation(s)
- Weijing Liu
- Department of Emergency, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
| | - Tao Wang
- Department of Emergency, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
| | - Pengfei Sun
- Department of Emergency, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
| | - Yanju Zhou
- Department of Emergency, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
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Work environment mediates a large part of social inequalities in the incidence of several common cardiovascular risk factors: Findings from the Gazel cohort. Soc Sci Med 2018; 216:59-66. [DOI: 10.1016/j.socscimed.2018.09.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/20/2018] [Accepted: 09/22/2018] [Indexed: 01/10/2023]
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Tinner L, Caldwell D, Hickman M, MacArthur GJ, Gottfredson D, Lana Perez A, Moberg DP, Wolfe D, Campbell R. Examining subgroup effects by socioeconomic status of public health interventions targeting multiple risk behaviour in adolescence. BMC Public Health 2018; 18:1180. [PMID: 30326897 PMCID: PMC6192072 DOI: 10.1186/s12889-018-6042-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/17/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Multiple risk behaviour (MRB) refers to two or more risk behaviours such as smoking, drinking alcohol, poor diet and unsafe sex. Such behaviours are known to co-occur in adolescence. It is unknown whether MRB interventions are equally effective for young people of low and high socioeconomic status (SES). There is a need to examine these effects to determine whether MRB interventions have the potential to narrow or widen inequalities. METHODS Two Cochrane systematic reviews that examined interventions to reduce adolescent MRB were screened to identify universal interventions that reported SES. Study authors were contacted, and outcome data stratified by SES and intervention status were requested. Risk behaviour outcomes alcohol use, smoking, drug use, unsafe sex, overweight/obesity, sedentarism, peer violence and dating violence were examined in random effects meta-analyses and subgroup analyses conducted to explore differences between high SES and low SES adolescents. RESULTS Of 49 studies reporting universal interventions, only 16 also reported having measured SES. Of these 16 studies, four study authors provided data sufficient for subgroup analysis. There was no evidence of subgroup differences for any of the outcomes. For alcohol use, the direction of effect was the same for both the high SES group (RR 1.26, 95% CI: 0.96, 1.65, p = 0.09) and low SES group (RR 1.14, 95% CI: 0.98, 1.32, p = 0.08). The direction of effect was different for smoking behaviour in favour of the low SES group (RR 0.83, 95% CI: 0.66, 1.03, p = 0.09) versus the high SES group (RR 1.16, 95% CI: 0.82, 1.63, p = 0.39). For drug use, the direction of effect was the same for both the high SES group (RR 1.29, 95% CI: 0.97, 1.73, p = 0.08) and the low SES group (RR 1.28, 95% CI: 0.84, 1.96, p = 0.25). CONCLUSIONS The majority of studies identified did not report having measured SES. There was no evidence of subgroup difference for all outcomes analysed among the four included studies. There is a need for routine reporting of demographic information within studies so that stronger evidence of effect by SES can be demonstrated and that interventions can be evaluated for their impact on health inequalities.
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Affiliation(s)
- Laura Tinner
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
| | - Deborah Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
| | - Georgina J MacArthur
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
| | - Denise Gottfredson
- Department of Criminology and Criminal Justice, University of Maryland, College Park, Prince George’s, MD USA
| | - Alberto Lana Perez
- Department of Preventive Medicine and Public Health, School of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain
| | - D Paul Moberg
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - David Wolfe
- Faculty of Education, Western University, Ontario, Canada
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
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Waenerlund AK, Mosquera PA, Gustafsson PE, San Sebastián M. Trends in educational and income inequalities in cardiovascular morbidity in middle age in Northern Sweden 1993-2010. Scand J Public Health 2018; 47:713-721. [PMID: 30113264 DOI: 10.1177/1403494818790406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Research is scarce regarding studies on income and educational inequality trends in cardiovascular disease in Sweden. The aim of this study was to assess trends in educational and income inequalities in first hospitalizations due to cardiovascular disease (CVD) from 1993 to 2010 among middle-aged women and men in Northern Sweden. Methods: The study comprised repeated cross-sectional register data from year 1993-2010 of all individuals aged 38-62 years enrolled in the Västerbotten Intervention Programme (VIP). Data included highest educational level, total earned income and first-time hospitalization for CVD from national registers. The relative and slope indices of inequality (RII and SII, respectively) were used to estimate educational and income inequalities in CVD for six subsamples for women and men, and interaction analyses were used to estimate trends across time periods. Results: Educational RII and SII were stable in women, while they decreased in men. Income inequalities in CVD developed differently compared with educational inequalities, with RII and SII for both men and women increasing during the study period, the most marked for RII in women rising from 1.52 in the 1990s to 2.62 in the late 2000s. Conclusions: The trend of widening income inequalities over 18 years in the middle-aged in Northern Sweden, in the face of stable or even decreasing educational inequalities, is worrisome from a public health perspective, especially as Swedish authorities monitor socioeconomical inequalities exclusively by education. The results show that certain social inequalities in CVD rise and persist even within a traditionally egalitarian welfare regime.
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Affiliation(s)
- Anna-Karin Waenerlund
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Paola A Mosquera
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per E Gustafsson
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Miguel San Sebastián
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Ward JB, Robinson WR, Pence BW, Maselko J, Albrecht SS, Haan MN, Aiello AE. Educational Mobility Across Generations and Depressive Symptoms Over 10 Years Among US Latinos. Am J Epidemiol 2018; 187:1686-1695. [PMID: 29762643 DOI: 10.1093/aje/kwy056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 03/09/2018] [Indexed: 01/19/2023] Open
Abstract
Few studies have collected intergenerational data to assess the association between educational mobility across multiple generations and offspring depression. Using data from the Sacramento Area Latino Study on Aging (1998-2008), we assessed the influence of intergenerational education on depressive symptoms over 10 years among 1,786 Latino individuals (mean age = 70.6 years). Educational mobility was classified as stable-low (low parental/low offspring education), upwardly mobile (low parental/high offspring education), stable-high (high parental/high offspring education), or downwardly mobile (high parental/low offspring education). Depressive symptoms were measured with the Center for Epidemiological Studies-Depression Scale (CES-D); higher scores indicated more depressive symptoms. To quantify the association between educational mobility and CES-D scores over follow-up, we used generalized estimating equations to account for repeated CES-D measurements and adjusted for identified confounders. Within individuals, depressive symptoms remained relatively stable over follow-up. Compared with stable-low education, stable-high education and upward mobility were associated with significantly lower CES-D scores (β = -2.75 and -2.18, respectively). Downwardly mobile participants had slightly lower CES-D scores than stable-low participants (β = -0.77). Our results suggest that sustained, low educational attainment across generations may have adverse mental health consequences, and improved educational opportunities in underresourced communities may counteract the adverse influence of low parental education on Latino depression.
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Affiliation(s)
- Julia B Ward
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina
| | - Whitney R Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Joanna Maselko
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina
| | - Sandra S Albrecht
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Mary N Haan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Allison E Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina
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Hussein M, Diez Roux AV, Mujahid MS, Hastert TA, Kershaw KN, Bertoni AG, Baylin A. Unequal Exposure or Unequal Vulnerability? Contributions of Neighborhood Conditions and Cardiovascular Risk Factors to Socioeconomic Inequality in Incident Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2018; 187:1424-1437. [PMID: 29186311 DOI: 10.1093/aje/kwx363] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 11/16/2017] [Indexed: 12/12/2022] Open
Abstract
Risk factors can drive socioeconomic inequalities in cardiovascular disease (CVD) through differential exposure and differential vulnerability. In this paper, we show how econometric decomposition directly enables simultaneous, policy-oriented assessment of these 2 mechanisms. We specifically estimate contributions of neighborhood environment and proximal risk factors to socioeconomic inequality in CVD incidence via these mechanisms. We followed 5,608 participants in the Multi-Ethnic Study of Atherosclerosis (2000-2012) to their first CVD event (median length of follow-up, 12.2 years). We used a summary measure of baseline socioeconomic position (SEP). Covariates included baseline demographics, neighborhood characteristics, and psychosocial, behavioral, and biomedical risk factors. Using Poisson models, we decomposed the difference (inequality) in incidence rates between low- and high-SEP groups into contributions of 1) differences in covariate means (differential exposure) and 2) differences in CVD risk associated with covariates (differential vulnerability). Notwithstanding large uncertainty in neighborhood estimates, our analysis suggested that differential exposure to poorer neighborhood socioeconomic conditions, adverse social environment, diabetes, and hypertension accounted for most of the inequality. Psychosocial and behavioral contributions were negligible. Further, neighborhood SEP, female sex, and white race were more strongly associated with CVD among low-SEP (vs. high-SEP) participants. These differentials in vulnerability also accounted for nontrivial portions of the inequality and could have important implications for intervention.
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Affiliation(s)
- Mustafa Hussein
- Joseph J. Zilber School of Public Health, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Mahasin S Mujahid
- Department of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Theresa A Hastert
- Department of Oncology, School of Medicine and Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Kiarri N Kershaw
- Division of Epidemiology, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ana Baylin
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Piccinelli C, Carnà P, Stringhini S, Sebastiani G, Demaria M, Marra M, Costa G, d’Errico A. The contribution of behavioural and metabolic risk factors to socioeconomic inequalities in mortality: the Italian Longitudinal Study. Int J Public Health 2018; 63:325-335. [DOI: 10.1007/s00038-018-1076-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/28/2017] [Accepted: 01/11/2018] [Indexed: 10/18/2022] Open
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Diederichs C, Neuhauser H, Rücker V, Busch MA, Keil U, Fitzgerald AP, Heuschmann PU. Predicted 10-year risk of cardiovascular mortality in the 40 to 69 year old general population without cardiovascular diseases in Germany. PLoS One 2018; 13:e0190441. [PMID: 29293619 PMCID: PMC5749805 DOI: 10.1371/journal.pone.0190441] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/14/2017] [Indexed: 11/18/2022] Open
Abstract
AIMS To estimate the 10-year risk of fatal cardiovascular disease (CVD) in the 40 to 69 year old general population in Germany stratified by sex and to analyze differences between socio-economic status (SES), region and community size in individuals without CVD. The analysis is based on the newly recalibrated SCORE Deutschland risk charts and considered other comorbidities for the classification of the high CVD risk group according to the guidelines of the European Society of Cardiology. METHODS AND RESULTS In 3,498 participants (40-69 years) from the German Health Examination Survey for Adults 2008-2011 (DEGS1) without a history of CVD (myocardial infarction, coronary heart disease, heart failure, stroke) we estimated the proportion with a low (SCORE <1%), moderate (SCORE 1-<5%) and high 10-year CVD mortality risk (SCORE ≥5% or diabetes, renal insufficiency, SBP/DPB ≥180/110 mmHg or cholesterol >8 mmol/l). The prevalence of low, moderate and high risk was 42.8%, 38.5% and 18.8% in men and 73.7%, 18.1% and 8.2% in women. The prevalence of high risk was significantly lower in women with a high compared to a low SES (3.3% vs. 11.2%) and in communities with ≥100.000 inhabitants compared to <20.000 inhabitants (5.4% vs.10.9%). There were no significant associations between predicted CVD mortality risk and SES or community size in men and regions in men and women. Among the high risk group, 58.2% of men and 9.8% of women had SCORE ≥5%, leaving the majority of women (60.1%) classified as high risks due to diabetes and SCORE <5%. CONCLUSION Our results suggest the persistence of socioeconomic disparities in predicted cardiovascular mortality in women and support the need of large-scale prevention efforts beyond individual lifestyle modification or treatment. Furthermore, the importance of additional comorbidities for the high risk group classification is highlighted.
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Affiliation(s)
- Claudia Diederichs
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- * E-mail:
| | - Hannelore Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Markus A. Busch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
| | - Ulrich Keil
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Anthony P. Fitzgerald
- Department of Epidemiology and Public Health, Department of Statistics, University College Cork, Cork, Ireland
| | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center Würzburg, University of Würzburg, Würzburg, Germany
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31
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Johnson SC, Cavallaro FL, Leon DA. A systematic review of allostatic load in relation to socioeconomic position: Poor fidelity and major inconsistencies in biomarkers employed. Soc Sci Med 2017; 192:66-73. [DOI: 10.1016/j.socscimed.2017.09.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/30/2017] [Accepted: 09/15/2017] [Indexed: 12/19/2022]
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Moreno-Betancur M, Koplin JJ, Ponsonby AL, Lynch J, Carlin JB. Measuring the impact of differences in risk factor distributions on cross-population differences in disease occurrence: a causal approach. Int J Epidemiol 2017; 47:217-225. [DOI: 10.1093/ije/dyx194] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Margarita Moreno-Betancur
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jennifer J Koplin
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Centre for Food and Allergy Research, Melbourne, VIC, Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia
- Centre for Food and Allergy Research, Melbourne, VIC, Australia
| | - John Lynch
- School of Population Health, University of Adelaide, Adelaide, SA, Australia
| | - John B Carlin
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Teng AM, Atkinson J, Disney G, Wilson N, Blakely T. Changing socioeconomic inequalities in cancer incidence and mortality: Cohort study with 54 million person-years follow-up 1981-2011. Int J Cancer 2017; 140:1306-1316. [PMID: 27925183 DOI: 10.1002/ijc.30555] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/24/2016] [Indexed: 11/10/2022]
Abstract
Cancer is increasingly responsible for the mortality gap between high and low socioeconomic position groups in high-income countries. This study investigates which cancers are contributing more to socioeconomic gaps in mortality and how this changes over time.New Zealand census data from 1981, 1986, 1991, 1996, 2001 and 2006, were linked to three to five years of subsequent mortality and cancer registrations, resulting in 54 and 42 million years of follow-up cancer incidence and mortality, respectively. Age- and ethnicity-standardised cancer mortality rates and the slope index of inequality (SII) by income were calculated.The contribution of cancer to absolute inequalities (SII) in mortality increased from 16 to 27% for men and from 12 to 31% for women from 1981-84 to 2006-11, peaking in 1991-94 for men and in 1996-99 for women and then levelling off, parallel to peaks in lung cancer inequalities. Lung cancer was the largest driver of cancer inequality trends (49% of the cancer mortality gap in 1981-84 to 33% in 2006-11 for men and 32 to 33% for women) followed by colorectal cancer in men (2 to 11%) and breast cancer in women (declining from 44 to 13%). Women in the lowest income quintile experienced no decline in cancer mortality.The contribution of cancer to income inequalities in all-cause mortality has expanded in this high-income country. Action to address socioeconomic inequalities should prioritise equitable tobacco control, obesity control and improved access to cancer screening, early diagnosis and high quality treatment for those with the lowest incomes.
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Affiliation(s)
- Andrea M Teng
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - June Atkinson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - George Disney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Tony Blakely
- Department of Public Health, University of Otago, Wellington, New Zealand
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Jarbøl DE, Larsen PV, Gyrd-Hansen D, Søndergaard J, Brandt C, Leppin A, Barfoed BL, Nielsen JB. Determinants of preferences for lifestyle changes versus medication and beliefs in ability to maintain lifestyle changes. A population-based survey. Prev Med Rep 2017; 6:66-73. [PMID: 28271023 PMCID: PMC5331161 DOI: 10.1016/j.pmedr.2017.02.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/21/2017] [Accepted: 02/13/2017] [Indexed: 01/16/2023] Open
Abstract
Preferences for medication treatment versus lifestyle changes are of major importance in the management of chronic diseases. This study aims to investigate determinants of preference for lifestyle changes versus medication for prevention of cardiovascular disease as well as determinants of respondents' beliefs in their ability to maintain lifestyle changes. A representative sample of 40-60-year old Danish inhabitants was in 2012 invited to a survey and were asked to imagine that they had been diagnosed as being at increased risk of heart disease. Subsequently they were presented with a choice between a preventive medical intervention versus lifestyle change. The study population for the present paper comprises 1069 participants. A total of 962 participants preferred lifestyle changes to medication treatment. Significant determinants for preferring lifestyle changes were female gender and high level of physical activity. Significant determinants for not opting for lifestyle changes were being self-employed, poor self-rated health and smoking. Low educational attainment, lifestyle risk factors, self-reported health-related challenges and prior experience with heart disease were associated with a low belief in ability to maintain lifestyle changes. For conclusion we found a pervasive preference for lifestyle changes over medical treatment when individuals were promised the same benefits. Lifestyle risk factors and socioeconomic characteristics were associated with preference for lifestyle changes as well as belief in ability to maintain lifestyle changes. For health professionals risk communication should not only focus on patient preferences but also on patients' beliefs in their own ability to initiate lifestyle changes and possible barriers against maintaining changes.
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Affiliation(s)
- Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
| | - Pia Veldt Larsen
- Research Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
| | - Dorte Gyrd-Hansen
- COHERE, Department of Public Health & Department of Business and Economics, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
| | - Carl Brandt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
| | - Anja Leppin
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9, DK-6700 Esbjerg, Denmark
| | - Benedicte Lind Barfoed
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
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Ethnic inequalities in cancer incidence and mortality: census-linked cohort studies with 87 million years of person-time follow-up. BMC Cancer 2016; 16:755. [PMID: 27669745 PMCID: PMC5037611 DOI: 10.1186/s12885-016-2781-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/14/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cancer makes up a large and increasing proportion of excess mortality for indigenous, marginalised and socioeconomically deprived populations, and much of this inequality is preventable. This study aimed to determine which cancers give rise to changing ethnic inequalities over time. METHODS New Zealand census data from 1981, 1986, 1991, 1996, 2001, and 2006, were all probabilistically linked to three to five subsequent years of mortality (68 million person-years) and cancer registrations (87 million person years) and weighted for linkage bias. Age-standardised rate differences (SRDs) for Māori (indigenous) and Pacific peoples, each compared to European/Other, were decomposed by cancer type. RESULTS The absolute size and percentage of the cancer contribution to excess mortality increased from 1981-86 to 2006-11 in Māori males (SRD 72.5 to 102.0 per 100,000) and females (SRD 72.2 to 109.4), and Pacific females (SRD -9.8 to 42.2) each compared to European/Other. Specifically, excess mortality (SRDs) increased for breast cancer in Māori females (linear trend p < 0.01) and prostate (p < 0.01) and colorectal cancers (p < 0.01) in Māori males. The incidence gap (SRDs) increased for breast (Māori and Pacific females p < 0.01), endometrial (Pacific females p < 0.01) and liver cancers (Māori males p = 0.04), and for cervical cancer it decreased (Māori females p = 0.03). The colorectal cancer incidence gap which formerly favoured Māori, decreased for Māori males and females (p < 0.01). The greatest contributors to absolute inequalities (SRDs) in mortality in 2006-11 were lung cancer (Māori males 50 %, Māori females 44 %, Pacific males 81 %), breast cancer (Māori females 18 %, Pacific females 23 %) and stomach cancers (Māori males 9 %, Pacific males 16 %, Pacific females 20 %). The top contributors to the ethnic gap in cancer incidence were lung, breast, stomach, endometrial and liver cancer. CONCLUSIONS A transition is occurring in what diseases contribute to inequalities. The increasing excess incidence and mortality rates in several obesity- and health care access-related cancers provide a sentinel warning of the emerging drivers of ethnic inequalities. Action to further address inequalities in cancer burden needs to be multi-pronged with attention to enhanced control of tobacco, obesity, and carcinogenic infectious agents, and focus on addressing access to effective screening and quality health care.
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Kjøllesdal MKR, Ariansen I, Mortensen LH, Davey Smith G, Næss Ø. Educational differences in cardiovascular mortality: The role of shared family factors and cardiovascular risk factors. Scand J Public Health 2016; 44:744-750. [PMID: 27655782 DOI: 10.1177/1403494816669427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To explore the confounding effects of early family factors shared by siblings and cardiovascular risk factors in midlife on the educational differences in mortality from cardiovascular disease (CVD). METHODS Data from national and regional health surveys in Norway (1974-2003) were linked with data from the Norwegian Family Based Life Course Study, the National Educational Registry and the Cause of Death Registry. The study population consisted of participants with at least one full sibling among the health survey participants ( n=271,310). Data were available on CVD risk factors, including weight, height, blood pressure, total cholesterol and smoking. RESULTS The hazards ratio (HR) of CVD mortality was 3.44 (95% confidence interval (CI) 2.98-3.96) in the lowest educational group relative to the highest. The HRs were little altered in the within-sibship analyses. Adjusted for risk factors, the HR for CVD mortality in the cohort analyses was 2.05 (CI 1.77-2.37) in the lowest educational group relative to the highest. The respective HR in the within-sibship analyses was 2.46 (CI 1.48-2.24). CONCLUSIONS Using a sibling design, we did not find that the association between education and CVD mortality was confounded by early life factors shared by siblings, but it was explained to a large extent by CVD risk factors. These results suggest that reducing levels of CVD risk factors could have the greatest effect on mortality in less well-educated people.
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Affiliation(s)
| | - I Ariansen
- 2 Norwegian Institute of Public Health, Norway
| | | | - G Davey Smith
- 4 MRC Integrative Epidemiology Unit, University of Bristol, UK
| | - Ø Næss
- 1 Institute of Health and Society, University of Oslo, Norway.,2 Norwegian Institute of Public Health, Norway
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Andersen MM, Nielsen MEJ. Personal Responsibility and Lifestyle Diseases. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2016; 41:480-99. [DOI: 10.1093/jmp/jhw015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Review Article: Vulnerability to Heat-related Mortality: A Systematic Review, Meta-analysis, and Meta-regression Analysis. Epidemiology 2016; 26:781-93. [PMID: 26332052 DOI: 10.1097/ede.0000000000000375] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Addressing vulnerability to heat-related mortality is a necessary step in the development of policies dictated by heat action plans. We aimed to provide a systematic assessment of the epidemiologic evidence regarding vulnerability to heat-related mortality. METHODS Studies assessing the association between high ambient temperature or heat waves and mortality among different subgroups and published between January 1980 and August 2014 were selected. Estimates of association for all the included subgroups were extracted. We assessed the presence of heterogeneous effects between subgroups conducting Cochran Q tests. We conducted random effect meta-analyses of ratios of relative risks (RRR) for high ambient temperature studies. We performed random effects meta-regression analyses to investigate factors associated with the magnitude of the RRR. RESULTS Sixty-one studies were included. Using the Cochran Q test, we consistently found evidence of vulnerability for the elderly ages >85 years. We found a pooled RRR of 0.99 (95% confidence interval [CI] = 0.97, 1.01) for male sex, 1.02 (95% CI = 1.01, 1.03) for age >65 years, 1.04 (95% CI = 1.02, 1.07) for ages >75 years, 1.03 (95% CI = 1.01, 1.05) for low individual socioeconomic status (SES), and 1.01 (95% CI = 0.99, 1.02) for low ecologic SES. CONCLUSIONS We found strongest evidence of heat-related vulnerability for the elderly ages >65 and >75 years and low SES groups (at the individual level). Studies are needed to clarify if other subgroups (e.g., children, people living alone) are also vulnerable to heat to inform public health programs.
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Shapiro GD, Bushnik T, Sheppard AJ, Kramer MS, Kaufman JS, Yang S. Paternal education and adverse birth outcomes in Canada. J Epidemiol Community Health 2016; 71:67-72. [DOI: 10.1136/jech-2015-206894] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 05/27/2016] [Accepted: 06/10/2016] [Indexed: 11/03/2022]
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Veronesi G, Ferrario MM, Kuulasmaa K, Bobak M, Chambless LE, Salomaa V, Soderberg S, Pajak A, Jørgensen T, Amouyel P, Arveiler D, Drygas W, Ferrieres J, Giampaoli S, Kee F, Iacoviello L, Malyutina S, Peters A, Tamosiunas A, Tunstall-Pedoe H, Cesana G. Educational class inequalities in the incidence of coronary heart disease in Europe. Heart 2016; 102:958-65. [PMID: 26849899 DOI: 10.1136/heartjnl-2015-308909] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/11/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the burden of social inequalities in coronary heart disease (CHD) and to identify their major determinants in 15 European populations. METHODS The MORGAM (MOnica Risk, Genetics, Archiving and Monograph) study comprised 49 cohorts of middle-aged European adults free of CHD (110 928 individuals) recruited mostly in the mid-1980s and 1990s, with comparable assessment of baseline risk and follow-up procedures. We derived three educational classes accounting for birth cohorts and used regression-based inequality measures of absolute differences in CHD rates and HRs (ie, Relative Index of Inequality, RII) for the least versus the most educated individuals. RESULTS N=6522 first CHD events occurred during a median follow-up of 12 years. Educational class inequalities accounted for 343 and 170 additional CHD events per 100 000 person-years in the least educated men and women compared with the most educated, respectively. These figures corresponded to 48% and 71% of the average event rates in each gender group. Inequalities in CHD mortality were mainly driven by incidence in the Nordic countries, Scotland and Lithuania, and by 28-day case-fatality in the remaining central/South European populations. The pooled RIIs were 1.6 (95% CI 1.4 to 1.8) in men and 2.0 (1.7 to 2.4) in women, consistently across population. Risk factors accounted for a third of inequalities in CHD incidence; smoking was the major mediator in men, and High-Density-Lipoprotein (HDL) cholesterol in women. CONCLUSIONS Social inequalities in CHD are still widespread in Europe. Since the major determinants of inequalities followed geographical and gender-specific patterns, European-level interventions should be tailored across different European regions.
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Affiliation(s)
- Giovanni Veronesi
- Centro Ricerche EPIMED-Epidemiologia e Medicina Preventiva, Università degli Studi dell'Insubria, Varese, Italy
| | - Marco M Ferrario
- Centro Ricerche EPIMED-Epidemiologia e Medicina Preventiva, Università degli Studi dell'Insubria, Varese, Italy
| | - Kari Kuulasmaa
- THL-National Institute for Health and Welfare, Helsinki, Finland
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Lloyd E Chambless
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Veikko Salomaa
- THL-National Institute for Health and Welfare, Helsinki, Finland
| | - Stefan Soderberg
- Department of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umeå University, Umeå, Sweden
| | - Andrzej Pajak
- Department of Epidemiology and Population Studies, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Capital Region of Denmark, Denmark Department of Public Health, Faculty of Medical Science, University of Copenhagen, Copenhagen, Denmark Faculty of Medicine, Aalborg University, Denmark
| | - Philippe Amouyel
- Department of Epidemiology & Public Health, Pasteur Institute of Lille, Lille, France
| | - Dominique Arveiler
- Department of Epidemiology and Public Health, University of Strasbourg, Strasbourg, France
| | - Wojciech Drygas
- Department of Epidemiology, CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland
| | - Jean Ferrieres
- Department of Cardiology, Toulouse University School of Medicine, Toulouse, France
| | | | - Frank Kee
- UKCRC Centre of Excellence for Public Health Research, Queen's University Belfast, Belfast, UK
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Sofia Malyutina
- The Institute of Internal and Preventive Medicine, Siberian Branch of Russian Academy of Medical Sciences, Novosibirsk, Russian Federation
| | - Annette Peters
- Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Hugh Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, UK
| | - Giancarlo Cesana
- Centro Studi e Ricerche in Sanità Pubblica (CESP), Università degli Studi di Milano-Bicocca, Monza, Italy
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Galobardes B, Granell R, Sterne J, Hughes R, Mejia-Lancheros C, Davey Smith G, Henderson J. Childhood wheezing, asthma, allergy, atopy, and lung function: different socioeconomic patterns for different phenotypes. Am J Epidemiol 2015; 182:763-74. [PMID: 26443417 PMCID: PMC4617295 DOI: 10.1093/aje/kwv045] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/10/2015] [Indexed: 11/13/2022] Open
Abstract
Identifying preventable exposures that lead to asthma and associated allergies has proved challenging, partly because of the difficulty in differentiating phenotypes that define homogeneous disease groups. Understanding the socioeconomic patterns of disease phenotypes can help distinguish which exposures are preventable. In the present study, we identified disease phenotypes that are susceptible to socioeconomic variation, and we determined which life-course exposures were associated with these inequalities in a contemporary birth cohort. Participants included children from the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in England, who were born in 1991 and 1992 and attended the clinic at 7–8 years of age (n = 6,378). Disease phenotypes included asthma, atopy, wheezing, altered lung function, and bronchial reactivity phenotypes. Combining atopy with a diagnosis of asthma from a doctor captured the greatest socioeconomic variation, including opposing patterns between phenotype groups: Children with a low socioeconomic position (SEP) had more asthma alone (adjusted multinomial odds ratio = 1.50, 95% confidence interval: 1.21, 1.87) but less atopy alone (adjusted multinomial odds ratio = 0.80, 95% confidence interval: 0.66, 0.98) than did children with high SEP. Adjustment for maternal exposure to tobacco smoke during pregnancy and childhood exposure to tobacco smoke reduced the odds of asthma alone in children with a low SEP. Current inequalities among children who have asthma but not atopy can be prevented by eliminating exposure to tobacco smoke. Other disease phenotypes were not socially patterned or had SEP patterns that were not related to smoke exposure.
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Affiliation(s)
- Bruna Galobardes
- Correspondence to Dr. Bruna Galobardes, University of Bristol, School of Social and Community Medicine, Oakfield House, Oakfield Grove, BS8 2BN, United Kingdom (e-mail: )
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El-Shabrawi MH, Kamal NM, Elhusseini MA, Hussein L, Abdallah EAA, Ali YZA, Azab AA, Salama MA, Kassab M, Krawinkel M. Folic Acid Intake and Neural Tube Defects: Two Egyptian Centers Experience. Medicine (Baltimore) 2015; 94:e1395. [PMID: 26376380 PMCID: PMC4635794 DOI: 10.1097/md.0000000000001395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Neural tube defects (NTDs) are a group of congenital malformations with worldwide distribution and complex etiopathogenesis. Folic acid plays a pivotal role in their prevention. We aimed to identify the protective effect of folic acid intake against NTDs and its dependence on different socioeconomic and environmental factors in a cohort of mothers in Egypt. A cross-sectional study was carried over a period of 12 months on mothers who gave birth to babies with NTDs (group 1) and a control group with healthy offsprings (group 2). Both groups completed 2 questionnaires: food frequency questionnaire targeting the daily folate intake, and socioeconomic status and medical history questionnaire. Both groups of mothers received folate <800 μg/day, recommended for pregnant women. A strong association was detected between NTDs and urban residency with medium educated mothers, with negative consanguinity, who had folate intake < 400 μg daily, and who had their food long cooked. Each of these factors separately had a limited impact to cause NTDs, but when present together they did augment each other. Interestingly enough is the role of fava bean, cauliflower, spinach, and mango in predisposing of NTDs in the presence of the above-mentioned factors. The protective effect of folic acid intake against NTDs may depend on the synergism of different socioeconomic and environmental factors (which differ from country to another). In Egypt, females especially the medium-educated who live in urban areas should be well-informed with the value of folate intake in the periconceptional period.
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Affiliation(s)
- Mortada H El-Shabrawi
- From the Professor of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt (MHE-S); Associate Professor of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt (NMK); Consultant Obstetrician and Gynecologist, Red Crescent Hospital, Ministry of Health and Population, Cairo, Egypt (MAE); Professor of Nutrition, Institute of Nutritional Sciences, University of Giessen, Giessen, Germany (MK); Professor of Nutrition, National Research Center, Cairo, Egypt (LH); Lecturer of Pediatrics and Neonatology, Faculty of Medicine, Cairo University, Cairo, Egypt (EAAA); Lecturer of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt (YZAA); Associate Professor of Pediatrics and Neonatology, Faculty of Medicine, Benha University, Egypt (AAA, MAS); Fellow in nutrition, Institute of Nutritional Sciences, University of Giessen, Giessen, Germany (MK); and Professor of Nutrition, Institute of Nutritional Sciences, University of Giessen, Giessen, Germany (MK)
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Socioeconomic inequalities in mortality and repeated measurement of explanatory risk factors in a 25 years follow-up. PLoS One 2015; 10:e0124690. [PMID: 25853571 PMCID: PMC4390361 DOI: 10.1371/journal.pone.0124690] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 03/17/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Socioeconomic inequalities in mortality can be explained by different groups of risk factors. However, little is known whether repeated measurement of risk factors can provide better explanation of socioeconomic inequalities in health. Our study examines the extent to which relative educational and income inequalities in mortality might be explained by explanatory risk factors (behavioral, psychosocial, biomedical risk factors and employment) measured at two points in time, as compared to one measurement at baseline. METHODS AND FINDINGS From the Norwegian total county population-based HUNT Study (years 1984-86 and 1995-1997, respectively) 61 513 men and women aged 25-80 (82.5% of all enrolled) were followed-up for mortality in 25 years until 2009, employing a discrete time survival analysis. Socioeconomic inequalities in mortality were observed. As compared to their highest socioeconomic counterparts, the lowest educated men had an OR (odds ratio) of 1.41 (95% CI 1.29-1.55) and for the lowest income quartile OR = 1.59 (1.48-1.571), for women OR = 1.35 (1.17-1.55), and OR = 1.40 (1.28-1.52), respectively. Baseline explanatory variables attenuated the association between education and income with mortality by 54% and 54% in men, respectively, and by 69% and 18% in women. After entering time-varying variables, this attainment increased to 63% and 59% in men, respectively, and to 25% (income) in women, with no improvement in regard to education in women. Change in biomedical factors and employment did not amend the explanation. CONCLUSIONS Addition of a second measurement for risk factors provided only a modest improvement in explaining educational and income inequalities in mortality in Norwegian men and women. Accounting for change in behavior provided the largest improvement in explained inequalities in mortality for both men and women, as compared to measurement at baseline. Psychosocial factors explained the largest share of income inequalities in mortality for men, but repeated measurement of these factors contributed only to modest improvement in explanation. Further comparative research on the relative importance of explanatory pathways assessed over time is needed.
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Fecht D, Fischer P, Fortunato L, Hoek G, de Hoogh K, Marra M, Kruize H, Vienneau D, Beelen R, Hansell A. Associations between air pollution and socioeconomic characteristics, ethnicity and age profile of neighbourhoods in England and the Netherlands. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2015; 198:201-10. [PMID: 25622242 DOI: 10.1016/j.envpol.2014.12.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 11/28/2014] [Accepted: 12/11/2014] [Indexed: 05/02/2023]
Abstract
Air pollution levels are generally believed to be higher in deprived areas but associations are complex especially between sensitive population subgroups. We explore air pollution inequalities at national, regional and city level in England and the Netherlands comparing particulate matter (PM10) and nitrogen dioxide (NO2) concentrations and publicly available population characteristics (deprivation, ethnicity, proportion of children and elderly). We saw higher concentrations in the most deprived 20% of neighbourhoods in England (1.5 μg/m(3) higher PM10 and 4.4 μg/m(3) NO2). Concentrations in both countries were higher in neighbourhoods with >20% non-White (England: 3.0 μg/m(3) higher PM10 and 10.1 μg/m(3) NO2; the Netherlands: 1.1 μg/m(3) higher PM10 and 4.5 μg/m(3) NO2) after adjustment for urbanisation and other variables. Associations for some areas differed from the national results. Air pollution inequalities were mainly an urban problem suggesting measures to reduce environmental air pollution inequality should include a focus on city transport.
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Affiliation(s)
- Daniela Fecht
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK.
| | - Paul Fischer
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 Bilthoven, The Netherlands
| | - Léa Fortunato
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Gerard Hoek
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Kees de Hoogh
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Marten Marra
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 Bilthoven, The Netherlands
| | - Hanneke Kruize
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 Bilthoven, The Netherlands
| | - Danielle Vienneau
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Rob Beelen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Anna Hansell
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK; Honorary Consultant, Imperial College Healthcare NHS Trust, London, UK
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Cheraghian B, Nedjat S, Mansournia MA, Majdzadeh R, Mohammad K, Vaez-Mahdavi MR, Faghihzadeh S, Haeri Mehrizi AA, Asadi-Lari M. Different patterns of association between education and wealth with non-fatal myocardial infarction in Tehran, Iran: A population-based case-control study. Med J Islam Repub Iran 2015; 29:160. [PMID: 26000255 PMCID: PMC4431366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 09/20/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Myocardial Infarction (MI) is a main cause of death and disability worldwide, which involves a number of genetic, physiopathologic and socio-economic determinants. The aim of this study was to assess the patterns of association between education, wealth and some other risk factors with non-fatal MI in Tehran population. METHODS Data derived from a second round of large cross-sectional study, Urban HEART-2, conducted in Tehran in 2011. Out of 118542 participants, all 249 self-reported incident cases of nonfatal MI were selected as the case group. A number of 996, matched on age and sex, were selected as controls. Principle component analysis (PCA) was used to calculate wealth index and logistic regression model to assess relations between the study variables. RESULTS Mean (SD) age of participants was 60.25 (12.26) years. A total of 870 (69.9%) of the study subjects were men. Education, wealth status, family violence, hypertension and diabetes were observed as independent predictors of non-fatal MI. Overall, as the level of education increased, the odds of non-fatal MI decreased (p<0.001). We observed an almost J-shaped association between wealth status and non-fatal MI. No significant associations were found between marital status, BMI and current smoking with non-fatal MI (p<0.05). CONCLUSION We found different patterns of association between education and wealth with nonfatal MI among Tehran adults. Lower risk of non-fatal MI is linked to high educated groups whereas economically moderate group has the lowest risk of non-fatal MI occurrence.
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Affiliation(s)
- Bahman Cheraghian
- 1 PhD student in Epidemiology, Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Saharnaz Nedjat
- 2 Associate Professor in Epidemiology, Department of Epidemiology and Biostatistics, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Ali Mansournia
- 3 Assistant professor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Majdzadeh
- 4 Professor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. rezamajd@ tums.ac.ir
| | - Kazem Mohammad
- 5 Professor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. mohamadk@ tums.ac.ir
| | | | - Soghrat Faghihzadeh
- 7 Professor, Department of Social Medicine, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Ali Asghar Haeri Mehrizi
- 8 Research Instructor, Health Education & Promotion Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research (IHSR), ACECR, Tehran, Iran.
| | - Mohsen Asadi-Lari
- 9 Associate Professor, Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran & Oncopathology Research Centre, Tehran, Iran. .
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Economic burden and cost determinants of coronary heart disease in rural southwest China: a multilevel analysis. Public Health 2015; 129:68-73. [DOI: 10.1016/j.puhe.2014.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 08/01/2014] [Accepted: 11/04/2014] [Indexed: 11/21/2022]
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Education and cause-specific mortality: the mediating role of differential exposure and vulnerability to behavioral risk factors. Epidemiology 2014; 25:389-96. [PMID: 24625538 DOI: 10.1097/ede.0000000000000080] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Differential exposures to behavioral risk factors have been shown to play an important mediating role on the education-mortality relation. However, little is known about the extent to which educational attainment interacts with health behavior, possibly through differential vulnerability. METHODS In a cohort study of 76,294 participants 30 to 70 years of age, we estimated educational differences in cause-specific mortality from 1980 through 2009 and the mediating role of behavioral risk factors (smoking, alcohol intake, physical activity, and body mass index). With the use of marginal structural models and three-way effect decomposition, we simultaneously regarded the behavioral risk factors as intermediates and clarified the role of their interaction with educational exposure. RESULTS Rate differences in mortality comparing participants with low to high education were 1,277 (95% confidence interval = 1,062 to 1,492) per 100,000 person-years for men and 746 (598 to 894) per 100,000 person-years for women. Smoking was the strongest mediator for cardiovascular disease, cancer, and respiratory disease mortality when conditioning on sex, age, and cohort. The proportion mediated through smoking was most pronounced in cancer mortality as a combination of the pure indirect effect, owing to differential exposure (men, 42% [25% to 75%]; women, 36% [17% to 74%]) and the mediated interactive effect, owing to differential vulnerability (men, 18% [2% to 35%], women, 26% [8% to 50%]). The mediating effects through body mass index, alcohol intake, or physical activity were partial and varied for the causes of deaths. CONCLUSION Differential exposure and vulnerability should be addressed simultaneously, as these mechanisms are not mutually exclusive and may operate at the same time.
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Choi JH, Yates Z, Veysey M, Heo YR, Lucock M. Contemporary issues surrounding folic Acid fortification initiatives. Prev Nutr Food Sci 2014; 19:247-60. [PMID: 25580388 PMCID: PMC4287316 DOI: 10.3746/pnf.2014.19.4.247] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 12/07/2014] [Indexed: 12/20/2022] Open
Abstract
The impact of folate on health and disease, particularly pregnancy complications and congenital malformations, has been extensively studied. Mandatory folic acid fortification therefore has been implemented in multiple countries, resulting in a reduction in the occurrence of neural tube defects. However, emerging evidence suggests increased folate intake may also be associated with unexpected adverse effects. This literature review focuses on contemporary issues of concern, and possible underlying mechanisms as well as giving consideration the future direction of mandatory folic acid fortification. Folate fortification has been associated with the presence of unmetabolized folic acid (PteGlu) in blood, masking of vitamin B12 deficiency, increased dosage for anti-cancer medication, photo-catalysis of PteGlu leading to potential genotoxicity, and a role in the pathoaetiology of colorectal cancer. Increased folate intake has also been associated with twin birth and insulin resistance in offspring, and altered epigenetic mechanisms of inheritance. Although limited data exists to elucidate potential mechanisms underlying these issues, elevated blood folate level due to the excess use of PteGlu without consideration of an individual's specific phenotypic traits (e.g. genetic background and undiagnosed disease) may be relevant. Additionally, the accumulation of unmetabolized PteGlu may lead to inhibition of dihydrofolate reductase and other enzymes. Concerns notwithstanding, folic acid fortification has achieved enormous advances in public health. It therefore seems prudent to target and carefully monitor high risk groups, and to conduct well focused further research to better understand and to minimize any risk of mandatory folic acid fortification.
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Affiliation(s)
- Jeong-Hwa Choi
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah, NSW 2258, Australia
- Human Economics Research Institute, Chonnam National University, Gwangju 500-757, Korea
| | - Zoe Yates
- Biomedical Sciences and Pharmacy, University of Newcastle, Ourimbah, NSW 2258, Australia
| | - Martin Veysey
- Teaching and Research Unit, Central Coast Local Health District, Gosford, NSW 2250, Australia
| | - Young-Ran Heo
- Department of Food and Nutrition, Chonnam National University, Gwangju 500-757, Korea
| | - Mark Lucock
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah, NSW 2258, Australia
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Ariansen I, Mortensen L, Igland J, Tell GS, Tambs K, Graff-Iversen S, Strand BH, Næss Ø. The educational gradient in coronary heart disease: the association with cognition in a cohort of 57,279 male conscripts. J Epidemiol Community Health 2014; 69:322-9. [PMID: 25395653 DOI: 10.1136/jech-2014-204597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Independently of cardiovascular disease (CVD) risk factors, cognitive ability may account for some of the excess risk of coronary heart disease (CHD) associated with lower education. We aimed to assess how late adolescence cognitive ability and midlife CVD risk factors are associated with the educational gradient in CHD in Norway. METHODS In a cohort of 57 279 men born during 1949-1959, health survey information was linked to military conscription records of cognitive ability, to national educational data, to hospitalisation records from the Cardiovascular Disease in Norway (CVDNOR) project and to the Norwegian Cause of Death Registry. RESULTS Age and period adjusted HR for incident CHD events was 3.62 (95% CI 2.50 to 5.24) for basic relative to tertiary education, and was attenuated after adjustment; to 2.86 (1.87 to 4.38) for cognitive ability, to 1.90 (1.30 to 2.78) for CVD risk factors, and to 1.84 (1.20 to 2.83) when adjusting for both. Age and period adjusted absolute rate difference was 51 (33 to 70) incident CHD events per 100,000 person years between basic and tertiary educated, and was attenuated after adjustment; to 42 (22 to 61) for cognitive ability, to 25 (7 to 42) for CVD risk factors, and to 24 (5 to 43) when adjusting for both. CONCLUSIONS Late adolescence cognitive ability attenuated the educational gradient in incident CHD events. CVD risk factors further attenuated the gradient, and to the same extent regardless of whether cognitive ability was included or not. Cognitive ability might be linked to the educational gradient through CVD risk factors.
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Affiliation(s)
- Inger Ariansen
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Laust Mortensen
- Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Department of Heart Disease, Norwegian Institute of Public Health, Bergen, Norway
| | - Kristian Tambs
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Bjørn Heine Strand
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Øyvind Næss
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Institute of Health and Society, University of Oslo, Oslo, Norway
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50
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Groffen DAI, Bosma H, Koster A, von Bonsdorff MB, Aspelund T, Eiriksdottir G, Penninx BWJH, Kempen GIJM, Kirschbaum C, Gudnason V, Harris TB. A blunted diurnal cortisol response in the lower educated does not explain educational differences in coronary heart disease: findings from the AGES-Reykjavik study. Soc Sci Med 2014; 127:143-9. [PMID: 25308232 DOI: 10.1016/j.socscimed.2014.09.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 08/01/2014] [Accepted: 09/24/2014] [Indexed: 11/24/2022]
Abstract
Lower educational attainment generally is a strong predictor of coronary heart disease (CHD). The underlying mechanisms of this effect are, however, less clear. One hypothesis is that stress related to limitations imposed by lower socioeconomic status elicits changes in hypothalamic-pituitary-adrenal axis functioning, which, in turn, increases risk of CHD. In a large cohort study, we examined whether educational attainment was related to risk of fatal and non-fatal CHD and the extent to which salivary cortisol mediated this relation independent of potential confounders, including lifestyles. Data came from 3723 participants aged 66 through 96 from the Age, Gene/Environment Susceptibility (AGES) - Reykjavik Study. Between 2002 and 2006, data were collected using questionnaires and examinations including morning and evening salivary samples. Hospital admission records and cause of death registries (ICD-9 and ICD-10 codes) were available until December 2009. Linear regression and Cox proportional hazards analyses were performed. Even after adjustment for potential confounders, including lifestyle, persons with lower educational attainment showed a blunted cortisol response and also greater risk of incident CHD. However, our data did not support the role of cortisol as a mediator in the association between education and CHD in an older sample (192).
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Affiliation(s)
- Daniëlle A I Groffen
- CAPHRI School for Public Health and Primary Care, Department of Social Medicine, Maastricht University, Maastricht, The Netherlands.
| | - Hans Bosma
- CAPHRI School for Public Health and Primary Care, Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Annemarie Koster
- CAPHRI School for Public Health and Primary Care, Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Mikaela B von Bonsdorff
- The Gerontology Research Centre, Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Thor Aspelund
- Icelandic Heart Association, Kopavogur, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Brenda W J H Penninx
- Department of Psychiatry/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertrudis I J M Kempen
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Clemens Kirschbaum
- Biological Psychology, Technical University of Dresden, Dresden, Germany
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Tamara B Harris
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
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