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Lawrence WR, Kucharska-Newton AM, Magnani JW, Brewer LC, Shiels MS, George KM, Lutsey PL, Jenkins BD, Sullivan KJ, Carson AP, Freedman ND. Neighborhood Socioeconomic Disadvantage Across the Life Course and Premature Mortality. JAMA Netw Open 2024; 7:e2426243. [PMID: 39110459 PMCID: PMC11307131 DOI: 10.1001/jamanetworkopen.2024.26243] [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: 01/31/2024] [Accepted: 06/10/2024] [Indexed: 08/10/2024] Open
Abstract
Importance There are consistent data demonstrating that socioeconomic disadvantage is associated with risk of premature mortality, but research on the relationship between neighborhood socioeconomic factors and premature mortality is limited. Most studies evaluating the association between neighborhood socioeconomic status (SES) and mortality have used a single assessment of SES during middle to older adulthood, thereby not considering the contribution of early life neighborhood SES. Objective To investigate the association of life course neighborhood SES and premature mortality. Design, Setting, and Participants This cohort study included Black and White participants of the multicenter Atherosclerosis Risk in Communities Study, a multicenter study conducted in 4 US communities: Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and the northwestern suburbs of Minneapolis, Minnesota. Participants were followed up for a mean (SD) of 18.8 (5.7) years (1996-2020). Statistical analysis was performed from March 2023 through May 2024. Exposure Participants' residential addresses during childhood, young adulthood, and middle adulthood were linked with US Census-based socioeconomic indicators to create summary neighborhood SES scores for each of these life epochs. Neighborhood SES scores were categorized into distribution-based tertiles. Main Outcomes and Measures Premature death was defined as all-cause mortality occurring before age 75 years. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs. Results Among 12 610 study participants, the mean (SD) age at baseline was 62.6 (5.6) years; 3181 (25.2%) were Black and 9429 (74.8%) were White; and 7222 (57.3%) were women. The lowest, compared with the highest tertile, of neighborhood SES score in middle adulthood was associated with higher risk of premature mortality (HR, 1.28; 95% CI, 1.07-1.54). Similar associations were observed for neighborhood SES in young adulthood among women (HR, 1.25; 95% CI, 1.00-1.56) and neighborhood SES in childhood among White participants (HR, 1.25; 95% CI, 1.01-1.56). Participants whose neighborhood SES remained low from young to middle adulthood had an increased premature mortality risk compared with those whose neighborhood SES remained high (HR, 1.25; 95% CI, 1.05-1.49). Conclusions and Relevance In this study, low neighborhood SES was associated with premature mortality. The risk of premature mortality was greatest among individuals experiencing persistently low neighborhood SES from young to middle adulthood. Place-based interventions that target neighborhood social determinants of health should be designed from a life course perspective that accounts for early-life socioeconomic inequality.
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Affiliation(s)
- Wayne R. Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Anna M. Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Jared W. Magnani
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - LaPrincess C. Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota
| | - Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Kristen M. George
- Department of Public Health Sciences, University of California Davis School of Medicine
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Brittany D. Jenkins
- Department of Biochemistry and Molecular Biology, Johns Hopkins University, Baltimore, Maryland
| | - Kevin J. Sullivan
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - April P. Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Zhou Y, Lu Y, Wei D, He S. Impacts of social deprivation on mortality and protective effects of greenness exposure in Hong Kong, 1999-2018: A spatiotemporal perspective. Health Place 2024; 87:103241. [PMID: 38599046 DOI: 10.1016/j.healthplace.2024.103241] [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: 12/01/2023] [Revised: 02/27/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024]
Abstract
Addressing health inequality is crucial for fostering healthy city development. However, there is a dearth of literature simultaneously investigating the effects of social deprivation and greenness exposure on mortality risks, as well as how greenness exposure may mitigate the adverse effect of social deprivation on mortality risks from a spatiotemporal perspective. Drawing on socioeconomic, remote sensing, and mortality record data, this study presents spatiotemporal patterns of social deprivation, population weighted greenness exposure, and all-cause and cause-specific mortality in Hong Kong. A Bayesian regression model was applied to investigate the impacts of social deprivation and greenness exposure on mortality and examine how socioeconomic inequalities in mortality may vary across areas with different greenness levels in Hong Kong from 1999 to 2018. We observed a decline in social deprivation (0.67-0.56), and an increase in greenness exposure (0.34-0.41) in Hong Kong during 1999-2018. Areas with high mortality gradually clustered in the Kowloon Peninsula and the northern regions of Hong Kong Island. Adverse impacts of social deprivation on all-cause mortality weakened in recent years (RR from 2009 to 2013: 1.103, 95%CI: 1.051-1.159, RR from 2014 to 2018: 1.041 95%CI: 0.950-1.139), while the protective impacts of greenness exposure consistently strengthened (RR from 1999 to 2003: 0.903, 95%CI: 0.827-0.984, RR from 2014 to 2018: 0.859, 95%CI: 0.763-0.965). Moreover, the adverse effects of social deprivation on mortality risks were found to be higher in areas with lower greenness exposure. These findings provide evidence of associations between social deprivation, greenness exposure, and mortality risks in Hong Kong over the past decades, and highlight the potential of greenness exposure to mitigate health inequalities. Our study provides valuable implications for policymakers to develop a healthy city.
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Affiliation(s)
- Yuxuan Zhou
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Yi Lu
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Di Wei
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong Special Administrative Region, China; School of Architecture and Urban Planning, Huazhong University of Science and Technology, Wuhan, China; Hubei Engineering and Technology Research Center of Urbanization, Wuhan, China.
| | - Shenjing He
- Department of Urban Planning and Design, Urban Systems Institute, And the Social Infrastructure for Equity and Wellbeing Lab, The University of Hong Kong, Hong Kong Special Administrative Region of China, China.
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Sasaki N, Tabuchi T, Fujiwara T, Nishi D. Adverse childhood experiences and living in the socially deprived areas in adulthood: a cross-sectional study of the nationwide data in Japan. BMC Public Health 2023; 23:1616. [PMID: 37620789 PMCID: PMC10463887 DOI: 10.1186/s12889-023-16557-z] [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: 05/08/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES This study aimed to examine whether having adverse childhood experiences (ACEs) was associated with living in a deprived area in adulthood. METHODS The cross-sectional study was conducted by using nation-wide data in 2022 of the Japan COVID-19 and Society Internet Survey (JACSIS). Participants were community dwelling people 18 years or older. ACEs were assessed by Japanese version of 15-items ACE measurement tool (ACE-J). Living condition was measured by Area Deprived Index (ADI) and Densely Inhabited District (DID) based on zip code. Multivariable logistic regression to analyze the associations between ADI and ACE 4 + was conducted, controlling for individual-level factors, such as age, sex, marital status, and education, as an additional analysis. RESULTS The total of 27,916 participants were included in the analysis. The prevalence of emotional neglect, childhood poverty, and school bullying were 38.2%, 26.5%, 20.8%, respectively. 75% of the population had one or more ACE(s). The number of ACEs was associated with significantly higher risk of living in deprived area in the adulthood (p = 0.001). ACEs were not associated with living in density area. The association between ADI and ACEs 4 + was non-significant after controlling the individual-level factors. CONCLUSION People with higher number of ACEs tend to live in deprived areas in adulthood. Policy makers in highly deprived areas can apply the trauma-informed approach for the community care and support, which is critical to mitigating deficit perspectives and facilitating comprehensive support for those with ACEs.
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Affiliation(s)
- Natsu Sasaki
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan.
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Mangel T, Mastracci TM. Outcomes of endovascular repair of abdominal and thoracoabdominal aneurysms in women - A review. Semin Vasc Surg 2022; 35:334-340. [DOI: 10.1053/j.semvascsurg.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/30/2022] [Accepted: 07/20/2022] [Indexed: 11/11/2022]
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Kurani S, Webb L, Cadet K, Ma M, Gibson M, Jallah N, Park JN, Johnson RM. Area-level deprivation and adverse childhood experiences among high school students in Maryland. BMC Public Health 2022; 22:811. [PMID: 35459200 PMCID: PMC9034595 DOI: 10.1186/s12889-022-13205-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Nearly one-half of Americans have been exposed to at least one adverse childhood experience (ACE) before turning 18, contributing to a broad array of problems spanning physical health, mental and behavioral health, and psychosocial functioning. METHODS This was a cross-sectional, survey research study, using 2018 data from a state adolescent health surveillance system, i.e., Maryland Youth Risk Behavior Survey/Youth Tobacco Survey. The population-based sample of Maryland high school students (n = 41,091) is representative at the state and county levels. The outcome variables included five binary measures of ACEs (i.e., food insecurity, parental substance use/gambling, parental mental illness, family member in jail/prison, and caregiver verbal abuse), and number of ACEs. The main exposure variable, area-level socioeconomic disadvantage, was assessed at the county level using a continuous measure of the area deprivation index (ADI). Additional covariates included: rural county status, age, race/ethnicity, sex, and sexual or gender minority (SGM) status. We used mixed-effect multivariate logistic regression to estimate the odds of ACEs in association with socioeconomic deprivation. Models were adjusted for all covariates. RESULTS County-level ADI was associated with 3 of the 5 ACES [i.e., food insecurity (OR = 1.10, 95% CI: 1.07-1.13), parental substance use/gambling (OR = 1.05, 95% CI: 1.02-1.07), and incarceration of a family member (OR = 1.14, 95% CI: 1.09-1.19)]; and with having at least one ACE (i.e., OR = 1.08, 95% CI: 1.05-1.10). Odds of reporting at least one ACE were higher among girls, older adolescents (i.e., aged 16 and ≥ 17 relative to those aged ≤ 14 years), and among SGM, Black, and Latinx students (all ORs > 1.20). CONCLUSIONS ACEs greatly increase risk for adolescent risk behaviors. We observed an increased likelihood of adversity among youth in more deprived counties and among Black, Latinx, or SGM youth, suggesting that social and structural factors play a role in determining the adversity that youth face. Therefore, efforts to address structural factors (e.g., food access, family financial support, imprisonment as a sanction for criminal behavior) could be a critical strategy for primary prevention of ACEs and promoting adolescent health.
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Affiliation(s)
- Shaheen Kurani
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
| | - Lindsey Webb
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Kechna Cadet
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ming Ma
- Department of Community & Behavioral Health, Colorado School of Public Health, Denver, CO, USA
| | - Marianne Gibson
- Maryland Department of Health, Opioid Operational Command Center, Crownsville, MD, USA
| | - Nikardi Jallah
- Maryland Department of Health, Prevention & Health Promotion, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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van Ingen T, Matheson FI. The 2011 and 2016 iterations of the Ontario Marginalization Index: updates, consistency and a cross-sectional study of health outcome associations. Canadian Journal of Public Health 2021; 113:260-271. [PMID: 34432255 DOI: 10.17269/s41997-021-00552-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 06/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The Ontario Marginalization Index (ON-Marg) is an area-based measure used widely to measure health inequalities in Ontario. Recently, the index was updated for 2011 and 2016. The loss of the 2011 long-form census required the use of alternative data sources for the 2011 version. This paper describes the update of ON-Marg, assesses consistency in the indices across census years using Dissemination Areas, and examines associations between ON-Marg 2016 and four health and social outcomes to demonstrate its potential to measure health inequalities. METHODS ON-Marg was created using factor analysis. Differences in quintile assignment was compared over time to assess whether the use of taxfiler, immigration, property assessment, and health card address data in 2011 affected consistency in measurement of marginalization. Inequalities in rates of overall mortality, gonorrhea incidence, mental health emergency department visits, and alcohol retail locations across quintiles of ON-Marg 2016 were quantified using the Relative Index of Inequality. RESULTS Depending on the dimension, between 81% and 96% of DAs showed limited or no changes in quintiles of marginalization between 2006, 2011 and 2016. Of the 45-64% of DAs that did not change quintile between 2006 and 2016, 1.8% to 8.8% of DAs in 2011 differed by two or more quintiles. Findings showed significant differences in rates of health and social outcomes across quintiles of ON-Marg 2016, with strength and directionality varying by dimension of ON-Marg. CONCLUSION Alternative data sources did not substantially affect the consistency of the 2011 version of ON-Marg. The updated ON-Marg is a comprehensive tool that can be used to study health inequalities in Ontario.
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Affiliation(s)
- Trevor van Ingen
- Public Health Ontario, 661 University Avenue, Suite 1701, Toronto, ON, M5G 1M1, Canada.
| | - Flora I Matheson
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, ON, M5T 3M7, Canada
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Xu W, Topping M, Fletcher J. State of birth and cardiovascular disease mortality: Multilevel analyses of the National Longitudinal Mortality Study. SSM Popul Health 2021; 15:100875. [PMID: 34345647 PMCID: PMC8319560 DOI: 10.1016/j.ssmph.2021.100875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/04/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading contributor to mortality in the United States. Previous studies have linked early life individual and family factors, along with various contemporaneous place-based exposures to differential individual CVD mortality risk. However, the impacts of early life place exposures and how they compare to the effects of an individual's current place of residence on CVD mortality risk is not well understood. Using the National Longitudinal Mortality Study, this research examined the effects of both state of birth and state of residence on individual's risk of CVD mortality. We estimated individual mortality risk by estimating multi-level logistic regression models. We found that during a follow-up period of 11 years, 18,292 (4.2%) out of 433,345 participants died from CVD. The impact of state of birth on subsequent CVD mortality risk are greater than state of residence, even after adjusting for socio-demographic factors. Individuals who were born in certain states such as Tennessee, Kentucky, and Pennsylvania on average had higher CVD mortality risk. Conversely, those born in California, North Dakota, and Montana were found to have lower risk, no matter where they presently live. This study implies that early life state-level environments may be more prominent to individual's CVD mortality risk, compared to the state in which one lives. Future research should address specific mechanisms through which state of birth may affect people's risk of CVD mortality. State of birth is a stronger predictor of CVD mortality than state of residence. Models including state of birth random effects better predict individual CVD mortality risk. Those born in Tennessee and Kentucky had the highest average CVD mortality risk while those born in California and North Dakota had the lowest risk. Tennessee, Kentucky, Virginia, West Virginia, and Pennsylvania are a cluster of high state of birth effects.
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Affiliation(s)
- Wei Xu
- Center for Demography of Health and Aging, University of Wisconsin Madison, 1180 Observatory Drive, WI, 53706, USA
| | - Michael Topping
- Department of Sociology, University of Wisconsin Madison, 1180 Observatory Drive, WI, 53706, USA
| | - Jason Fletcher
- Center for Demography of Health and Aging, University of Wisconsin Madison, 1180 Observatory Drive, WI, 53706, USA.,Department of Sociology, University of Wisconsin Madison, 1180 Observatory Drive, WI, 53706, USA
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Bryden GM, Browne M, Rockloff M, Unsworth C. The privilege paradox: Geographic areas with highest socio-economic advantage have the lowest rates of vaccination. Vaccine 2019; 37:4525-4532. [DOI: 10.1016/j.vaccine.2019.06.060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 06/04/2019] [Accepted: 06/18/2019] [Indexed: 12/17/2022]
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Area-Based Socio-Economic Inequalities in Mortality from Lung Cancer and Respiratory Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101791. [PMID: 31117163 PMCID: PMC6571595 DOI: 10.3390/ijerph16101791] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/09/2019] [Accepted: 05/16/2019] [Indexed: 11/24/2022]
Abstract
Background: After political transformation in 1989/1990, Poland experienced a general improvement in living conditions and quality of life, but the benefits did not extend evenly across all segments of the society. We hypothesized that the regional differences in mortality due to diseases of the respiratory system are related to socioeconomic status (SES) and its changes over time. Materials and methods: An ecological study was carried out in 66 sub-regions of Poland using the data from the period of 2010 to 2014. Age-standardized mortality rates (SMRs) were calculated separately for men and women in three age categories: ≥15, 25–64 years, and ≥65 years. An area-based SES index was derived from the characteristics of the sub-regions using the z-score method. Multiple weighted linear regression models were constructed to estimate a real socioeconomic gradient for mortality resulting from lung cancer and respiratory diseases. Results: In the regions studied, the SMRs for respiratory disease varied from 70/100,000 to 215/100,000 in men and from 18/100,000 to 53/100,000 in women. The SMRs for lung cancer varied from 36/100,000 to 110/100,000 among men and from 26/100,000 to 77/100,000 among women. After adjusting for the prevalence of smoking and environmental pollution, the SES index was found to be inversely associated with the SMR for lung cancer in each category of age among men, and in the age group of 25–64 years among women. An increase of the SES index between 2010 and 2014 was associated with a decrease of SMR for respiratory disease both in men and women, but this change was not significantly associated with the SMR for lung cancer. Conclusion: SES appears to be an important correlate of mortality from respiratory diseases and lung cancer at the population level, particularly in men. A lower SES was associated with greater mortality from lung cancer and respiratory diseases. An increase in SES over time was related to a decrease in mortality from respiratory disease, but not from lung cancer.
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Greiner GG, Schwettmann L, Goebel J, Maier W. Primary care in Germany: access and utilisation-a cross-sectional study with data from the German Socio-Economic Panel (SOEP). BMJ Open 2018; 8:e021036. [PMID: 30355791 PMCID: PMC6224727 DOI: 10.1136/bmjopen-2017-021036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES (1) To describe the accessibility of general practitioners (GPs) by the German population; (2) to determine factors on individual and area level, such as settlement structure and area deprivation, which are associated with the walking distance to a GP; and (3) to identify factors that may cause differences in the utilisation of any doctors. DESIGN Cross-sectional study using individual survey data from the representative German Socio-Economic Panel (SOEP) linked with area deprivation data from the German Index of Multiple Deprivation for 2010 (GIMD 2010) and official data for settlement structure (urban/rural areas) at district level. Logistic regression models were estimated to determine the relationship of individual and area factors with the distance to a GP. Negative binomial regressions were used to analyse the association with utilisation. SETTING Germany. POPULATION n=20 601 respondents from the SOEP survey data 2009. PRIMARY OUTCOME MEASURE Walking distance to a GP. SECONDARY OUTCOME MEASURE Doctor visits. RESULTS Nearly 70% of the sample lives within a 20 min walk to a GP. People living in the most deprived areas have a 1.4-fold (95% CI 1.3 to 1.6) increased probability of a greater walking distance compared with the least deprived quintile, even after controlling for settlement structure and individual factors. In rural districts, people have a 3.1-fold (95% CI 2.8 to 3.4) higher probability of a greater walking distance compared with those in cities. Both area deprivation and rurality have a negative relationship with the utilisation of physicians, whereas the distance to a GP is not associated with the utilisation of physicians. CONCLUSION Walking distance to a GP depends on individual and area factors. In Germany, area deprivation is negatively correlated with the accessibility of GPs while controlling for settlement structure and individual factors. Both area factors are negatively associated with the utilisation of doctors. This knowledge could be used for future GP requirement plans.
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Affiliation(s)
- Gregory Gordon Greiner
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), Ludwig-Maximilians-Universität München (LMU), Munich, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Jan Goebel
- German Institute for Economic Research (DIW Berlin), Berlin, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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Chaparro MP, Benzeval M, Richardson E, Mitchell R. Neighborhood deprivation and biomarkers of health in Britain: the mediating role of the physical environment. BMC Public Health 2018; 18:801. [PMID: 29945580 PMCID: PMC6020450 DOI: 10.1186/s12889-018-5667-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 06/04/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Neighborhood deprivation has been consistently linked to poor individual health outcomes; however, studies exploring the mechanisms involved in this association are scarce. The objective of this study was to investigate whether objective measures of the physical environment mediate the association between neighborhood socioeconomic deprivation and biomarkers of health in Britain. METHODS We linked individual-level biomarker data from Understanding Society: The UK Household Longitudinal Survey (2010-2012) to neighborhood-level data from different governmental sources. Our outcome variables were forced expiratory volume in 1 s (FEV1%; n=16,347), systolic blood pressure (SBP; n=16,846), body mass index (BMI; n=19,417), and levels of C-reactive protein (CRP; n=11,825). Our measure of neighborhood socioeconomic deprivation was the Carstairs index, and the neighborhood-level mediators were levels of air pollutants (sulphur dioxide [SO2], particulate matter [PM10], nitrogen dioxide [NO2], and carbon monoxide [CO]), green space, and proximity to waste and industrial facilities. We fitted a multilevel mediation model following a multilevel structural equation framework in MPlus v7.4, adjusting for age, gender, and income. RESULTS Residents of poor neighborhoods and those exposed to higher pollution and less green space had worse health outcomes. However, only SO2 exposure significantly and partially mediated the association between neighborhood socioeconomic deprivation and SBP, BMI, and CRP. CONCLUSION Reducing air pollution exposure and increasing access to green space may improve population health but may not decrease health inequalities in Britain.
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Affiliation(s)
- M. Pia Chaparro
- Institute for Social and Economic Research (ISER), University of Essex. Wivenhoe Park, Colchester, Essex, CO4 3SQ UK
- Present Address : Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., suite 2200-16, New Orleans, LA 70112 USA
| | - Michaela Benzeval
- Institute for Social and Economic Research (ISER), University of Essex. Wivenhoe Park, Colchester, Essex, CO4 3SQ UK
- Institute for Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ UK
| | - Elizabeth Richardson
- NHS Health Scotland, Gyle Square, 1 S Gyle Cres, Edinburgh, EH12 9EB UK
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Drummond Street, Edinburgh, EH8 9XP UK
| | - Richard Mitchell
- Institute for Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB UK
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Nam HS. Area-level Socioeconomic Deprivation Affect Individual Cancer Mortality in Korea. J Korean Med Sci 2017; 32:1905. [PMID: 29115067 PMCID: PMC5680484 DOI: 10.3346/jkms.2017.32.12.1905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 10/26/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hae Sung Nam
- Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
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O'Doherty M, French D, Steptoe A, Kee F. Social capital, deprivation and self-rated health: Does reporting heterogeneity play a role? Results from the English Longitudinal Study of Ageing. Soc Sci Med 2017; 179:191-200. [DOI: 10.1016/j.socscimed.2017.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 11/16/2022]
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Lowry D, Singh J, Mytton J, Tiwari A. Sex-related Outcome Inequalities in Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2016; 52:518-525. [DOI: 10.1016/j.ejvs.2016.07.083] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/20/2016] [Indexed: 11/25/2022]
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Bethea TN, Palmer JR, Rosenberg L, Cozier YC. Neighborhood Socioeconomic Status in Relation to All-Cause, Cancer, and Cardiovascular Mortality in the Black Women's Health Study. Ethn Dis 2016; 26:157-64. [PMID: 27103765 DOI: 10.18865/ed.26.2.157] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Neighborhood socioeconomic status (SES) is associated with adverse health outcomes, but longitudinal data among Black Americans, who tend to live in more deprived neighborhoods, is lacking. OBJECTIVE We prospectively assessed the relation of neighborhood SES to mortality in the Black Women's Health Study. DESIGN A prospective cohort of 59,000 Black women was followed from 1995-2011. Participant addresses were geocoded and US Census block group was identified. Neighborhood SES was measured by a score based on US Census block group data for six indicators of income, education and wealth. MAIN OUTCOME MEASURES Deaths were identified through the National Death Index. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs with control for covariates. RESULTS Based on 2,598 deaths during 1995-2011, lower neighborhood SES was associated with increased all-cause and cancer mortality irrespective of individual education: among those with 16 or more years of education, HRs for lowest relative to highest neighborhood SES quartile were 1.42 (95% CI 1.18-1.71) for all-cause and 1.54 (95% CI 1.14-2.07) for cancer mortality. Neighborhood SES was associated with cardiovascular mortality among less-educated women. CONCLUSIONS Lower neighborhood SES is associated with greater risk of mortality among Black women. The presence of the association even among women with high levels of education suggests that individual SES may not overcome the unfavorable influence of neighborhood deprivation.
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16
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Moran V, Jacobs R, Mason A. Variations in Performance of Mental Health Providers in the English NHS: An Analysis of the Relationship Between Readmission Rates and Length-of-Stay. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 44:188-200. [PMID: 26749002 DOI: 10.1007/s10488-015-0711-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Length-of-stay (LOS) for inpatient mental health care is a major driver of variation in resource use internationally. We explore determinants of LOS in England, focusing on the impact of emergency readmission rates which can serve as a measure of the quality of care. Data for 2009/2010 and 2010/2011 are analysed using hierarchical and non-hierarchical models. Unexplained residual variation among providers is quantified using Empirical Bayes techniques. Diagnostic, treatment and patient-level demographic variables are key drivers of LOS. Higher emergency readmission rates are associated with shorter LOS. Ranking providers by residual variation reveals significant differences, suggesting some providers can improve performance.
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Affiliation(s)
- Valerie Moran
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Rowena Jacobs
- Centre for Health Economics and Department of Economics and Related Studies, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK
| | - Anne Mason
- Centre for Health Economics and Department of Economics and Related Studies, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK
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17
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Mackenbach JD, Lakerveld J, van Lenthe FJ, Bárdos H, Glonti K, Compernolle S, De Bourdeaudhuij I, Oppert JM, Roda C, Rutter H, Brug J, Nijpels G. Exploring why residents of socioeconomically deprived neighbourhoods have less favourable perceptions of their neighbourhood environment than residents of wealthy neighbourhoods. Obes Rev 2016; 17 Suppl 1:42-52. [PMID: 26879112 DOI: 10.1111/obr.12375] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 11/27/2022]
Abstract
Residents of socioeconomically deprived areas perceive their neighbourhood as less conducive to healthy behaviours than residents of more affluent areas. Whether these unfavourable perceptions are based on objective neighbourhood features or other factors is poorly understood. We examined individual and contextual correlates of socioeconomic inequalities in neighbourhood perceptions across five urban regions in Europe. Data were analysed from 5205 participants of the SPOTLIGHT survey. Participants reported perceptions of their neighbourhood environment with regard to aesthetics, safety, the presence of destinations and functionality of the neighbourhood, which were summed into an overall neighbourhood perceptions score. Multivariable multilevel regression analyses were conducted to investigate whether the following factors were associated with socioeconomic inequalities in neighbourhood perceptions: objectively observed neighbourhood features, neighbourhood social capital, exposure to the neighbourhood, self-rated health and lifestyle behaviours. Objectively observed traffic safety, aesthetics and the presence of destinations in the neighbourhood explained around 15% of differences in neighbourhood perceptions between residents of high and low neighbourhoods; levels of neighbourhood social cohesion explained around 52%. Exposure to the neighbourhood, self-rated health and lifestyle behaviours were significant correlates of neighbourhood perceptions but did not contribute to socioeconomic differences. This cross-European study provided evidence that socioeconomic differences in neighbourhood perceptions are not only associated with objective neighbourhood features but also with social cohesion. Levels of physical activity, sleep duration, self-rated health, happiness and neighbourhood preference were also associated with neighbourhood perceptions.
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Affiliation(s)
- J D Mackenbach
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - J Lakerveld
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - F J van Lenthe
- Department of Public Health, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - H Bárdos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - K Glonti
- ECOHOST - The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - S Compernolle
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - J-M Oppert
- Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Université Paris 13, Bobigny, France.,Sorbonne Universités, Université Pierre et Marie Curie, Université Paris 06; Institute of Cardiometabolism and Nutrition, Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Roda
- Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Université Paris 13, Bobigny, France
| | - H Rutter
- ECOHOST - The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - J Brug
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - G Nijpels
- Department of General Practice and Elderly Care, EMGO Institute for Health and Care Research, VU Medical Center Amsterdam, Amsterdam, The Netherlands
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18
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Uggla C, Mace R. Effects of local extrinsic mortality rate, crime and sex ratio on preventable death in Northern Ireland. EVOLUTION MEDICINE AND PUBLIC HEALTH 2015; 2015:266-77. [PMID: 26338679 PMCID: PMC4604479 DOI: 10.1093/emph/eov020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/14/2015] [Indexed: 11/15/2022]
Abstract
Variation in preventable death can be understood from an evolutionary life history perspective. However, previous studies have failed to isolate ecological effects on preventable death. We use population-wide Census data from Northern Ireland and find that extrinsic mortality rate and crime, but not sex ratio, impacts on male preventable death. Background and objectives: Individual investment in health varies greatly within populations and results in significant differences in the risk of preventable death. Life history theory predicts that individuals should alter their investment in health (somatic maintenance) in response to ecological cues that shift the perceived fitness payoffs to such investments. However, previous research has failed to isolate the effects of different ecological factors on preventable death, and has often relied on macro-level data without individual controls. Here, we test some key predictions concerning the local ecology—that higher extrinsic mortality rate (EMR), crime rate and mate-scarcity (male/female-biased sex ratio) at the ward-level—will be associated with a higher risk of preventable death. Methodology: We use census-based data from Northern Ireland (n = 927 150) on preventable death during an 8.7-year period from the 2001 Census and run Cox regressions for (i) accident/suicide or alcohol-related death and (ii) deaths from preventable diseases, for men and women separately, controlling for a wide range of individual variables. Results: We find evidence of ward-level EMR and crime rate being positively associated with preventable death among men, particularly men with low socioeconomic position. There was a tentative relationship between male-biased sex ratio and preventable death among women, but not among men. Conclusion and implications: Both behaviours that might lead to ‘risky’ death and health neglect might be adaptive responses to local ecologies. Efforts to reduce crime might be as effective as those to reduce extrinsic mortality, and both could have positive effects on various health behaviours.
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Affiliation(s)
- Caroline Uggla
- Department of Anthropology, University College London, London WC1H 0BW, UK
| | - Ruth Mace
- Department of Anthropology, University College London, London WC1H 0BW, UK
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19
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Regidor E, Vallejo F, Reques L, Cea L, Miqueleiz E, Barrio G. Area-level socioeconomic context, total mortality and cause-specific mortality in Spain: Heterogeneous findings depending on the level of geographic aggregation. Soc Sci Med 2015; 141:142-50. [DOI: 10.1016/j.socscimed.2015.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/16/2015] [Accepted: 07/26/2015] [Indexed: 11/26/2022]
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20
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Shweikh Y, Ko F, Chan MPY, Patel PJ, Muthy Z, Khaw PT, Yip J, Strouthidis N, Foster PJ. Measures of socioeconomic status and self-reported glaucoma in the U.K. Biobank cohort. Eye (Lond) 2015; 29:1360-7. [PMID: 26315700 PMCID: PMC4815692 DOI: 10.1038/eye.2015.157] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/20/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine ocular, demographic, and socioeconomic associations with self-reported glaucoma in the U.K. Biobank. METHODS Biobank is a study of U.K. residents aged 40-69 years registered with the National Health Service. Data were collected on visual acuity, intraocular pressure (IOP), corneal biomechanics, and questionnaire from 112,690 participants. Relationships between ocular, demographic, and socioeconomic variables with reported diagnosis of glaucoma were examined. RESULTS In all, 1916 (1.7%) people in U.K. Biobank reported glaucoma diagnosis. Participants reporting glaucoma were more likely to be older (mean 61.4 vs. 56.7 years, P<0.001) and male (2.1% vs. 1.4%, P=0.001). The rate of reported glaucoma was significantly higher in Black (3.28%, P<0.001) and Asian (2.14%, P=0.009) participants compared with White participants (1.62%, reference). Cases of reported glaucoma had a higher mean IOP (18 mm Hg both eyes, P<0.001), lower corneal hysteresis (9.96 right eye, 9.89 left eye, P<0.001), and lower visual acuity (0.09 logMAR right eye, 0.08 logMAR left eye, P<0.001) compared with those without (16 mm Hg both eyes, hysteresis 10.67 right eye, 10.63 left eye, 0.03 logMAR right eye, 0.02 logMAR left eye). The mean Townsend deprivation index was -0.72 for those reporting glaucoma and -0.95 for those without (P<0.001), indicating greater relative deprivation in those reporting glaucoma. Multivariable logistic regression showed that people in the lowest income group (<£18,000/year) were significantly more likely to report a diagnosis of glaucoma compared with any other income level (P<0.01). We observed increasing glaucoma risk across the full range of income categories, with highest risk among those of lowest income, and no evidence of a threshold effect. CONCLUSIONS In a large U.K. cohort, individuals reporting glaucoma had more adverse socioeconomic characteristics. Study of the mechanisms explaining these effects may aid our understanding of health inequality and will help inform public health interventions.
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Affiliation(s)
- Y Shweikh
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - F Ko
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - M P Y Chan
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - P J Patel
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Z Muthy
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - P T Khaw
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - J Yip
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - N Strouthidis
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.,Singapore Eye Research Institute, Singapore, Singapore.,Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia
| | - P J Foster
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
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21
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Ramsay SE, Morris RW, Whincup PH, Subramanian SV, Papacosta AO, Lennon LT, Wannamethee SG. The influence of neighbourhood-level socioeconomic deprivation on cardiovascular disease mortality in older age: longitudinal multilevel analyses from a cohort of older British men. J Epidemiol Community Health 2015; 69:1224-31. [PMID: 26285580 PMCID: PMC4680118 DOI: 10.1136/jech-2015-205542] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 07/14/2015] [Indexed: 11/16/2022]
Abstract
Background Evidence from longitudinal studies on the influence of neighbourhood socioeconomic factors in older age on cardiovascular disease (CVD) mortality is limited. We aimed to investigate the prospective association of neighbourhood-level deprivation in later life with CVD mortality, and assess the underlying role of established cardiovascular risk factors. Methods A socially representative cohort of 3924 men, aged 60–79 years in 1998–2000, from 24 British towns, was followed up until 2012 for CVD mortality. Quintiles of the national Index of Multiple Deprivation (IMD), a composite score of neighbourhood-level factors (including income, employment, education, housing and living environment) were used. Multilevel logistic regression with discrete-time models (stratifying follow-up time into months) were used. Results Over 12 years, 1545 deaths occurred, including 580 from CVD. The risk of CVD mortality showed a graded increase from IMD quintile 1 (least deprived) to 5 (most deprived). Compared to quintile 1, the age-adjusted odds of CVD mortality in quintile 5 were 1.71 (95% CI 1.32 to 2.21), and 1.62 (95% CI 1.23 to 2.13) on further adjustment for individual social class, which was attenuated slightly to 1.44 (95% CI 1.09 to 1.89), but remained statistically significant after adjustment for smoking, body mass index, physical activity and use of alcohol. Further adjustment for blood pressure, high-density lipoprotein cholesterol and prevalent diabetes made little difference. Conclusions Neighbourhood-level deprivation was associated with an increased risk of CVD mortality in older people independent of individual-level social class and cardiovascular risk factors. The role of other specific neighbourhood-level factors merits further research.
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Affiliation(s)
- S E Ramsay
- Department of Primary Care & Population Health, UCL, London, UK
| | - R W Morris
- Department of Primary Care & Population Health, UCL, London, UK
| | - P H Whincup
- Division of Population Health Sciences and Education, St George's University of London, London, UK
| | - S V Subramanian
- Department of Social and Behavioural Science, Harvard University, Boston, Massachusetts, USA
| | - A O Papacosta
- Department of Primary Care & Population Health, UCL, London, UK
| | - Lucy T Lennon
- Department of Primary Care & Population Health, UCL, London, UK
| | - S G Wannamethee
- Department of Primary Care & Population Health, UCL, London, UK
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22
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Rider T, Malik M, Chevassut T. Haematology patients and the Internet--the use of on-line health information and the impact on the patient-doctor relationship. PATIENT EDUCATION AND COUNSELING 2014; 97:223-238. [PMID: 25053474 DOI: 10.1016/j.pec.2014.06.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 06/18/2014] [Accepted: 06/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Patients access on-line health information (OHI) to better understand their health. We aimed to determine which demographic factors influence OHI use. We also explored how OHI is used and subsequent implications to the patient-doctor relationship. METHODS We distributed a self-administered questionnaire to 202 haematology out-patients. RESULTS 62.3% used the internet and 54.3% used OHI. Higher education, (P<0.001, OR 34.62, 95% CI 5.20-230.66) and household incomes of £15000-25000 (P=0.023 OR 4.8 95% CI 1.236-18.59) were positively associated with OHI use. Those reassured after reading OHI had improved trust in their specialist (P<0.001, OR 52.1, 95% CI 12.3-221.1), improved confidence during consultations, (P<0.001, OR 23.0, 95% CI 2.8-188.2) and were improved decisions makers (P=0.008, OR 13.6, 95% CI 4.1-45.7). Those with increased trust in their haematologist also had improved confidence (P<0.001, OR 6.2, 95% CI 2.2-17.3) and improved decision making ability (P<0.001, OR 13.6, 95% CI 4.7-39.4). 74.6% of patients did not share OHI with their haematologist. CONCLUSIONS Two-thirds of participants were exposed directly or indirectly to OHI. OHI affects patients' view of their health and influences behaviour during consultations. PRACTICE IMPLICATIONS Haematologists could facilitate patients using OHI by recommending high quality websites and act supportively when patients share OHI.
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Affiliation(s)
- Tom Rider
- Department of Hematology, Brighton and Sussex University Hospital Trust, Brighton, UK
| | - Muzaffar Malik
- Institute of Postgraduate Medicine, Brighton and Sussex Medical School, Mayfield House, University of Brighton, Falmer, UK
| | - Timothy Chevassut
- Research Department, Brighton and Sussex Medical School, Brighton, UK.
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23
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Garcia-Gil M, Elorza JM, Banque M, Comas-Cufí M, Blanch J, Ramos R, Méndez-Boo L, Hermosilla E, Bolibar B, Prieto-Alhambra D. Linking of primary care records to census data to study the association between socioeconomic status and cancer incidence in Southern Europe: a nation-wide ecological study. PLoS One 2014; 9:e109706. [PMID: 25329578 PMCID: PMC4203762 DOI: 10.1371/journal.pone.0109706] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 09/05/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Area-based measures of economic deprivation are seldom applied to large medical records databases to establish population-scale associations between deprivation and disease. OBJECTIVE To study the association between deprivation and incidence of common cancer types in a Southern European region. METHODS Retrospective ecological study using the SIDIAP (Information System for the Development of Research in Primary Care) database of longitudinal electronic medical records for a representative population of Catalonia (Spain) and the MEDEA index based on urban socioeconomic indicators in the Spanish census. Study outcomes were incident cervical, breast, colorectal, prostate, and lung cancer in 2009-2012. The completeness of SIDIAP cancer recording was evaluated through linkage of a geographic data subset to a hospital cancer registry. Associations between MEDEA quintiles and cancer incidence was evaluated using zero-inflated Poisson regression adjusted for sex, age, smoking, alcoholism, obesity, hypertension, and diabetes. RESULTS SIDIAP sensitivity was 63% to 92% for the five cancers studied. There was direct association between deprivation and lung, colorectal, and cervical cancer: incidence rate ratios (IRR) 1.82 [1.64-2.01], IRR 1.60 [1.34-1.90], IRR 1.22 [1.07-1.38], respectively, comparing the most deprived to most affluent areas. In wealthy areas, prostate and breast cancers were more common: IRR 0.92 [0.80-1.00], IRR 0.91 [0.78-1.06]. Adjustment for confounders attenuated the association with lung cancer risk (fully adjusted IRR 1.16 [1.08-1.25]), reversed the direction of the association with colorectal cancer (IRR 0.90 [0.84-0.95]), and did not modify the associations with cervical (IRR 1.27 [1.11-1.45]), prostate (0.74 [0.69-0.80]), and breast (0.76 [0.71-0.81]) cancer. CONCLUSIONS Deprivation is associated differently with the occurrence of various cancer types. These results provide evidence that MEDEA is a useful, area-based deprivation index for analyses of the SIDIAP database. This information will be useful to improve screening programs, cancer prevention and management strategies, to reach patients more effectively, particularly in deprived urban areas.
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Affiliation(s)
- Maria Garcia-Gil
- Research Unit, Family Medicine, Girona, Spain, and Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
- Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Catalunya, Spain
| | - Josep-Maria Elorza
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Marta Banque
- Cancer Prevention Unit and Cancer Registry, Department of Epidemiology and Evaluation, Hospital del Mar, Barcelona, Catalunya, Spain
| | - Marc Comas-Cufí
- Research Unit, Family Medicine, Girona, Spain, and Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Jordi Blanch
- Research Unit, Family Medicine, Girona, Spain, and Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Rafel Ramos
- Primary Care Services, Girona, Spain, and Catalan Institute of Health (ICS), Catalunya, Spain
| | - Leonardo Méndez-Boo
- Primary Care Information System, Catalan Institute of Health (ICS), Catalunya, Spain
| | - Eduardo Hermosilla
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Bonaventura Bolibar
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
| | - Daniel Prieto-Alhambra
- Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Catalunya, Spain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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24
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Sharma HE, Mathewson PA, Lane M, Shah P, Glover N, Palmer H, Haque MS, Denniston AK, Tsaloumas MD. The role of social deprivation in severe neovascular age-related macular degeneration. Br J Ophthalmol 2014; 98:1625-8. [PMID: 24997180 DOI: 10.1136/bjophthalmol-2014-304959] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Advances in therapy have improved outcomes for patients with neovascular age-related macular degeneration (nAMD). Prompt access to treatment is a priority and may be used as a key performance indicator. In this study, we investigate how social deprivation may impact on access to services, treatment and visual impairment registration. METHODS Patients were identified retrospectively through the Certificate of Visual Impairment system for the University Hospitals Birmingham Medical Retina service. The Index of Multiple Deprivation (IMD) 2007 score was calculated for each patient. The impact of deprivation, age, gender and ethnicity on key stages in the care pathway was assessed. RESULTS 120 patients were identified. Patients with greater social deprivation were under-represented, had worse visual acuity at first presentation (correlation of the better-seeing eye with IMD 0.225 (p=0.013)) and had sight-impairment registration earlier (correlation -0.246; p=0.007). Deprivation did not affect time to first appointment, and was not associated with a higher rate of non-attendance. CONCLUSIONS The late presentation and under-representation of patients with greater social deprivation is a serious concern. Our study strongly suggests that this vulnerable group is encountering barriers in accessing treatment in nAMD, and that these occur prior to entry into the Hospital Eye Service.
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Affiliation(s)
- Hannah E Sharma
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Priscilla A Mathewson
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark Lane
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Shah
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK Centre for Health and Social Care Improvement, School of Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Nicholas Glover
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Palmer
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Sayeed Haque
- Department of Primary Care and Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK Academic Unit of Ophthalmology, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Marie D Tsaloumas
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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