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Dharmayani PNA, Mihrshahi S. The prevalence of psychological distress and its associated sociodemographic factors in the Australian adults aged 18-64 years during COVID-19: Data from the Australian National Health Survey. J Affect Disord 2024; 368:312-319. [PMID: 39293604 DOI: 10.1016/j.jad.2024.09.085] [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] [Received: 05/06/2024] [Revised: 09/02/2024] [Accepted: 09/14/2024] [Indexed: 09/20/2024]
Abstract
OBJECTIVE COVID-19 significantly contributed to an increase in psychological distress and may have disproportionally impacted certain sociodemographic groups. This study aimed to assess the prevalence of psychological distress among Australian adults aged 18-64 years and identify sociodemographic factors associated with psychological distress during the COVID-19 pandemic. METHODS Secondary analyses were conducted using data from the National Health Survey 2020-21 to calculate weighted national estimates of the prevalence of psychological distress using the Kessler Psychological Distress scale (K10). The association between sociodemographic factors and psychological distress was analysed using multivariable logistic regression, with adjustments for complex survey design. RESULTS The average of K10 score was 16.94, with a prevalence of combined high/very high distress reported at 21.13 % among Australian adults. Young women aged 18-25 reported the highest average scores (M = 20.44) across all sex and age groups. Risk factors associated with psychological distress included lower personal income, marital status (never married; widowed/divorced/separated) and being 'born in Australia'. Protective factors included homeownership and having children in the household. Additionally, among women, being aged ≥56 was significantly associated with lower odds of psychological distress. LIMITATIONS Data collection relied on self-completed online form, and a cross-sectional design limits the inference of a causal relationship. DISCUSSION During COVID-19 pandemic, lower personal income and being female have consistently been identified as risk factors for psychological distress. Targeted and tailored interventions based on age, sex and disadvantage are warranted, particularly focusing on younger women, to alleviate the adverse effect of the pandemic on the population's mental health.
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Affiliation(s)
- Putu Novi Arfirsta Dharmayani
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia.
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
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Ludlow T, Fooken J, Rose C, Tang KK. Out-of-pocket expenditure, need, utilisation, and private health insurance in the Australian healthcare system. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024; 24:33-56. [PMID: 37819482 PMCID: PMC10960905 DOI: 10.1007/s10754-023-09362-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/09/2023] [Indexed: 10/13/2023]
Abstract
Despite widespread public service provision, public funding, and private health insurance (PHI), 20% of all healthcare expenditure across the OECD is covered by out-of-pocket expenditure (OOPE). This creates an equity concern for the increasing number of individuals with chronic conditions and greater need, particularly if higher need coincides with lower income. Theoretically, individuals may mitigate OOPE risk by purchasing PHI, replacing variable OOPE with fixed expenditure on premiums. Furthermore, if PHI premiums are not risk-rated, PHI may redistribute some of the financial burden from less healthy PHI holders that have greater need to healthier PHI holders that have less need. We investigate if the burden of OOPE for individuals with greater need increases less strongly for individuals with PHI in the Australian healthcare system. The Australian healthcare system provides public health insurance with full, partial, or limited coverage, depending on the healthcare service used, and no risk rating of PHI premiums. Using data from the Household, Income and Labour Dynamics in Australia survey we find that individuals with PHI spend a greater share of their disposable income on OOPE and that the difference in OOPE share between PHI and non-PHI holders increases with greater need and utilisation, contrary to the prediction that PHI may mitigate OOPE. We also show that OOPE is a greater concern for poorer individuals for whom the difference in OOPE by PHI is the greatest.
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Affiliation(s)
- Timothy Ludlow
- School of Economics, The University of Queensland, St Lucia, Australia
| | - Jonas Fooken
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Australia.
- Macquarie Centre for the Health Economy, Macquarie University, North Ryde, Australia.
| | - Christiern Rose
- School of Economics, The University of Queensland, St Lucia, Australia
| | - Kam Ki Tang
- School of Economics, The University of Queensland, St Lucia, Australia
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Butler DC, Larkins S, Jorm L, Korda RJ. Does use of GP and specialist services vary across areas and according to individual socioeconomic position? A multilevel analysis using linked data in Australia. BMJ Open 2024; 14:e074624. [PMID: 38184309 PMCID: PMC10773367 DOI: 10.1136/bmjopen-2023-074624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/07/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE Timely access to primary care and supporting specialist care relative to need is essential for health equity. However, use of services can vary according to an individual's socioeconomic circumstances or where they live. This study aimed to quantify individual socioeconomic variation in general practitioner (GP) and specialist use in New South Wales (NSW), accounting for area-level variation in use. DESIGN Outcomes were GP use and quality-of-care and specialist use. Multilevel logistic regression was used to estimate: (1) median ORs (MORs) to quantify small area variation in outcomes, which gives the median increased risk of moving to an area of higher risk of an outcome, and (2) ORs to quantify associations between outcomes and individual education level, our main exposure variable. Analyses were adjusted for individual sociodemographic and health characteristics and performed separately by remoteness categories. SETTING Baseline data (2006-2009) from the 45 and Up Study, NSW, Australia, linked to Medicare Benefits Schedule and death data (to December 2012). PARTICIPANTS 267 153 adults aged 45 years and older. RESULTS GP (MOR=1.32-1.35) and specialist use (1.16-1.18) varied between areas, accounting for individual characteristics. For a given level of need and accounting for area variation, low education-level individuals were more likely to be frequent users of GP services (no school certificate vs university, OR=1.63-1.91, depending on remoteness category) and have continuity of care (OR=1.14-1.24), but were less likely to see a specialist (OR=0.85-0.95). CONCLUSION GP and specialist use varied across small areas in NSW, independent of individual characteristics. Use of GP care was equitable, but specialist care was not. Failure to address inequitable specialist use may undermine equity gains within the primary care system. Policies should also focus on local variation.
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Affiliation(s)
- Danielle C Butler
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Wood B, Sacks G. The influence of share buybacks on ill-health and health inequity: an exploratory analysis using a socio-ecological determinants of health lens. Global Health 2023; 19:3. [PMID: 36631805 PMCID: PMC9832402 DOI: 10.1186/s12992-023-00905-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Share buybacks, when a corporation buys back its own shares, are recognised as having potentially harmful impacts on society. This includes by contributing to economic inequalities, and by impeding investments with the potential to protect and promote the welfare of various stakeholders. Share buybacks, however, have received minimal analytical attention in the public health literature. This paper aimed to explore the potential influence of share buybacks on population health and health inequity using a socio-ecological determinants of health lens. METHODS We conducted a descriptive analysis of share buybacks made by corporations listed on United States (US) stock exchanges between 1982 and 2021, using quantitative data sourced from Compustat. We examined annual trends in share buyback expenditure, including comparisons to dividend, net income, capital expenditure, and research and development expenditure data. We then purposively sampled a set of corporations to provide illustrative examples of how share buybacks potentially influence key socio-ecological determinants of health. The examples were: i) three COVID-19 vaccine manufacturers; ii) five of the world's largest fossil fuel corporations; and iii) US car manufacturer General Motors. For these, we conducted an analysis of data from Compustat, company reports and grey literature materials, focusing on key sources of profits and their allocation to share buybacks and particular investments. RESULTS US-listed corporations spent an estimated US$9.2 trillion in real terms on share buybacks between 2012 and 2021 (nearly 12 times more than from 1982 to 1991). The contribution of share buybacks to total shareholder 'returns' increased from 11% in 1982 to 55% in 2021, with expenditure on shareholder returns increasing considerably relative to capital, research and development expenditure over this period. The three examples illustrated how some corporations have prioritised the short-term financial interests of their shareholders, including via implementing large share buyback programs, over investments with considerable potential to protect and promote the public's health. CONCLUSION The potentially substantial impacts of share buybacks on health warrant increased research and policy attention. Arguably, more must be done to regulate share buybacks as part of efforts to address the corporate drivers of ill-health and inequity.
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Affiliation(s)
- Benjamin Wood
- Global Centre for Preventive Health and Nutrition, Deakin University, Institute for Health Transformation, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Gary Sacks
- grid.1021.20000 0001 0526 7079Global Centre for Preventive Health and Nutrition, Deakin University, Institute for Health Transformation, 221 Burwood Highway, Burwood, VIC 3125 Australia
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Socioeconomic Inequalities in the Prevalence of Non-Communicable Diseases among Older Adults in India. Geriatrics (Basel) 2022; 7:geriatrics7060137. [PMID: 36547273 PMCID: PMC9778373 DOI: 10.3390/geriatrics7060137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Understanding socioeconomic inequalities in non-communicable disease prevalence and preventive care usage can help design effective action plans for health equality programs among India's aging population. Hypertension (HTN) and diabetes mellitus (DM) are frequently used as model non-communicable diseases for research and policy purposes as these two are the most prevalent NCDs in India and are the leading causes of mortality. For this investigation, data on 31,464 older persons (aged 60 years and above) who took part in the Longitudinal Ageing Survey of India (LASI: 2017-2018) were analyzed. The concentration index was used to assess socioeconomic inequality whereas relative inequalities indices were used to compare HTN, DM, and preventive care usage between the different groups of individuals based on socioeconomic status. The study reveals that wealthy older adults in India had a higher frequency of HTN and DM than the poor elderly. Significant differences in the usage of preventive care, such as blood pressure/blood glucose monitoring, were found among people with HTN or DM. Furthermore, economic position, education, type of work, and residential status were identified as important factors for monitoring inequalities in access to preventive care for HTN and DM. Disparities in non-communicable diseases can be both a cause and an effect of inequality across social strata in India.
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Ma Y, Leung P, Wang Y, Wang L. Psychological resilience, activities of daily living, and cognitive functioning among older male Tekun adults in rural long-term care facilities in China. SOCIAL WORK IN HEALTH CARE 2022; 61:445-467. [PMID: 36398735 DOI: 10.1080/00981389.2022.2147628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 10/29/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Most of the rural long-term care (LTC) facilities in China are ill-equipped to manage the physical and psychological needs of older residents with dementia. These facilities mostly consist of older male Tekun (socially and economically vulnerable) adults. Preventing or delaying the onset of dementia is especially crucial for these older Tekun adults. A sample of 711 older male Tekun adults from rural LTC facilities in the Anhui province of China was used to investigate the association between psychological resilience and cognitive functioning, and to examine the moderating effect of activities of daily living (ADLs) on that association. Linear and quantile regression found that resilience was positively associated with cognitive functioning for the total sample, with a greater effect among those with a lower level of cognitive functioning. The benefit of resilience on cognitive functioning was observed only in participants with disability in ADLs. Our findings present evidence in support of interventions to foster psychological resilience and potentially improve cognitive functioning among vulnerable older adults. Resilience-promoting intervention is a strength-based approach that aligns with social work values and can be used in practice. The implications for social work practice were discussed.
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Affiliation(s)
- Ying Ma
- Graduate College of Social Work, University of Houston, Houston, TEXAS, USA
| | - Patrick Leung
- Graduate College of Social Work, University of Houston, Houston, TEXAS, USA
| | - Yi Wang
- School of Social Work, University of Iowa, Ames, Iowa, USA
| | - Li Wang
- Department of Healthcare Insurance, School of Healthcare Administration, Anhui Medical University, Hefei, Anhui, China
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Armstrong G, Haregu T, Young J, Paradies Y. What are the effects of ethnicity, sexuality, disability and obesity on the odds of experiencing discrimination among Australian males? A nationwide cross-sectional survey. BMJ Open 2022; 12:e053355. [PMID: 35063959 PMCID: PMC8785162 DOI: 10.1136/bmjopen-2021-053355] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The global public health community has been slow to acknowledge the important role of discrimination in health inequality. Existing evidence on discrimination is largely based on studies of specific subpopulations and specific forms of discrimination, with limited evidence from general population samples. We assessed the individual and combined effects of ethnicity, sexuality, disability and obesity on the likelihood of discrimination among a general population sample of Australian males. DESIGN AND SETTING We used data from The Australian Longitudinal Study on Male Health (n=15 988, with response rate of 35%) to estimate the prevalence of self-perceived discrimination within the preceding 2 years and we used binary logistic regression models to assess the individual and combined effects of ethnicity, sexuality, disability and obesity on discrimination. PARTICIPANTS 13 763 adult males were included in this analysis. RESULTS One in five (19.7%) males reported experiencing discrimination in the preceding 2 years. Aboriginal and/or Torres Strait Islander males were nearly three times (OR=2.97, p<0.001) more likely to experience discrimination. Those born in Southern/Eastern Europe, Asia or Africa were at least twice more likely to report discrimination. Homosexual or bisexual males (35.2%; OR=2.23, p=<0.001), men with morbid obesity (29.2%; OR=1.91, p<0.001) and men with a disability (33.8%; OR=2.07, p<0.001) also had higher odds of experiencing discrimination. Those belonging to one (30.4%; OR=2.60, p<0.001) or two or more (38.2%; OR=3.50, p<0.001) risk groups were increasingly more likely to experience discrimination. CONCLUSIONS Discrimination was correlated with ethnicity, sexuality, obesity and disability. Belonging to two or more of the risk groups was associated with substantial increases in the likelihood of experiencing discrimination. Approaches to preventing discrimination need to acknowledge and address the impact of this intersectionality.
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Affiliation(s)
- Gregory Armstrong
- The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Tilahun Haregu
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jesse Young
- Centre for Health Equity, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Yin Paradies
- Deakin University Alfred Deakin Institute for Citizenship and Globalisation, Burwood, Victoria, Australia
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Houlding-Braunberger E, Petkovic J, Lebel N, Tugwell P. Experts prioritize osteoarthritis non-surgical interventions from Cochrane systematic reviews for translation into "Evidence4Equity" summaries. Int J Equity Health 2021; 20:136. [PMID: 34112156 PMCID: PMC8193871 DOI: 10.1186/s12939-021-01477-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/14/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Osteoarthritis generates substantial health and socioeconomic burden, which is particularly marked in marginalized groups. It is imperative that practitioners have ready access to summaries of evidence-based interventions for osteoarthritis that incorporate equity considerations. Summaries of systematic reviews can provide this. The present study surveyed experts to prioritize a selection ofinterventions, from which equity focused summaries will be generated. Specifically, the prioritized interventions will be developed into Cochrane Evidence4Equity (E4E) summaries. METHODS Twenty-seven systematic reviews of OA interventions were found. From these, twenty-nine non-surgical treatments for osteoarthritis were identified, based on statistically significant findings for desired outcome variables or adverse events. Key findings from these studies were summarised and provided to 9 experts in the field of osteoarthritis.. Expert participants were asked to rate interventions based on feasibility, health system effects, universality, impact on inequities, and priority for translation into equity based E4E summaries. Expert participants were also encouraged to make comments to provide context for each rating. Free text responses were coded inductively and grouped into subthemes and themes. RESULTS Expert participants rated the intervention home land-based exercise for knee OA highest for priority for translation into an E4E summaries, followed by the interventions individual land-based exercise for knee OA, class land-based exercise for knee OA, exercise for hand OA and land-based exercise for hip OA. Upon qualitative analysis of the expert participants' comments, fifteen subthemes were identified and grouped into three overall themes: (1) this intervention or an aspect of this intervention is unnecessary or unsafe; (2) this intervention or an aspect of this intervention may increase health inequities; and (3) experts noted difficulties completing rating exercise. CONCLUSION The list of priority interventions and corresponding expert commentary generated information that will be used to direct and support knowledge translation efforts.
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Affiliation(s)
- Elizabeth Houlding-Braunberger
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Faculty of Science, University of Ottawa, Ottawa, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jennifer Petkovic
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
- WHO Collaborating Centre for knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Canada
| | - Nicholas Lebel
- Faculty of Science, University of Ottawa, Ottawa, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter Tugwell
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- WHO Collaborating Centre for knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Canada.
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
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Oliveira NGN, Tavares DMDS. Active ageing among elderly community members: structural equation modeling analysis. Rev Bras Enferm 2020; 73:e20200110. [PMID: 33111807 DOI: 10.1590/0034-7167-2020-0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/05/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to propose a structural model of active ageing among elderly community members based on the World Health Organization's theoretical framework and to identify the most relevant determinants of active ageing to the proposed model. METHODS a cross-sectional and analytical study conducted with 957 elderly community members. Confirmatory factor analysis and structural equation modeling were performed. RESULTS the final measurement model was composed of the six determinants of active ageing: behavioral (R²=0.66); personal (R²=0.74); physical environment (R²=0.70); social (R²=0.77); economic (R²=0.44); and social and health services (R²=0.95). The last one showed good quality of adjustment: χ2/gl=3.50; GFI=0.94; CFI=0.92; TLI=0.90; RMSEA=0.05. By analyzing the trajectories between determinants and active ageing, the most representative was social and health services active ageing (λ=0.97; p<0.001). CONCLUSION satisfaction with access to health services and positive self-assessment of health status were the factors that most contributed to active ageing in this population.
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Ding Y, Chen D, Ding X, Wang G, Wan Y, Shen Q. A bibliometric analysis of income and cardiovascular disease: Status, Hotspots, Trends and Outlook. Medicine (Baltimore) 2020; 99:e21828. [PMID: 32846827 PMCID: PMC7447358 DOI: 10.1097/md.0000000000021828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Income is 1 of the socio-economic indicators and could directly influence the health outcomes of cardiovascular disease (CVD). The relationship between income and CVD has attracted more and more scholars' attention in the past 20 years. METHODS To study the current research dynamics of this field, a bibliometric analysis was conducted to evaluate the publications from 1990 to 2018 based on the Science Citation Index Expanded database. By using the Derwent Date Analyzer software, the following aspects were explored: RESULTS:: The USA ranked first in this field, followed by UK and Canada in terms of number of publications. As for institutions, Harvard University took the leading place in the number of publications, as well as the h-index. Plos One had the most publications and "health" was the most frequent used keyword. The leading research area was "public environmental occupational health". CONCLUSIONS In conclusion, the elderly, the children and the puerpera were the main study population in this field and "disease prevention" was the main study direction. The most concerned health issues in this field were "obesity" and "diet". There might be a lack of articles that explore the associations between income and CVD with a global perspective. Articles on this content are urgently warranted.
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Affiliation(s)
- Ye Ding
- School of Public Health, Hangzhou Medical College
| | - Dingwan Chen
- School of Public Health, Hangzhou Medical College
| | - Xufen Ding
- Institute of Information Resources, Zhejiang University of Technology
- Library, Zhejiang University of Technology, Hangzhou, China
| | - Guan Wang
- School of Public Health, Hangzhou Medical College
| | - Yuehua Wan
- Institute of Information Resources, Zhejiang University of Technology
- Library, Zhejiang University of Technology, Hangzhou, China
| | - Qing Shen
- School of Public Health, Hangzhou Medical College
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Fang M, Li G, Kang X, Hou F, Lv G, Xu X, Kong L, Li P. The role of gender and self-esteem as moderators of the relationship between stigma and psychological distress among infertile couples. PSYCHOL HEALTH MED 2020; 26:1181-1194. [PMID: 32804542 DOI: 10.1080/13548506.2020.1808233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To determine if perceived stigma is positively associated with psychological distress, and examine if self-esteem has a moderating effect on the relationship between stigma and psychological distress among infertile Chinese couples. 369 infertile couples completed questionnaires including socio-demographic and clinical characteristics, stigma, self-esteem, and psychological distress. Stigma had a significant, positive association with psychological distress (r = 0.461, P < 0.01). Self-esteem moderated the association between stigma and psychological distress differently for men compared to women. Stigma had a positive, moderate association with psychological distress in men with high self-esteem compared to men with low self-esteem (t = 3.232, P < 0.01). However, there was no significant difference in the relationship between stigma and psychological distress between women with high and low self-esteem, tests of the simple slopes showed that non-significant difference of slopes between the two groups (t = -0.017, P = 0.987). The results indicate that self-esteem buffers the net effect of stigma on psychological distress in men but not women. Future research should focus on interventions that use self-esteem as a way to decrease the negative association of stigma with psychological distress, especially among men who are infertile and have low self-esteem.
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Affiliation(s)
- Mei Fang
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Guopeng Li
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Xiaofei Kang
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Fangyan Hou
- School of Nursing, Shandong University, Shandong, People's Republic of China
| | - Gaorong Lv
- School of Nursing, Shandong University, Shandong, People's Republic of China
| | - Xiaofang Xu
- School of Nursing, Shandong University, Shandong, People's Republic of China
| | - Linghua Kong
- School of Nursing, Shandong University, Shandong, People's Republic of China
| | - Ping Li
- School of Nursing, Shandong University, Shandong, People's Republic of China
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Henriksen T, Dalhoff KP, Hansen HE, Brenneche AW, Lønberg US, Danielsen EH. Access and Use of Device-Aided Therapies for Parkinson's Disease in Denmark. Mov Disord Clin Pract 2020; 7:656-663. [PMID: 32775511 DOI: 10.1002/mdc3.12988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/28/2020] [Accepted: 05/03/2020] [Indexed: 11/06/2022] Open
Abstract
Background In Denmark's five regions, there is potential inequality in access to device-aided therapy (DAT) for Parkinson's disease (PD) based on structural or socioeconomic factors. It is unclear how long DAT is maintained and affects concomitant medication. Objectives To investigate access to DAT by comparing the proportion of patients with DBS, subcutaneous apomorphine infusion (SCAI), or levodopa/carbidopa intestinal gel (LCIG) in Danish regions 2008-2016 and describe demographics of patients, changes in use of comedication, and maintenance of DAT. Methods This work is a retrospective nationwide population-based registry analysis generated by combining various registries and statistics in Denmark. Results From 2008 to 2016, 612 patients started DAT. There were statistically significant differences in the number of patients starting DAT between the Capital Region (99.5 per 1,000) and both Central Jutland (66.6 per 1,000) and North Jutland (70.6 per 1,000; P < 0.05). Among DBS and LCIG patients, respectively, 4% and 42% were aged ≥70 years, 68% and 63% were men (vs. 59% in the general PD population; P < 0.05 for DBS), 73% and 63% had a partner (vs. 62% in the general PD population), and 73% and 71% had a qualifying education (vs. 63% in the general PD population; P < 0.05). Use of PD-related medication decreased significantly from 4 years before to 4 years after DAT. Eighty-one percent of the patients who started LCIG, alive 4 years later, had maintained this treatment. Conclusions There is unequal access to DAT in the Danish regions, and political and social considerations are warranted to address structural and socioeconomic causes.
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Affiliation(s)
- Tove Henriksen
- Movement Disorder Clinic, Department of Neurology Bispebjerg Hospital Copenhagen Denmark
| | - Kim Peder Dalhoff
- Department of Clinical Pharmacology Bispebjerg Hospital Copenhagen Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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Hossin MZ, Östergren O, Fors S. Is the Association Between Late Life Morbidity and Disability Attenuated Over Time? Exploring the Dynamic Equilibrium of Morbidity Hypothesis. J Gerontol B Psychol Sci Soc Sci 2020; 74:e97-e106. [PMID: 28575329 DOI: 10.1093/geronb/gbx067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 05/09/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE There is evidence suggesting that the prevalence of disability in late life has declined over time while the prevalence of chronic diseases has increased. The dynamic equilibrium of morbidity hypothesis suggests that these patterns are due to the attenuation of the morbidity-disability link over time. This study aimed to test this assumption empirically. METHODS Data were drawn from three repeated cross-sections of SWEOLD, a nationally representative survey of the Swedish population aged 77 years and older. Poisson regression models were fitted to assess the trends in the prevalence of Activities of Daily Living (ADL) disability, Instrumental ADL (IADL) disability, and selected groups of chronic conditions. The changes in the associations between chronic conditions and disabilities were examined on both multiplicative and additive scales. RESULTS Between 1992 and 2011, the prevalence of both ADL and IADL disabilities decreased whereas the prevalence of nearly all chronic morbidities increased. Significant attenuations of the morbidity-disability associations were found for cardiovascular diseases, metabolic disorders, poor lung function, and psychological distress. DISCUSSION In agreement with the dynamic equilibrium of morbidity hypothesis, this study concludes that the morbidity-disability associations among the Swedish older adults largely waned between 1992 and 2011.
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Affiliation(s)
| | | | - Stefan Fors
- Aging Research Center, Karolinska Institute/Stockholm University, Stockholm, Sweden
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Shangren Q, Zirui H, Ye D. Income-Related Inequalities in Chronic Disease Situation Among the Chinese Population Aged Above 45 Years. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019860383. [PMID: 31431097 PMCID: PMC6704424 DOI: 10.1177/0046958019860383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
There is relatively little published on the socioeconomic distribution of chronic disease burden in older people. This study aims to quantify income-related inequalities in chronic disease situation among ≥45-year-old people in China. Data were collected from the 2015 China Health and Retirement Longitudinal Study. Self-reported chronic conditions included 14 diseases (ie, heart problem, diabetes). Multivariate Generalized Quasi-Poisson Regression was used to evaluate associations between prevalence and personal income. Prevalence of hypertension was highest among people above ≥ 75 (male participants 44.41%, female participants 47.53%). Heart problem prevalence increased with age. Chronic disease prevalence among population aged 45 to 59 years was greatly affected by income. Prevalence ratios (PRs) were highest for heart problems in 45 to 59 middle-income male participants and for memory-related diseases in 45 to 59 middle-income female participants. Significant inequalities in chronic conditions prevalence persist into old age, particularly among 45- to 59-year-old people. Opposite to developed countries, the prevalence of some chronic disease (ie, heart problem) is higher in richer populations in China. These findings pose the policy challenge of needing to prevent such inequalities in older years.
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Affiliation(s)
| | | | - Ding Ye
- 2 Hangzhou Medical College, China
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15
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Association of childhood socioeconomic status with edentulism among Chinese in mid-late adulthood. BMC Oral Health 2019; 19:292. [PMID: 31884947 PMCID: PMC6935473 DOI: 10.1186/s12903-019-0968-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/22/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the association between childhood socioeconomic status (SES) and edentulism. METHODS The edentulous status of Chinese in mid-late adulthood was determined using self-reported lost all of teeth from the Health and Retirement Longitudinal Study (CHARLS). Childhood SES was determined based on the following parameters: the education, occupation and working status of the parents; financial situation of the family; relationship with the parents; care, love and affection from the mother; quarrels and fights between parents; primary residence; neighbors' willingness to help and with close-knit relationships. Adulthood SES was assessed by educational achievements. This study used principal component analysis (PCA) to select variables and binary logistic regression models to determine the association between childhood SES and edentulism. RESULTS Data were available from a total of 17,713 respondents, 984 of whom were edentulous (2.9%). The prevalence of edentulism in mid- to late-age Chinese individuals was higher in those with poor childhood SES. In final regression model, edentulism was significantly associated with willingness of neighbors to help with close-knit relationships (OR = 0.89, 95% CI = 0.79-0.99), parents with high school education or above (OR = 1.18, 95% CI = 1.01-1.39) and drinking and smoking habits of the father (OR = 1.10, 95% CI = 0.97-1.24). CONCLUSION Childhood SES was significantly associated with the prevalence of edentulism in mid- to late-age Chinese individuals. In particular, parents with high school education or above, unwillingness of neighbor to help with close-knit relationships, drinking and smoking habits of the father independent of adulthood SES were significantly associated with edentulism. Accordingly, the development of optimal recommendations and more effective intervention strategies requires considering the experiences in early life associated with poor SES contributes to poor oral health.
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Lai S, Shen C, Yang X, Zhang X, Xu Y, Li Q, Gao J, Zhou Z. Socioeconomic inequalities in the prevalence of chronic diseases and preventive care among adults aged 45 and older in Shaanxi Province, China. BMC Public Health 2019; 19:1460. [PMID: 31694609 PMCID: PMC6833131 DOI: 10.1186/s12889-019-7835-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/23/2019] [Indexed: 11/14/2022] Open
Abstract
Background Monitoring inequalities in chronic disease prevalence and their preventive care can help build effective strategies to improve health equality. Using hypertension and diabetes as a model, this study measures and decomposes socioeconomic inequalities in their prevalence and preventive care among Chinese adults aged 45 years and older in Shaanxi Province, an underdeveloped western region of China. Methods Data of 27,728 respondents aged 45 years and older who participated in the fifth National Health Services Survey conducted in 2013 in Shaanxi Province were analyzed. The relative indexes of inequalities based on Poisson regressions were used to assess disparities in the prevalence of hypertension and diabetes and their preventive care between those with the lowest and the highest socioeconomic status, and the concentration index was used to measure the magnitude of the socioeconomic-related inequality across the entire socioeconomic spectrum. The contribution of each factor to the inequality was further estimated via the concentration index decomposition. Results Our results indicate a higher prevalence of hypertension and diabetes among the rich than the poor individuals aged 45 years and older in Shaanxi Province, China. Among individuals with hypertension or diabetes, significant inequalities favoring the rich were observed in the use of preventive care, i.e. in adequate use of medication and of blood pressure/blood glucose monitoring. Furthermore, economic status, educational level, employment status, and urban-rural areas were identified as the key socioeconomic indicators for monitoring the inequalities in the patient preventive care. Conclusions Our study suggests that the existence of clear inequities in the prevalence of chronic diseases and preventive care among adults aged 45 and older in Shaanxi Province, China. These inequalities in chronic diseases could be as much a cause as a consequence of socioeconomic inequalities.
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Affiliation(s)
- Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Xiaowei Yang
- School of Public Policy and Administration, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Xiaolong Zhang
- Jinhe Center for Economic Research, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Yongjian Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Qian Li
- the First Affiliated Hospital of Xi'an Jiaotong University, No.277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Jianmin Gao
- School of Public Policy and Administration, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, China.
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, China.
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Eyjólfsdóttir HS, Baumann I, Agahi N, Fritzell J, Lennartsson C. Prolongation of working life and its effect on mortality and health in older adults: Propensity score matching. Soc Sci Med 2019; 226:77-86. [PMID: 30849673 DOI: 10.1016/j.socscimed.2019.02.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/17/2019] [Accepted: 02/16/2019] [Indexed: 11/28/2022]
Abstract
Many countries are raising the age of pension eligibility because of increases in life expectancy. Given the social gradient in life expectancy and health, it is important to understand the potential late-life health effects of prolonging working life and whether any effects differ by socioeconomic position. We examined the effect of prolonging working life beyond age 65 on mortality and a series of indicators of late-life physical health (the ability to climb stairs without difficulty, self-rated health, ADL limitations, and musculoskeletal pain) in a representative sample of the Swedish population. In addition to average effects, we also examined heterogeneous effects, for instance by occupational social class. To do this, we use propensity score matching, a method suitable for addressing causality in observational data. The data came from two linked Swedish longitudinal surveys based on nationally representative samples with repeated follow-ups; The Swedish Level of Living Survey and the Swedish Panel Study of Living conditions of the Oldest Old, and from national income and mortality registries. The analytical sample for the mortality outcome included 1852 people, and for late-life physical health outcomes 1461 people. We found no significant average treatment effect on the treated (ATT) of working to age 66 or above on the outcomes, measured an average of 12 years after retirement: mortality (ATT -0.039), the ability to climb stairs (ATT -0.023), self-rated health (ATT -0.009), ADL limitations (ATT -0.023), or musculoskeletal pain (ATT -0.009) in late life. Analyses of whether the results varied by occupational social class or the propensity to prolong working life were inconclusive but suggest a positive effect of prolonging working life on health outcomes. Accordingly, more detailed knowledge about the precise mechanisms underlying these results are needed. In conclusion, working to age 66 or above did not have effect on mortality or late-life physical health.
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Affiliation(s)
- H S Eyjólfsdóttir
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden.
| | - I Baumann
- Center for Health Sciences, Zurich University of Applied Sciences, Switzerland; National Center of Competence in Research "Overcoming Vulnerability: Life Course Perspectives", Switzerland
| | - N Agahi
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
| | - J Fritzell
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
| | - C Lennartsson
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
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18
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Lundgren-Nilsson Å, Dencker A, Palstam A, Person G, Horton MC, Escorpizo R, Küçükdeveci AA, Kutlay S, Elhan AH, Stucki G, Tennant A, Conaghan PG. Patient-reported outcome measures in osteoarthritis: a systematic search and review of their use and psychometric properties. RMD Open 2018; 4:e000715. [PMID: 30622735 PMCID: PMC6307597 DOI: 10.1136/rmdopen-2018-000715] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/31/2018] [Accepted: 11/04/2018] [Indexed: 01/11/2023] Open
Abstract
Introduction Patient-reported outcome measures (PROM) or self-completed questionnaires have been used to report outcomes in osteoarthritis (OA) for over 35 years. Choices will always need to be made about what should be measured and, if relevant, what would be the most appropriate PROM to use. The current study aims to describe the available PROMs used in OA and their performance quality, so that informed choices can be made about the most appropriate PROM for a particular task. Methods The study included a systematic search for PROMs that have been in use over 17 years (period 2000–2016), and to catalogue their psychometric properties, and to present the evidence in a user-friendly fashion. Results 78 PROMs were identified with psychometric evidence available. The domains of pain, self-care, mobility and work dominated, whereas domains such as cleaning and laundry and leisure, together with psychological and contextual factors, were poorly served. The most frequently used PROMs included the Western Ontario McMaster Osteoarthritis Index, the Short Form 36 and the Knee Disability and Osteoarthritis Outcome Score which, between them, appeared in more than 4000 papers. Most domains had at least one PROM with the highest level of psychometric evidence. Conclusion A broad range of PROMs are available for measuring OA outcomes. Some have good psychometric evidence, others not so. Some important psychological areas such as self-efficacy were poorly served. The study provides a current baseline for what is available, and identifies the shortfall in key domains if the full biopsychosocial model is to be explored.
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Affiliation(s)
- Åsa Lundgren-Nilsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Dencker
- Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annie Palstam
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Mike C Horton
- Psychometric Laboratory for Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Ayse A Küçükdeveci
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sehim Kutlay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Atilla H Elhan
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gerold Stucki
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Alan Tennant
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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19
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Hamada S, Takahashi H, Sakata N, Jeon B, Mori T, Iijima K, Yoshie S, Ishizaki T, Tamiya N. Household Income Relationship With Health Services Utilization and Healthcare Expenditures in People Aged 75 Years or Older in Japan: A Population-Based Study Using Medical and Long-term Care Insurance Claims Data. J Epidemiol 2018; 29:377-383. [PMID: 30249946 PMCID: PMC6737189 DOI: 10.2188/jea.je20180055] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background This study aimed to determine whether there are disparities in healthcare services utilization according to household income among people aged 75 years or older in Japan. Methods We used data on medical and long-term care (LTC) insurance claims and on LTC insurance premiums and needs levels for people aged 75 years or older in a suburban city. Data on people receiving public welfare were not available. Participants were categorized according to household income level using LTC insurance premiums data. The associations of low income with physician visit frequency, length of hospital stay (LOS), and medical and LTC expenditures were evaluated and adjusted for 5-year age groups and LTC needs level. Results The study analyzed 12,852 men and 18,020 women, among which 13.3% and 41.5%, respectively, were categorized as low income. Participants with low income for both genders were more likely to be functionally dependent. In the adjusted analyses, lower income was associated with fewer physician visits (incidence rate ratio [IRR] 0.90; 95% confidence interval [CI], 0.87–0.92 for men and IRR 0.97; 95% CI, 0.95–0.99 for women), longer LOS (IRR 1.98; 95% CI, 1.54–2.56 and IRR 1.42; 95% CI, 1.20–1.67, respectively), and higher total expenditures (exp(β) 1.09; 95% CI, 1.01–1.18 and exp(β) 1.09; 95% CI, 1.05–1.14, respectively). Conclusions This study suggests that older people with lower income had fewer consultations with physicians but an increased use of inpatient services. The income categorization used in this study may be an appropriate proxy of socioeconomic status.
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Affiliation(s)
- Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba
| | | | - Nobuo Sakata
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba
| | - Boyoung Jeon
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba.,Division of Health Service for the Disabled, National Rehabilitation Center
| | - Takahiro Mori
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
| | | | - Satoru Yoshie
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba.,Institute of Gerontology, The University of Tokyo.,Department of Health Policy and Management, School of Medicine, Keio University
| | - Tatsuro Ishizaki
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
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20
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Zhu J, Xu L, Sun L, Li J, Qin W, Ding G, Wang Q, Zhang J, Xie S, Yu Z. Chronic Disease, Disability, Psychological Distress and Suicide Ideation among Rural Elderly: Results from a Population Survey in Shandong. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1604. [PMID: 30060593 PMCID: PMC6121389 DOI: 10.3390/ijerph15081604] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 12/12/2022]
Abstract
Objective: Suicide is a major public health and social problem in contemporary societies. Previous studies showed that the older the seniors were, the more likely it was that they would experience disability, chronic disease, or both. The objective of this study was to examine the joint effects of chronic disease and physical disability on suicide ideation while controlling for psychological distress among the rural elderly living in Shandong Province, China. Method: A total of 5514 rural elderly individuals (60+) living in Shandong Province, China were included in this study. Suicidal ideation was assessed by using questions from the National Comorbidity Survey (NCS). Multiple logistic analyses were performed to examine the factors associated with suicide ideation. A path analysis was conducted to test the direct and indirect effects of chronic disease and of activity of daily living (ADL) limitation on suicide ideation while controlling for psychological distress. Results: The prevalence of suicide ideation among the rural elderly in Shandong, China was 11.0%. Psychological distress had the strongest direct (β = 0.392) and total effect (β = 0.392), chronic disease (β = -0.034; β = -0.063) had both direct and indirect impacts, and ADL (β = 0.091) had indirect impacts on suicide ideation. Psychological distress was a mediator between chronic disease, ADL limitation, and suicide ideation. Conclusions: Psychological distress was the greatest influencing factor of suicide ideation among the rural elderly, followed by chronic disease and disability. Effective intervention measures should be taken to facilitate the early detection of psychological distress in clinical practice among the rural elderly.
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Affiliation(s)
- Jing Zhu
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wen-hua-xi Road, Jinan 250012, China.
| | - Lingzhong Xu
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wen-hua-xi Road, Jinan 250012, China.
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Long Sun
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wen-hua-xi Road, Jinan 250012, China.
| | - Jiajia Li
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wen-hua-xi Road, Jinan 250012, China.
| | - Wenzhe Qin
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wen-hua-xi Road, Jinan 250012, China.
| | - Gan Ding
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wen-hua-xi Road, Jinan 250012, China.
| | - Qian Wang
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wen-hua-xi Road, Jinan 250012, China.
| | - Jiao Zhang
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wen-hua-xi Road, Jinan 250012, China.
| | - Su Xie
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wen-hua-xi Road, Jinan 250012, China.
| | - Zihang Yu
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wen-hua-xi Road, Jinan 250012, China.
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Mondor L, Cohen D, Khan AI, Wodchis WP. Income inequalities in multimorbidity prevalence in Ontario, Canada: a decomposition analysis of linked survey and health administrative data. Int J Equity Health 2018. [PMID: 29941034 DOI: 10.1186/s12939‐018‐0800‐6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The burden of multimorbidity is a growing clinical and health system problem that is known to be associated with socioeconomic status, yet our understanding of the underlying determinants of inequalities in multimorbidity and longitudinal trends in measured disparities remains limited. METHODS We included all adult respondents from four cycles of the Canadian Community Health Survey (CCHS) (between 2005 to 2011/12), linked at the individual-level to health administrative data in Ontario, Canada (pooled n = 113,627). Multimorbidity was defined at each survey response as having ≥2 (of 17) high impact chronic conditions, based on claims data. Using a decomposition method of the Erreygers-corrected concentration index (CErreygers), we measured household income inequality and the contribution of the key determinants of multimorbidity (including socio-demographic, socio-economic, lifestyle and health system factors) to these disparities. Differences over time are described. We tested for statistically significant changes to measured inequality using the slope index (SII) and relative index of inequality (RII) with a 2-way interaction on pooled data. RESULTS Multimorbidity prevalence in 2011/12 was 33.5% and the CErreygers was - 0.085 (CI: -0.108 to - 0.062), indicating a greater prevalence among lower income groups. In decomposition analyses, income itself accounted more than two-thirds (69%) of this inequality. Age (21.7%), marital status (15.2%) and physical inactivity (10.9%) followed, and the contribution of these factors increased from baseline (2005 CCHS survey) with the exception of age. Other lifestyle factors, including heavy smoking and obesity, had minimal contribution to measured inequality (1.8 and 0.4% respectively). Tests for trends (SII/RII) across pooled survey data were not statistically significant (p = 0.443 and 0.405, respectively), indicating no change in inequalities in multimorbidity prevalence over the study period. CONCLUSIONS A pro-rich income gap in multimorbidity has persisted in Ontario from 2005 to 2011/12. These empirical findings suggest that to advance equality in multimorbidity prevalence, policymakers should target chronic disease prevention and control strategies focused on older adults, non-married persons and those that are physically inactive, in addition to addressing income disparities directly.
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Affiliation(s)
- Luke Mondor
- Institute for Clinical Evaluative Sciences (ICES), G1 06 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Deborah Cohen
- Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada.,School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G Z53, Canada
| | - Anum Irfan Khan
- Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada.,Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Walter P Wodchis
- Institute for Clinical Evaluative Sciences (ICES), G1 06 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. .,Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada. .,Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada. .,Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, ON, L5B 1B8, Canada.
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22
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Mondor L, Cohen D, Khan AI, Wodchis WP. Income inequalities in multimorbidity prevalence in Ontario, Canada: a decomposition analysis of linked survey and health administrative data. Int J Equity Health 2018; 17:90. [PMID: 29941034 PMCID: PMC6019796 DOI: 10.1186/s12939-018-0800-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/11/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The burden of multimorbidity is a growing clinical and health system problem that is known to be associated with socioeconomic status, yet our understanding of the underlying determinants of inequalities in multimorbidity and longitudinal trends in measured disparities remains limited. METHODS We included all adult respondents from four cycles of the Canadian Community Health Survey (CCHS) (between 2005 to 2011/12), linked at the individual-level to health administrative data in Ontario, Canada (pooled n = 113,627). Multimorbidity was defined at each survey response as having ≥2 (of 17) high impact chronic conditions, based on claims data. Using a decomposition method of the Erreygers-corrected concentration index (CErreygers), we measured household income inequality and the contribution of the key determinants of multimorbidity (including socio-demographic, socio-economic, lifestyle and health system factors) to these disparities. Differences over time are described. We tested for statistically significant changes to measured inequality using the slope index (SII) and relative index of inequality (RII) with a 2-way interaction on pooled data. RESULTS Multimorbidity prevalence in 2011/12 was 33.5% and the CErreygers was - 0.085 (CI: -0.108 to - 0.062), indicating a greater prevalence among lower income groups. In decomposition analyses, income itself accounted more than two-thirds (69%) of this inequality. Age (21.7%), marital status (15.2%) and physical inactivity (10.9%) followed, and the contribution of these factors increased from baseline (2005 CCHS survey) with the exception of age. Other lifestyle factors, including heavy smoking and obesity, had minimal contribution to measured inequality (1.8 and 0.4% respectively). Tests for trends (SII/RII) across pooled survey data were not statistically significant (p = 0.443 and 0.405, respectively), indicating no change in inequalities in multimorbidity prevalence over the study period. CONCLUSIONS A pro-rich income gap in multimorbidity has persisted in Ontario from 2005 to 2011/12. These empirical findings suggest that to advance equality in multimorbidity prevalence, policymakers should target chronic disease prevention and control strategies focused on older adults, non-married persons and those that are physically inactive, in addition to addressing income disparities directly.
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Affiliation(s)
- Luke Mondor
- Institute for Clinical Evaluative Sciences (ICES), G1 06 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
- Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Deborah Cohen
- Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON M5T 3M6 Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G Z53 Canada
| | - Anum Irfan Khan
- Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON M5T 3M6 Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Walter P. Wodchis
- Institute for Clinical Evaluative Sciences (ICES), G1 06 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
- Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON M5T 3M6 Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6 Canada
- Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, ON L5B 1B8 Canada
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Does Walkability Contribute to Geographic Variation in Psychosocial Distress? A Spatial Analysis of 91,142 Members of the 45 and Up Study in Sydney, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020275. [PMID: 29415461 PMCID: PMC5858344 DOI: 10.3390/ijerph15020275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 01/03/2023]
Abstract
Walkability describes the capacity of the built environment to promote walking, and has been proposed as a potential focus for community-level mental health planning. We evaluated this possibility by examining the contribution of area-level walkability to variation in psychosocial distress in a population cohort at spatial scales comparable to those used for regional planning in Sydney, Australia. Data on psychosocial distress were analysed for 91,142 respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. We fit conditional auto regression models at the postal area level to obtain smoothed “disease maps” for psychosocial distress, and assess its association with area-level walkability after adjusting for individual- and area-level factors. Prevalence of psychosocial distress was 7.8%; similar for low (7.9%), low-medium (7.9%), medium-high (8.0%), and high (7.4%) walkability areas; and decreased with reducing postal area socioeconomic disadvantage: 12.2% (most), 9.3%, 7.5%, 5.9%, and 4.7% (least). Unadjusted disease maps indicated strong geographic clustering of psychosocial distress with 99.0% of excess prevalence due to unobserved and spatially structured factors, which was reduced to 55.3% in fully adjusted maps. Spatial and unstructured variance decreased by 97.3% and 39.8% after adjusting for individual-level factors, and another 2.3% and 4.2% with the inclusions of area-level factors. Excess prevalence of psychosocial distress in postal areas was attenuated in adjusted models but remained spatially structured. Postal area prevalence of high psychosocial distress is geographically clustered in Sydney, but is unrelated to postal area walkability. Area-level socioeconomic disadvantage makes a small contribution to this spatial structure; however, community-level mental health planning will likely deliver greatest benefits by focusing on individual-level contributors to disease burden and inequality associated with psychosocial distress.
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Pujilestari CU, Nyström L, Norberg M, Weinehall L, Hakimi M, Ng N. Socioeconomic inequality in abdominal obesity among older people in Purworejo District, Central Java, Indonesia - a decomposition analysis approach. Int J Equity Health 2017; 16:214. [PMID: 29233136 PMCID: PMC5727959 DOI: 10.1186/s12939-017-0708-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/27/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Obesity has become a global health challenge as its prevalence has increased globally in recent decades. Studies in high-income countries have shown that obesity is more prevalent among the poor. In contrast, obesity is more prevalent among the rich in low- and middle-income countries, hence requiring different focal points to design public health policies in the latter contexts. We examined socioeconomic inequalities in abdominal obesity in Purworejo District, Central Java, Indonesia and identified factors contributing to the inequalities. METHODS We utilised data from the WHO-INDEPTH Study on global AGEing and adult health (WHO-INDEPTH SAGE) conducted in the Purworejo Health and Demographic Surveillance System (HDSS) in Purworejo District, Indonesia in 2010. The study included 14,235 individuals aged 50 years and older. Inequalities in abdominal obesity across wealth groups were assessed separately for men and women using concentration indexes. Decomposition analysis was conducted to assess the determinants of socioeconomic inequalities in abdominal obesity. RESULTS Abdominal obesity was five-fold more prevalent among women than in men (30% vs. 6.1%; p < 0.001). The concentration index (CI) analysis showed that socioeconomic inequalities in abdominal obesity were less prominent among women (CI = 0.26, SE = 0.02, p < 0.001) compared to men (CI = 0.49, SE = 0.04, p < 0.001). Decomposition analysis showed that physical labour was the major determinant of socioeconomic inequalities in abdominal obesity among men, explaining 47% of the inequalities, followed by poor socioeconomic status (31%), ≤ 6 years of education (15%) and current smoking (11%). The three major determinants of socioeconomic inequalities in abdominal obesity among women were poor socio-economic status (48%), physical labour (17%) and no formal education (16%). CONCLUSION Abdominal obesity was more prevalent among older women in a rural Indonesian setting. Socioeconomic inequality in abdominal obesity exists and concentrates more among the rich population in both sexes. The inequality gap is less prominent among women, indicating a trend towards obesity being more common in poor women. Policies to address social determinants of health need to be developed to address the socioeconomic inequality gaps in obesity, with particular focus on addressing the existing burden of obesity among the better-off population group, while preventing the imminent burden of obesity among the worst-off group, particularly among women.
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Affiliation(s)
- Cahya Utamie Pujilestari
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
| | - Lennarth Nyström
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
| | - Margareta Norberg
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
| | - Lars Weinehall
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
| | - Mohammad Hakimi
- Centre for Reproductive Health, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Nawi Ng
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
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Celeste RK, Fritzell J. Do socioeconomic inequalities in pain, psychological distress and oral health increase or decrease over the life course? Evidence from Sweden over 43 years of follow-up. J Epidemiol Community Health 2017; 72:160-167. [PMID: 29175868 PMCID: PMC5800356 DOI: 10.1136/jech-2017-209123] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 10/03/2017] [Accepted: 10/16/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Inequalities over the life course may increase due to accumulation of disadvantage or may decrease because ageing can work as a leveller. We report how absolute and relative socioeconomic inequalities in musculoskeletal pain, oral health and psychological distress evolve with ageing. METHODS Data were combined from two nationally representative Swedish panel studies: the Swedish Level-of-Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old. Individuals were followed up to 43 years in six waves (1968, 1974, 1981, 1991/1992, 2000/2002, 2010/2011) from five cohorts: 1906-1915 (n=899), 1925-1934 (n=906), 1944-1953 (n=1154), 1957-1966 (n=923) and 1970-1981 (n=1199). The participants were 15-62 years at baseline. Three self-reported outcomes were measured as dichotomous variables: teeth not in good conditions, psychological distress and musculoskeletal pain. The fixed-income groups were: (A) never poor and (B) poor at least once in life. The relationship between ageing and the outcomes was smoothed with locally weighted ordinary least squares, and the relative and absolute gaps were calculated with Poisson regression using generalised estimating equations. RESULTS All outcomes were associated with ageing, birth cohort, sex and being poor at least once in live. Absolute inequalities increased up to the age of 45-64 years, and then they decreased. Relative inequalities were large already in individuals aged 15-25 years, showing a declining trend over the life course. Selective mortality did not change the results. The socioeconomic gap was larger for current poverty than for being poor at least once in life. CONCLUSION Inequalities persist into very old age, though they are more salient in midlife for all three outcomes observed.
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Affiliation(s)
- Roger Keller Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Johan Fritzell
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Mayne DJ, Morgan GG, Jalaludin BB, Bauman AE. The contribution of area-level walkability to geographic variation in physical activity: a spatial analysis of 95,837 participants from the 45 and Up Study living in Sydney, Australia. Popul Health Metr 2017; 15:38. [PMID: 28974226 PMCID: PMC5627488 DOI: 10.1186/s12963-017-0149-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 08/25/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Individual-level studies support a positive relation between walkable built environments and participation in moderate-intensity walking. However, the utility of this evidence for population-level planning is less clear as it is derived at much finer spatial scales than those used for regional programming. The aims of this study were to: evaluate if individual-level relations between walkability and walking to improve health manifest at population-level spatial scales; assess the specificity of area-level walkability for walking relative to other moderate and vigorous physical activity (MVPA); describe geographic variation in walking and other MVPA; and quantify the contribution of walkability to this variation. METHODS Data on sufficient walking, sufficient MVPA, and high MVPA to improve health were analyzed for 95,837 Sydney respondents to the baseline survey of the 45 and Up Study between January 2006 and April 2010. We used conditional autoregressive models to create smoothed MVPA "disease maps" and assess relations between sufficient MVPA to improve health and area-level walkability adjusted for individual-level demographic, socioeconomic, and health factors, and area-level relative socioeconomic disadvantage. RESULTS Within-cohort prevalence of meeting recommendations for sufficient walking, sufficient MVPA, and high MVPA were 31.7 (95% CI 31.4-32.0), 69.4 (95% CI 69.1-69.7), and 56.1 (95% CI 55.8-56.4) percent. Prevalence of sufficient walking was increased by 1.20 (95% CrI 1.12-1.29) and 1.07 (95% CrI 1.01-1.13) for high and medium-high versus low walkability postal areas, and for sufficient MVPA by 1.05 (95% CrI 1.01-1.08) for high versus low walkability postal areas. Walkability was not related to high MVPA. Postal area walkability explained 65.8 and 47.4 percent of residual geographic variation in sufficient walking and sufficient MVPA not attributable to individual-level factors. CONCLUSIONS Walkability is associated with area-level prevalence and geographic variation in sufficient walking and sufficient MVPA to improve health in Sydney, Australia. Our study supports the use of walkability indexes at multiple spatial scales for informing population-level action to increase physical activity and the utility of spatial analysis for walkability research and planning.
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Affiliation(s)
- Darren J. Mayne
- Sydney School of Public Health, The University of Sydney, Camperdown, 2006 NSW Australia
- Public Health Unit, Illawarra Shoalhaven Local Health District, Warrawong, 2502 NSW Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, 2500 NSW Australia
- Illawarra Health and Medical Research Institute, Wollongong, 2500 NSW Australia
| | - Geoffrey G. Morgan
- University Centre for Rural Health - North Coast, School of Public Health, The University of Sydney, Camperdown, 2006 NSW Australia
| | - Bin B. Jalaludin
- Ingham Institute, University of New South Wales, Sydney, 2052 NSW Australia
- Epidemiology, Healthy People and Places Unit, Population Health, South Western Sydney Local Health District, Liverpool, 1871 NSW Australia
| | - Adrian E. Bauman
- Sydney School of Public Health, The University of Sydney, Camperdown, 2006 NSW Australia
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Matsuyama Y, Aida J, Tsuboya T, Hikichi H, Kondo K, Kawachi I, Osaka K. Are Lowered Socioeconomic Circumstances Causally Related to Tooth Loss? A Natural Experiment Involving the 2011 Great East Japan Earthquake. Am J Epidemiol 2017; 186:54-62. [PMID: 28472254 DOI: 10.1093/aje/kwx059] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/03/2017] [Indexed: 11/13/2022] Open
Abstract
Oral health status is correlated with socioeconomic status. However, the causal nature of the relationship is not established. Here we describe a natural experiment involving deteriorating socioeconomic circumstances following exposure to the 2011 Great East Japan Earthquake and Tsunami. We investigated the relationship between subjective economic deterioration and housing damage due to the disaster and tooth loss in a cohort of community-dwelling residents (n = 3,039), from whom we obtained information about socioeconomic status and health status in 2010 (i.e., predating the disaster). A follow-up survey was performed in 2013 (postdisaster), and 82.1% of the 4,380 eligible survivors responded. We estimated the impact of subjective economic deterioration and housing damage due to the disaster on tooth loss by fitting an instrumental variable probit model. Subjective economic deterioration and housing damage due to the disaster were significantly associated with 8.1% and 1.7% increases in the probability of tooth loss (probit coefficients were 0.469 (95% confidence interval: 0.065, 0.872) and 0.103 (95% confidence interval: 0.011, 0.196), respectively). In this natural experiment, we confirmed the causal relationship between deteriorating socioeconomic circumstances and tooth loss.
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The association between personal income and aging: A population-based 13-year longitudinal study. Arch Gerontol Geriatr 2017; 70:76-83. [DOI: 10.1016/j.archger.2017.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 12/23/2016] [Accepted: 01/02/2017] [Indexed: 11/22/2022]
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von dem Knesebeck O, Vonneilich N, Lüdecke D. Income and functional limitations among the aged in Europe: a trend analysis in 16 countries. J Epidemiol Community Health 2017; 71:584-591. [DOI: 10.1136/jech-2016-208369] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/11/2016] [Accepted: 12/14/2016] [Indexed: 11/03/2022]
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Resilience moderates the association between stigma and psychological distress among family caregivers of patients with schizophrenia. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.02.062] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kastor A, Mohanty SK. Associated Covariates of Functional Limitation Among Older Adults in India: an Exploration. AGEING INTERNATIONAL 2016. [DOI: 10.1007/s12126-016-9241-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Flatz A, Casillas A, Stringhini S, Zuercher E, Burnand B, Peytremann-Bridevaux I. Association between education and quality of diabetes care in Switzerland. Int J Gen Med 2015; 8:87-92. [PMID: 25759596 PMCID: PMC4346359 DOI: 10.2147/ijgm.s77139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Low socioeconomic status is associated with higher prevalence of diabetes, worse outcomes, and worse quality of care. We explored the relationship between education, as a measure of socioeconomic status, and quality of care in the Swiss context. PATIENTS AND METHODS Data were drawn from a population-based survey of 519 adults with diabetes during fall 2011 and summer 2012 in a canton of Switzerland. We assessed patients and diabetes characteristics. Eleven indicators of quality of care were considered (six of process and five of outcomes of care). After bivariate analyses, regression analyses adjusted for age, sex, and diabetic complications were performed to assess the relationship between education and quality of care. RESULTS Of 11 quality-of-care indicators, three were significantly associated with education: funduscopy (patients with tertiary versus primary education were more likely to get the exam: odds ratio, 1.8; 95% confidence interval [CI], 1.004-3.3) and two indicators of health-related quality of life (patients with tertiary versus primary education reported better health-related quality of life: Audit of Diabetes-Dependent Quality of Life: β=0.6 [95% CI, 0.2-0.97]; SF-12 mean physical component summary score: β=3.6 [95% CI, 0.9-6.4]). CONCLUSION Our results suggest the presence of educational inequalities in quality of diabetes care. These findings may help health professionals focus on individuals with increased needs to decrease health inequalities.
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Affiliation(s)
- Aline Flatz
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Alejandra Casillas
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Emilie Zuercher
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
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