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Galán I, Fontán J, Ortiz C, López-Cuadrado T, Téllez-Plaza M, García-Esquinas E. Volume of alcohol intake, heavy episodic drinking, and all-cause mortality in Spain: A longitudinal population-based study. Addict Behav 2024; 158:108108. [PMID: 39033565 DOI: 10.1016/j.addbeh.2024.108108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/13/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION The impact of alcohol consumption on health, particularly in low quantities, remains controversial. Our objective was to assess the association between alcohol volume and heavy episodic drinking (HED) with all-cause mortality, while minimizing many of the known methodological issues. METHODOLOGY This longitudinal study used data from the 2011-2012 National Health Survey and the 2014 European Health Survey in Spain. Data from 43,071 participants aged ≥ 15 years were linked to mortality records as of December 2021. Alcohol consumption categories were defined based on intake volume and frequency: never-drinkers, former drinkers, infrequent occasional drinkers (≤once/month), frequent occasional drinkers ( once /month). Regular drinkers (≥once/week) were further classified by volume: >0-10 g/day, >10-20 g/day, >20-40 g/day, and > 40 g/day. Heavy Episodic Drinking (HED) was defined as ≥ 6 and ≥ 5 standard drinks (10 g) within 4-6 h for men and women, respectively. Hazard ratios (HR) were calculated using Cox regression, adjusting for sociodemographic variables, lifestyle factors, health status, and alcohol volume or HED. RESULTS Compared to infrequent occasional drinkers, HRs for never-drinkers and former drinkers were 1.30 (95 %CI:1.14-1.47) and 1.32 (95 %CI:1.15-1.50), respectively. No differences in mortality risk were observed for intakes up to 20 g/day, but it increased for consumptions > 20-40 g/day and > 40 g/day (HR = 1.29; 95 %CI:1.05-1.58 and HR = 1.57; 95 %CI:1.14-2.17, respectively). The HR of weekly HED vs. never was 1.31 (95 %CI:0.98-1.75). CONCLUSIONS Compared to infrequent occasional drinking, consuming low amounts of alcohol had no impact on mortality risk. However, never-drinkers, former drinkers, individuals with regular consumption > 20 g/day, and those engaging in weekly HED, experienced higher mortality risk.
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Affiliation(s)
- Iñaki Galán
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain.
| | - Julia Fontán
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Cristina Ortiz
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.
| | - Teresa López-Cuadrado
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain.
| | - María Téllez-Plaza
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain.
| | - Esther García-Esquinas
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain.
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Danpanichkul P, Suparan K, Ng CH, Dejvajara D, Kongarin S, Panpradist N, Chaiyakunapruk N, Muthiah MD, Chen VL, Huang DQ, Díaz LA, Noureddin M, Arab JP, Wijarnpreecha K. Global and regional burden of alcohol-associated liver disease and alcohol use disorder in the elderly. JHEP Rep 2024; 6:101020. [PMID: 38515553 PMCID: PMC10956070 DOI: 10.1016/j.jhepr.2024.101020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 03/23/2024] Open
Abstract
Background & Aims Alcohol-associated liver diseases (ALDs) and alcohol use disorder (AUD) pose a global health risk. AUD is underrecognized in the elderly, and the burden of AUD complications, including ALD, may increase with aging populations and rising alcohol intake. However, there is a lack of epidemiological evidence on AUD and ALD in the elderly. Methods Using the Global Burden of Disease Study 2019, we analyzed the prevalence, mortality, disability-adjusted life years (DALYs), age-standardized rates (ASRs), and temporal change from 2000 to 2019 of ALD and AUD in the overall population and the elderly (65-89 years). The findings were categorized by sex, region, nation, and sociodemographic index. Results The prevalence rates of ALD in the elderly were higher than those in adolescents and young adults, whereas AUD levels were lower than those in adolescents and young adults. In 2019, there were 9.39 million cases (8.69% of cases in the overall population) of AUD, 3.23 million cases (21.8% of cases in the overall population) of alcohol-associated cirrhosis, and 68,468 cases (51.27% of cases in the overall population) of liver cancer from alcohol among the elderly. ASRs of the prevalence of ALD and AUD in the elderly increased in most regions; on the contrary, ASRs of death and DALYs decreased in most regions. Nevertheless, ASRs of death and DALYs from liver cancer from alcohol increased in many areas. Conclusions Our findings highlighted the increased prevalence of ALD in the elderly, with a burden of AUD comparable with that in the overall population. Public health strategies on ALD and AUD targeting the elderly are urgently needed. Impact and implications The burden of alcohol-associated liver disease (ALD) and alcohol use disorder (AUD) is increasing. Advances in healthcare and education have resulted in a remarkable spike in life expectancy and a consequential population aging. Nevertheless, little is known about the epidemiology of ALD and AUD in the elderly. Our study indicates the increasing burden of ALD and AUD in the elderly population, necessitating early detection, intervention, and tailored care to the unique needs and complexities faced by older individuals grappling with these conditions.
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Affiliation(s)
- Pojsakorn Danpanichkul
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokphong Suparan
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Cheng Han Ng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | | | | | - Nuttada Panpradist
- Global Center for Integrated Health for Women, Adolescents, and Children (Global WACh), Department of Global Health, University of Washington, Seattle, WA, USA
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Mark D. Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Vincent L. Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Q. Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore
| | - Luis Antonio Díaz
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Mazen Noureddin
- Houston Methodist and Houston Research Institute, Houston, TX, USA
| | - Juan Pablo Arab
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, ON, Canada
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Internal Medicine, Banner University Medical Center, Phoenix, AZ, USA
- BIO5 Institute, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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Zhu Y, Llamosas-Falcón L, Kerr W, Puka K, Probst C. Differential Associations of Alcohol Use With Ischemic Heart Disease Mortality by Socioeconomic Status in the US, 1997-2018. JAMA Netw Open 2024; 7:e2354270. [PMID: 38300620 PMCID: PMC10835511 DOI: 10.1001/jamanetworkopen.2023.54270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/11/2023] [Indexed: 02/02/2024] Open
Abstract
Importance People with low socioeconomic status (SES) experience greater burden from alcohol-attributable health conditions and mortality at equal levels of alcohol consumption compared with those with high SES. A U-shaped association has been established between alcohol use and ischemic heart disease (IHD), but no study has explored how such an association differs by SES in the US. Objective To investigate how the association of alcohol use with ischemic heart disease mortality differs by SES in the general US population. Design, Setting, and Participants This cohort study used record-linked, cross-sectional National Health Interview Survey data for US adults aged 25 years and older, covering 1997 to 2018 with mortality follow-up until 2019. Data analysis was performed from March to June 2023. Exposures SES (operationalized using education attainment) and alcohol consumption were obtained from self-reported questionnaires. Main Outcomes and Measures The outcome was time to IHD mortality or last presumed alive by December 31, 2019. Cox proportional hazard models were applied to evaluate the interaction of SES and alcohol use on IHD mortality, with age as the time scale. Sex-stratified analyses were performed, adjusting for race and ethnicity, marital status, smoking, body mass index, physical activity, and survey year. Fine-Gray subdistribution models were applied to account for competing risks. Results This cohort study of 524 035 participants (mean [SD] age at baseline, 50.3 [16.2] years; 290 492 women [51.5%]) found a statistically significantly greater protective association of drinking less than 20 g per day (vs lifetime abstinence) with IHD mortality in the high-SES group compared with the low-SES group (interaction term hazard ratio [HR], 1.22 [95% CI, 1.02-1.45] in men; HR, 1.35 [95% CI, 1.09-1.67] in women). In addition, the differential associations of drinking less than 20 g per day with IHD mortality by SES were observed only among people with less than monthly heavy episodic drinking (HED) (interaction term, HR, 1.20 [95% CI, 1.01-1.43] in men; HR, 1.34 [95% CI, 1.08-1.67] in women); no difference was found in people with at least monthly HED. Among women there was a greater protective association of drinking less than 20 g per day with IHD mortality in the high-SES group than the middle-SES group (interaction term, HR, 1.35 [95% CI, 1.06-1.72]). Among men, the harmful association of drinking more than 60 g per day with IHD mortality in the low-SES group was largely explained by other behavioral risk factors (ie, smoking, body mass index, and physical activity). Conclusions and Relevance This cohort study found a greater protective association between drinking less than 20 g per day with less than monthly HED and IHD mortality in the high-SES group compared with the low-SES group, in both sexes even after adjusting for key covariables and behavioral risk factors. The findings suggest that public health interventions on alcohol use should account for different socioeconomic backgrounds when assessing the level of risk related to alcohol exposure, bearing in mind that levels of consumption deemed safe regarding a specific outcome such as IHD may indeed be less safe or not safe across all sociodemographic groups.
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Affiliation(s)
- Yachen Zhu
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Laura Llamosas-Falcón
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - William Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Klajdi Puka
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Heidelberg Institute of Global Health, Universitätsklinikum Heidelberg, Heidelberg, Germany
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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de Carvalho WRG, Meira KC, de Medeiros AGP, Neves LBDS, Vardiero NA, Mendonça Guimarães R. Socio-economic vulnerability and deaths of despair in Brazilian counties. Prev Med Rep 2024; 38:102623. [PMID: 38375166 PMCID: PMC10874878 DOI: 10.1016/j.pmedr.2024.102623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Over the past few years, there has been a progressive increase in premature deaths attributable to suicide, drug overdose, and alcohol-related liver disease that impact life expectancy. Regarding the relationship with contextual effects, the evidence is developing, especially in countries with a peripheral economy, as is the case of Brazil. We carried out an analysis aimed at estimating the relationship between socioeconomic insecurity and deaths due to despair in Brazilian cities. We used 5,570 counties' data to create clusters concerning socioeconomic development and then analyzed age-adjusted mortality rates (ASMR) from each of them and compared them using the ANOVA test. Cluster analysis generated two groups of Brazilian municipalities. DoD rates are consistently higher in the group that experiences more deprivation. However, considering differences between 2010 and 2019, the increase in rates was higher in the group with less deprivation experience (48.82 % vs. 39.53 %) We verified an existing gap between the clusters before the beginning of economic stagnation in 2010 The gap between those two groups decreased from 20.58 % (p < 0.001) in 2010 to 14.03 % in 2019 (p = 0.034). The conjuncture of economic crises creates mortality differentials in certain population groups. Also, significant inequalities explain how causes of death from despair affect different subpopulations. Our first approach assessed this assumption, and we could check those differentials at an ecological level. Public policies should focus on reducing the difference in mortality from despair between higher and lower socioeconomic strata.
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Affiliation(s)
| | | | | | | | | | - Raphael Mendonça Guimarães
- Oswaldo Cruz Foundation, National School of Public Health, Department of Social Sciences. Rio de Janeiro, RJ, Brazil
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Chen D, Ejlskov L, Laustsen LM, Weye N, Sørensen CLB, Momen NC, Dreier JW, Zheng Y, Damgaard AJ, McGrath JJ, Sørensen HT, Plana-Ripoll O. The Role of Socioeconomic Position in the Association Between Mental Disorders and Mortality: A Systematic Review and Meta-Analysis. JAMA Psychiatry 2024; 81:125-134. [PMID: 37966825 PMCID: PMC10652216 DOI: 10.1001/jamapsychiatry.2023.4316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/14/2023] [Indexed: 11/16/2023]
Abstract
Importance Studies are lacking summarizing how the association between mental disorders and mortality varies by socioeconomic position (SEP), particularly considering different aspects of SEP, specific types of mental disorders, and causes of death. Objective To investigate the role of SEP in the association between mental disorders and mortality and the association between SEP and mortality among people with mental disorders. Data Sources MEDLINE, Embase, PsycINFO, and Web of Science were searched from January 1, 1980, through April 3, 2023, and a snowball search of reference and citation lists was conducted. Study Selection Inclusion criteria were observational studies estimating the associations between different types of mental disorders and mortality, stratified by SEP and between SEP and mortality in people with mental disorders. Data Extraction and Synthesis Pairs of reviewers independently extracted data using a predefined data extraction form and assessed the risk of bias using the adapted Newcastle-Ottawa scale. Graphical analyses of the dose-response associations and random-effects meta-analyses were performed. Heterogeneity was explored through meta-regressions and sensitivity analyses. Main Outcomes and Measures All-cause and cause-specific mortality. Results Of 28 274 articles screened, 71 including more than 4 million people with mental disorders met the inclusion criteria (most of which were conducted in high-income countries). The relative associations between mental disorders and mortality were similar across SEP levels. Among people with mental disorders, belonging to the highest rather than the lowest SEP group was associated with lower all-cause mortality (pooled relative risk [RR], 0.79; 95% CI, 0.73-0.86) and mortality from natural causes (RR, 0.73; 95% CI, 0.62-0.85) and higher mortality from external causes (RR, 1.18; 95% CI, 0.99-1.41). Heterogeneity was high (I2 = 83% to 99%). Results from subgroup, sensitivity, and meta-regression analyses were consistent with those from the main analyses. Evidence on absolute scales, specific diagnoses, and specific causes of death was scarce. Conclusion and Relevance This study did not find a sufficient body of evidence that SEP moderated the relative association between mental disorders and mortality, but the underlying mortality rates may differ by SEP group, despite having scarcely been reported. This information gap, together with our findings related to SEP and a possible differential risk between natural and external causes of death in individuals with specific types of mental disorders, warrants further research.
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Affiliation(s)
- Danni Chen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Linda Ejlskov
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Lisbeth Mølgaard Laustsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Nanna Weye
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Natalie C. Momen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | | | - Yan Zheng
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Jensen Damgaard
- Master Program in Health Science, Rehabilitation and Prevention, Aarhus University, Aarhus, Denmark
| | - John J. McGrath
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Queensland Centre for Mental Health Research, University of Queensland, Wacol, Queensland, Australia
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
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Kilian C, Rehm J, Shield K, Manthey J. Changes in Alcohol-Specific Mortality During the COVID-19 Pandemic in 14 European Countries. SUCHT 2023; 69:285-293. [PMID: 39183774 PMCID: PMC11343567 DOI: 10.1024/0939-5911/a000841] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Aim Exploring trends in 1) alcohol-specific mortality and 2) alcohol sales in European countries in the years before and during the COVID-19 pandemic. Method Complete data on alcohol-specific mortality and alcohol sales were obtained for 14 European countries (13 EU countries and UK) for the years 2010 to 2020, with six countries having mortality data available up to 2021. Age-standardised mortality rates were calculated and descriptive statistics used. Results When compared to 2019, alcohol-specific mortality rates in 2020 increased by 7.7 % and 8.2 % for women and men, respectively. Increases in alcohol-specific mortality were seen in the majority of countries and continued in 2021. In contrast, alcohol sales declined by an average of 5.0 %. Conclusion Despite a drop in alcohol consumption, more people died due to alcohol-specific causes during the COVID-19 pandemic in Europe.
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Affiliation(s)
- Carolin Kilian
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Campbell Family Mental Health Research Institute (CAMH), Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto (UofT), Canada
- Department of Psychiatry (UofT), Toronto, Canada
- WHO European Region Collaborating Centre at Public Health Institute of Catalonia, Barcelona, Spain
- Department of Psychiatry and Psychotherapy, Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Germany
| | - Kevin Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Campbell Family Mental Health Research Institute (CAMH), Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto (UofT), Canada
| | - Jakob Manthey
- Department of Psychiatry and Psychotherapy, Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Germany
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Leonhardt M, Bramness JG, Lien L. Incidence of SARS-CoV-2 and all-cause mortality in persons with co-occurring substance use disorder and mental illness during the pandemic: a Norwegian cohort study. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02599-6. [PMID: 38015236 DOI: 10.1007/s00127-023-02599-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Most people were affected by the COVID-19 pandemic. Persons with co-occurring substance use disorder (SUD) and mental illness (MI) are already a marginalized group, with above average mortality. Thus, the study aim was to investigate SARS-CoV-2 incidence and mortality among persons with SUD/MI during the first two years of the pandemic. METHODS This historical cohort study merged data from the Norwegian Patient Register, the Norwegian Surveillance System for Communicable Diseases and census data from Statistics Norway. We calculated crude mortality rates for persons with SUD and mild/moderate vs. severe MI and compared them to persons with physical illnesses or healthy controls. The incidence rate ratios for SARS-CoV-2 infection and mortality were estimated using Poisson regression models. RESULTS Compared to healthy controls, the SARS-Cov-2-infection rate was marginally lower in persons with SUD and mild/moderate MI (IRR,1.19 [95%CI,1.09-1.30]) as in persons with physical illness (IRR,1.35 [95%CI, 1.23-1.47]), whereas persons with SUD and severe MI showed a lower rate compared to healthy controls. Crude mortality rates for persons with SUD/MI were substantially higher and increased much more during the pandemic than for persons with physical illnesses or healthy controls. The IRR for mortality in persons with SUD and mild/moderate MI was 10.61 (95%CI,7.19-15.67) and 11.44 (95%CI,7.50-17.45) for SUD and severe MI, compared to 5.03 (3.34-7.57]) for persons with physical illnesses only. CONCLUSION The analysis showed excess mortality during COVID-19-pandemic for SUD/MI, but without higher SARS-CoV-2 infection rates in this group. Consequently, excess mortality among persons with SUD/MI was not due to SARS-CoV-2 infection.
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Affiliation(s)
- Marja Leonhardt
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, PB 104, Brumunddal, 2381, Norway.
- Faculty of Health Studies, VID Specialized University, Oslo, Norway.
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, PB 104, Brumunddal, 2381, Norway
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, PB 104, Brumunddal, 2381, Norway
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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Kilian C, Lemp JM, Probst C. Who benefits from alcohol screening and brief intervention? A mini-review on socioeconomic inequalities with a focus on evidence from the United States. Addict Behav 2023; 145:107765. [PMID: 37315509 PMCID: PMC10330915 DOI: 10.1016/j.addbeh.2023.107765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
Alcohol-attributable mortality contributes to growing health inequalities. Addressing hazardous alcohol use and alcohol use disorders through alcohol screening and brief intervention is therefore a promising public health strategy to improve health equity. In this narrative mini-review, we discuss the extent to which socioeconomic differences exist in the alcohol screening and brief intervention cascade, highlighting the example of the United States. We have searched PubMed to identify and summarize relevant literature addressing socioeconomic inequalities in (a) accessing and affording healthcare, (b) receiving alcohol screenings, and/or (c) receiving brief interventions, focusing predominantly on literature from the Unites States. We found evidence for income-related inequalities in access to healthcare in the United States, partly due to inadequate health insurance coverage for individuals with low socioeconomic status. Alcohol screening coverage appears to be generally very low, as is the probability of receiving a brief intervention when indicated. However, research suggests that the latter is more likely to be provided to individuals with low socioeconomic status than those with high socioeconomic status. Individuals with low socioeconomic status also tend to benefit more from brief interventions, showing greater reductions in their alcohol use. Once access to and affordability of healthcare is ensured and high coverage of alcohol screening is achieved for all, alcohol screening and brief interventions have the potential to enhance health equity by reducing alcohol consumption and alcohol-related health harms.
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Affiliation(s)
- Carolin Kilian
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Julia M Lemp
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Leung J, Chiu V, Man N, Yuen WS, Dobbins T, Dunlop A, Gisev N, Hall W, Larney S, Pearson S, Degenhardt L, Peacock A. All-cause and cause-specific mortality in individuals with an alcohol-related emergency or hospital inpatient presentation: A retrospective data linkage cohort study. Addiction 2023; 118:1751-1762. [PMID: 37132062 PMCID: PMC10952273 DOI: 10.1111/add.16218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 04/03/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND AIMS Alcohol consumption is a leading risk factor for premature mortality globally, but there are limited studies of broader cohorts of people presenting with alcohol-related problems outside of alcohol treatment services. We used linked health administrative data to estimate all-cause and cause-specific mortality among individuals who had an alcohol-related hospital inpatient or emergency department presentation. DESIGN Observational study using data from the Data linkage Alcohol Cohort Study (DACS), a state-wide retrospective cohort of individuals with an alcohol-related hospital inpatient or emergency department presentation. SETTING Hospital inpatient or emergency department presentation in New South Wales, Australia, between 2005 and 2014. PARTICIPANTS Participants comprised 188 770 individuals aged 12 and above, 66% males, median age 39 years at index presentation. MEASUREMENTS All-cause mortality was estimated up to 2015 and cause-specific mortality (by those attributable to alcohol and by specific cause of death groups) up to 2013 due to data availability. Age-specific and age-sex-specific crude mortality rates (CMRs) were estimated, and standardized mortality ratios (SMRs) were calculated using sex and age-specific deaths rates from the NSW population. FINDINGS There were 188 770 individuals in the cohort (1 079 249 person-years of observation); 27 855 deaths were recorded (14.8% of the cohort), with a CMR of 25.8 [95% confidence interval (CI) = 25.5, 26.1] per 1000 person-years and SMR of 6.2 (95% CI = 5.4, 7.2). Mortality in the cohort was consistently higher than the general population in all adult age groups and in both sexes. The greatest excess mortality was from mental and behavioural disorders due to alcohol use (SMR = 46.7, 95% CI = 41.4, 52.7), liver cirrhosis (SMR = 39.0, 95% CI = 35.5, 42.9), viral hepatitis (SMR = 29.4, 95% CI = 24.6, 35.2), pancreatic diseases (SMR = 23.8, 95% CI = 17.9, 31.5) and liver cancer (SMR = 18.3, 95% CI = 14.8, 22.5). There were distinct differences between the sexes in causes of excess mortality (all causes fully attributable to alcohol female versus male risk ratio = 2.5 (95% CI = 2.0, 3.1). CONCLUSIONS In New South Wales, Australia, people who came in contact with an emergency department or hospital for an alcohol-related presentation between 2005 and 2014 were at higher risk of mortality than the general New South Wales population during the same period.
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Affiliation(s)
- Janni Leung
- National Drug and Alcohol Research Centre, UNSW SydneySydneyNSWAustralia
- Faculty of Health and Behavioural SciencesUniversity of QueenslandBrisbaneQLDAustralia
| | - Vivian Chiu
- National Drug and Alcohol Research Centre, UNSW SydneySydneyNSWAustralia
- Faculty of Health and Behavioural SciencesUniversity of QueenslandBrisbaneQLDAustralia
| | - Nicola Man
- National Drug and Alcohol Research Centre, UNSW SydneySydneyNSWAustralia
| | - Wing See Yuen
- National Drug and Alcohol Research Centre, UNSW SydneySydneyNSWAustralia
| | | | - Adrian Dunlop
- Hunter New England Health, New South Wales GovernmentNewcastleNSWAustralia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW SydneySydneyNSWAustralia
| | - Wayne Hall
- Faculty of Health and Behavioural SciencesUniversity of QueenslandBrisbaneQLDAustralia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW SydneySydneyNSWAustralia
- Department of Family Medicine and Emergency MedicineUniversity of MontréalMontréalQCCanada
- Centre de recherche du Centre hospitalier de l'Université de MontréalMontréalQCCanada
| | - Sallie‐Anne Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in HealthUNSW SydneySydneyNSWAustralia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW SydneySydneyNSWAustralia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW SydneySydneyNSWAustralia
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10
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Liu C, He L, Li Y, Yang A, Zhang K, Luo B. Diabetes risk among US adults with different socioeconomic status and behavioral lifestyles: evidence from the National Health and Nutrition Examination Survey. Front Public Health 2023; 11:1197947. [PMID: 37674682 PMCID: PMC10477368 DOI: 10.3389/fpubh.2023.1197947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
Background Diabetes disproportionately affects minorities and those with low socioeconomic status (SES) in the United States, and differences in behavioral lifestyles are largely responsible for the unequal distribution of diabetes among different groups. Methods With data of 9,969 participants collected in the 2007-2008 and 2009-2010 cycles of the US National Health and Nutrition Examination Survey (NHANES), this study examined several mediators and their mediating effects in the connection between SES and the risk of diabetes. The SES is assessed by the income-to-poverty ratio (IPR), education level, and employment status. For the mediation analysis, we used health-related behaviors as mediators (smoking, alcohol use, consumption of green vegetables and fruits, physical activity and sedentary time, health insurance, and healthcare). In this study, the structural equation model was utilized to evaluate the mediating effects of behavioral lifestyle as a mediator in the relationship between SES and diabetes. Results A total of 9,969 participants were included in this study. We found a negative nonlinear association between IPR and diabetes risk (Poverall < 0.001; Pnon-linear = 0.46), which was independent of the majority of known or suspected risk factors and confounding variables (gender, age, race). Participants with lower SES had higher risk of diabetes compared with those with higher SES. In mediating analysis, we found alcohol intake (OR = 0.996), physical activity (OR = 0.993), health insurance (OR = 0.998), and healthcare (OR = 1.002) mediated the IPR-diabetes association. But in the relationship between education status and diabetes, the mediation effect of alcohol intake (OR = 0.995), physical activity (OR = 0.991), and health care (OR = 1.008) were obvious. Likewise, alcohol intake (OR = 0.996), fruit intake (OR = 0.998), and health care (OR = 0.975) were important mediators in the association between employment status and diabetes. Conclusion This study provides critical insights on the link between SES and diabetes. Our results highlight that poor health-related behaviors and limited access to healthcare are important pathways for increased diabetes risk related to those with low SES, particularly among Mexican Americans and males. They should be top priorities for agencies and healthcare providers to develop behavior-related interventions to reduce inequalities in diabetes risk.
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Affiliation(s)
- Ce Liu
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, China
| | - Li He
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yuanfei Li
- Department of Sociology, University at Albany, State University of New York, Albany, CA, United States
| | - Aimin Yang
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, United States
| | - Bin Luo
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, China
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11
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Liu Y, Sun Z, Wang Q, Wu K, Tang Z, Zhang B. Contribution of alcohol use to the global burden of cirrhosis and liver cancer from 1990 to 2019 and projections to 2044. Hepatol Int 2023; 17:1028-1044. [PMID: 36871271 PMCID: PMC9985909 DOI: 10.1007/s12072-023-10503-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Identifying the temporal trends of cirrhosis and liver cancer attributable to alcohol use in both the past and the future can formulate the control strategies. METHODS Data on cirrhosis and liver cancer attributable to alcohol use from 1990 to 2019, including mortality and disability-adjusted life year (DALY) rates were collected from the 2019 Global Burden of Disease (GBD) study. To analyze the temporal trends, the average annual percentage change (AAPC) was calculated, and the Bayesian age-period-cohort model was applied. RESULT Deaths and DALY of cirrhosis and liver cancer attributable to alcohol use increased year by years, but the age-standardized death rate (ASDR) and age-standardized DALY rate declined or remained stable from 1990 to 2019 in most regions of the world. The burden of cirrhosis attributable to alcohol increased in low-middle social-development index (SDI) regions, while the burden of liver cancer increased in high-SDI regions. Eastern Europe and Central Asia have the highest burden of cirrhosis and liver cancer caused by alcohol use. Deaths and DALYs are mainly distributed in people aged 40+ years, but there is an increasing trend in people aged under 40 years. New deaths from cirrhosis and liver cancer attributable to alcohol use are predicted to increase in the next 25 years, but the ASDR of cirrhosis in males will increase slightly. CONCLUSIONS Although the age-standardized rate of cirrhosis and liver cancer due to alcohol use have decreased, the absolute burden increased and will continue to increase. Therefore, alcohol control measures should be further strengthened and improved through effective national policies.
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Affiliation(s)
- Yang Liu
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China
| | - Zhouyi Sun
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China
| | - Qianwen Wang
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China
| | - Kangze Wu
- The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310000, Zhejiang Province, China
| | - Zhe Tang
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China
| | - Bo Zhang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310000, Zhejiang Province, China.
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12
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Kilian C, Manthey J, Braddick F, López-Pelayo H, Rehm J. Social disparities in alcohol's harm to others: evidence from 32 European countries. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104079. [PMID: 37271071 DOI: 10.1016/j.drugpo.2023.104079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Alcohol use can cause harm not only to the person who consumes it but also to others. Prior research has found that these alcohol-attributable harms to others differ across socioeconomic groups, though several findings have been contradictory. The aim of this contribution was to study the role of individual-level and population-level income inequalities in alcohol's harm to others among women and men. METHODS Logistic regression analysis of cross-sectional survey data from 2021, covering 39,629 respondents from 32 European countries. Harms from others' drinking were defined as experiences of physical harm, involvement in a serious argument, or involvement in a traffic accident, due to another person's drinking, within the past year. We examined the association of individual-level income and country-specific income inequality (Gini index) with harms from a known person's or a stranger's drinking, adjusting for the respondent's age, daily drinking levels, and at least monthly risky single-occasion drinking. RESULTS At the individual level, people with lower incomes had 21% to 47% increased odds of reporting harms from a known person's drinking (women and men) or stranger's drinking (men only) than their same-gender counterparts in the highest income quintile. At the national level, countries with higher income inequality showed increased risks of harms from a known person's drinking among women (OR = 1.09, 95% confidence interval [CI]: 1.05 - 1.14), while among men the risk of harm from strangers' drinking decreased with higher income inequality (OR = 0.86, 95% CI: 0.81 - 0.92). These associations with income inequality were observed among respondents from all but the lowest income groups. CONCLUSION Alcohol can cause harm to others, with women and people with low incomes being disproportionally exposed to these harms. Alcohol control policies targeting high consumption levels, especially among men, as well as upstream policies to reduce inequalities, are needed to lower the health burden of alcohol beyond those who consume it.
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Affiliation(s)
- Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Jakob Manthey
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Fleur Braddick
- Grup de Recerca en Addicions Clínic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Hugo López-Pelayo
- Grup de Recerca en Addicions Clínic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Addictions Unit, Psychiatry Department, Hospital Clínic, Barcelona, Spain
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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13
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Probst C, Buckley C, Lasserre AM, Kerr WC, Mulia N, Puka K, Purshouse RC, Ye Y, Rehm J. Simulation of Alcohol Control Policies for Health Equity (SIMAH) Project: Study Design and First Results. Am J Epidemiol 2023; 192:690-702. [PMID: 36702471 PMCID: PMC10423629 DOI: 10.1093/aje/kwad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/15/2022] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
Since about 2010, life expectancy at birth in the United States has stagnated and begun to decline, with concurrent increases in the socioeconomic divide in life expectancy. The Simulation of Alcohol Control Policies for Health Equity (SIMAH) Project uses a novel microsimulation approach to investigate the extent to which alcohol use, socioeconomic status (SES), and race/ethnicity contribute to unequal developments in US life expectancy and how alcohol control interventions could reduce such inequalities. Representative, secondary data from several sources will be integrated into one coherent, dynamic microsimulation to model life-course changes in SES and alcohol use and cause-specific mortality attributable to alcohol use by SES, race/ethnicity, age, and sex. Markov models will be used to inform transition intensities between levels of SES and drinking patterns. The model will be used to compare a baseline scenario with multiple counterfactual intervention scenarios. The preliminary results indicate that the crucial microsimulation component provides a good fit to observed demographic changes in the population, providing a robust baseline model for further simulation work. By demonstrating the feasibility of this novel approach, the SIMAH Project promises to offer superior integration of relevant empirical evidence to inform public health policy for a more equitable future.
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Affiliation(s)
- Charlotte Probst
- Correspondence to Dr. Charlotte Probst, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula-Franklin Street, Toronto, ON M5S 2S1, Canada (e-mail: )
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Room R, Rehm J. "Harm per litre" as a concept and a measure in studying determinants of relations between alcohol consumption and harm. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104006. [PMID: 36965304 DOI: 10.1016/j.drugpo.2023.104006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/27/2023]
Abstract
The term "harm per litre" has been increasingly used in alcohol research in recent years as a concept and a comparative measure of alcohol-attributable harm in comparisons between environments, circumstances, and patterns of drinking. This essay discusses the origins of the term in connection with analyses in terms of patterns as well as levels of drinking and with concerns about differential harms from drinking different beverage types. Also discussed is the term's current primary usage, in the context of epidemiological concerns about differentially severe harms for poorer persons who drink. It is noted that these same concerns have been discussed, particularly in Britain, using the phrase "alcohol harm paradox". "Harm per litre" was initially most often used in comparisons between rates of alcohol-attributable harm by beverage type. After 2010, the expression was applied more broadly, particularly after its use in various World Health Organization-related discussions and documents. In addition, and especially from 2018 onwards when most of the papers using this term were published, it has been used in comparisons by socioeconomic status at the individual level, and by level of socioeconomic development at the country level. Almost all the findings indicate that people with lower socioeconomic status, and countries with lower average income, e.g., low income and lower-middle income countries, incur considerably higher harm per litre (with harm being expressed in disease burden and mortality) than upper middle-income and high-income countries. "Harm per litre" is a practicable and easy-to-understand concept to compare groups of individuals or countries, and to quantify health inequalities. The next important step will need to be elucidating a better causal understanding of the processes underlying these inequalities, with an emphasis on factors which can be most easily changed by interventions.
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Affiliation(s)
- Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada; Dalla Lana School of Public Health & Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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15
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Skarstein S, Lien L, Abebe DS. The burden of somatic diseases among people with alcohol- and drug use disorders are influenced by mental illness and low socioeconomic status. A registry-based cohort study in Norway. J Psychosom Res 2023; 165:111137. [PMID: 36608508 DOI: 10.1016/j.jpsychores.2022.111137] [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: 03/02/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Persons with alcohol use disorder (AUD) and drug use disorder (DUD) have a lower life expectancy than the general population. We examined the burden of somatic diseases among persons with AUD or DUD and investigated impact of socioeconomic status (SES) and mental health disorders on the co-occurrence of somatic diseases in these groups. METHODS We performed a retrospective, register-based cohort study with a 6-year follow-up of persons (aged ≥18 y) with AUD (13,478) or DUD (16,659). Cox regression analyses were used to estimate hazard ratios (HRs) of somatic diseases. RESULTS Patients with DUD were, on average, 10 years younger at the point of diagnosis than patients with AUD. Mental illnesses were prominent in both groups (AUD: 40.5%, and DUD: 46.9% vs 3.5% in controls). Adjusting for mental disorders, the risk of all somatic diseases among the AUD and DUD groups was reduced by 30%. Some of the elevated risk of somatic diseases among persons with AUD and DUD is explained by low SES, though less than that explained by the presence of mental disorders. The diseases with highest risk among AUD patients were metabolic disorders (16.9-fold) and hypertension (14.8-fold), and among AUD patients, viral hepatitis (23.3-fold), after adjusting for low SES and mental disorders. CONCLUSIONS Persons with AUD had a higher risk of most somatic diseases, while those with DUD had specific risks for infections and viral hepatitis. Mental health disorders and SES adjusted the associations regarding most somatic diseases. In general, improvement of socio-economic conditions, preferably in combination with professional support to self-manage mental health problems, will reduce the risk of somatic illness in both groups. For DUD patients, available sterile user equipment will reduce the risk of viral hepatis.
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Affiliation(s)
- Siv Skarstein
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway; Faculty of Social and Health Sciences, Inland University of Applied Sciences, Norway.
| | - Dawit Shawel Abebe
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway; Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway.
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Fortinguerra F, Pierantozzi A, Trotta F. The use of medications approved for alcohol use disorders in Italy. Front Public Health 2023; 11:1110435. [PMID: 36875354 PMCID: PMC9975714 DOI: 10.3389/fpubh.2023.1110435] [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: 11/28/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023] Open
Abstract
Background Italy has the highest per capita alcohol consumption among European countries. Several pharmacological treatments for alcohol use disorders (AUDs) are currently available in Italy, but no consumption data are available. A first analysis of national drug consumption, comprising the whole Italian population over a long-term period covering the COVID-19 pandemic, was performed. Methods To analyze the consumption of medications indicated for therapy of alcohol dependence, different national data sources were used. Consumption was measured as a defined daily dose (DDD) per 1,000,000 inhabitants per day. Results In 2020, the total consumption of medicines used in the treatment of AUDs amounted to 310.3 DDD per 1 million inhabitants per day (0.018% of the overall drug consumption in Italy) with a decreasing gradient from the north (373.9 DDD) to the south (250.7 DDD). 53.2% of the overall doses were dispensed by public healthcare facilities and 23.5% by community pharmacies, while the remaining 23.3% were purchased privately. The temporal trend of consumption seemed to be stable across the last few years, although an impact of the COVID-19 pandemic was observed. Disulfiram was the most consumed medicine over years. Conclusion All Italian regions offer pharmacological treatments to patients with AUDs, but differences in the number of dispensed doses suggest a different local organization of patient care, which can be partly explained by the different severity of the clinical condition of residing patients. Pharmacotherapy of alcoholism should be deeply investigated to describe the clinical characteristics of treated patients (i.e., comorbidities) and evaluate the appropriateness of prescribed medications.
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Room R, Cook M, Laslett AM. Substance use and the Sustainable Development Goals: will development bring greater problems? DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2022.2150125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Megan Cook
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Anne-Marie Laslett
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
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Silver D, Bae JY, McNeill E, Macinko J. Do alcohol policies affect everyone equally? An assessment of the effects of state policies on education-related patterns of alcohol use, 2011-2019. Drug Alcohol Depend 2022; 239:109591. [PMID: 35947919 DOI: 10.1016/j.drugalcdep.2022.109591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Public policies are a powerful tool to change behaviors that may harm population health, but little is known about how state alcohol policies affect different population groups. This study assesses the effects of a comprehensive measure of the state alcohol regulatory environment (the State Alcohol Policy Score or SAPS) on heavy drinking-a risk factor for premature death-on different population groups, defined by levels of educational attainment, then by race/ethnicity, and sex. METHODS We pool each state's Behavioral Risk Factor Surveillance Survey (BRFSS) 2011-2019 and use robust Poisson regression analyses that control for individual-level factors, state-level factors (1 year lagged SAPS score for each state, state fixed effects), and year fixed effects to assess the relationship between SAPS and heavy drinking behaviors by education group. Interaction terms test whether education moderates the relationship by race/ethnicity and gender. RESULTS SAPS scores increased 2010-2018, but substantial gaps persist between states. A 10 % increase in a state's alcohol policy score is associated with a 2 % lower prevalence in current drinking (APR=0.97, 95 % CI=0.97-0.97, p < 0.0011) although not for those with a high school education or less. A 10 % increase in the SAPS was associated with a 3 % lower prevalence of heavy drinking; interaction terms in models reveal that a 10 % increase in the SAPS was associated with a lower prevalence of heavy drinking among those with less than a college education. CONCLUSION Narrowing gaps in alcohol policies between states may reduce heavy drinking among those with lower educational attainment.
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Affiliation(s)
- Diana Silver
- Department of Public Health Policy and Management, New York University School of Global Public Health, 708 Broadway, NY 10003, USA.
| | - Jin Yung Bae
- Department of Public Health Policy and Management, New York University School of Global Public Health, 708 Broadway, NY 10003, USA
| | - Elizabeth McNeill
- Department of Public Health Policy and Management, New York University School of Global Public Health, 708 Broadway, NY 10003, USA
| | - James Macinko
- Departments of Community Health Sciences and Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
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Xu Y, Geldsetzer P, Manne-Goehler J, Theilmann M, Marcus ME, Zhumadilov Z, Quesnel-Crooks S, Mwalim O, Moghaddam SS, Koolaji S, Karki KB, Farzadfar F, Ebrahimi N, Damasceno A, Aryal KK, Agoudavi K, Atun R, Bärnighausen T, Davies J, Jaacks LM, Vollmer S, Probst C. The socioeconomic gradient of alcohol use: an analysis of nationally representative survey data from 55 low-income and middle-income countries. Lancet Glob Health 2022; 10:e1268-e1280. [PMID: 35961350 PMCID: PMC9582994 DOI: 10.1016/s2214-109x(22)00273-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Alcohol is a leading risk factor for over 200 conditions and an important contributor to socioeconomic health inequalities. However, little is known about the associations between individuals' socioeconomic circumstances and alcohol consumption, especially heavy episodic drinking (HED; ≥5 drinks on one occasion) in low-income or middle-income countries. We investigated the association between individual and household level socioeconomic status, and alcohol drinking habits in these settings. METHODS In this pooled analysis of individual-level data, we used available nationally representative surveys-mainly WHO Stepwise Approach to Surveillance surveys-conducted in 55 low-income and middle-income countries between 2005 and 2017 reporting on alcohol use. Surveys from participants aged 15 years or older were included. Logistic regression models controlling for age, country, and survey year stratified by sex and country income groups were used to investigate associations between two indicators of socioeconomic status (individual educational attainment and household wealth) and alcohol use (current drinking and HED amongst current drinkers). FINDINGS Surveys from 336 287 participants were included in the analysis. Among males, the highest prevalence of both current drinking and HED was found in lower-middle-income countries (L-MICs; current drinking 49·9% [95% CI 48·7-51·2] and HED 63·3% [61·0-65·7]). Among females, the prevalence of current drinking was highest in upper-middle-income countries (U-MIC; 29·5% [26·1-33·2]), and the prevalence of HED was highest in low-income countries (LICs; 36·8% [33·6-40·2]). Clear gradients in the prevalence of current drinking were observed across all country income groups, with a higher prevalence among participants with high socioeconomic status. However, in U-MICs, current drinkers with low socioeconomic status were more likely to engage in HED than participants with high socioeconomic status; the opposite was observed in LICs, and no association between socioeconomic status and HED was found in L-MICs. INTERPRETATION The findings call for urgent alcohol control policies and interventions in LICs and L-MICs to reduce harmful HED. Moreover, alcohol control policies need to be targeted at socially disadvantaged groups in U-MICs. FUNDING Deutsche Forschungsgemeinschaft and the National Center for Advancing Translational Sciences of the US National Institutes of Health.
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Affiliation(s)
- Yuanwei Xu
- School of Economics and Management, Gottfried Wilhelm Leibniz University of Hannover, Hannover, Germany; Faculty of Management and Economics, Ruhr University Bochum, Bochum, Germany.
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Jen Manne-Goehler
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Maja-E Marcus
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | | | - Sarah Quesnel-Crooks
- Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
| | | | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sogol Koolaji
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Khem B Karki
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ebrahimi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Krishna K Aryal
- Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | | | - Rifat Atun
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Global Health and Social Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Till Bärnighausen
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Boston, MA, USA; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany; Africa Health Research Institute, Somkhele, South Africa
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lindsay M Jaacks
- Global Academy of Agriculture and Food Security, The University of Edinburgh, Easter Bush Campus, Midlothian, UK
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany.
| | - Charlotte Probst
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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20
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Employment Status and Alcohol-Attributable Mortality Risk-A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127354. [PMID: 35742600 PMCID: PMC9224380 DOI: 10.3390/ijerph19127354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022]
Abstract
Being unemployed has been linked to various health burdens. In particular, there appears to be an association between unemployment and alcohol-attributable deaths. However, risk estimates presented in a previous review were based on only two studies. Thus, we estimated updated sex-stratified alcohol-attributable mortality risks for unemployed compared with employed individuals. A systematic literature search was conducted in August 2020 using the following databases: Embase, MEDLINE, PsycINFO, and Web of Science. The relative risk (RR) of dying from an alcohol-attributable cause of death for unemployed compared with employed individuals was summarized using sex-stratified random-effects DerSimonian-Laird meta-analyses. A total of 10 studies were identified, comprising about 14.4 million women and 19.0 million men, among whom there were about 3147 and 17,815 alcohol-attributable deaths, respectively. The pooled RRs were 3.64 (95% confidence interval (CI): 2.04–6.66) and 4.93 (95% CI 3.45–7.05) for women and men, respectively. The findings of our quantitative synthesis provide evidence that being unemployed is associated with an over three-fold higher risk of alcohol-attributable mortality compared with being employed. Consequently, a global public health strategy connecting brief interventions and specialized care with social services assisting those currently unemployed is needed.
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21
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Blair KJ, de Virgilio M, Dissak-Delon FN, Dang LE, Christie SA, Carvalho M, Oke R, Mbianyor MA, Hubbard AE, Etoundi AM, Kinge T, Njock RL, Nkusu DN, Tsiagadigui JG, Dicker RA, Chichom-Mefire A, Juillard C. Associations between social determinants of health and interpersonal violence-related injury in Cameroon: a cross-sectional study. BMJ Glob Health 2022; 7:bmjgh-2021-007220. [PMID: 35022181 PMCID: PMC8756282 DOI: 10.1136/bmjgh-2021-007220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Risk factors for interpersonal violence-related injury (IPVRI) in low-income and middle-income countries (LMICs) remain poorly defined. We describe associations between IPVRI and select social determinants of health (SDH) in Cameroon. Methods We conducted a cross-sectional analysis of prospective trauma registry data collected from injured patients >15 years old between October 2017 and January 2020 at four Cameroonian hospitals. Our primary outcome was IPVRI, compared with unintentional injury. Explanatory SDH variables included education level, employment status, household socioeconomic status (SES) and alcohol use. The EconomicClusters model grouped patients into household SES clusters: rural, urban poor, urban middle-class (MC) homeowners, urban MC tenants and urban wealthy. Results were stratified by sex. Categorical variables were compared via Pearson’s χ2 statistic. Associations with IPVRI were estimated using adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). Results Among 7605 patients, 5488 (72.2%) were men. Unemployment was associated with increased odds of IPVRI for men (aOR 2.44 (95% CI 1.95 to 3.06), p<0.001) and women (aOR 2.53 (95% CI 1.35 to 4.72), p=0.004), as was alcohol use (men: aOR 2.33 (95% CI 1.91 to 2.83), p<0.001; women: aOR 3.71 (95% CI 2.41 to 5.72), p<0.001). Male patients from rural (aOR 1.45 (95% CI 1.04 to 2.03), p=0.028) or urban poor (aOR 2.08 (95% CI 1.27 to 3.41), p=0.004) compared with urban wealthy households had increased odds of IPVRI, as did female patients with primary-level/no formal (aOR 1.78 (95% CI 1.10 to 2.87), p=0.019) or secondary-level (aOR 1.54 (95% CI 1.03 to 2.32), p=0.037) compared with tertiary-level education. Conclusion Lower educational attainment, unemployment, lower household SES and alcohol use are risk factors for IPVRI in Cameroon. Future research should explore LMIC-appropriate interventions to address SDH risk factors for IPVRI.
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Affiliation(s)
- Kevin J Blair
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Michael de Virgilio
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Lauren Eyler Dang
- Division of Biostatistics, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - S Ariane Christie
- Department of Trauma and Acute Care Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Melissa Carvalho
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Rasheedat Oke
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Mbiarikai Agbor Mbianyor
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Alan E Hubbard
- Division of Biostatistics, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Alain Mballa Etoundi
- Department of Disease Epidemic and Pandemic Control, Cameroon Ministry of Public Health, Yaoundé, Cameroon
| | - Thompson Kinge
- Hospital Administration, Limbe Regional Hospital, Limbe, Southwest Region, Cameroon
| | - Richard L Njock
- Hospital Administration, Hopital Laquintinie de Duoala, Duoala, Cameroon
| | - Daniel N Nkusu
- Hospital Administration, Catholic Hospital of Pouma, Pouma, Cameroon
| | | | - Rochelle A Dicker
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Alain Chichom-Mefire
- Department of Surgery and Obs/Gyn, University of Buea Faculty of Health Sciences, Buea, Cameroon
| | - Catherine Juillard
- Program for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
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