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Costa C, Freitas A, Almendra R, Santana P. The Association between Material Deprivation and Avoidable Mortality in Lisbon, Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228517. [PMID: 33212953 PMCID: PMC7698341 DOI: 10.3390/ijerph17228517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/04/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
There is considerable evidence pointing to the existence of a socioeconomic gradient in mortality, which tends to be steeper in urban areas. Similar to other European cities, Lisbon is far from homogeneous since considerable geographical inequalities exist between the more advantaged and the more deprived neighborhoods. The main goals of this study are to describe the geographical pattern of premature deaths (before 65 years old), avoidable deaths (preventable and amenable to healthcare) and cause-specific mortality (HIV/AIDS and suicide) in Lisbon, at the lower administrative level (civil parish, in Portuguese: Freguesia), and analyze the statistical association between mortality risk and deprivation, before (1999–2003) and during the economic crisis (2008–2012). Smoothed Standardized Mortality Ratios (sSMR) and Relative Risk (RR) with 95% credible intervals were calculated to identify the association between mortality and deprivation. The analysis of the geographical distribution of cause-specific mortality reveals that civil parishes with high sSMR in the first period continued to present higher mortality rates in the second. Moreover, a significant statistical association was found between all the causes of death and deprivation, except suicide. These findings contribute to understanding how social conditions influence health outcomes and can offer insights about potential policy directions for local government.
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Affiliation(s)
- Claudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
- Correspondence:
| | - Angela Freitas
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
| | - Ricardo Almendra
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
- Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
- Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal
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Campos-Matos I, Russo G, Perelman J. Connecting the dots on health inequalities--a systematic review on the social determinants of health in Portugal. Int J Equity Health 2016; 15:26. [PMID: 26879973 PMCID: PMC4754837 DOI: 10.1186/s12939-016-0314-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/01/2016] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Health inequalities are recognised as a public health issue worldwide, but only a few countries have developed national strategies to monitor and reduce them. Despite its considerable health inequalities, Portugal seems to lack a systematic strategy to tackle them, possibly due to the absence of organised evidence on the issue. We performed a systematic review that aimed to describe the available evidence on social inequalities in health in Portugal, in order to contribute towards a comprehensive and focused strategy to tackle them. METHODS We followed the PRISMA guidelines and searched Scopus, Web of Science and PubMed for studies that looked at the association between a measure of socioeconomic status and a health outcome in the Portuguese resident population since the year 2000. We excluded health behaviours and healthcare use from our search. We performed a qualitative description of the results. RESULTS Seventy-one publications were selected, all reporting observational analyses, most of them using cross-sectional data. These publications showed strong evidence for health inequalities related to education and gender, chiefly for obesity, self-rated health and mental health. CONCLUSIONS Analysis of the eligible publications showed that current research does not seem to have consistently covered the link between health and key Portuguese social problems. A strategy focusing on the monitoring of most prevalent diseases, most determining socioeconomic factors and vulnerable populations would be crucial to guide academic research in a country in which health inequalities are so ubiquitous and deeply rooted. REGISTRATION This systematic review is not registered.
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Affiliation(s)
- Inês Campos-Matos
- Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal.
- Centro de Investigação em Saúde Pública, Lisbon, Portugal.
| | - Giuliano Russo
- Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, NOVA University of Lisbon, Lisbon, Portugal
| | - Julian Perelman
- Centro de Investigação em Saúde Pública, Lisbon, Portugal
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
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Santana P, Costa C, Marí-Dell'Olmo M, Gotsens M, Borrell C. Mortality, material deprivation and urbanization: exploring the social patterns of a metropolitan area. Int J Equity Health 2015; 14:55. [PMID: 26051558 PMCID: PMC4483227 DOI: 10.1186/s12939-015-0182-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/04/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Socioeconomic inequalities affecting health are of major importance in Europe. The literature enhances the role of social determinants of health, such as socioeconomic characteristics and urbanization, to achieve health equity. Yet, there is still much to know, mainly concerning the association between cause-specific mortality and several social determinants, especially in metropolitan areas. This study aims to describe the geographical pattern of cause-specific mortality in the Lisbon Metropolitan Area (LMA), at small area level (parishes), and analyses the statistical association between mortality risk and health determinants (material deprivation and urbanization level). Fourteen causes have been selected, representing almost 60 % of total mortality between 1995 and 2008, particularly those associated with urbanization and material deprivation. Methods A cross-sectional ecological study was carried out. Using a hierarchical Bayesian spatial model, we estimated sex–specific smoothed Standardized Mortality Ratios (sSMR) and measured the relative risks (RR), and 95 % credible intervals, for cause-specific mortality relative to 1. urbanization level, 2. material deprivation and 3. material deprivation adjusted by urbanization. Results The statistical association between mortality and material deprivation and between mortality and urbanization changes by cause of death and sex. Dementia and MN larynx, trachea, bronchus and lung are the causes of death showing higher relative risk associated with urbanization. Infectious and parasitic diseases, Chronic liver disease and Diabetes are the causes of death presenting higher relative risk associated with material deprivation. Ischemic heart disease was the only cause with a statistical association with both determinants, and MN female breast was the only without any statistical association. Urbanization level reduces the impact of material deprivation for most of the causes of death. Men face a higher impact of material deprivation and urbanization level, than women, in most cause-specific mortality, even when considering the adjusted model. Conclusions Our findings explore the specific pattern of fourteen causes of death in LMA and reveals small areas with an excess risk of mortality associated with material deprivation, thereby identifying problematic areas that could potentially benefit from public policies effecting social inequalities. Electronic supplementary material The online version of this article (doi:10.1186/s12939-015-0182-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paula Santana
- Departamento de Geografia, Centro de Estudos de Geografia e Ordenamento do Território, Universidade de Coimbra, Colégio S. Jerónimo, Largo D. Dinis, 3000-043, Coimbra, Portugal.
| | - Claudia Costa
- Departamento de Geografia, Centro de Estudos de Geografia e Ordenamento do Território, Universidade de Coimbra, Colégio S. Jerónimo, Largo D. Dinis, 3000-043, Coimbra, Portugal.
| | - Marc Marí-Dell'Olmo
- CIBER Epidemiología y Salud Pública (CIBERESP), 3-5, Pabellón 11. Planta 0, Monforte de Lemos, 28029, Madrid, Spain. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
| | - Mercè Gotsens
- CIBER Epidemiología y Salud Pública (CIBERESP), 3-5, Pabellón 11. Planta 0, Monforte de Lemos, 28029, Madrid, Spain. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
| | - Carme Borrell
- CIBER Epidemiología y Salud Pública (CIBERESP), 3-5, Pabellón 11. Planta 0, Monforte de Lemos, 28029, Madrid, Spain. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain. .,Universitat Pompeu Fabra, Doctor Aiguader, 80, 08003, Barcelona, Spain.
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Country of birth does not influence long-term clinical, virologic, and immunological outcome of HIV-infected children living in the Netherlands: a cohort study comparing children born in the Netherlands with children born in Sub-Saharan Africa. J Acquir Immune Defic Syndr 2015; 68:178-85. [PMID: 25405830 DOI: 10.1097/qai.0000000000000431] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Immigrant HIV-infected adults in industrialized countries show a poorer clinical and virologic outcome compared with native patients. We aimed to investigate potential differences in clinical, immunological, and virologic outcome in Dutch HIV-infected children born in the Netherlands (NL) versus born in Sub-Saharan Africa (SSA) in a national cohort analysis. METHODS We included all HIV-infected children registered between 1996 and 2013. Descriptive statistics, mixed-effects models, and Cox proportional hazard models were used to investigate differences between groups. RESULTS In total, 319 HIV-infected children were registered. The majority of these children were born in SSA (n = 148, 47%) or NL (n = 113, 36%) and most were black (n = 158, 61%). Children born in NL were diagnosed at a median age of 1.2 years and initiated combination antiretroviral therapy (cART) at a median age of 2.6 years, compared with 3.7 and 5.3 years, respectively, for children born in SSA (HIV diagnosis: P < 0.001; cART initiation: P < 0.001). Despite a lower initial CD4 T-cell Z-score in children born in SSA, their immunological reconstitution was similar to children from NL. Virologic suppression was achieved in the majority of all cART-treated children (NL: 96%, SSA: 94%). There was no difference in the occurrence or timing of virologic failure. CONCLUSIONS Most immigrant HIV-infected children living in NL were born in SSA. Children born in SSA were diagnosed and initiated cART at an older age than children born in NL. Despite initial differences in CD4 T-cell counts and HIV viral load, the long-term immunological and virologic response to cART was similar in both groups.
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Jin Y, Liu Z, Chen X, Wang X, Wang D, Jiang Z, Liu Y, Wang J, Zou W, Guo H, Xu L. Survival of people living with HIV after treatment with traditional Chinese medicine in Henan province of China: a retrospective cohort study. J TRADIT CHIN MED 2014; 34:430-6. [PMID: 25185360 DOI: 10.1016/s0254-6272(15)30042-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To provide survival estimates of people living with human immunodeficiency virus (PLHIV) after treatment with Traditional Chinese Medicine (TCM) in rural China, to identify the prognostic factors at enrollment, and to explore the effectiveness ofTCM in treating PLHIV. METHODS PLHIV who enrolled in national TCM HIV treatment trial program in October 2004 were analyzed in this study and followed up to October 2010. Survival time was estimated by the Kaplan-Meier curve and hazard ratios, and identifying prognostic factors were computed through Cox proportional hazard models. RESULTS A total of 1666 PLHIV were included with 102 591 person-months of follow-up. Overall, 312 (18.7%) patients died. The total mortality rate over the study period was 3.6 per 100 person-years, which was lower than the worldwide rate. The cumulative survival rate was 95.9% at 1 year [95% confidence interval (CI) (94.8-96.8)] and 80.4% at 6 years [95% CI (78.4-82.3)]. Elevated death risks emerged among males, older individuals, and those with lower CD4+ T-cell counts. CONCLUSION TCM could increase survival and lengthen the life span of PLHIV in Henan province of China, as shown by our retrospective cohort study. Factors such as sex, age, education, and CD4+ T-cell counts correlated to survival. However, retrospective cohorts bias the data, so more prospective studies should be performed to confirm our primary results.
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Norredam M, Agyemang C, Hoejbjerg Hansen OK, Petersen JH, Byberg S, Krasnik A, Kunst AE. Duration of residence and disease occurrence among refugees and family reunited immigrants: test of the 'healthy migrant effect' hypothesis. Trop Med Int Health 2014; 19:958-67. [PMID: 24889930 DOI: 10.1111/tmi.12340] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The 'healthy migrant effect' (HME) hypothesis postulates that health selection has a positive effect on migrants' health outcomes, especially in the first years after migration. We examined the potential role of the HME by assessing the association between residence duration and disease occurrence. METHODS We performed a historical prospective cohort study. We included migrants who obtained residence permits in Denmark between 1 January 1993 and 31 December 2010 (n = 114,331). Occurrence of severe conditions was identified through linkage to the Danish National Patient Register. Hazard Ratios (HRs) were modelled for disease incidence by residence duration since arrival (0-5 years; 0-10 years; 0-18 years) adjusting for age and sex. RESULTS Compared with Danish-born individuals, refugees and family reunited immigrants had lower HRs of stroke and breast cancer within 5 years after arrival; however, HRs increased at longer follow-up. For example, HRs of stroke among refugees increased from 0.77 (95% CI: 0.66; 0.91) to 0.96 (95% CI: 0.88; 1.05). For ischaemic heart disease (IHD) and diabetes, refugees and family reunited migrants had higher HRs within 5 years after arrival, and most HRs had increased by end of follow-up. For example, HRs of IHD among family reunited migrants increased from 1.29 (95% CI: 1.17; 1.42) to 1.43 (95% CI: 1.39; 1.52). In contrast, HRs for TB and HIV/AIDS showed a consistent decrease over time. CONCLUSION Our analyses of the effect of duration of residence on disease occurrence among migrants imply that, when explaining migrants' advantageous health outcomes, the ruling theory of the HME should be used with caution, and other explanatory models should be included.
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Affiliation(s)
- Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Section of Immigrant Medicine, Department of Infectious Disease, University Hospital Copenhagen, Hvidovre, Denmark
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Norredam M, Olsbjerg M, Petersen JH, Bygbjerg I, Krasnik A. Mortality from infectious diseases among refugees and immigrants compared to native Danes: a historical prospective cohort study. Trop Med Int Health 2011; 17:223-30. [DOI: 10.1111/j.1365-3156.2011.02901.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rodríguez-Cerdeira C, Cruces M, Taboada J. A quarter of a century with AIDS. Open AIDS J 2011; 5:1-8. [PMID: 21629502 PMCID: PMC3103892 DOI: 10.2174/1874613601105010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 07/19/2010] [Accepted: 11/15/2010] [Indexed: 11/25/2022] Open
Abstract
In Northwestern Spain (NWS), the annual incidence of AIDS diagnoses increased from 1984 (when the first case was diagnosed) until 1996. However, since 1996, this incidence has reduced considerably, including a notable 40% reduction between 1997 and 1998. The Galician Register of AIDS supplies information on the evolution of AIDS pathology in NWS. This report compiles data on patients who were diagnosed with AIDS in NWS between 1984 and 2008. From 1981, when the first case of AIDS was described, until December 31, 2008, a total of 3,766 AIDS cases were registered in NWS. Of these, 2,085 cases (55.4%) resulted in death. Examining data from individual provinces revealed that the highest number of cases was in A Coruña (1,548 cases) followed by Pontevedra (1,485 cases).For almost half of the new cases of AIDS diagnosed between 2003 and 2008 (44%), less than six months passed between the diagnosis of infection and manifestations of the disease. Thus, the number of patients that do not receive early diagnosis of HIV infection has remained high.With regard to the transmission mechanism, 64% of the cases occurring during these years resulted from needle-sharing among injected drug users (IDUs). Unprotected heterosexual and homosexual practices were responsible for 20% and 17% of the cases, respectively.
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Affiliation(s)
| | - M.J Cruces
- Dirección Xeral de Saúde Pública, Xunta de Galicia, Santiago de Compostela, Spain
| | - J.A Taboada
- Dirección Xeral de Saúde Pública, Xunta de Galicia, Santiago de Compostela, Spain
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Factors associated with HIV testing among immigrants in Portugal. Int J Public Health 2010; 56:559-66. [DOI: 10.1007/s00038-010-0215-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Revised: 10/20/2010] [Accepted: 10/21/2010] [Indexed: 11/30/2022] Open
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