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Abreu TC, Beulens JWJ, Heuvelman F, Schoonmade LJ, Mackenbach JD. Associations between dimensions of the social environment and cardiometabolic health outcomes: a systematic review and meta-analysis. BMJ Open 2024; 14:e079987. [PMID: 39209497 PMCID: PMC11367359 DOI: 10.1136/bmjopen-2023-079987] [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: 09/18/2023] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES The social environment (SE), that is, the social relationships and social context in which groups of people live and interact, is an understudied element of the broader living environment which impacts health. We aim to summarise the available evidence on the associations between SE and cardiometabolic disease (CMD) outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Scopus and Web of Science Core Collection were searched from inception to 28 February 2024. ELIGIBILITY CRITERIA We included studies for which determinants were SE factors such as area-level deprivation and social network characteristics and outcomes were type 2 diabetes mellitus and cardiovascular diseases incidence and prevalence. DATA EXTRACTION AND SYNTHESIS Titles and abstracts and full text were screened in duplicate. Data appraisal and extraction were based on the study protocol published in PROSPERO. Methodological quality was assessed with the Newcastle-Ottawa Scale. We synthesised the data through vote counting and meta-analyses. RESULTS From 10 143 records screened, 281 studies reporting 1108 relevant associations are included in this review. Of the 384 associations included in vote counting, 271 (71%) suggested that a worse SE is associated with a higher risk of CMD. 14 meta-analyses based on 180 associations indicated that worse SE was associated with increased odds of CMD outcomes, with 4 of them being statistically significant. For example, more economic and social disadvantage was associated with higher heart failure risk (OR 1.58, 95% CI 1.08 to 1.61; n=18; I2=95%). With the exception of two meta-analyses for men, meta-analysed sex-specific associations consistently showed results in the same direction as the overall meta-analyses. CONCLUSION Worse SE seems to be associated with increased odds of CMD outcomes, although certain SE dimensions are underexplored in relation to CMD. PROSPERO REGISTRATION NUMBER CRD42021223035.
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Affiliation(s)
- Taymara C Abreu
- Department of Epidemiology & Data Science, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Upstream Team, Amsterdam UMC, Amsterdam, Netherlands
| | - Joline WJ Beulens
- Department of Epidemiology & Data Science, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Upstream Team, Amsterdam UMC, Amsterdam, Netherlands
| | - Fleur Heuvelman
- Department of Epidemiology & Data Science, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Upstream Team, Amsterdam UMC, Amsterdam, Netherlands
| | - Linda J Schoonmade
- University Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joreintje D Mackenbach
- Department of Epidemiology & Data Science, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Upstream Team, Amsterdam UMC, Amsterdam, Netherlands
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Wu Q, Ailshire JA, Kim JK, Crimmins EM. The Association Between Cardiometabolic Risk and Cognitive Function Among Older Americans and Chinese. J Gerontol A Biol Sci Med Sci 2024; 79:glae116. [PMID: 38699992 PMCID: PMC11157968 DOI: 10.1093/gerona/glae116] [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: 10/01/2023] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Cardiometabolic risk (CMR) is associated with cognitive health, but the association can be affected by broader social, economic, and medical contexts. The United States and China have very different developmental and epidemiological histories, and thus CMR among older people could be linked to cognitive function differently in the 2 countries. METHODS Cross-sectional and longitudinal ordinary least squares regression models were estimated for each country using nationally representative samples of populations over age 50: 7 430/4 474 Americans and 6 108/3 655 Chinese in the cross-sectional/longitudinal samples. RESULTS In the United States, higher CMR is associated with worse cognitive function (b = -0.08, p < .016). Longitudinally, CMR increase is associated with worse cognitive function at a marginally significant level (b = -0.10, p = .055). No relationship between CMR level or change and cognitive function is observed in China. Higher education levels are linked to better cognitive function and slower cognitive decline in both countries. Unlike older Americans, relative to those with very low education levels, among older Chinese with the highest education level, a higher CMR links to better cognitive function (b = 0.63, p = .013) and slower cognitive decline (b = 0.35, p = .062); Nevertheless, a rapid increase in CMR is additionally harmful (b = -0.54, p = .050) for cognitive function and may lead to faster cognitive decline (b = -0.35, p = .079). CONCLUSIONS The significant relationship between CMR and cognitive function in the United States suggests the importance of monitoring and controlling CMR factors at older ages. The insignificant relationship in China may be explained by the high CMR among those with high education levels, highlighting the need for improving cardiometabolic health through education and promoting healthy lifestyles.
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Affiliation(s)
- Qiao Wu
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California 90089, USA
| | - Jennifer A Ailshire
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California 90089, USA
| | - Jung Ki Kim
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California 90089, USA
| | - Eileen M Crimmins
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California 90089, USA
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3
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Jordan G, Ridder D, Joost S, Vollenweider P, Preisig M, Marques-Vidal P, Guessous I, Vaucher J. Spatial analysis of 10-year predicted risk and incident atherosclerotic cardiovascular disease: the CoLaus cohort. Sci Rep 2024; 14:4752. [PMID: 38413661 PMCID: PMC10899582 DOI: 10.1038/s41598-024-54900-5] [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: 11/29/2023] [Accepted: 02/18/2024] [Indexed: 02/29/2024] Open
Abstract
Whether cardiovascular risk scores geographically aggregate and inform on spatial development of atherosclerotic cardiovascular diseases (ASCVD) remains unknown. Our aim is to determine the spatial distribution of 10-year predicted cardiovascular risk and ASCVD, and to compare the overlap of the resulting spatial distributions. Using prospective data from the CoLaus|PsyCoLaus cohort study (2003-2021) we computed SCORE2 in participants free from ASCVD. Geographical distributions of predicted risk and events were determined using the Gi* Getis-Ord autocorrelation statistic. 6203 individuals (54% women, mean age 52.5 ± SD 10.7, ASCVD incidence rate 5.7%) were included. We identified clusters of high versus low predicted risk (4%, 6%, respectively) and ASCVD (5%, 5% respectively) at baseline. They persisted at follow-up. Overlap of SCORE2 and ASCVD clusters was marginal. Body-mass index and alcohol consumption explained most of the predicted risk distribution. For ASCVD, high clusters persisted or were reinforced after multivariate adjustment, while low incidence clusters were reduced, multifactorial determinants. Incidence rate of ASCVD was 2.5% higher (IC 95%, 1.4-3.7) in clusters of higher incidence of ASCVD. To develop up-to-date, geographically targeted prevention strategies, there is a need to study novel geographically risk factors affecting ASCVD and to update commonly used prediction models for a population approach.
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Affiliation(s)
- Guillaume Jordan
- Department of Medicine, Division of Internal Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - David Ridder
- Department of Primary Care Medicine, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Laboratory for Biological Geochemistry (LGB), Group of Geospatial Molecular Epidemiology (GEOME), Institute of Environmental Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stephane Joost
- Department of Primary Care Medicine, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Laboratory for Biological Geochemistry (LGB), Group of Geospatial Molecular Epidemiology (GEOME), Institute of Environmental Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Division of Internal Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Martin Preisig
- CEPP, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Division of Internal Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Idris Guessous
- Department of Primary Care Medicine, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Laboratory for Biological Geochemistry (LGB), Group of Geospatial Molecular Epidemiology (GEOME), Institute of Environmental Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julien Vaucher
- Department of Medicine, Division of Internal Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Department of Medicine and Specialties, Service of Internal Medicine, Fribourg Hospital and University of Fribourg, Fribourg, Switzerland
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Schillen P, in der Schmitten J, Danielzik K, Hillal E, Moebus S, Dehnen A. [Primary Care Inequalities to the Disadvantage of the Population of Socially Deprived Urban Areas: A Case Study of Essen, Germany]. DAS GESUNDHEITSWESEN 2023; 85:1131-1139. [PMID: 37963576 PMCID: PMC10713330 DOI: 10.1055/a-2175-8290] [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] [Indexed: 11/16/2023]
Abstract
Background As a large city in the middle of a metropolitan area, the city of Essen is characterized by strong social segregation and a north-south divide in the social status of its population. The conventional demand planning does not take such strong disparities within a planning unit into account. The present study aims to analyze the distribution of primary care structures using the example of two large urban areas within the city of Essen and to identify perspectives for strengthening primary care in disadvantaged urban areas. Methods First, a secondary data analysis was carried out at the district level and the study area Essen North (258,790 residents), consisting of 19 districts, was defined on the basis of two inclusion criteria - 1. location of the district north of the A40 freeway and 2. a mean subsistence rate>17.20 percent (average value of the city of Essen). Subsequently the study area was compared with the rest of the city (332,242 residents) with regard to the indicators a) social status, and b) available general practioners and pediatricians. The data of the selected indicators is based on the social reporting of the city of Essen and the "Online Practice Search" (Online-Praxissuche) of the Association of Statutory Health Insurance Physicians North Rhine. The resulting database (last update: 10/20212) was then evaluated at the district level and the primary care situation of the two urban areas was compared. Results The results revealed a significantly lower primary care coverage in the socially disadvantaged study area Essen North by about 25 percent for general practioners and by almost half for pediatricians. Thus, higher social disadvantage was associated with poorer access to primary care close to home, especially for children and adolescents. Conclusion The distribution of primary care providers in the city of Essen increases the risk of contributing to the manifestation of geographic disparities and health inequalities. The existing planning system in particular is not suitable for addressing the threatening or already existing undersupply of primary health care to the population in disadvantaged urban districts.
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Affiliation(s)
- Philip Schillen
- Institut für Allgemeinmedizin, Universität
Duisburg-Essen Medizinische Fakultät, Essen, Germany
| | - Jürgen in der Schmitten
- Institut für Allgemeinmedizin, Universität
Duisburg-Essen Medizinische Fakultät, Essen, Germany
| | - Katja Danielzik
- Institut für Allgemeinmedizin, Universität
Duisburg-Essen Medizinische Fakultät, Essen, Germany
| | - Ellen Hillal
- Institut für Urban Public Health, Universitätsklinikum
Essen, Essen, Germany
| | - Susanne Moebus
- Institut für Urban Public Health, Universitätsklinikum
Essen, Essen, Germany
| | - Alessia Dehnen
- Institut für Allgemeinmedizin, Universität
Duisburg-Essen Medizinische Fakultät, Essen, Germany
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5
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Lin CY, Chandrabose M, Hadgraft N, Selvakumaran S, Owen N, Oka K, Shibata A, Sugiyama T. Neighborhood socioeconomic status and cardiometabolic risk: mediating roles of domain-specific physical activities and sedentary behaviors. Ann Epidemiol 2023; 83:1-7. [PMID: 37094624 DOI: 10.1016/j.annepidem.2023.04.011] [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: 01/02/2023] [Revised: 04/03/2023] [Accepted: 04/19/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE We examined the potential mediating roles of domain-specific physical activities and sedentary behaviors in the relationship between area-level socioeconomic status (SES) and cardiometabolic risk. METHODS Data were from the 2011/2012 Australian Diabetes, Obesity and Lifestyle study (n = 3431). The outcome was a clustered cardiometabolic risk (CCR) score, and the exposure was suburb-level SES. Potential mediators were domain-specific physical activities and sedentary behaviors. Multilevel linear regression models examined associations between SES and potential mediators (α) and between mediators and CCR (β). Mediation was assessed using the joint-significance test. RESULTS Higher SES was associated with a lower CCR score. Lower SES was associated with less frequent walking for transport, lower vigorous-intensity recreational physical activity, and higher TV time, which were associated with higher CCR scores. However, higher SES was associated with longer transport-related sitting time (all modes and in cars), which were associated with higher CCR scores. CONCLUSIONS The SES-cardiometabolic risk relationship may be partially explained by walking for transport, vigorous-intensity recreational physical activity, and TV viewing. These findings, which require corroboration from prospective evidence and clarification of the roles of transport-related sitting and occupational physical activity, can inform initiatives addressing socioeconomic inequalities in cardiometabolic health.
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Affiliation(s)
- Chien-Yu Lin
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan; Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Victoria, Australia.
| | - Manoj Chandrabose
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Victoria, Australia; Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Nyssa Hadgraft
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Victoria, Australia; Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Sungkavi Selvakumaran
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Neville Owen
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Victoria, Australia; Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Ai Shibata
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takemi Sugiyama
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Victoria, Australia; Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
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6
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Maksimov S, Muromtseva G, Kutsenko V, Shalnova S, Evstifeeva S, Drapkina O. Major and minor ECG abnormalities depending on regional living conditions in Russia. Sci Rep 2023; 13:8934. [PMID: 37264214 DOI: 10.1038/s41598-023-35947-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/26/2023] [Indexed: 06/03/2023] Open
Abstract
The goal of our study was to explore the effect of living conditions on the odd of major and minor ECG abnormalities on a large region scale in Russia. For the analysis, cross-sectional data of the Russian study, ESSE-RF 2013-2014, were used. They were collected on a sample of 16,400 subjects from 10 regions of the Russia. ECG abnormalities were grouped into two categories: Major and Minor (sensu the 2009 version of the Minnesota Code Classification System). Regional living conditions were considered comprehensively via five indices combining 33 characteristics of the regions. The estimates were presented as odds ratios and their 95% confidence intervals. The prevalence values of major abnormalities in the sample were 8.4% among women and 9.4% among men (p = 0.021). The prevalence of minor abnormalities constituted 34.1% and 45.9%, respectively (p < 0.001). In men, the odd of major ECG abnormalities increased with the demographic depression growth (1.08: 1.04-1.12) and with industrial development growth in the region (1.12: 1.07-1.17). In women, an increase in the odd of major ECG abnormalities was directly associated with industrial development (1.12: 1.07-1.16) and inversely related to the economic development in the region (0.94: 0.89-0.99). The odd of minor ECG abnormalities in men and women declined with the growth of the regional economic development: OR of 0.95: 0.93-0.98, and OR of 0.92: 0.87-0.99, respectively. The study demonstrated an effect of regional living conditions of the Russian population on the odd of major and minor ECG abnormalities. The most stable and logically explainable relationships were obtained for industrial and economic characteristics of living conditions.
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Affiliation(s)
- Sergey Maksimov
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russian Federation.
| | - Galina Muromtseva
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russian Federation
| | - Vladimir Kutsenko
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russian Federation
| | - Svetlana Shalnova
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russian Federation
| | - Svetlana Evstifeeva
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russian Federation
| | - Oksana Drapkina
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russian Federation
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Griggs S, Al-Kindi S, Hardin H, Irani E, Rajagopalan S, Crawford SL, Hickman RL. Socioeconomic deprivation and cardiometabolic risk factors in individuals with type 1 diabetes: T1D exchange clinic registry. Diabetes Res Clin Pract 2023; 195:110198. [PMID: 36513270 PMCID: PMC9908846 DOI: 10.1016/j.diabres.2022.110198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 09/05/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
AIMS Social determinants of health (SDOH) influence cardiovascular health in the general population; however, the degree to which this occurs in individuals with type 1 diabetes (T1D) is not well understood. We evaluated associations among socioeconomic deprivation and cardiometabolic risk factors (hemoglobin A1c, low-density lipoprotein, blood pressure, body mass index, physical activity) in individuals with T1D from the T1D Clinic Exchange Registry. METHODS We evaluated the association between the social deprivation index (SDI) and cardiometabolic risk factors using multivariable and logistic regression among 18,754 participants ages 13 - 90 years (mean 29.2 ± 17) in the T1D Exchange clinic registry from 6,320 zip code tabulation areas (2007-2017). RESULTS SDI was associated with multiple cardiometabolic risk factors even after adjusting for covariates (age, biological sex, T1D duration, and race/ethnicity) in the multivariable linear regression models. Those in the highest socially deprived areas had 1.69 (unadjusted) and 1.78 (adjusted) times odds of a triple concomitant risk burden of poor glycemia, dyslipidemia, and hypertension. CONCLUSIONS Persistent SDOH differences could account for a substantial degree of poor achievement of cardiometabolic targets in individuals with T1D. Our results suggest the need for a broader framework to understand the association between T1D and adverse cardiometabolic outcomes.
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Affiliation(s)
- Stephanie Griggs
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH 44106, United States.
| | - Sadeer Al-Kindi
- Center for Vascular Metabolic Disease, School of Medicine, Cleveland, OH, 44106, United States; Cardiovascular Research Institute, Case Western Reserve University, School of Medicine, Cleveland, OH, 44106, United States.
| | - Heather Hardin
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH 44106, United States
| | - Elliane Irani
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH 44106, United States.
| | - Sanjay Rajagopalan
- Cardiovascular Research Institute, Case Western Reserve University, School of Medicine, Cleveland, OH, 44106, United States.
| | - Sybil L Crawford
- University of Massachusetts Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, MA 01655, United States.
| | - Ronald L Hickman
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH 44106, United States.
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Zhou RZ, Hu Y, Tirabassi JN, Ma Y, Xu Z. Deriving neighborhood-level diet and physical activity measurements from anonymized mobile phone location data for enhancing obesity estimation. Int J Health Geogr 2022; 21:22. [PMID: 36585658 PMCID: PMC9801358 DOI: 10.1186/s12942-022-00321-4] [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: 08/25/2022] [Accepted: 12/10/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Obesity is a serious public health problem. Existing research has shown a strong association between obesity and an individual's diet and physical activity. If we extend such an association to the neighborhood level, information about the diet and physical activity of the residents of a neighborhood may improve the estimate of neighborhood-level obesity prevalence and help identify the neighborhoods that are more likely to suffer from obesity. However, it is challenging to measure neighborhood-level diet and physical activity through surveys and interviews, especially for a large geographic area. METHODS We propose a method for deriving neighborhood-level diet and physical activity measurements from anonymized mobile phone location data, and examine the extent to which the derived measurements can enhance obesity estimation, in addition to the socioeconomic and demographic variables typically used in the literature. We conduct case studies in three different U.S. cities, which are New York City, Los Angeles, and Buffalo, using anonymized mobile phone location data from the company SafeGraph. We employ five different statistical and machine learning models to test the potential enhancement brought by the derived measurements for obesity estimation. RESULTS We find that it is feasible to derive neighborhood-level diet and physical activity measurements from anonymized mobile phone location data. The derived measurements provide only a small enhancement for obesity estimation, compared with using a comprehensive set of socioeconomic and demographic variables. However, using these derived measurements alone can achieve a moderate accuracy for obesity estimation, and they may provide a stronger enhancement when comprehensive socioeconomic and demographic data are not available (e.g., in some developing countries). From a methodological perspective, spatially explicit models overall perform better than non-spatial models for neighborhood-level obesity estimation. CONCLUSIONS Our proposed method can be used for deriving neighborhood-level diet and physical activity measurements from anonymized mobile phone data. The derived measurements can enhance obesity estimation, and can be especially useful when comprehensive socioeconomic and demographic data are not available. In addition, these derived measurements can be used to study obesity-related health behaviors, such as visit frequency of neighborhood residents to fast-food restaurants, and to identify primary places contributing to obesity-related issues.
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Affiliation(s)
- Ryan Zhenqi Zhou
- grid.273335.30000 0004 1936 9887GeoAI Lab, Department of Geography, University at Buffalo, The State University of New York, Buffalo, NY 14260 USA
| | - Yingjie Hu
- grid.273335.30000 0004 1936 9887GeoAI Lab, Department of Geography, University at Buffalo, The State University of New York, Buffalo, NY 14260 USA
| | - Jill N. Tirabassi
- grid.273335.30000 0004 1936 9887Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY 14260 USA
| | - Yue Ma
- grid.273335.30000 0004 1936 9887GeoAI Lab, Department of Geography, University at Buffalo, The State University of New York, Buffalo, NY 14260 USA
| | - Zhen Xu
- grid.410625.40000 0001 2293 4910College of Landscape Architecture, Nanjing Forestry University, Nanjing, Jiangsu 210037 China
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Rezaei Z, Vahidnia MH. Effective medical center finding during COVID-19 pandemic using a spatial DSS centered on ontology engineering. GEOJOURNAL 2022; 88:2721-2735. [PMID: 36320661 PMCID: PMC9612622 DOI: 10.1007/s10708-022-10777-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 06/02/2023]
Abstract
The global spread of the coronavirus has generated one of the most critical circumstances forcing healthcare systems to deal with it everywhere in the world. The complexity of crisis management, particularly in Iran, the unfamiliarity of the disease, and a lack of expertise, provided the foundation for researchers and implementers to propose innovative solutions. One of the most important obstacles in COVID-19 crisis management is the lack of information and the need for immediate and real-time data on the situation and appropriate solutions. Such complex problems fall into the category of semi-structured problems. In this respect, decision support systems use people's mental resources with computer capabilities to improve the quality of decisions. In synergetic situations, for instance, healthcare domains cooperating with spatial solutions, coming to a decision needs logical reasoning and high-level analysis. Therefore, it is necessary to add rich semantics to different classes of involved data, find their relationships, and conceptualize the knowledge domain. For the COVID-19 case in this study, ontologies allow for querying over such established relationships to find related medical solutions based on description logic. Bringing such capabilities to a spatial decision support system (SDSS) can help with better control of the COVID-19 pandemic. Ontology-based SDSS solution has been developed in this study due to the complexity of information related to coronavirus and its geospatial aspect in the city of Tehran. According to the results, ontology can rationalize different classes and properties about the user's clinical information, various medical centers, and users' priority. Then, based on the user's requests in a web-based SDSS, the system focuses on the inference made, advises the users on choosing the most related medical center, and navigates the user on a map. The ontology's capacity for reasoning, overcoming knowledge gaps, and combining geographic and descriptive criteria to choose a medical center all contributed to promising outcomes and the satisfaction of the sample community of evaluators.
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Affiliation(s)
- Zahra Rezaei
- Department of Remote Sensing and GIS, Faculty of Natural Resources and Environment, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad H. Vahidnia
- Department of Remote Sensing and GIS, Faculty of Natural Resources and Environment, Science and Research Branch, Islamic Azad University, Tehran, Iran
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10
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Maksimov SA, Balanova YA, Shalnova SA, Muromtseva GA, Kapustina AV, Drapkina OM. Regional living conditions and the prevalence, awareness, treatment, control of hypertension at the individual level in Russia. BMC Public Health 2022; 22:202. [PMID: 35094684 PMCID: PMC8801098 DOI: 10.1186/s12889-022-12645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The objective of our study was to investigate the associations of characteristics inherent in large Russian Federation (RF) regions with prevalence, awareness, treatment and control of hypertension at the individual level.
Methods
Regional characteristics were obtained from the official website of the Federal State Statistics Service of the RF. We employed principal component analysis to reduce the dimensionality of data, which allowed defining five integral regional indices. Prevalence, awareness, treatment and control of hypertension were assessed from the data of the cross-sectional stage of ESSE-RF study conducted in 2013–2014. The final sample included 19,791 patients from 12 RF regions. Generalized estimating equations were used to identify the associations of regional indices with prevalence, awareness, treatment and control of hypertension at the individual level, taking into consideration nested data structures (study subjects in the regions).
Results
The index characterizing deterioration of social living conditions and societal marginalization exhibited positive associations with the prevalence of hypertension among men (OR = 1.18; 95% CI: 1.05–1.32) and elderly people (OR = 1.16; 95% CI: 1.02–1.32). Moreover, deterioration in the social environment was associated with a reduction in treatment (OR = 0.76; 95% CI: 0.64–0.90) and control of hypertension (OR = 0.79; 95% CI: 0.69–0.90). Hypertension awareness was directly connected with demographic crisis (OR = 1.13; 95% CI: 1.02–1.25) and augmented industrial development (OR = 1.15; 95% CI: 1.01–1.33) in the regions. The association of regional living conditions with the prevalence of hypertension is relatively weak, compared to predictors at the individual level, but this influence is important for awareness, treatment and control of hypertension.
Conclusion
The study contributed to evaluating the associations of the vital characteristics inherent in population of large RF regions with arterial hypertension prevalence, as well as with awareness, treatment and control of this disease. Our results provided original insights from the standpoint of cardiovascular disease epidemiology in the RF, as well as in the context of investigating the impact of living conditions on population health.
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5G, Big Data, and AI for Smart City and Prevention of Virus Infection. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1368:189-214. [DOI: 10.1007/978-981-16-8969-7_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Ptushkina V, Seidel-Jacobs E, Maier W, Schipf S, Völzke H, Markus MRP, Nauck M, Meisinger C, Peters A, Herder C, Schwettmann L, Dörr M, Felix SB, Roden M, Rathmann W. Educational Level, but Not Income or Area Deprivation, is Related to Macrovascular Disease: Results From Two Population-Based Cohorts in Germany. Int J Public Health 2021; 66:633909. [PMID: 34744587 PMCID: PMC8565278 DOI: 10.3389/ijph.2021.633909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: An inverse relationship between education and cardiovascular risk has been described, however, the combined association of education, income, and neighborhood socioeconomic status with macrovascular disease is less clear. The aim of this study was to evaluate the association of educational level, equivalent household income and area deprivation with macrovascular disease in Germany. Methods: Cross-sectional data from two representative German population-based studies, SHIP-TREND (n = 3,731) and KORA-F4 (n = 2,870), were analyzed. Multivariable logistic regression models were applied to estimate odds ratios and 95% confidence intervals for the association between socioeconomic determinants and macrovascular disease (defined as self-reported myocardial infarction or stroke). Results: The study showed a higher odds of prevalent macrovascular disease in men with low and middle educational level compared to men with high education. Area deprivation and equivalent income were not related to myocardial infarction or stroke in any of the models. Conclusion: Educational level, but not income or area deprivation, is significantly related to the macrovascular disease in men. Effective prevention of macrovascular disease should therefore start with investing in individual education.
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Affiliation(s)
- Violetta Ptushkina
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes, Research at Heinrich-Heine-University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany
| | - Esther Seidel-Jacobs
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes, Research at Heinrich-Heine-University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany
| | - Werner Maier
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), München-Neuherberg, Germany
| | - Sabine Schipf
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Marcello Ricardo Paulista Markus
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Christa Meisinger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, München-Neuherberg, Germany.,Chair of Epidemiology, University of Augsburg at University Hospital of Augsburg, Augsburg, Germany
| | - Annette Peters
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), München-Neuherberg, Germany
| | - Christian Herder
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.,Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), München-Neuherberg, Germany.,Department of Economics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Marcus Dörr
- German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Stephan B Felix
- German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.,Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes, Research at Heinrich-Heine-University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany
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13
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Maksimov SA, Shalnova SA, Kutsenko VA, Balanova YA, Muromtseva GA, Kapustina AV, Evstifeeva SE, Imaeva AE, Karamnova NS, Drapkina OM. Effect of regional living conditions on middle-term cardiovascular outcomes: data from prospective stage of the ESSE-RF study. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To assess regional living conditions with cardiovascular outcomes based on prospective stage of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study.Material and methods. We used data from a 3- and 5-year prospective stage of the ESSE-RF study (2012-2013). For initial screening, 16210 people aged 25-64 were included. To characterize the regions of residence, 5 regional indices (RIs) were used. The following endpoints were considered: cardiovascular death, myocardial infarction, stroke, composite endpoint (cardiovascular death + myocardial infarction + stroke). To assess the correlations, generalized estimating equations with nested data structure (individuals in the regions) were used. The studied associations were adjusted for a wide range of potential effect modifiers.Results. There are multiple direct associations of RIs with the likelihood of all endpoints. The exception was the reverse association of Industrial RI with cardiovascular death. The most stable associations regarded Mixed RI, Industrial RI and Socio-geographical RI, with a high RI significance in endpoint development, compared with well-known individual cardiovascular risk factors. Separate associations were noted for Economic RI and Demographic RI.Conclusion. The results indicate a significant contribution of a number of regional living conditions to individual risk of fatal and non-fatal cardiovascular outcomes.
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Affiliation(s)
- S. A. Maksimov
- National Medical Research Center for Therapy and Preventive Medicine
| | - S. A. Shalnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - V. A. Kutsenko
- National Medical Research Center for Therapy and Preventive Medicine
| | - Yu. A. Balanova
- National Medical Research Center for Therapy and Preventive Medicine
| | - G. A. Muromtseva
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. V. Kapustina
- National Medical Research Center for Therapy and Preventive Medicine
| | - S. E. Evstifeeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. E. Imaeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - N. S. Karamnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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14
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Piko P, Dioszegi J, Sandor J, Adany R. Changes in the Prevalence of Metabolic Syndrome and Its Components as Well as in Relevant Preventive Medication between 2006 and 2018 in the Northeast Hungarian Population. J Pers Med 2021; 11:jpm11010052. [PMID: 33467044 PMCID: PMC7829989 DOI: 10.3390/jpm11010052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 12/21/2022] Open
Abstract
Metabolic syndrome (MetS) is a worldwide problem with severe health consequences. In this study, we examine the changes in the prevalence of MetS and its components in two disadvantaged counties of Northeastern Hungary. Two health examination surveys were performed in the Hungarian population aged 20–64 years in 2006 (n = 450) and 2018 (n = 397) and the data were compared to each other. It was found that the prevalence of MetS increased significantly in the period examined (from 34.9% to 42.2%, p = 0.035) due to the increased prevalence of raised blood pressure (from 45.6% to 57.0%, p = 0.002) and raised fasting glucose concentration (13.2% vs. 24.8%, p < 0.001). The increase mainly affects the younger (20–34 years old) age group (12.1% in 2006 vs. 31.6% in 2018, p = 0.001). It is quite alarming that the prevalence of MetS and its components has increased significantly in the last decade, while the prevalence of preventive medication is unchanged (antihypertensive and antidiabetic treatments) or even significantly decreased (lipid-lowering medication). Consequently, the number of individuals untreated for hypertension and metabolic disturbances is severely increased. A targeted public health strategy is desperately needed to prevent further worsening the situation.
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Affiliation(s)
- Peter Piko
- MTA-DE Public Health Research Group, University of Debrecen, 4032 Debrecen, Hungary; (P.P.); (J.D.)
| | - Judit Dioszegi
- MTA-DE Public Health Research Group, University of Debrecen, 4032 Debrecen, Hungary; (P.P.); (J.D.)
| | - Janos Sandor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Roza Adany
- MTA-DE Public Health Research Group, University of Debrecen, 4032 Debrecen, Hungary; (P.P.); (J.D.)
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
- Correspondence: ; Tel.: +36-52-512-765 (ext. 77174)
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15
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Jin K, Neubeck L, Atherton I. Impact of area deprivation on the cardiac mortality in the UK between1991 and 2010: evidence from a population-based longitudinal study. Eur J Cardiovasc Nurs 2020; 20:436-444. [PMID: 33620472 DOI: 10.1093/eurjcn/zvaa021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 11/13/2022]
Abstract
AIMS Evidence from longitudinal studies on the influence of area deprivation in cardiac mortality is limited. We aimed to examine the impact of area deprivation on cardiac mortality in a large representative Scottish population. We also examined differences between women and men. METHODS AND RESULTS Retrospective analysis was performed by using linked data from Scottish Longitudinal Study from 1991 to 2010. The main exposure variable was socioeconomic status using the Carstairs deprivation scores, a composite score of area-level factors. Cox proportional-hazards models were constructed to evaluate the hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiac mortality and all-cause mortality associated with area-based deprivation. Subgroup analyses were stratified by sex. In a representative population of 217 965 UK adults, a total of 58 770 deaths occurred over a median of 10 years of follow-up period. The risk of cardiac mortality and all-cause mortality showed a consistent graded increased across the deprived groups. Compared to the least deprived group, the adjusted HR of cardiac mortality in the most deprived group was 1.27 (1.15-1.39, P < 0.000). There was strong evidence that women from more deprived areas had significantly higher cardiac death risk than those from the least deprived areas (HR 1.42, 95% CI 1.22-1.65), while this observation was not strong in men with same background. CONCLUSION Our study demonstrated area deprivation was the strong predictor of long-term cardiac mortality and all-cause mortality. The inequalities were substantially greater in women from more deprived areas than men from the same background.
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Affiliation(s)
- Kai Jin
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, 9 Little France Road, Edinburgh, EH16 4UX, UK
| | - Lis Neubeck
- School of Health and Social Care, Sighthill Campus, Sighthill Court , Sighthill, Edinburgh, EH11 4BN, UK
| | - Iain Atherton
- School of Health and Social Care, Sighthill Campus, Sighthill Court , Sighthill, Edinburgh, EH11 4BN, UK
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16
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Yousefinaghani S, Dara RA, Poljak Z, Sharif S. A decision support framework for prediction of avian influenza. Sci Rep 2020; 10:19011. [PMID: 33149144 PMCID: PMC7642392 DOI: 10.1038/s41598-020-75889-7] [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] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022] Open
Abstract
For years, avian influenza has influenced economies and human health around the world. The emergence and spread of avian influenza virus have been uncertain and sudden. The virus is likely to spread through several pathways such as poultry transportation and wild bird migration. The complicated and global spread of avian influenza calls for surveillance tools for timely and reliable prediction of disease events. These tools can increase situational awareness and lead to faster reaction to events. Here, we aimed to design and evaluate a decision support framework that aids decision makers by answering their questions regarding the future risk of events at various geographical scales. Risk patterns were driven from pre-built components and combined in a knowledge base. Subsequently, questions were answered by direct queries on the knowledge base or through a built-in algorithm. The evaluation of the system in detecting events resulted in average sensitivity and specificity of 69.70% and 85.50%, respectively. The presented framework here can support health care authorities by providing them with an opportunity for early control of emergency situations.
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Affiliation(s)
| | - Rozita A Dara
- School of Computer Science, University of Guelph, Guelph, ON, Canada.
| | - Zvonimir Poljak
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Shayan Sharif
- Department of Pathobiology, University of Guelph, Guelph, ON, Canada
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17
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Toms R, Mayne DJ, Feng X, Bonney A. Geographic variation in cardiometabolic risk factor prevalence explained by area-level disadvantage in the Illawarra-Shoalhaven region of the NSW, Australia. Sci Rep 2020; 10:12770. [PMID: 32728133 PMCID: PMC7391748 DOI: 10.1038/s41598-020-69552-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
Cardiometabolic risk factors (CMRFs) demonstrate significant geographic variation in their distribution. The study aims to quantify the general contextual effect of the areas on CMRFs; and the geographic variation explained by area-level socioeconomic disadvantage. A cross sectional design and multilevel logistic regression methods were adopted. Data included objectively measured routine pathology test data between years 2012 and 2017 on: fasting blood sugar level; glycated haemoglobin; total cholesterol; high density lipoprotein; urinary albumin creatinine ratio; estimated glomerular filtration rate; and body mass index. The 2011 Australian census based Index of Relative Socioeconomic Disadvantage (IRSD) were the area-level study variables, analysed at its smallest geographic unit of reporting. A total of 1,132,029 CMRF test results from 256,525 individuals were analysed. After adjusting for individual-level covariates, all CMRFs significantly associated with IRSD and the probability of higher risk CMRFs increases with greater area-level disadvantage. Though the specific contribution of IRSD in the geographic variation of CMRF ranged between 57.8 and 14.71%, the general contextual effect of areas were found minimal (ICCs 0.6-3.4%). The results support universal interventions proportional to the need and disadvantage level of populations for the prevention and control of CMRFs, rather than any area specific interventions as the contextual effects were found minimal in the study region.
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Affiliation(s)
- Renin Toms
- School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia.
| | - Darren J Mayne
- School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia
- Public Health Unit, Illawarra Shoalhaven Local Health District, Warrawong, NSW, 2502, Australia
- School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Andrew Bonney
- School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia
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18
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Toms R, Feng X, Mayne DJ, Bonney A. Role of Area-Level Access to Primary Care on the Geographic Variation of Cardiometabolic Risk Factor Distribution: A Multilevel Analysis of the Adult Residents in the Illawarra-Shoalhaven Region of NSW, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4297. [PMID: 32560149 PMCID: PMC7344656 DOI: 10.3390/ijerph17124297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Access to primary care is important for the identification, control and management of cardiometabolic risk factors (CMRFs). This study investigated whether differences in geographic access to primary care explained area-level variation in CMRFs. METHODS Multilevel logistic regression models were used to derive the association between area-level access to primary care and seven discrete CMRFs after adjusting for individual and area-level co-variates. Two-step floating catchment area method was used to calculate the geographic access to primary care for the small areas within the study region. RESULTS Geographic access to primary care was inversely associated with low high density lipoprotein (OR 0.94, CI 0.91-0.96) and obesity (OR 0.91, CI 0.88-0.93), after adjusting for age, sex and area-level disadvantage. The intra-cluster correlation coefficient (ICCs) of all the fully adjusted models ranged between 0.4-1.8%, indicating low general contextual effects of the areas on CMRF distribution. The area-level variation in CMRFs explained by primary care access was ≤10.5%. CONCLUSION The findings of the study support proportionate universal interventions for the prevention and control of CMRFs, rather than any area specific interventions based on their primary care access, as the contextual influence of areas on all the analysed CMRFs were found to be minimal. The findings also call for future research that includes other aspects of primary care access, such as road-network access, financial affordability and individual-level acceptance of the services in order to gain an overall picture of the area-level contributing role of primary care on CMRFs in the study region.
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Affiliation(s)
- Renin Toms
- School of Medicine, University of Wollongong, Wollongong NSW 2522, Australia; (D.J.M.); (A.B.)
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong NSW 2500, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2033, Australia
| | - Darren J Mayne
- School of Medicine, University of Wollongong, Wollongong NSW 2522, Australia; (D.J.M.); (A.B.)
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
- Illawarra Shoalhaven Local Health District, Public Health Unit, Warrawong NSW 2502, Australia
- School of Public Health, The University of Sydney, Sydney NSW 2006, Australia
| | - Andrew Bonney
- School of Medicine, University of Wollongong, Wollongong NSW 2522, Australia; (D.J.M.); (A.B.)
- Illawarra Health and Medical Research Institute, Wollongong NSW 2522, Australia;
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Congdon P. A diabetes risk index for small areas in England. Health Place 2020; 63:102340. [PMID: 32543429 DOI: 10.1016/j.healthplace.2020.102340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/26/2020] [Accepted: 04/06/2020] [Indexed: 01/03/2023]
Abstract
UK and international studies point to significant area variation in diabetes risk, and summary indices of diabetic risk are potentially of value in effective targeting of health interventions and healthcare resources. This paper aims to develop a summary measure of the diabetic risk environment which can act as an index for targeting health care resources. The diabetes risk index is for 6791 English small areas (which provide entire coverage of England) and has advantages in incorporating evidence from both diabetes outcomes and area risk factors, and in including spatial correlation in its construction. The analysis underlying the risk index shows that area socio-economic status, social fragmentation and south Asian ethnic concentration are all positive risk factors for diabetes risk. However, urban-rural and regional differences in risk intersect with these socio-demographic influences.
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Affiliation(s)
- Peter Congdon
- School of Geography, Queen Mary University of London, Mile End Rd, London, E1 4NS, UK.
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Toms R, Mayne DJ, Feng X, Bonney A. Geographic variation in cardiometabolic risk distribution: A cross-sectional study of 256,525 adult residents in the Illawarra-Shoalhaven region of the NSW, Australia. PLoS One 2019; 14:e0223179. [PMID: 31574124 PMCID: PMC6772048 DOI: 10.1371/journal.pone.0223179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Metabolic risk factors for cardiovascular disease (CVD) warrant significant public health concern globally. This study aims to utilise the regional database of a major laboratory network to describe the geographic distribution pattern of eight different cardiometabolic risk factors (CMRFs), which in turn can potentially generate hypotheses for future research into locality specific preventive approaches. METHOD A cross-sectional design utilising de-identified laboratory data on eight CMRFs including fasting blood sugar level (FBSL); glycated haemoglobin (HbA1c); total cholesterol (TC); high density lipoprotein (HDL); albumin creatinine ratio (ACR); estimated glomerular filtration rate (eGFR); body mass index (BMI); and diabetes mellitus (DM) status was used to undertake descriptive and spatial analyses. CMRF test results were dichotomised into 'higher risk' and 'lower risk' values based on existing risk definitions. Australian Census Statistical Area Level 1 (SA1) were used as the geographic units of analysis, and an Empirical Bayes (EB) approach was used to smooth rates at SA1 level. Choropleth maps demonstrating the distribution of CMRFs rates at SA1 level were produced. Spatial clustering of CMRFs was assessed using Global Moran's I test and Local Indicators of Spatial Autocorrelation (LISA). RESULTS A total of 1,132,016 test data derived from 256,525 individuals revealed significant geographic variation in the distribution of 'higher risk' CMRF findings. The populated eastern seaboard of the study region demonstrated the highest rates of CMRFs. Global Moran's I values were significant and positive at SA1 level for all CMRFs. The highest spatial autocorrelation strength was found among obesity rates (0.328), and the lowest for albuminuria (0.028). LISA tests identified significant High-High (HH) and Low-Low (LL) spatial clusters of CMRFs, with LL predominantly in the less populated northern, central and southern regions of the study area. CONCLUSION The study describes a range of CMRFs with different distributions in the study region. The results allow generation of hypotheses to test in future research concerning location specific population health approaches.
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Affiliation(s)
- Renin Toms
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Darren J. Mayne
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
- Public Health Unit, Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Xiaoqi Feng
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Andrew Bonney
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
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