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Allain S, Naouri D, Deroyon T, Costemalle V, Hazo JB. Income and professional inequalities in chronic diseases: prevalence and incidence in France. Public Health 2024; 228:55-64. [PMID: 38306754 DOI: 10.1016/j.puhe.2023.12.022] [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: 08/21/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVES In France, almost nine of 10 deaths are caused by non-communicable diseases, and there is significant social inequality in mortality rates. However, it is not easy to collect robust data on the incidence and prevalence of such diseases according to socio-economic status. Based on data from the link between the primary longitudinal population sample and the national health data system, the aim of our study was to compute the standardised incidence and prevalence of seven major groups of chronic diseases according to socio-economic status. STUDY DESIGN Descriptive retrospective cohort study. METHODS This was a descriptive retrospective cohort study on a weighted representative sample of the French population, comprising 3.4 million individuals from data collected 2016-2017. Main chronic disease categories include diabetes, cancers, psychiatric disorders, liver and pancreatic diseases, neurological conditions, respiratory and cardiovascular diseases, calculated from the 2016-2017 period by combining health care consumption and diagnoses received during hospitalisations and/or associated with specific full healthcare coverage. Socio-economic status was measured by disposable income from the 2013-2014 tax returns and census-derived socioprofessional groups, and findings were standardised for age and sex. RESULTS For all disease categories except cancers, standardised incidence rates showed a gradient favouring the wealthiest, with a risk ratio between the first and tenth standard of living deciles ranging from 1.4 (cardiovascular diseases) to 2.8 (diabetes). Incidence of all disease categories, except cancers, was higher for all groups compared with executives and higher academic professions (risk ratios between workers and executives ranged from 2.0 to 1.3 in psychiatric and cardiovascular diseases, respectively). Conversely, cancer incidence rate followed a flat curve, reduced in the two poorest standard of living deciles, and there were no significant differences between socioprofessional groups. Standardised prevalence rates followed the same patterns, although risk ratios were highest for psychiatric diseases, varying according to sex and disease. CONCLUSIONS Deep social inequalities in incidence and prevalence of chronic diseases were observed in a large representative sample of the French population. The reverse social inequalities in cancer incidence and prevalence calls for more detailed research into cancer types and selection mechanisms, the data from which would allow the long-term monitoring of such disparities.
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Affiliation(s)
- Samuel Allain
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Diane Naouri
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Thomas Deroyon
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Vianney Costemalle
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Jean-Baptiste Hazo
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France.
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Kopasker D, Katikireddi SV, Santos JV, Richiardi M, Bronka P, Rostila M, Cecchini M, Ali S, Emmert-Fees K, Bambra C, Hoven H, Backhaus I, Balaj M, Eikemo TA. Microsimulation as a flexible tool to evaluate policies and their impact on socioeconomic inequalities in health. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100758. [PMID: 37876527 PMCID: PMC10590730 DOI: 10.1016/j.lanepe.2023.100758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Daniel Kopasker
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK
| | | | - João Vasco Santos
- Public Health Unit, ACES Grande Porto V – Porto Ocidental, ARS Norte, Portugal
- MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Portugal
- CINTESIS - Centre for Health Technology and Services Research, Portugal
| | - Matteo Richiardi
- Centre for Microsimulation and Policy Analysis, University of Essex, UK
| | - Patryk Bronka
- Centre for Microsimulation and Policy Analysis, University of Essex, UK
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Sweden
- Aging Research Center (ARC), Karolinska Institutet, Sweden
| | - Michele Cecchini
- Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Shehzad Ali
- Department of Epidemiology and Biostatistics, Western University, Canada
- Department of Health Sciences, University of York, UK
- WHO Collaborating Centre for Knowledge Translation and HTA in Health Equity, Canada
| | - Karl Emmert-Fees
- School of Medicine and Health, Technical University of Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Germany
| | - Clare Bambra
- Population Health Sciences Institute, University of Newcastle, UK
| | - Hanno Hoven
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Germany
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | - Insa Backhaus
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | - Mirza Balaj
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
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Zazueta-Borboa JD, Martikainen P, Aburto JM, Costa G, Peltonen R, Zengarini N, Sizer A, Kunst AE, Janssen F. Reversals in past long-term trends in educational inequalities in life expectancy for selected European countries. J Epidemiol Community Health 2023; 77:421-429. [PMID: 37173136 PMCID: PMC10314064 DOI: 10.1136/jech-2023-220385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/01/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Across Europe, socioeconomic inequalities in mortality are large and persistent. To better understand the drivers of past trends in socioeconomic mortality inequalities, we identified phases and potential reversals in long-term trends in educational inequalities in remaining life expectancy at age 30 (e30), and assessed the contributions of mortality changes among the low-educated and the high-educated at different ages. METHODS We used individually linked annual mortality data by educational level (low, middle and high), sex and single age (30+) from 1971/1972 onwards for England and Wales, Finland and Italy (Turin). We applied segmented regression to trends in educational inequalities in e30 (e30 high-educated minus e30 low-educated) and employed a novel demographic decomposition technique. RESULTS We identified several phases and breakpoints in the trends in educational inequalities in e30. The long-term increases (Finnish men, 1982-2008; Finnish women, 1985-2017; and Italian men, 1976-1999) were driven by faster mortality declines among the high-educated aged 65-84, and by mortality increases among the low-educated aged 30-59. The long-term decreases (British men, 1976-2008, and Italian women, 1972-2003) were driven by faster mortality improvements among the low-educated than among the high-educated at age 65+. The recent stagnation of increasing inequality (Italian men, 1999) and reversals from increasing to decreasing inequality (Finnish men, 2008) and from decreasing to increasing inequality (British men, 2008) were driven by mortality trend changes among the low-educated aged 30-54. CONCLUSION Educational inequalities are plastic. Mortality improvements among the low-educated at young ages are imperative for achieving long-term decreases in educational inequalities in e30.
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Affiliation(s)
- Jesus Daniel Zazueta-Borboa
- Aging and Longevity, Netherlands Interdisciplinary Demographic Institute - KNAW/University of groningen, The Hage, The Netherlands
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Jose Manuel Aburto
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
- Interdisciplinary Centre on Population Dynamics, Southern Denmark University, Odense, Denmark
| | - Giuseppe Costa
- Department of Public Health and Microbiology, University of Turin, Turin, Italy
| | - Riina Peltonen
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Nicolas Zengarini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (Torino), Italy
| | - Alison Sizer
- Department of Information Studies, University College London, London, UK
| | - Anton E Kunst
- Social Medicine, Amsterdam UMC, Locatie AMC, Amsterdam, The Netherlands
| | - Fanny Janssen
- Aging and Longevity, Netherlands Interdisciplinary Demographic Institute - KNAW/University of groningen, The Hage, The Netherlands
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
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Lamu AN, Chen G, Olsen JA. Amplified disparities: The association between spousal education and own health. Soc Sci Med 2023; 323:115832. [PMID: 36947992 DOI: 10.1016/j.socscimed.2023.115832] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
Positive associations between own educational attainment and own health have been extensively documented. Studies have also shown spousal educational attainment to be associated with own health. This paper investigates the extent to which spousal education contributes to the social gradient in health, net of own education; and whether parts of a seeming spousal education effect are attributable to differences in early-life human capital, as measured by respondents' height and childhood living standard. Furthermore, we investigate the relative contribution of predictors in the regression analysis by use of Shapley value decomposition. We use data from a comprehensive health survey from Northern Norway (conducted in 2015/16, N = 21,083, aged 40 and above). We apply three alternative health outcome measures: the EQ-5D-5L index, a visual analogue scale (EQ-VAS) and self-rated health. In all models considered, spousal education is generally positively significant for both men and women. The results also suggest that spousal education is generally more important for men than women. In the sub-sample of individuals having a spouse, decomposition analyses showed that the relative contribution of spousal education to the goodness-of-fit in men's (women's) health was 13% (14%) with the EQ-5D-5L; 25% (20%) with the EQ-VAS and; 30% (21%) with self-rated health. Heterogeneity analyses showed stronger spousal education effects in younger age groups. In conclusion, we have provided empirical evidence that spousal education may contribute to explaining the amplified health gradient in an egalitarian country like Norway.
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Affiliation(s)
- Admassu N Lamu
- NORCE - Norwegian Research Center, Bergen, Norway; Department of Community Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Jan Abel Olsen
- Department of Community Medicine, UiT - the Arctic University of Norway, Tromsø, Norway; Centre for Health Economics, Monash University, Melbourne, Australia; Norwegian Institute of Public Health, Oslo, Norway.
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5
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Molarius A. Socioeconomic inequalities in health - debates on the persistence. Perspect Public Health 2023; 143:20-21. [PMID: 36694968 DOI: 10.1177/17579139221138447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A Molarius
- Region Värmland, Centre for Clinical Research, 651 85 Karlstad, Sweden.,Department of Public Health Sciences, Karlstad University, Karlstad, Sweden
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Beliefs about harms of cigarette smoking among Norwegian adults born from 1899 to 1969. Do variations across education, smoking status and sex mirror the decline in smoking? PLoS One 2022; 17:e0271647. [PMID: 35921379 PMCID: PMC9348701 DOI: 10.1371/journal.pone.0271647] [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: 10/04/2021] [Accepted: 07/05/2022] [Indexed: 12/05/2022] Open
Abstract
Background and aim Smoking is one of the most important causes of socioeconomic disparities in morbidity and mortality. The aim of this study was to examine if beliefs about harms of smoking differed across gender, smoking status and education among Norwegian adults born between 1899 and 1969. Methods Using data from a nationally representative survey of smoking habits and a multinomial logit/negative binomial two-stage hurdle model design, we examined (first hurdle) the associations between birth cohort, gender, education and smoking status and four beliefs about cigarette smoking: i) smoking is not harmful, ii) do not know if smoking is harmful, iii) any number of cigarettes per day (CPD) is harmful and iv) smoking more than a given nonzero number of CPD is harmful, and (second hurdle) the predicted number of CPD that could be smoked without causing harm (from outcome iv). Results The probability of believing that smoking was not harmful was close to zero, regardless of birth cohort, sex, education and smoking status. The probability of not knowing if smoking was harmful decreased from around 0.7 to almost zero across cohorts. The probability of believing that smoking more than zero CPD was harmful increased from less than 0.1 to around 0.7, while the probability of believing that there is some safe level of smoking increased with cohorts born from 1900 to 1930 before declining. Respondents with primary/secondary education consistently believed smoking to be less harmful compared to respondents with tertiary education, but cohort trajectories were similar. Discussion The similar birth cohort trajectories in beliefs about the harms of smoking do not support the idea that Norwegian adults with lower education has had qualitatively different beliefs about the harmfulness of smoking compared to those with higher education. The persistent and large socioeconomic gradient is likely a result of other factors.
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Barros MBDA, Medina LDPB, Lima MG, Sousa NFDS, Malta DC. Changes in prevalence and in educational inequalities in Brazilian health behaviors between 2013 and 2019. CAD SAUDE PUBLICA 2022; 38Suppl 1:e00122221. [PMID: 35857955 DOI: 10.1590/0102-311x00122221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 04/28/2022] [Indexed: 11/22/2022] Open
Abstract
Considering the relevance of health behaviors for chronic diseases prevalence and mortality and the increase in income concentration observed in the world and in Brazil, this study aimed to evaluate the changes in the prevalence and in the educational inequalities of Brazilian adult health behaviors between 2013 and 2019. We analyzed data of 49,025 and 65,803 adults (18-59 years of age) from the Brazilian National Health Survey (PNS), 2013 and 2019. Prevalence of health behaviors (smoking, alcohol intake, diet, physical activity and sedentarism) were estimated for three educational strata, for both surveys. Prevalence ratios (PR) between year of survey and between educational strata were estimated by Poisson regression models. Significant reductions were found in the prevalence of smoking, physical inactivity, sedentarism, insufficient consumption of fruits, and the excessive consumption of sweetened beverages. However, an increase was observed in alcohol consumption and binge drinking; vegetable consumption remained stable. Contrasting the favorable change in some behaviors, inequalities among schooling strata remained very high in 2019, specially for smoking (PR = 2.82; 95%CI: 2.49-3.20), passive smoking (PR = 2.88; 95%CI: 2.56-3.23) and physical inactivity (PR = 2.02; 95%CI: 1.92-2.13). There was a significant increase in the educational inequality regarding physical inactivity (21%), insufficient intake of fruit (8%) and in the frequent consumption of sweetened beverages (32%). The persistence and enlargement of inequalities highlight the behaviors and social segments that should be special targets for policies and programs focused in promoting healthy lifestyles.
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Zijp A, van Deelen TRD, van den Putte B, Kunst AE, Kuipers MAG. Educational inequalities in exposure to tobacco promotion at the point of sale among adolescents in four Dutch cities. Health Place 2022; 76:102824. [PMID: 35660750 DOI: 10.1016/j.healthplace.2022.102824] [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: 02/03/2022] [Revised: 04/29/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
Abstract
This study aimed to assess educational differences in adolescents' exposure to tobacco outlets. Data were collected among 312 13-17-year-old non-smoking secondary school students in four Dutch cities. In a smartphone app, exposure (≤10 m from outlet) was measured using GPS and participants reported their educational track (pre-vocational vs. pre-university). Associations were estimated in negative binomial regression models. Mean exposure to tobacco outlet was 16.6 times in 14 days. Pre-vocational education was associated with higher exposure compared to pre-university education (IRR:1.46, 95%CI:1.08-1.98), especially around school (IRR:2.61,95%CI:1.50-4.55). These differences may contribute to socioeconomic inequalities in smoking.
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Affiliation(s)
- Anne Zijp
- Department of Public and Occupational Health, Amsterdam UMC-University of Amsterdam, Meibergdreef 15, 1105, AZ, Amsterdam, the Netherlands.
| | - Tessa R D van Deelen
- Department of Public and Occupational Health, Amsterdam UMC-University of Amsterdam, Meibergdreef 15, 1105, AZ, Amsterdam, the Netherlands
| | - Bas van den Putte
- Amsterdam School of Communication Research, University of Amsterdam, Nieuwe Achtergracht 166, 1018, WV, Amsterdam, the Netherlands
| | - Anton E Kunst
- Department of Public and Occupational Health, Amsterdam UMC-University of Amsterdam, Meibergdreef 15, 1105, AZ, Amsterdam, the Netherlands
| | - Mirte A G Kuipers
- Department of Public and Occupational Health, Amsterdam UMC-University of Amsterdam, Meibergdreef 15, 1105, AZ, Amsterdam, the Netherlands
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Plass D, Hilderink H, Lehtomäki H, Øverland S, Eikemo TA, Lai T, Gorasso V, Devleesschauwer B. Estimating risk factor attributable burden - challenges and potential solutions when using the comparative risk assessment methodology. Arch Public Health 2022; 80:148. [PMID: 35624479 PMCID: PMC9137119 DOI: 10.1186/s13690-022-00900-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/12/2022] [Indexed: 03/21/2024] Open
Abstract
Background Burden of disease analyses quantify population health and provide comprehensive overviews of the health status of countries or specific population groups. The comparative risk assessment (CRA) methodology is commonly used to estimate the share of the burden attributable to risk factors. The aim of this paper is to identify and address some selected important challenges associated with CRA, illustrated by examples, and to discuss ways to handle them. Further, the main challenges are addressed and finally, similarities and differences between CRA and health impact assessments (HIA) are discussed, as these concepts are sometimes referred to synonymously but have distinctly different applications. Results CRAs are very data demanding. One key element is the exposure-response relationship described e.g. by a mathematical function. Combining estimates to arrive at coherent functions is challenging due to the large variability in risk exposure definitions and data quality. Also, the uncertainty attached to this data is difficult to account for. Another key issue along the CRA-steps is to define a theoretical minimal risk exposure level for each risk factor. In some cases, this level is evident and self-explanatory (e.g., zero smoking), but often more difficult to define and justify (e.g., ideal consumption of whole grains). CRA combine all relevant information and allow to estimate population attributable fractions (PAFs) quantifying the proportion of disease burden attributable to exposure. Among many available formulae for PAFs, it is important to use the one that allows consistency between definitions, units of the exposure data, and the exposure response functions. When combined effects of different risk factors are of interest, the non-additive nature of PAFs and possible mediation effects need to be reflected. Further, as attributable burden is typically calculated based on current exposure and current health outcomes, the time dimensions of risk and outcomes may become inconsistent. Finally, the evidence of the association between exposure and outcome can be heterogeneous which needs to be considered when interpreting CRA results. Conclusions The methodological challenges make transparent reporting of input and process data in CRA a necessary prerequisite. The evidence for causality between included risk-outcome pairs has to be well established to inform public health practice.
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Affiliation(s)
- Dietrich Plass
- German Environment Agency, Section Exposure Assessment and Environmental Health Indicators, Berlin, Germany.
| | - Henk Hilderink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Heli Lehtomäki
- Finnish Institute for Health and Welfare (THL), Health Security, Environmental Health, Helsinki, Finland.,University of Eastern Finland (UEF), Faculty of Health Sciences, School of Pharmacy, Kuopio, Finland
| | - Simon Øverland
- Section for Health Care Collaboration, Haukeland University Hospital, Bergen, Norway
| | - Terje A Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Taavi Lai
- Fourth View Consulting, Tallinn, Estonia
| | - Vanessa Gorasso
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
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Ladislav K, Marek B. The geographical epidemiology of smoking-related premature mortality: a registry-based small-area analysis of the Czech death statistics. Spat Spatiotemporal Epidemiol 2022; 41:100501. [DOI: 10.1016/j.sste.2022.100501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 12/04/2021] [Accepted: 03/05/2022] [Indexed: 11/26/2022]
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Rasmussen M, Larsson M, Gilljam H, Adami J, Wärjerstam S, Post A, Björk-Eriksson T, Helgason AR, Tønnesen H. Effectiveness of tobacco cessation interventions for different groups of tobacco users in Sweden: a study protocol for a national prospective cohort study. BMJ Open 2022; 12:e053090. [PMID: 35078840 PMCID: PMC8796232 DOI: 10.1136/bmjopen-2021-053090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Tobacco is still one of the single most important risk factors among the lifestyle habits that cause morbidity and mortality in humans. Furthermore, tobacco has a heavy social gradient, as the consequences are even worse among disadvantaged and vulnerable groups. To reduce tobacco-related inequity in health, those most in need should be offered the most effective tobacco cessation intervention. The aim of this study is to facilitate and improve the evaluation of already implemented national tobacco cessation efforts, focusing on 10 disadvantaged and vulnerable groups of tobacco users. METHODS AND ANALYSIS This is a prospective cohort study. Data will be collected by established tobacco cessation counsellors in Sweden. The study includes adult tobacco or e-cigarette users, including disadvantaged and vulnerable patients, receiving in-person interventions for tobacco or e-cigarette cessation (smoking, snus and/or e-cigarettes). Patient inclusion was initiated in April 2020. For data analyses patients will be sorted into vulnerable groups based on risk factors and compared with tobacco users without the risk factor in question.The primary outcome is continuous successful quitting after 6 months, measured by self-reporting. Secondary outcomes include abstinence at the end of the treatment programme, which could be from minutes over days to weeks, 14-day point prevalence after 6 months, and patient satisfaction with the intervention. Effectiveness of successful quitting will be examined by comparing vulnerable with non-vulnerable patients using a mixed-effect logistic regression model adjusting for potential prognostic factors and known confounders. ETHICS AND DISSEMINATION The project will follow the guidelines from the Swedish Data Protection Authority and have been approved by the Swedish Ethical Review Authority before patient inclusion (Dnr: 2019-02221). Only patients providing written informed consent will be included. Both positive and negative results will be published in scientific peer-reviewed journals and presented at national and international conferences. Information will be provided through media available to the public, politicians, healthcare providers and planners as these are all important stakeholders. TRIAL REGISTRATION NUMBER NCT04819152.
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Affiliation(s)
- Mette Rasmussen
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, Malmö, Sweden
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, Frederiksberg University Hospital, Frederiksberg, Denmark
| | - Matz Larsson
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, Malmö, Sweden
- The Cardiology-Lung Clinic, Örebro University Hospital, Örebro, Sweden
| | - Hans Gilljam
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Sanne Wärjerstam
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, Malmö, Sweden
| | - Ann Post
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Centre West, Western Sweden Healthcare Region, Goteborg, Sweden
- Department of Oncology, University of Gothenburg, Institute of Clinical Sciences, Sahlgrenska Academy, Goteborg, Sweden
| | | | - Hanne Tønnesen
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, Malmö, Sweden
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, Frederiksberg University Hospital, Frederiksberg, Denmark
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Pelletier CA, White N, Duchesne A, Sluggett L. Barriers to physical activity for adults in rural and urban Canada: A cross-sectional comparison. SSM Popul Health 2021; 16:100964. [PMID: 34841038 PMCID: PMC8606540 DOI: 10.1016/j.ssmph.2021.100964] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/21/2021] [Accepted: 11/09/2021] [Indexed: 12/04/2022] Open
Abstract
Background Individual differences in physical activity behavior are associated with a collection of individual and environmental factors manifesting as barriers to participation. Understanding how barriers to physical activity differ based on sociodemographic characteristics can support identification and elimination of health inequities. Objectives To compare the odds of reporting individual and environmental barriers to physical activity in rural and urban adults, and explore interactions between rural-urban location and sociodemographic factors to characterize patterns in barriers to physical activity. Design Cross-sectional. Methods We analyzed the 2017 Canadian Community Health Survey Barriers to Physical Activity Rapid Response, with a final weighted sample of 24,499,462 (unweighted n=21,967). The likelihood of reporting each barrier domain based on rural-urban location was examined using binary logistic regression following a model-fitting approach with sociodemographic characteristics as covariates or interaction terms. Results Adjusting for sociodemographic factors, rural residents showed 85% higher odds of reporting at least one social or built environmental barrier (OR=1.85 [1.66, 2.07]). Compared to urban residents, rural residents showed significantly higher odds of reporting barriers to facility access (OR=4.15 [3.58, 4.83]) and a lack of social support to be active (OR=1.17 [1.04, 1.32]). Urban residents reported lower preference for physical activity, lower enjoyment of physical activity and lower confidence in their ability to regularly engage in physical activity. Interactions between socioeconomic status and location were identified related to enjoyment and confidence to be active. There was no effect of location on predicting the odds of reporting an individual resource-related variable (e.g., time, energy). Conclusions Despite being more likely than urban residents to prefer and enjoy physical activity, rural residents have fewer opportunities and receive less social support to be active. It is important to consider geographic location when characterizing barriers to physical activity and in the development of context-specific health promotion strategies. Rural residents have a higher odds of reporting social or built environmental barriers to physical activity. The most common environmental barrier for rural residents was lack of access to free or low-cost facilities. Urban residents reported a lower preference and enjoyment of physical activity. There was no rural-urban location-based difference in barriers related to time or costs to be active. It is important to consider geographic location and sex when characterising barriers to physical activity.
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Affiliation(s)
- Chelsea A Pelletier
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada
| | - Nicole White
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada.,Department of Psychology, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada
| | - Annie Duchesne
- Department of Psychology, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada
| | - Larine Sluggett
- University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada
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Long D, Mackenbach J, Martikainen P, Lundberg O, Brønnum-Hansen H, Bopp M, Costa G, Kovács K, Leinsalu M, Rodríguez-Sanz M, Menvielle G, Nusselder W. Smoking and inequalities in mortality in 11 European countries: a birth cohort analysis. Popul Health Metr 2021; 19:3. [PMID: 33516235 PMCID: PMC7847590 DOI: 10.1186/s12963-021-00247-2] [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: 09/21/2020] [Accepted: 01/21/2021] [Indexed: 01/17/2023] Open
Abstract
Purpose To study the trends of smoking-attributable mortality among the low and high educated in consecutive birth cohorts in 11 European countries. Methods Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung cancer mortality rates using the Preston-Glei-Wilmoth method. Rate ratios and rate differences among the low and high-educated were estimated and used to estimate the contribution of inequality in smoking-attributable mortality to inequality in total mortality. Results In most countries, smoking-attributable mortality decreased in consecutive birth cohorts born between 1906 and 1961 among low- and high-educated men and high-educated women, but not among low-educated women among whom it increased. Relative educational inequalities in smoking-attributable mortality increased among both men and women with no signs of turning points. Absolute inequalities were stable among men but slightly increased among women. The contribution of inequality in smoking-attributable mortality to inequality in total mortality decreased in consecutive generations among men but increased among women. Conclusions Smoking might become less important as a driver of inequalities in total mortality among men in the future. However, among women, smoking threatens to further widen inequalities in total mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12963-021-00247-2.
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Affiliation(s)
- Di Long
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Johan Mackenbach
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Olle Lundberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | | | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Giuseppe Costa
- Department of Clinical Medicine and Biology, University of Turin, Torino, Italy
| | | | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden.,Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Haeberer M, León-Gómez I, Pérez-Gómez B, Téllez-Plaza M, Pérez-Ríos M, Schiaffino A, Rodríguez-Artalejo F, Galán I. Social inequalities in tobacco-attributable mortality in Spain. The intersection between age, sex and educational level. PLoS One 2020; 15:e0239866. [PMID: 32986786 PMCID: PMC7521746 DOI: 10.1371/journal.pone.0239866] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION First study of social inequalities in tobacco-attributable mortality (TAM) in Spain considering the joint influence of sex, age, and education (intersectional perspective). METHODS Data on all deaths due to cancer, cardiometabolic and respiratory diseases among people aged ≥35 years in 2016 were obtained from the Spanish Statistical Office. TAM was calculated based on sex-, age- and education-specific smoking prevalence, and on sex-, age- and disease-specific relative risks of death for former and current smokers vs lifetime non-smokers. As inequality measures, the relative index of inequality (RII) and the slope index of inequality (SII) were calculated using Poisson regression. The RII is interpreted as the relative risk of mortality between the lowest and the highest educational level, and the SII as the absolute difference in mortality. RESULTS The crude TAM rate was 55 and 334 per 100,000 in women and men, respectively. Half of these deaths occurred among people with the lowest educational level (27% of the population). The RII for total mortality was 0.39 (95%CI: 0.35-0.42) in women and 1.61 (95%CI: 1.55-1.67) in men. The SII was -41 and 111 deaths per 100,000, respectively. Less-educated women aged <55 years and men (all ages) showed an increased mortality risk; nonetheless, less educated women aged ≥55 had a reduced risk. CONCLUSIONS TAM is inversely associated with educational level in men and younger women, and directly associated with education in older women. This could be explained by different smoking patterns. Appropriate tobacco control policies should aim to reduce social inequalities in TAM.
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Affiliation(s)
- Mariana Haeberer
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain
| | | | - Beatriz Pérez-Gómez
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Téllez-Plaza
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Mónica Pérez-Ríos
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Anna Schiaffino
- Direcció General de Planificació en Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
- Institut Catala d’Oncologia, Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando Rodríguez-Artalejo
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Iñaki Galán
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
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Witvliet MI, Toch-Marquardt M, Eikemo TA, Mackenbach JP. Improving job strain might reduce inequalities in cardiovascular disease mortality in european men. Soc Sci Med 2020; 267:113219. [PMID: 32771223 DOI: 10.1016/j.socscimed.2020.113219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/04/2019] [Accepted: 07/12/2020] [Indexed: 10/23/2022]
Abstract
Unfavorable psychosocial working conditions can lead to cardiovascular disease (CVD) mortality. Lower-occupational groups typically experience unfavorable psychosocial working conditions as compared to higher-occupational groups. We investigate the extent to which CVD mortality inequalities might be reduced if psychosocial working conditions for manual workers are raised to the level experienced by non-manual workers (upward-leveling scenario). We also investigate what would occur if psychosocial working conditions among manual and non-manual workers are raised to better levels as observed in the 'ideal' region (best practice scenario). Individual-level CVD mortality data from 12 European countries were obtained from the EURO-GBD-SE project (1998-2007). Psychosocial working conditions data (i.e. job strain) were extracted from the European Working Conditions Survey (2005) and rate ratios from literature reviews. Population attributable fractions (PAF) and two counterfactual scenarios (namely, upward-leveling scenario and best-practice scenario) were developed to examine employed male non-manual and manual workers. Results appeared to show that CVD mortality might be reduced in men when unfavorable psychosocial working conditions are improved for manual workers (PAF = 7.7%, 95% CI: 6.5-10.0). The upward-leveling scenario seems to reduce CVD mortality inequalities for manual workers, by 13-74%. Best-practice scenario shows the largest reduction in CVD mortality in the Baltic region (87 deaths per 100,000 person years). Findings suggest that rendering job strain in manual workers to the level experienced by non-manual workers might substantially reduce CVD mortality inequalities in European men.
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Affiliation(s)
- M I Witvliet
- Department of Sociology, Social Work and Criminal Justice, Lamar University, USA; Department of Sociology and Political Science, Norwegian University of Science and Technology, Norway
| | - M Toch-Marquardt
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Norway; Department of Public Health and Nursing, Norwegian University of Science and Technology, Norway.
| | - T A Eikemo
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands; Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - J P Mackenbach
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
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16
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Rydland HT, Fjær EL, Eikemo TA, Huijts T, Bambra C, Wendt C, Kulhánová I, Martikainen P, Dibben C, Kalėdienė R, Borrell C, Leinsalu M, Bopp M, Mackenbach JP. Educational inequalities in mortality amenable to healthcare. A comparison of European healthcare systems. PLoS One 2020; 15:e0234135. [PMID: 32614848 PMCID: PMC7332057 DOI: 10.1371/journal.pone.0234135] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Educational inequalities in health and mortality in European countries have often been studied in the context of welfare regimes or political systems. We argue that the healthcare system is the national level feature most directly linkable to mortality amenable to healthcare. In this article, we ask to what extent the strength of educational differences in mortality amenable to healthcare vary among European countries and between European healthcare system types. METHODS This study uses data on mortality amenable to healthcare for 21 European populations, covering ages 35-79 and spanning from 1998 to 2006. ISCED education categories are used to calculate relative (RII) and absolute inequalities (SII) between the highest and lowest educated. The healthcare system typology is based on the latest available classification. Meta-analysis and ANOVA tests are used to see if and how they can explain between-country differences in inequalities and whether any healthcare system types have higher inequalities. RESULTS All countries and healthcare system types exhibited relative and absolute educational inequalities in mortality amenable to healthcare. The low-supply and low performance mixed healthcare system type had the highest inequality point estimate for the male (RII = 3.57; SII = 414) and female (RII = 3.18; SII = 209) population, while the regulation-oriented public healthcare systems had the overall lowest (male RII = 1.78; male SII = 123; female RII = 1.86; female SII = 78.5). Due to data limitations, results were not robust enough to make substantial claims about typology differences. CONCLUSIONS This article aims at discussing possible mechanisms connecting healthcare systems, social position, and health. Results indicate that factors located within the healthcare system are relevant for health inequalities, as inequalities in mortality amenable to medical care are present in all healthcare systems. Future research should aim at examining the role of specific characteristics of healthcare systems in more detail.
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Affiliation(s)
- Håvard T. Rydland
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Erlend L. Fjær
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Terje A. Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Tim Huijts
- Research Centre for Education and the Labour Market, Maastricht University, Maastricht, The Netherlands
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Claus Wendt
- Sociology of Health and Healthcare Systems, University of Siegen, Siegen, Germany
| | - Ivana Kulhánová
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | - Chris Dibben
- School of Geosciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Carme Borrell
- Agència de Salut de Pública de Barcelona, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
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Guldbrandsson K, Bremberg S. Cross-sectoral cooperation at the ministerial level in three Nordic countries - With a focus on health inequalities. Soc Sci Med 2020; 256:112999. [PMID: 32504865 DOI: 10.1016/j.socscimed.2020.112999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/24/2020] [Accepted: 04/14/2020] [Indexed: 01/19/2023]
Abstract
To reduce health inequalities requires interventions that address the social determinants of health. The responsibilities, at the ministerial level, for these determinants are mainly situated outside the ministry of health. Accordingly, interventions to reduce health inequalities require coordination between the ministry of health and other ministries. Yet, a large literature in public administration has demonstrated that cross-sectoral cooperation is hard to achieve. The goal of this paper was to examine whether inter-ministerial cooperation relating to the reduction of health inequalities is occurring in practice. Semi-structured interviews were performed with senior officials at 26 ministries in Finland, Norway, and Sweden. The interviews were analyzed both qualitatively and quantitatively. The point of departure was a question if the ministries had initiated substantial measures, such as reforms, regulations, funding, or fiscal strategies, aiming to promote health equity in the population and, if so, if this was done in cooperation with other ministries. The informants reported 80 measures intended to promote health equity and stated inter-ministerial cooperation for 65 of these measures. Many informants described that cooperation between the ministries was routine and well-functioning. Thus, there was no recorded lack of inter-ministerial cooperation. However, the measures that were reported, seemed to be insufficient to reduce health inequalities, both due to lack of extent and lack of effectiveness. This might be due to insufficient political commitment to tackle health inequalities. If so, the WHO Health in All Policies approach might not be effective.
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Affiliation(s)
- Karin Guldbrandsson
- Public Health Agency of Sweden, Folkhälsomyndigheten, SE-171 82, Solna, Sweden; Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Sven Bremberg
- Public Health Agency of Sweden, Folkhälsomyndigheten, SE-171 82, Solna, Sweden; Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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18
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Timonin S, Jasilionis D, Shkolnikov VM, Andreev E. New perspective on geographical mortality divide in Russia: a district-level cross-sectional analysis, 2008-2012. J Epidemiol Community Health 2020; 74:144-150. [PMID: 31676666 PMCID: PMC6993025 DOI: 10.1136/jech-2019-213239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 12/02/2022]
Abstract
BACKGROUND Prior studies on spatial inequalities in mortality in Russia were restricted to the highest level of administrative division, ignoring variations within the regions. Using mortality data for 2239 districts, this study is the first analysis to capture the scale of the mortality divide at a more detailed level. METHODS Age-standardised death rates are calculated using aggregated deaths for 2008-2012 and population exposures from the 2010 census. Inequality indices and decomposition are applied to quantify both the total mortality disparities across the districts and the contributions of the variations between and within regions. RESULTS Regional variations in mortality mask one-third (males) and one-half (females) of the inequalities observed at the district level. A comparison of the 5% of individuals residing in the districts with the highest and the lowest mortality shows a gap of 15.5 years for males and 10.3 years for females. The lowest life expectancy levels are in the shrinking areas of the Far East and Northwest of Russia. The highest life expectancy clusters are in the intercity districts of Moscow and Saint Petersburg, and in several science cities. Life expectancy in these best-practice districts is close to the national averages of Poland and Estonia, but is still substantially below the averages in Western countries. CONCLUSION The large between-regional and within-regional disparities suggest that national-level mortality could be lowered if these disparities are reduced by improving health in the laggard areas. This can be achieved by introducing policies that promote health convergence both within and between the Russian regions.
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Affiliation(s)
- Sergey Timonin
- International Laboratory for Population and Health, National Research University Higher School of Economics, Moscow, Russia
| | - Domantas Jasilionis
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Vladimir M Shkolnikov
- International Laboratory for Population and Health, National Research University Higher School of Economics, Moscow, Russia
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Evgeny Andreev
- International Laboratory for Population and Health, National Research University Higher School of Economics, Moscow, Russia
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19
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Nußbaumer-Streit B, Teufer B, Langer G, Meerpohl JJ, Ebenberger A, Gartlehner G. [GRADE equity guidelines 2: Considering health equity in GRADE guideline development - equity extension of the guideline development checklist]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2019; 147-148:120-126. [PMID: 31757658 DOI: 10.1016/j.zefq.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To provide guidance for guideline developers on how to consider health equity at key stages of the guideline development process. STUDY DESIGN AND SETTING Literature review followed by group discussions and consensus building. RESULTS The key stages at which guideline developers could consider equity include setting priorities, guideline group membership, identifying the target audience(s), generating the guideline questions, considering the importance of outcomes and interventions, deciding what evidence to include and searching for evidence, summarizing the evidence and considering additional information, wording of recommendations, and evaluation and use. We provide examples of how guidelines have actually considered equity at each of these stages. CONCLUSION Guideline projects should consider the aforementioned suggestions for recommendations that are equity sensitive.
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Affiliation(s)
- Barbara Nußbaumer-Streit
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich.
| | - Birgit Teufer
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich
| | - Gero Langer
- Institut für Gesundheits- und Pflegewissenschaft, German Center for Evidence-based Nursing »sapere aude«, Halle (Saale), Deutschland
| | - Joerg J Meerpohl
- Cochrane Deutschland / Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Agnes Ebenberger
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich
| | - Gerald Gartlehner
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich; RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA
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20
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Mackenbach JP, Valverde JR, Bopp M, Brønnum-Hansen H, Deboosere P, Kalediene R, Kovács K, Leinsalu M, Martikainen P, Menvielle G, Regidor E, Nusselder WJ. Determinants of inequalities in life expectancy: an international comparative study of eight risk factors. LANCET PUBLIC HEALTH 2019; 4:e529-e537. [DOI: 10.1016/s2468-2667(19)30147-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022]
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21
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Arntzen A, Bøe T, Dahl E, Drange N, Eikemo TA, Elstad JI, Fosse E, Krokstad S, Syse A, Sletten MA, Strand BH. 29 recommendations to combat social inequalities in health. The Norwegian Council on Social Inequalities in Health. Scand J Public Health 2019; 47:598-605. [PMID: 31512561 DOI: 10.1177/1403494819851364] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
All political parties in Norway agree that social inequalities in health comprise a public health problem and should be reduced. Against this background, the Council on Social Inequalities in Health has taken action to provide specific advice to reduce social health differences. Our recommendations focus on the entire social gradient rather than just poverty and the socially disadvantaged. By proposing action on the social determinants of health such as affordable child-care, education, living environments and income structures, we aim to facilitate a possible re-orientation of policy away from redistribution to universalism. The striking challenges of the causes of health differences are complex, and the 29 recommendations to combat social inequality of health demand cross sectorial actions. The recommendations are listed thematically and have not been prioritized. Some are fundamental and require pronounced changes across sectors, whereas others are minor and sector-specific.
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Affiliation(s)
- Annett Arntzen
- Department of Business, History and Social Sciences, University of South-Eastern Norway
| | - Tormod Bøe
- Department of Psychosocial Science, University of Bergen, Norway.,NORCE Norwegian Research Centre AS, Regional Centre for Child and Youth Mental Health and Child Welfare, Bergen, Norway
| | - Espen Dahl
- Faculty of Social Science, Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Norway
| | | | - Terje A Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Norway
| | - Jon Ivar Elstad
- NOVA, Centre for Welfare and Labour Research, Oslo Metropolitan University, Norway
| | - Elisabeth Fosse
- Department of Health Promotion and Development, University of Bergen, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Norway
| | - Astri Syse
- Department of Research, Statistics Norway
| | - Mira Aaboen Sletten
- NOVA, Centre for Welfare and Labour Research, Oslo Metropolitan University, Norway
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Finger JD, Busch MA, Heidemann C, Lange C, Mensink GBM, Schienkiewitz A. Time trends in healthy lifestyle among adults in Germany: Results from three national health interview and examination surveys between 1990 and 2011. PLoS One 2019; 14:e0222218. [PMID: 31498839 PMCID: PMC6733449 DOI: 10.1371/journal.pone.0222218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/23/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The combined impact of multiple healthy behaviors on health exceeds that of single behaviors. This study aimed to estimate trends in the prevalence of a healthy lifestyle among adults in Germany. METHODS A data set of 18,058 adults aged 25-69 years from three population-based national health examination surveys 1990-92, 1997-99 and 2008-11 with complete information for five healthy behavior factors was used. A 'daily intake of both fruits and vegetables, 'sufficient physical exercise', 'no current smoking' and 'no current risk drinking' were assessed with self-reports and 'normal body weight' was calculated based on measured body weight and height. A dichotomous 'healthy lifestyle' indicator was defined as meeting at least four out of five healthy behaviors. Age-standardized prevalence was calculated stratified by sex, age groups (25-34, 35-44, 45-54 and 55-69 years) and education level (low, medium and high). Trends were expressed in relative change (RC) between 1990-92 and 2008-11. RESULTS In Germany, the overall prevalence of healthy lifestyle increased from 9.3% in 1990-92 to 13.5% in 1997-99 and to 14.7% in 2008-11 (RC: +58.1%). The prevalence increased among men and women and in all age groups, with the exception of men aged 45-54 years. The RC of increasing healthy lifestyle prevalence between 1990-92 and 2008-11 was stronger albeit on a higher level among women compared to men. Therefore, the gender difference in healthy lifestyle has increased, but age-related differences have overall decreased in this period. Among high educated men the prevalence of a healthy lifestyle increased between 1990-92 and 2008-11 from 10.6% to 16.3% (p = 0.01) and among high educated women from 16.4% to 30.3% and also among medium educated women (10.9 to 16.6, p<0.01), but no significant increase in healthy lifestyle prevalence was observed among men with low and medium education and among women with low education level. CONCLUSIONS The prevalence of a lifestyle with at least four out of five healthy behaviors markedly increased from 1990-92 to 2008-11. Nevertheless, additional health promotion interventions are needed to improve the number of combined healthy behavior factors and the awareness in the population that each additional healthy behavior factor leads to a further improvement in health, especially in men in the age-range 45 to 54 years, and among persons with low education level.
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Affiliation(s)
- Jonas D. Finger
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Markus A. Busch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Cornelia Lange
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Gert B. M. Mensink
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anja Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Melaku YA, Gill TK, Appleton SL, Hill C, Boyd MA, Adams RJ. Sociodemographic, lifestyle and metabolic predictors of all-cause mortality in a cohort of community-dwelling population: an 18-year follow-up of the North West Adelaide Health Study. BMJ Open 2019; 9:e030079. [PMID: 31446418 PMCID: PMC6720239 DOI: 10.1136/bmjopen-2019-030079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Studies examining potential factors of all-cause mortality comprehensively at community level are rare. Using long-term community-based follow-up study, we examined the association of sociodemographic and behavioural characteristics, metabolic and chronic conditions, and medication and health service utilisation with all-cause mortality. METHODS We followed 4056 participants, aged 18-90 years, for 18 years in the North West Adelaide Health Study (NWAHS). Mortality data were obtained from South Australian (SA) public hospitals and registries including SA births, deaths and marriages, the National Death Index and the NWAHS follow-up. Predictors of all-cause mortality were explored using Cox proportional hazard model, adjusting for potential confounders. We performed subgroup analyses by sex and age. RESULTS Mean (SD) age at baseline was 50.4 (16.4) years. Less than half (47.8%) of the participants were men. A total of 64 689.7 person-years from 4033 participants with 18.7 years of follow-up were generated. The median follow-up time was 17.7 years; 614 deaths were recorded. The overall crude death rate was 9.6 (95% CI 8.9 to 10.4) per 1000 person-years. After adjusting for potential confounders, a reduced risk of mortality was significantly associated with being separated or divorced, being in the highest Socioeconomic Indexes for Areas quintile, engaging in moderate exercise, being overweight (body mass index: 25.0-29.9 kg/m2) and per 10% increase in per cent predicted forced expiratory volume in 1 s. We found that the most important predictors of all-cause mortality were sociodemographic and behavioural characteristics. Sociodemographic factors were more important predictors of all-cause mortality in young age bracket compared with older people. CONCLUSIONS Socioeconomic factors were found to be the most important predictors of all-cause mortality. The study highlights the need to address the social inequalities and strengthen behavioural interventions for different subgroups of population to prevent premature deaths.
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Affiliation(s)
- Yohannes Adama Melaku
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tiffany K Gill
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sarah L Appleton
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Adelaide, South Australia, Australia
- Freemason's Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Catherine Hill
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospitals, Adelaide, South Australia, Australia
| | - Mark A Boyd
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Adelaide, South Australia, Australia
- Freemason's Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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Paalanen L, Härkänen T, Tolonen H. Protocol of a research project 'Projections of the burden of disease and disability in Finland - health policy prospects' using cross-sectional health surveys and register-based follow-up. BMJ Open 2019; 9:e029338. [PMID: 31227540 PMCID: PMC6596950 DOI: 10.1136/bmjopen-2019-029338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION With the rapid ageing of the population in Europe, reliable estimates of the future development of the disease and disability burden as well as healthy life years in the older sections of the population are crucial. Meanwhile, the future prospects of the health and functional ability of the working-aged population are critical. The aims of the Projections of the burden of disease and disability in Finland - health policy prospects research project are to provide information about the long-term consequences of health-related behaviours of the population and to project the potential improvement of the burden of disease and disability based on realistic scenarios about the development of risk behaviours in the total population and its subgroups. METHODS AND ANALYSIS The analyses will be based on data from representative cross-sectional and longitudinal health examination surveys (HESs) conducted between 1972 to 2017 in Finland, and register data from several national administrative registers. Included HESs (FINRISK Surveys from 1972 to 2012, Mini-Finland Survey from 1978 to 1980, the Health 2000/2011 Surveys and the FinHealth 2017 Study) provide abundant information about biological and behavioural risk factors and the health and morbidity of the population. The modifiable risk factors used as predictors include hypertension, hyperlipidaemia, obesity, diabetes, physical inactivity, smoking, alcohol use and unfavourable diet. The main outcomes are ischaemic heart disease, cerebrovascular diseases, lung cancer, chronic obstructive pulmonary disease, Alzheimer's disease and diabetes. Within the project, novel projection techniques of data-driven Bayesian hierarchical models to provide robust and comparable estimates will be developed. ETHICS AND DISSEMINATION The prevailing legislation and regulations have been followed for all surveys. Surveys since 1997 have been approved by the respective Ethics Committees covering the scope of this project. A written informed consent was obtained from participants since 1997. The outputs of the project will include 8 to 10 scientific papers in peer-reviewed journals.
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Affiliation(s)
- Laura Paalanen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Hanna Tolonen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
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Schram JLD, Schuring M, Oude Hengel KM, Burdorf A. Health-related educational inequalities in paid employment across 26 European countries in 2005-2014: repeated cross-sectional study. BMJ Open 2019; 9:e024823. [PMID: 31154297 PMCID: PMC6549613 DOI: 10.1136/bmjopen-2018-024823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The study investigates the trends in health-related inequalities in paid employment among men and women in different educational groups in 26 countries in 5 European regions. DESIGN Individual-level analysis of repeated cross-sectional annual data (2005-2014) from the EU Statistics on Income and Living Conditions. SETTING 26 European countries in 5 European regions. PARTICIPANTS 1 844 915 individuals aged 30-59 years were selected with information on work status, chronic illness, educational background, age and gender. OUTCOME MEASURES Absolute differences were expressed by absolute differences in proportion in paid employment between participants with and without a chronic illness, using linear regression. Relative differences were expressed by prevalence ratios in paid employment, using a Cox proportional hazard model. Linear regression was used to examine the trends of inequalities. RESULTS Participants with a chronic illness had consistently lower labour force participation than those without illnesses. Educational inequalities were substantial with absolute differences larger within lower educated (men 21%-35%, women 10%-31%) than within higher educated (men 5%-13%, women 6%-16%). Relative differences showed that low-educated men with a chronic illness were 1.4-1.9 times (women 1.3-1.8 times) more likely to be out of paid employment than low-educated persons without a chronic illness, whereas this was 1.1-1.2 among high-educated men and women. In the Nordic, Anglo-Saxon and Eastern regions, these health-related educational inequalities in paid employment were more pronounced than in the Continental and Southern region. For most regions, absolute health-related educational inequalities in paid employment were generally constant, whereas relative inequalities increased, especially among low-educated persons. CONCLUSIONS Men and women with a chronic illness have considerable less access to the labour market than their healthy colleagues, especially among lower educated persons. This exclusion from paid employment will increase health inequalities.
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Affiliation(s)
- Jolinda L D Schram
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Merel Schuring
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Karen M Oude Hengel
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Moissl AP, Delgado GE, Krämer BK, März W, Kleber ME, Grammer TB. Area-based socioeconomic status and mortality: the Ludwigshafen Risk and Cardiovascular Health study. Clin Res Cardiol 2019; 109:103-114. [DOI: 10.1007/s00392-019-01494-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/16/2019] [Indexed: 12/15/2022]
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Quantifying the impact of reducing socioeconomic inequalities in modifiable risk factors on mortality and mortality inequalities in South Korea. Int J Public Health 2019; 64:585-594. [PMID: 30887061 DOI: 10.1007/s00038-019-01231-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES We quantified the impact of reducing socioeconomic inequalities in risk factors on mortality and mortality inequalities in South Korea. METHODS The mortality risk function from the 12-year mortality follow-up data of the National Health Insurance Service-National Health Screening Cohort, the prevalence of major risk factors from the Korea National Health and Nutrition Examination Survey 2013-2015, and the Health Plan 2020 (HP2020) goals for major risk factors were used to estimate the magnitude of reduction in mortality inequalities by changing the magnitude of income-based inequalities in risk factors in various scenarios under gender-specific models among participants aged 40-79 years. RESULTS The greatest reduction in absolute and relative inequalities in mortality would occur if the low-income group achieved the HP2020 goals earlier than the high-income group. A 10-20% reduction in all-cause mortality inequalities was expected if absolute gaps between income groups in risk factors were halved. CONCLUSIONS With the practical goal halving the socioeconomic gaps in modifiable risk factors, reducing inequalities in all-cause mortality by 10-20% would be possible. Further reduction in mortality inequalities would need more aggressive policies on social determinants of health.
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Hussein M, Diez Roux AV, Mujahid MS, Hastert TA, Kershaw KN, Bertoni AG, Baylin A. Unequal Exposure or Unequal Vulnerability? Contributions of Neighborhood Conditions and Cardiovascular Risk Factors to Socioeconomic Inequality in Incident Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2018; 187:1424-1437. [PMID: 29186311 DOI: 10.1093/aje/kwx363] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 11/16/2017] [Indexed: 12/12/2022] Open
Abstract
Risk factors can drive socioeconomic inequalities in cardiovascular disease (CVD) through differential exposure and differential vulnerability. In this paper, we show how econometric decomposition directly enables simultaneous, policy-oriented assessment of these 2 mechanisms. We specifically estimate contributions of neighborhood environment and proximal risk factors to socioeconomic inequality in CVD incidence via these mechanisms. We followed 5,608 participants in the Multi-Ethnic Study of Atherosclerosis (2000-2012) to their first CVD event (median length of follow-up, 12.2 years). We used a summary measure of baseline socioeconomic position (SEP). Covariates included baseline demographics, neighborhood characteristics, and psychosocial, behavioral, and biomedical risk factors. Using Poisson models, we decomposed the difference (inequality) in incidence rates between low- and high-SEP groups into contributions of 1) differences in covariate means (differential exposure) and 2) differences in CVD risk associated with covariates (differential vulnerability). Notwithstanding large uncertainty in neighborhood estimates, our analysis suggested that differential exposure to poorer neighborhood socioeconomic conditions, adverse social environment, diabetes, and hypertension accounted for most of the inequality. Psychosocial and behavioral contributions were negligible. Further, neighborhood SEP, female sex, and white race were more strongly associated with CVD among low-SEP (vs. high-SEP) participants. These differentials in vulnerability also accounted for nontrivial portions of the inequality and could have important implications for intervention.
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Affiliation(s)
- Mustafa Hussein
- Joseph J. Zilber School of Public Health, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Mahasin S Mujahid
- Department of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Theresa A Hastert
- Department of Oncology, School of Medicine and Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Kiarri N Kershaw
- Division of Epidemiology, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ana Baylin
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Engelgau MM, Narayan KMV, Ezzati M, Salicrup LA, Belis D, Aron LY, Beaglehole R, Beaudet A, Briss PA, Chambers DA, Devaux M, Fiscella K, Gottlieb M, Hakkinen U, Henderson R, Hennis AJ, Hochman JS, Jan S, Koroshetz WJ, Mackenbach JP, Marmot MG, Martikainen P, McClellan M, Meyers D, Parsons PE, Rehnberg C, Sanghavi D, Sidney S, Siega-Riz AM, Straus S, Woolf SH, Constant S, Creazzo TL, de Jesus JM, Gavini N, Lerner NB, Mishoe HO, Nelson C, Peprah E, Punturieri A, Sampson U, Tracy RL, Mensah GA. Implementation Research to Address the United States Health Disadvantage: Report of a National Heart, Lung, and Blood Institute Workshop. Glob Heart 2018; 13:65-72. [PMID: 29716847 PMCID: PMC6504971 DOI: 10.1016/j.gheart.2018.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/20/2018] [Accepted: 03/19/2018] [Indexed: 12/30/2022] Open
Abstract
Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health-a health disadvantage. The National Heart, Lung, and Blood Institute convened a panel of national and international health experts and stakeholders for a Think Tank meeting to explore the U.S. health disadvantage and to seek specific recommendations for implementation research opportunities for heart, lung, blood, and sleep disorders. Recommendations for National Heart, Lung, and Blood Institute consideration were made in several areas including understanding the drivers of the disadvantage, identifying potential solutions, creating strategic partnerships with common goals, and finally enhancing and fostering a research workforce for implementation research. Key recommendations included exploring why the United States is doing better for health indicators in a few areas compared with peer countries; targeting populations across the entire socioeconomic spectrum with interventions at all levels in order to prevent missing a substantial proportion of the disadvantage; assuring partnership have high-level goals that can create systemic change through collective impact; and finally, increasing opportunities for implementation research training to meet the current needs. Connecting with the research community at large and building on ongoing research efforts will be an important strategy. Broad partnerships and collaboration across the social, political, economic, and private sectors and all civil society will be critical-not only for implementation research but also for implementing the findings to have the desired population impact. Developing the relevant knowledge to tackle the U.S. health disadvantage is the necessary first step to improve U.S. health outcomes.
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Affiliation(s)
- Michael M Engelgau
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
| | | | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Medical Research Council (MRC) and Public Health England (PHE) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; World Health Organisation Collaborating Centre on Noncommunicable Disease Surveillance and Epidemiology, Imperial College London, London, UK
| | - Luis A Salicrup
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Deshiree Belis
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laudan Y Aron
- Center on Labor, Human Services, and Population, The Urban Institute, Washington, DC, USA
| | | | - Alain Beaudet
- Canadian Institutes of Health Research, Ottawa, Ontario, Canada
| | - Peter A Briss
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marion Devaux
- Organization for Economic Cooperation and Development, Paris, France
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Gottlieb
- Foundation for the National Institutes of Health, Bethesda, MD, USA
| | - Unto Hakkinen
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Rain Henderson
- Clinton Health Matters Initiative, Clinton Foundation, New York, NY, USA
| | - Anselm J Hennis
- Department of Noncommunicable Disease and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Judith S Hochman
- Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Stephen Jan
- The George Institute for Global Health, Sydney, Australia; University of Sydney, Sydney, New South Wales, Australia
| | - Walter J Koroshetz
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - M G Marmot
- Institute of Health Equity and Department of Epidemiology and Public Health, University College London, London, UK
| | - Pekka Martikainen
- Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Mark McClellan
- Duke-Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC, USA
| | - David Meyers
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Polly E Parsons
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Clas Rehnberg
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - Darshak Sanghavi
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD, USA
| | | | - Anna Maria Siega-Riz
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sharon Straus
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Knowledge Translation Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Steven H Woolf
- Center on Society and Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephanie Constant
- Office of Scientific Review, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tony L Creazzo
- Office of Scientific Review, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Janet M de Jesus
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nara Gavini
- Division of Extramural Science Programs, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Norma B Lerner
- Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Helena O Mishoe
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cheryl Nelson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Emmanuel Peprah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Antonello Punturieri
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Uchechukwu Sampson
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Mackenbach JP. Nordic paradox, Southern miracle, Eastern disaster: persistence of inequalities in mortality in Europe. Eur J Public Health 2018; 27:14-17. [PMID: 29028239 DOI: 10.1093/eurpub/ckx160] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The persistence of socioeconomic inequalities in health, despite all that has been done to reduce social and economic inequalities in many European countries, is one of the great disappointments of public health. In this paper, I summarize the results of a series of studies into the explanation of variations and trends in inequalities in mortality in three European regions: the Nordic countries with their puzzlingly large inequalities in mortality, Southern European countries with their miraculously small inequalities in mortality and Central & Eastern European countries in which inequalities in mortality have disastrously exploded since the early 1990 s. The results of these studies show that inequalities in mortality are remarkably variable and dynamic, which suggests that it may be possible to reduce them if we exploit the entry-points for policy that these studies have also identified, such as poverty, smoking, excessive alcohol consumption and lack of access to health care. At the same time, another lesson is that health inequalities are influenced in sometimes unexpected ways by factors that are not under our control, and that we cannot expect to eliminate these health inequalities soon.
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Piccinelli C, Carnà P, Stringhini S, Sebastiani G, Demaria M, Marra M, Costa G, d’Errico A. The contribution of behavioural and metabolic risk factors to socioeconomic inequalities in mortality: the Italian Longitudinal Study. Int J Public Health 2018; 63:325-335. [DOI: 10.1007/s00038-018-1076-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/28/2017] [Accepted: 01/11/2018] [Indexed: 10/18/2022] Open
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Associations of Neighborhood Environmental Attributes with Walking in Japan: Moderating Effects of Area-Level Socioeconomic Status. J Urban Health 2017; 94:847-854. [PMID: 28900893 PMCID: PMC5722731 DOI: 10.1007/s11524-017-0199-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Several studies have examined how the associations of built environment attributes with walking behaviors may be moderated by socioeconomic status (SES). Such understanding is important to address socioeconomic inequalities in health through urban design initiatives. However, to date, there is no study examining the moderation effects of SES in the relationships of environmental attributes and walking in non-Western countries. The current study aims to examine associations of environmental attributes with walking behaviors among Japanese adults, and to test whether these associations were moderated by area-level SES. Data on walking were collected from Japanese adults using a nationwide Internet survey (N = 4605). Built environment measures including population density, street density, distance to the nearest public open space, and distance to the nearest commercial destination were calculated using geographic information systems software. An index of neighborhood deprivation was used as an area-level indicator of SES. Logistic regression models adjusted for clustering and sociodemographic variables were used. It was found that more residents in high SES areas walked for commuting, for errands, and for exercise compared with those who lived in low SES areas. When the whole sample was examined, all environmental attributes were associated with walking behaviors (except for street density not being associated with walking for exercise). Associations of environmental attributes with walking behaviors were moderated by area-level SES only in walking for exercise. Walking for exercise was associated with higher population density, higher street density (marginally significant), and shorter distance to the nearest commercial destination only in high SES areas. Our findings showed that the associations of these environmental attributes and walking behaviors were largely consistent across different SES levels. Therefore, urban design interventions focusing on low SES areas may help to reduce socioeconomic disparities in walking.
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Luiz T, Dittrich S, Pollach G, Madler C. [Knowledge of the population about leading symptoms of cardiovascular emergencies and the responsibility and accessibility of medical facilities in emergencies : Results of the KZEN study in Western Palatinate]. Anaesthesist 2017; 66:840-849. [PMID: 29046934 DOI: 10.1007/s00101-017-0367-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/20/2017] [Accepted: 08/28/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND The Westpfalz is a mainly rural region in the southwestern part of the German state of Rhineland-Palatinate with 527,000 inhabitants and demonstrates a higher than average cardiovascular mortality compared to the rest of Germany. The reasons are not known. Our study attempted to investigate whether significant deficits in knowledge of the population on cardiovascular emergencies, the accessibility of emergency medical services (EMS) or the different responsibilities and abilities of the medical facilities could be held responsible for this. These factors are of the utmost importance for the timely initiation and administration of curative therapeutic strategies. METHODS We conducted standardized telephone interviews with 1126 inhabitants of Westpfalz as a representative sample of the population in the study area. The interviewees were asked about demographic data, participation in first aid courses, knowledge of emergency telephone numbers and the different responsibilities of preclinical emergency physicians which are a part of the EMS and the doctor-on-call system for non-life-threatening conditions (ÄBD). Moreover, we asked about the leading symptoms of myocardial infarction and stroke. Finally, we enquired how the respondents would react in fictitious cardiovascular emergencies. RESULTS Of the participants 651 (57.8%) were female and 475 (42.2%) male. The mean age in our study was 51 ± 18 years and 1002 of the participants (89%) had some formal first aid training. The current telephone number of the EMS system (112) was known to 29.5% of the interviewees and 15.4% could only recall the old number (19222) which is no longer in use. In the case of participants who gave the correct telephone number the first aid course took place 10 years ago (median), whereas for participants who did not know the correct number, the course dated back 15 years (median, p < 0.01). The telephone number 116117 of the ÄBD, usually a family physician, was familiar to only 23 of the people interviewed (2.0%). The basic differences in the functions and responsibilities of the ÄBD and the emergency physician within the EMS were known to only 235 participants (20.2%), 231 (20.5%) were not able to name a single leading symptom of a myocardial infarction and 354 did not know a leading symptom (31.4%) of stroke. In the fictitious case report of an unconscious patient with respiratory arrest (as a sign of cardiac arrest) 96.8% of the interviewees would have correctly informed the EMS, for patients with acute coronary syndrome 81.8% and for a stroke patient 76.8% (cardiac arrest vs. acute coronary syndrome: p < 0.001, cardiac arrest vs. stroke: p < 0.001, acute coronary syndrome vs. stroke: p = 0.005). CONCLUSION AND RECOMMENDATIONS A large proportion of the population were found to be ignorant about the telephone numbers for medical emergency calls and the different functions of the ÄBD and emergency physicians within the EMS. Moreover, our results indicate that a significant percentage of the population would neither be in a position to recognize a stroke or myocardial infarction in an emergency situation nor be informed enough to communicate with the correct part of the emergency system. The association of these deficits with the time elapsed since the last first aid course should be reason enough to continuously motivate the population, especially at risk patients and their relatives, to repeat such courses several times. Furthermore, digital media should be used more intensively in providing first aid instructions. In our opinion, this study clearly shows that in Germany a uniform number for medical emergency calls is mandatory.
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Affiliation(s)
- T Luiz
- Klinik für Anästhesie, Intensiv- und Notfallmedizin 1, Westpfalz-Klinikum GmbH, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland.
| | - S Dittrich
- Medizinische Klinik 2, Westpfalz-Klinikum GmbH, Kaiserslautern, Deutschland
| | - G Pollach
- Klinik für Anästhesie, Intensiv- und Notfallmedizin 1, Westpfalz-Klinikum GmbH, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland
| | - C Madler
- Klinik für Anästhesie, Intensiv- und Notfallmedizin 1, Westpfalz-Klinikum GmbH, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland
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Al-Rahamneh MJ, Al-Rahamneh A, Guillén-Grima F, Arnedo-Pena A, Aguinaga-Ontoso I. Mortality trends for tuberculosis in European Union countries, 2000-2010. Enferm Infecc Microbiol Clin 2017; 36:342-351. [PMID: 28733107 DOI: 10.1016/j.eimc.2017.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/03/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The objective of this study was to update and analyze tuberculosis (TB) mortality data in the European Union between 2000 and 2010 separately for men and women and try to detect if there have been any changes in trends in each country and the association with the economic situation and inequalities. METHODS Data were extracted for tuberculosis deaths in 2000-2010 for 29 European Union countries and for Switzerland, via the World Health Organization (WHO) European detailed mortality database (DMDB), using the Mortality tabulation list 1 (MTL1) codes for men and women separately for one age group (20-85+). We estimated age-standardised mortality rates, and analyzed data using the Joinpoint Regression Program for men and women separately in the European Union overall and by individual country for each year. RESULTS Between 2000 and 2010, there were 68,771 recorded tuberculosis deaths in the European Union and the mortality rates were higher for men than women in the entire study zone. Overall, TB mortality rates declined linearly for both genders, but more in women than in men (from 5.43/100,000 in 2000 to 2.59/100,000 in 2010 in men and from 1.37/100,000 in 2000 to 0.51/100,000 in 2010 in women). There was decline in both genders for the entire study period, with a significant Estimated Annual Percentage Change (EAPC) of -8.1 for women and -7 for men when alpha<0.05 and with a 95% confidence interval (CI). A higher tuberculosis mortality was associated with lower economic resources and greater inequalities. CONCLUSIONS TB mortality rates in the European Union decreased overall in 2000-2010 for both genders. Men have higher TB mortality rates than women in all countries. Our findings were consistent with the downward TB mortality trend in many other countries worldwide.
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Affiliation(s)
- Moad J Al-Rahamneh
- Public University of Navarra, Department of Health Sciences, Avda. Barañain s/n, Pamplona, Navarra 31008, Spain.
| | - Anas Al-Rahamneh
- Citius-Center for Research on Information Technologies, Santiago de Compostela, A Coruña, Spain
| | - Francisco Guillén-Grima
- Public University of Navarra, Department of Health Sciences, Avda. Barañain s/n, Pamplona, Navarra 31008, Spain; Clínica Universitaria de Navarra, Department of Preventive Medicine, Pamplona, Navarra, Spain; Servicio Navarro de Salud-Osasunbidea-IdiSNA, Navarra Institute for Health Research, 31002 Pamplona, Spain
| | - Alberto Arnedo-Pena
- Public University of Navarra, Department of Health Sciences, Avda. Barañain s/n, Pamplona, Navarra 31008, Spain
| | - Inés Aguinaga-Ontoso
- Public University of Navarra, Department of Health Sciences, Avda. Barañain s/n, Pamplona, Navarra 31008, Spain
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Mackenbach JP, Bopp M, Deboosere P, Kovacs K, Leinsalu M, Martikainen P, Menvielle G, Regidor E, de Gelder R. Determinants of the magnitude of socioeconomic inequalities in mortality: A study of 17 European countries. Health Place 2017; 47:44-53. [PMID: 28738213 DOI: 10.1016/j.healthplace.2017.07.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 06/24/2017] [Accepted: 07/18/2017] [Indexed: 11/24/2022]
Abstract
The magnitude of socioeconomic inequalities in mortality differs importantly between countries, but these variations have not been satisfactorily explained. We explored the role of behavioral and structural determinants of these variations, by using a dataset covering 17 European countries in the period 1970-2010, and by conducting multilevel multivariate regression analyses. Our results suggest that between-country variations in inequalities in current mortality can partly be understood from variations in inequalities in smoking, excessive alcohol consumption, and poverty. Also, countries with higher national income, higher quality of government, higher social transfers, higher health care expenditure and more self-expression values have smaller inequalities in mortality. Finally, trends in behavioral risk factors, particularly smoking and excessive alcohol consumption, appear to partly explain variations in inequalities in mortality trends. This study shows that analyses of variations in health inequalities between countries can help to identify entry-points for policy.
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Affiliation(s)
- Johan P Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands.
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Patrick Deboosere
- Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Katalin Kovacs
- Demographic Research Institute of the Central Statistical Office, Budapest, Hungary
| | - Mall Leinsalu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia; Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden
| | | | - Gwenn Menvielle
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Sorbonne Universités, UPMC Univ Paris 06, INSERM, Paris, France
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Rianne de Gelder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
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Akl EA, Welch V, Pottie K, Eslava-Schmalbach J, Darzi A, Sola I, Katikireddi SV, Singh J, Murad MH, Meerpohl J, Stanev R, Lang E, Matovinovic E, Shea B, Agoritsas T, Alexander PE, Snellman A, Brignardello-Petersen R, Gloss D, Thabane L, Shi C, Stein AT, Sharaf R, Briel M, Guyatt G, Schünemann H, Tugwell P. GRADE equity guidelines 2: considering health equity in GRADE guideline development: equity extension of the guideline development checklist. J Clin Epidemiol 2017; 90:68-75. [PMID: 28499847 DOI: 10.1016/j.jclinepi.2017.01.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 01/09/2017] [Accepted: 01/19/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To provide guidance for guideline developers on how to consider health equity at key stages of the guideline development process. STUDY DESIGN AND SETTING Literature review followed by group discussions and consensus building. RESULTS The key stages at which guideline developers could consider equity include setting priorities, guideline group membership, identifying the target audience(s), generating the guideline questions, considering the importance of outcomes and interventions, deciding what evidence to include and searching for evidence, summarizing the evidence and considering additional information, wording of recommendations, and evaluation and use. We provide examples of how guidelines have actually considered equity at each of these stages. CONCLUSION Guideline projects should consider the aforementioned suggestions for recommendations that are equity sensitive.
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Affiliation(s)
- Elie A Akl
- Clinical Research Institute, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon; Department of Medicine, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon; AUB GRADE Center, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon.
| | - Vivian Welch
- Bruyére Research Institute, Bruyére Continuing Care and University of Ottawa, Bruyère St., Ottawa, Ontario, K1N 5C8, Canada
| | - Kevin Pottie
- Centre for Global Health, Institute of Population Health, University of Ottawa, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada
| | - Javier Eslava-Schmalbach
- Group of Equity in Health, Faculty of Medicine, Universidad Nacional de Colombia, Edif. Uriel Gutiérrez, Bogotá D.C., Colombia; Technology Development Center, Sociedad Colombiana de Anestesiologia y Reanimacion, Sociedad Colombiana de Anestesiología y ReanimaciónCra, 15 A No 120-74, Piso 4y5, Edif. Concord Center, Santa Fe de Bogotá, Colombia
| | - Andrea Darzi
- Clinical Research Institute, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon; AUB GRADE Center, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Ivan Sola
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Srinivasa Vittal Katikireddi
- Public Health MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200, Renfield Street, Glasgow G2 3QB, Scotland
| | - Jasvinder Singh
- Department of Medicine, School of Medicine, Birmingham VA Medical Center, 700 19th St S, Birmingham, AL 35233, USA; Division of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), 1720 2nd Ave S, Birmingham, AL 35294, USA; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - M Hassan Murad
- Mayo Clinic Evidence-based Practice Center, Preventive Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Joerg Meerpohl
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité-U1153, Inserm/Université Paris Descartes, 1 place du Parvis Notre-Dame, 75004 Paris, France; Cochrane France, Hôpital Hôtel-Dieu, 1 place du Parvis Notre Dame, 75181 Paris, Cedex 04, France; Cochrane Germany, Medical Center-University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
| | - Roger Stanev
- Institute of Technology, University of Washington, Tacoma, Washington, USA
| | - Eddy Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW Calgary, Alberta, T2N 4N1, Canada
| | - Elizabeth Matovinovic
- Faculty of Medicine, Chiang Mai University, Su Thep, Mueang Chiang Mai District, Chiang Mai 50200, Thailand
| | - Beverley Shea
- Ottawa Hospital Research Institute, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario, K1N 6N5, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
| | - Paul E Alexander
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
| | | | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada; Evidence Based Dentistry Unit, Faculty of Dentistry, University of Chile, Av. Libertador Bernardo O'Higgins, Santiago 1058, Chile
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, 1201 Washington Street East, Suite 100, Charleston, WV 25301, USA
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
| | - Chunhu Shi
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester M13 9PL, UK
| | - Airton T Stein
- Public Health Ufcspa, Ulbra and Conceicao Hospital, Av. Farroupilha, 8001, Bairro São José, Canoas (RS), Brasil
| | - Ravi Sharaf
- Long Island Jewish Medical Center North Shore University Hospital, 270-05 76th Ave, Queens, NY 11040, USA
| | - Matthias Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 21, 4056 Basel, Switzerland
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada; McMaster GRADE Center, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada; Department of Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada
| | - Peter Tugwell
- The Centre for Global Health, Institute of Population Health, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario, K1N 6N5, Canada
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Hu Y, van Lenthe FJ, Hoffmann R, van Hedel K, Mackenbach JP. Assessing the impact of natural policy experiments on socioeconomic inequalities in health: how to apply commonly used quantitative analytical methods? BMC Med Res Methodol 2017; 17:68. [PMID: 28427353 PMCID: PMC5397741 DOI: 10.1186/s12874-017-0317-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The scientific evidence-base for policies to tackle health inequalities is limited. Natural policy experiments (NPE) have drawn increasing attention as a means to evaluating the effects of policies on health. Several analytical methods can be used to evaluate the outcomes of NPEs in terms of average population health, but it is unclear whether they can also be used to assess the outcomes of NPEs in terms of health inequalities. The aim of this study therefore was to assess whether, and to demonstrate how, a number of commonly used analytical methods for the evaluation of NPEs can be applied to quantify the effect of policies on health inequalities. METHODS We identified seven quantitative analytical methods for the evaluation of NPEs: regression adjustment, propensity score matching, difference-in-differences analysis, fixed effects analysis, instrumental variable analysis, regression discontinuity and interrupted time-series. We assessed whether these methods can be used to quantify the effect of policies on the magnitude of health inequalities either by conducting a stratified analysis or by including an interaction term, and illustrated both approaches in a fictitious numerical example. RESULTS All seven methods can be used to quantify the equity impact of policies on absolute and relative inequalities in health by conducting an analysis stratified by socioeconomic position, and all but one (propensity score matching) can be used to quantify equity impacts by inclusion of an interaction term between socioeconomic position and policy exposure. CONCLUSION Methods commonly used in economics and econometrics for the evaluation of NPEs can also be applied to assess the equity impact of policies, and our illustrations provide guidance on how to do this appropriately. The low external validity of results from instrumental variable analysis and regression discontinuity makes these methods less desirable for assessing policy effects on population-level health inequalities. Increased use of the methods in social epidemiology will help to build an evidence base to support policy making in the area of health inequalities.
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Affiliation(s)
- Yannan Hu
- Erasmus MC, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
| | | | - Rasmus Hoffmann
- Erasmus MC, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
- European University Institute, Florence, Italy
| | - Karen van Hedel
- Erasmus MC, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
- Max Planck Institute for Demographic Research, Rostock, Germany
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Pinilla J, Abásolo I. The effect of policies regulating tobacco consumption on smoking initiation and cessation in Spain: is it equal across socioeconomic groups? Tob Induc Dis 2017; 15:8. [PMID: 28149259 PMCID: PMC5273787 DOI: 10.1186/s12971-016-0109-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 12/27/2016] [Indexed: 01/30/2023] Open
Abstract
Background In Spain, the Law 28/2005, which came into effect on January 2006, was a turning point in smoking regulation and prevention, serving as a guarantee for the progress of future strategies in the direction marked by international organizations. It is expected that this regulatory policy should benefit relatively more to lower socioeconomic groups, thus contributing to a reduction in socioeconomic health inequalities. This research analyzes the effect of tobacco regulation in Spain, under Law 28/2005, on the initiation and cessation of tobacco consumption, and whether this effect has been unequal across distinct socioeconomic levels. Methods Micro-data from the National Health Survey in its 2006 and 2011 editions are used (study numbers: 4382 and 5389 respectively; inventory of statistical operations (ISO) code: 54009), with a sample size of approximately 24,000 households divided into 2,000 census areas. This allows individuals’ tobacco consumption records to be reconstructed over five years before the initiation of each survey, as well as identifying those individuals that started or stopped smoking. The methodology is based on “time to event analysis”. Cox’s proportional hazard models are adapted to show the effects of a set of explanatory variables on the conditional probability of change in tobacco consumption: initiation as a daily smoker by young people or the cessation of daily smoking by adults. Results Initiation rates among young people went from 25% (95% confidence interval (CI), 23–27) to 19% (95% CI, 17–21) following the implementation of the Law, and the change in cessation rates among smokers was even greater, with rates increasing from 12% (95% CI, 11–13) to 20% (95% CI, 19–21). However, this effect has not been equal by socioeconomic groups as shown by relative risks. Before the regulation policy, social class was not a statistically significant factor in the initiation of daily smoking (p > 0.05); however, following the implementation of the Law, young people belonging to social classes IV-V and VI had a relative risk of starting smoking 63% (p = 0.03) and 82% (p = 0.02) higher than young people of higher social classes I-II. On the other hand, lower social class also means a lower probability of smoking cessation; however, the relative risk of cessation for a smoker belonging to a household of social class VI (compared to classes I-II) went from 24% (p < 0.001) lower before the Law to 33% (p < 0.001) lower following the law’s implementation. Conclusion Law 28/2005 has been effective, as after its promulgation there has been a decrease in the rate of smoking initiation among young people and an increase in the rate of cessation among adult smokers. However, this effect has not been equal by socioeconomic groups, favoring relatively more to those individuals belonging to higher social classes.
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Affiliation(s)
- Jaime Pinilla
- Departamento de Métodos Cuantitativos en Economía y Gestión (Universidad de Las Palmas de Gran Canaria). Facultad de Economía, Empresa y Turismo. Campus Universitario de Tafira, 35017 Las Palmas de Gran Canaria, Spain
| | - Ignacio Abásolo
- Departamento de Economía Aplicada y Métodos Cuantitativos; Instituto Universitario de Desarrollo Regional (Universidad de La Laguna). Facultad de Economía, Empresa y Turismo. Universidad de La Laguna, Campus de Guajara, 38071 La Laguna, Tenerife Spain
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Hämäläinen RM, Sandu P, Syed AM, Jakobsen MW. An evaluation of equity and equality in physical activity policies in four European countries. Int J Equity Health 2016; 15:191. [PMID: 27881131 PMCID: PMC5122031 DOI: 10.1186/s12939-016-0481-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/15/2016] [Indexed: 11/30/2022] Open
Abstract
Background There is strong research evidence on the importance of health equity and equality for wellbeing in societies. As chronic non-communicable diseases are widespread, the positive impact of physical activity (PA) on health has gained importance. However, PA at the population level is far from optimal. PA depends not only on individual factors, but also on policies for PA in sport, health, transport, education and other sectors, on social and cultural factors, and on the environment. Addressing health inequalities and inequities in PA promotion policies could benefit from policy development processes based on partnership and collaboration between various sectors, researchers, practitioners and policy makers (= cross-sectoral, evidence-informed policy making). The objective of this article is to describe how equity and equality was addressed in PA policies in four EU member states (Denmark, Finland, Romania and England), who were partners in the REPOPA project (www.repopa.eu, EC/FP7/Health Research/GA 281532). Methods Content analysis of 14 PA policies and 61 interviews were undertaken between 2012 and 2013 with stakeholders involved in developing PA policies in partner countries. Results Even though specific population subgroups were mentioned in the policy documents analysed, they were not necessarily defined as vulnerable populations nor was there a mention of additional emphasis to support such groups from being marginalised by the policy due to inequity or inequality. There were no clear objectives and activities in the analysed policies suggesting commitment of additional resources in favour of such groups. Addressing equity and equality were often not included in the core aims of the policies analysed; these aspects were mentioned in the background of the policy documents analysed, without being explicitly stated in the aims or activities of the policies. In order to tackle health inequities and inequalities and their consequences on the health status of different population subgroups, a more instrumental approach to health equality and equity in PA promotion policies is needed. Policies should include aims to address health inequalities and inequities as fundamental objectives and also consider opportunities to allocate resources to reduce them for identified groups in this regard: the socially excluded, the remote, and the poor. Conclusions The inclusion of aspects related to health inequalities and inequities in PA policies needs monitoring, evaluation and transparent accountability if we are to see the best gains in health of socially disadvantaged group. To tackle health inequities and inequalities governance structures need to take into consideration proportionate universalism. Thus, to achieve change in the social determinants of health, policy makers should pay attention to PA and proportionally invest for universal access to PA services. PA promotion advocates should develop a deeper awareness of political and policy structures and require more equity and equality in PA policies from those who they seek to influence, within specific settings for policy making and developing the policy agenda.
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Affiliation(s)
| | - Petru Sandu
- Department of Public Health, Babes-Bolyai University, Pandurilor 7, Cluj-Napoca, Romania
| | - Ahmed M Syed
- National Health Service, 80 London Road, London, SE1 6LH, UK
| | - Mette W Jakobsen
- Unit for Health Promotion Research, Institute of Public Health, University of Southern Denmark, Niels Bohrs Vej 9, 6700, Esbjerg, Denmark
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Ayán Pérez C, Molina AJ, Varela Mato V, Cancela Carral JM, Barrio Lera JP, Martín Sánchez V. [Relationship between tobacco consumption and sport practice among health and education science university students]. ENFERMERIA CLINICA 2016; 27:21-27. [PMID: 27817984 DOI: 10.1016/j.enfcli.2016.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/24/2016] [Accepted: 08/11/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify the prevalence and relationship between the practice of sports and smoking in university students enrolled on accredited qualifications related to health and/or education sciences. METHODS Cross-sectional study including 540 students (average age of 21.3±3.8 years; 68% women) of the University of Vigo registered in degree programs linked to health (Physical Therapy and Nursing), or education (Pre-School, Primary School and Physical Activity and Sport Sciences) who answered an "ad hoc" questionnaire relating sports practice and tobacco consumption. RESULTS Women showed a lower habit on sports practice and a higher tobacco consumption, regardless of their academic degree. The average share of students who recognized practicing sports was significantly minor in those enrolled in health careers (37.7 vs. 57.5%). Regarding tobacco consumption, the students enrolled in health careers reported the lowest prevalence (16.7%). Among the students associated to education, this prevalence was found to be 25.9%. The bivariate analysis showed a trend towards a lower sport practice among the smokers. This association was significant only among the moderate consumers. CONCLUSIONS The findings of this research show a low prevalence in sports practice among students enrolled in degrees associated to health, and a more relevant tobacco consumption among those enrolled in degrees associated to education. It seems necessary to develop strategies aimed at promoting healthy habits that should be taking into account the tobacco consumption reported by the student.
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Affiliation(s)
- Carlos Ayán Pérez
- Departamento de Didácticas especiales, Facultad de Ciencias de la Actividad Física y del Deporte, Universidad de Vigo, Vigo, España; Grupo de Investigación HealthyFit (HI22), Área de Educación Física y Deportiva, Universidad de Vigo, Vigo, España.
| | - Antonio J Molina
- Grupo de Investigación en Interacción Gen-Ambiente-Salud (GIIGAS), Área de Medicina Preventiva y Salud Pública, Universidad de León, León, España
| | - Verónica Varela Mato
- Departamento de Didácticas especiales, Facultad de Ciencias de la Actividad Física y del Deporte, Universidad de Vigo, Vigo, España; Grupo de Investigación HealthyFit (HI22), Área de Educación Física y Deportiva, Universidad de Vigo, Vigo, España
| | - José María Cancela Carral
- Departamento de Didácticas especiales, Facultad de Ciencias de la Actividad Física y del Deporte, Universidad de Vigo, Vigo, España; Grupo de Investigación HealthyFit (HI22), Área de Educación Física y Deportiva, Universidad de Vigo, Vigo, España
| | - Juan Pablo Barrio Lera
- Área de Fisiología, Grupo de Investigación en Interacción Gen-Ambiente-Salud (GIIGAS), Universidad de León, León, España
| | - Vicente Martín Sánchez
- Grupo de Investigación en Interacción Gen-Ambiente-Salud (GIIGAS), Área de Medicina Preventiva y Salud Pública, Universidad de León, León, España; CIBER de Epidemiología y Salud Pública (CIBERESP)
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McAuley A, Denny C, Taulbut M, Mitchell R, Fischbacher C, Graham B, Grant I, O’Hagan P, McAllister D, McCartney G. Informing Investment to Reduce Inequalities: A Modelling Approach. PLoS One 2016; 11:e0159256. [PMID: 27486857 PMCID: PMC4972318 DOI: 10.1371/journal.pone.0159256] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 06/29/2016] [Indexed: 11/24/2022] Open
Abstract
Background Reducing health inequalities is an important policy objective but there is limited quantitative information about the impact of specific interventions. Objectives To provide estimates of the impact of a range of interventions on health and health inequalities. Materials and Methods Literature reviews were conducted to identify the best evidence linking interventions to mortality and hospital admissions. We examined interventions across the determinants of health: a ‘living wage’; changes to benefits, taxation and employment; active travel; tobacco taxation; smoking cessation, alcohol brief interventions, and weight management services. A model was developed to estimate mortality and years of life lost (YLL) in intervention and comparison populations over a 20-year time period following interventions delivered only in the first year. We estimated changes in inequalities using the relative index of inequality (RII). Results Introduction of a ‘living wage’ generated the largest beneficial health impact, with modest reductions in health inequalities. Benefits increases had modest positive impacts on health and health inequalities. Income tax increases had negative impacts on population health but reduced inequalities, while council tax increases worsened both health and health inequalities. Active travel increases had minimally positive effects on population health but widened health inequalities. Increases in employment reduced inequalities only when targeted to the most deprived groups. Tobacco taxation had modestly positive impacts on health but little impact on health inequalities. Alcohol brief interventions had modestly positive impacts on health and health inequalities only when strongly socially targeted, while smoking cessation and weight-reduction programmes had minimal impacts on health and health inequalities even when socially targeted. Conclusions Interventions have markedly different effects on mortality, hospitalisations and inequalities. The most effective (and likely cost-effective) interventions for reducing inequalities were regulatory and tax options. Interventions focused on individual agency were much less likely to impact on inequalities, even when targeted at the most deprived communities.
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Affiliation(s)
- Andrew McAuley
- Public Health Science Directorate, NHS Health Scotland, Glasgow, United Kingdom
- * E-mail:
| | - Cheryl Denny
- Information Services Division, NHS National Services Scotland, Edinburgh, United Kingdom
| | - Martin Taulbut
- Public Health Science Directorate, NHS Health Scotland, Glasgow, United Kingdom
| | - Rory Mitchell
- Public Health Science Directorate, NHS Health Scotland, Glasgow, United Kingdom
| | - Colin Fischbacher
- Information Services Division, NHS National Services Scotland, Edinburgh, United Kingdom
| | - Barbara Graham
- Information Services Division, NHS National Services Scotland, Edinburgh, United Kingdom
| | - Ian Grant
- Information Services Division, NHS National Services Scotland, Edinburgh, United Kingdom
| | - Paul O’Hagan
- Information Services Division, NHS National Services Scotland, Edinburgh, United Kingdom
| | - David McAllister
- Public Health, NHS Fife, Kirkcaldy, United Kingdom
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Gerry McCartney
- Public Health Science Directorate, NHS Health Scotland, Glasgow, United Kingdom
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Hoffmann R, Hu Y, de Gelder R, Menvielle G, Bopp M, Mackenbach JP. The impact of increasing income inequalities on educational inequalities in mortality - An analysis of six European countries. Int J Equity Health 2016; 15:103. [PMID: 27390929 PMCID: PMC4938956 DOI: 10.1186/s12939-016-0390-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 06/30/2016] [Indexed: 11/18/2022] Open
Abstract
Background Over the past decades, both health inequalities and income inequalities have been increasing in many European countries, but it is unknown whether and how these trends are related. We test the hypothesis that trends in health inequalities and trends in income inequalities are related, i.e. that countries with a stronger increase in income inequalities have also experienced a stronger increase in health inequalities. Methods We collected trend data on all-cause and cause-specific mortality, as well as on the household income of people aged 35–79, for Belgium, Denmark, England & Wales, France, Slovenia, and Switzerland. We calculated absolute and relative differences in mortality and income between low- and high-educated people for several time points in the 1990s and 2000s. We used fixed-effects panel regression models to see if changes in income inequality predicted changes in mortality inequality. Results The general trend in income inequality between high- and low-educated people in the six countries is increasing, while the mortality differences between educational groups show diverse trends, with absolute differences mostly decreasing and relative differences increasing in some countries but not in others. We found no association between trends in income inequalities and trends in inequalities in all-cause mortality, and trends in mortality inequalities did not improve when adjusted for rising income inequalities. This result held for absolute as well as for relative inequalities. A cause-specific analysis revealed some association between income inequality and mortality inequality for deaths from external causes, and to some extent also from cardiovascular diseases, but without statistical significance. Conclusions We find no support for the hypothesis that increasing income inequality explains increasing health inequalities. Possible explanations are that other factors are more important mediators of the effect of education on health, or more simply that income is not an important determinant of mortality in this European context of high-income countries. This study contributes to the discussion on income inequality as entry point to tackle health inequalities. More research is needed to test the common and plausible assumption that increasing income inequality leads to more health inequality, and that one needs to act against the former to avoid the latter. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0390-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rasmus Hoffmann
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, Netherlands.
| | - Yannan Hu
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, Netherlands
| | - Rianne de Gelder
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, Netherlands
| | - Gwenn Menvielle
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, Netherlands
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Gregoraci G, van Lenthe FJ, Artnik B, Bopp M, Deboosere P, Kovács K, Looman CWN, Martikainen P, Menvielle G, Peters F, Wojtyniak B, de Gelder R, Mackenbach JP. Contribution of smoking to socioeconomic inequalities in mortality: a study of 14 European countries, 1990-2004. Tob Control 2016; 26:260-268. [PMID: 27122064 DOI: 10.1136/tobaccocontrol-2015-052766] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/04/2016] [Accepted: 03/31/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Smoking contributes to socioeconomic inequalities in mortality, but the extent to which this contribution has changed over time and driven widening or narrowing inequalities in total mortality remains unknown. We studied socioeconomic inequalities in smoking-attributable mortality and their contribution to inequalities in total mortality in 1990-1994 and 2000-2004 in 14 European countries. METHODS We collected, harmonised and standardised population-wide data on all-cause and lung-cancer mortality by age, gender, educational and occupational level in 14 European populations in 1990-1994 and 2000-2004. Smoking-attributable mortality was indirectly estimated using the Preston-Glei-Wilmoth method. RESULTS In 2000-2004, smoking-attributable mortality was higher in lower socioeconomic groups in all countries among men, and in all countries except Spain, Italy and Slovenia, among women, and the contribution of smoking to socioeconomic inequalities in mortality varied between 19% and 55% among men, and between -1% and 56% among women. Since 1990-1994, absolute inequalities in smoking-attributable mortality and the contribution of smoking to inequalities in total mortality have decreased in most countries among men, but increased among women. CONCLUSIONS In many European countries, smoking has become less important as a determinant of socioeconomic inequalities in mortality among men, but not among women. Inequalities in smoking remain one of the most important entry points for reducing inequalities in mortality.
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Affiliation(s)
- G Gregoraci
- Department of Public Health Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Medical and Biological Sciences, University of Udine, Institute of Hygiene and Clinical Epidemiology, Udine, Italy
| | - F J van Lenthe
- Department of Public Health Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B Artnik
- Department of Public Health, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - M Bopp
- Department of Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - P Deboosere
- Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - K Kovács
- Demographic Research Institute of the Central Statistical Office, Budapest, Hungary
| | - C W N Looman
- Department of Public Health Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P Martikainen
- Department of Sociology, University of Helsinki, Helsinki, Finland
| | - G Menvielle
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Sorbonne Universités, UPMC Univ Paris 06, INSERM, Paris, France
| | - F Peters
- Department of Public Health Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B Wojtyniak
- Department Centre of Monitoring and Analyses of Population Health, National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland
| | - R de Gelder
- Department of Public Health Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J P Mackenbach
- Department of Public Health Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Nogueira H. What is happening to health in the economic downturn? A view of the Lisbon Metropolitan Area, Portugal. Ann Hum Biol 2016; 43:164-8. [DOI: 10.3109/03014460.2015.1131846] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Soler-Vila H, García-Esquinas E, León-Muñoz LM, López-García E, Banegas JR, Rodríguez-Artalejo F. Contribution of health behaviours and clinical factors to socioeconomic differences in frailty among older adults. J Epidemiol Community Health 2015; 70:354-60. [PMID: 26567320 DOI: 10.1136/jech-2015-206406] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/24/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND To examine the association between socioeconomic status (SES) and risk of frailty, and to assess whether behavioural and clinical factors (BCF) mediate this association. METHODS Cohort of 1857 non-institutionalised individuals aged ≥ 60 years recruited in 2008-2010 and followed through 2012. Education, occupation, and BCF were ascertained at baseline, and incident frailty was assessed at follow-up with the Fried frailty criteria. RESULTS Men showed no differences in frailty risk by education or occupation. Compared with women with university education, the adjusted OR (aOR) adjusted for age and the number of frailty criteria at baseline for incident frailty in women with primary or lower education was 3.02 (95% CI 1.25 to 7.30); once fully adjusted for BCF, the OR was 2.00 (95% CI 0.76 to 5.23). No alcohol intake (vs light-moderate), longer time spent watching TV, less time spent reading, and a higher frequency of obesity, depression and musculoskeletal disease in those with primary or lower education accounted for most of the decline in OR. BCF explained 50.5% of the excess frailty risk associated with lower education. The aOR of frailty incidence for manual versus non-manual occupation was 2.24 (95% CI 1.41 to 3.56) versus a fully aOR of 2.05 (95% CI 1.24 to 3.37). BCF explained 15.3% of the association, with individual mediators being similar to those for education-related differences. CONCLUSIONS A lower education or a manual occupation was associated with higher frailty risk in older women. These associations were partly explained by lower alcohol consumption, higher sedentariness, and higher obesity and chronic disease rates in women with lower SES.
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Affiliation(s)
- Hosanna Soler-Vila
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain Department of Public Health Sciences, Leonard Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Luz Ma León-Muñoz
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Esther López-García
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - José R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Been JV, Mackenbach JP, Millett C, Basu S, Sheikh A. Tobacco control policies and perinatal and child health: a systematic review and meta-analysis protocol. BMJ Open 2015; 5:e008398. [PMID: 26399572 PMCID: PMC4593151 DOI: 10.1136/bmjopen-2015-008398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Children experience considerable morbidity and mortality due to tobacco smoke exposure. Tobacco control policies may benefit child health by reducing this exposure. We aim to comprehensively assess the effects of the range of tobacco control policies advocated by the WHO on perinatal and child health. METHODS AND ANALYSIS We will systematically search 19 electronic literature databases (from inception) for published studies, and the WHO International Clinical Trials Registry Platform for unpublished studies. Additional work will be identified via handsearching references and citations, and through consulting an international panel of experts. No language restrictions will apply. Following Cochrane Effective Practice and Organisation of Care (EPOC) guidelines, randomised and clinical controlled trials, controlled before-and-after studies, and interrupted time series designs, are eligible. Studies of interest will assess the impact of any of the WHO-advocated tobacco control policies contained in the MPOWER acronym (except 'Monitoring tobacco use') on at least one outcome of interest among children aged 0-12 years. The primary outcomes are: perinatal mortality, preterm birth, asthma exacerbations requiring hospital attendance and respiratory infections requiring hospital attendance. Data will be extracted using customised forms and authors will be contacted to obtain missing information. Risk of bias will be assessed using EPOC criteria. Findings will be reported in narrative and tabular form. Between-study heterogeneity will be assessed clinically and statistically using I(2). If appropriate and possible, random-effects meta-analysis will be conducted for each unique combination of intervention and outcome. Subgroup analyses will be performed to assess the influence of the comprehensiveness of each policy, and to explore the impact of each policy according to socioeconomic status. ETHICS AND DISSEMINATION No ethical assessment is necessary as we will summarise existing studies. We will publish our findings in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER PROSPERO; CRD42015023448.
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Affiliation(s)
- Jasper V Been
- Division of Neonatology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, TheNetherlands
- School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, TheNetherlands
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, TheNetherlands
| | - Christopher Millett
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Sanjay Basu
- Prevention Research Center, Stanford University, Stanford, California, USA
| | - Aziz Sheikh
- School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, TheNetherlands
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
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Niedzwiedz CL, Pell JP, Mitchell R. The Relationship Between Financial Distress and Life-Course Socioeconomic Inequalities in Well-Being: Cross-National Analysis of European Welfare States. Am J Public Health 2015; 105:2090-8. [PMID: 26270289 DOI: 10.2105/ajph.2015.302722] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We investigated to what extent current financial distress explains the relationship between life-course socioeconomic position and well-being in Southern, Scandinavian, Postcommunist, and Bismarckian welfare regimes. METHODS We analyzed individuals (n = 18 324) aged 50 to 75 years in the Survey of Health, Ageing, and Retirement in Europe, 2006-2009. Well-being was measured with CASP-12 (which stands for control, autonomy, self-realization, and pleasure) and life satisfaction. We generated a life-course socioeconomic index from 8 variables and calculated multilevel regression models (containing individuals nested within 13 countries), as well as stratified single-level models by welfare regime. RESULTS Life-course socioeconomic advantage was related to higher well-being; the difference in life satisfaction between the most and least advantaged was 2.09 (95% confidence interval = 1.87, 2.31) among women and 1.65 (95% confidence interval = 1.43, 1.87) among men. The weakest associations were found among Scandinavian countries. Financial distress was associated with lower well-being and attenuated the relationship between life-course socioeconomic position and well-being in all regimes (ranging from 34.26% in Postcommunist to 72.22% in Scandinavian countries). CONCLUSIONS We found narrower inequalities in well-being in the Scandinavian regime. Reducing financial distress may help improve well-being and reduce inequalities.
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Affiliation(s)
- Claire L Niedzwiedz
- Claire L. Niedzwiedz is with Centre for Research on Environment, Society, and Health, University of Edinburgh, Edinburgh, Scotland. Jill P. Pell is with Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland. Richard Mitchell is with Centre for Research on Environment, Society, and Health, Institute of Health and Wellbeing, University of Glasgow
| | - Jill P Pell
- Claire L. Niedzwiedz is with Centre for Research on Environment, Society, and Health, University of Edinburgh, Edinburgh, Scotland. Jill P. Pell is with Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland. Richard Mitchell is with Centre for Research on Environment, Society, and Health, Institute of Health and Wellbeing, University of Glasgow
| | - Richard Mitchell
- Claire L. Niedzwiedz is with Centre for Research on Environment, Society, and Health, University of Edinburgh, Edinburgh, Scotland. Jill P. Pell is with Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland. Richard Mitchell is with Centre for Research on Environment, Society, and Health, Institute of Health and Wellbeing, University of Glasgow
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Social Inequality in Cigarette Consumption, Cigarette Dependence, and Intention to Quit among Norwegian Smokers. BIOMED RESEARCH INTERNATIONAL 2015; 2015:835080. [PMID: 26273648 PMCID: PMC4529928 DOI: 10.1155/2015/835080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/13/2015] [Accepted: 02/26/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The study aim was to examine the influence of education and income on multiple measures of risk of smoking continuation. METHODS Three logistic regression models were run on cigarette consumption, dependence, and intention to quit based on nationally representative samples (2007-2012) of approximately 1 200 current smokers aged 30-66 years in Norway. RESULTS The relative risk ratio for current versus never smokers was RRR 5.37, 95% CI [4.26-6.77] among individuals with low educational level versus high and RRR 1.53, 95% CI [1.14-2.06] in the low-income group versus high (adjusted model). Low educational level was associated with high cigarette consumption, high cigarette dependence, and no intention to quit. The difference in predicted probability for having high cigarette consumption, high cigarette dependence, and no intention to quit were in the range of 10-20 percentage points between smokers with low versus those with high educational level. A significant difference between low- and high-income levels was observed for intention to quit. The effect of education on high consumption and dependence was mainly found in smokers with high income. CONCLUSION Increased effort to combat social differences in smoking behaviour is needed. Implementation of smoking cessation programmes with high reach among low socioeconomic groups is recommended.
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Phillimore J, Bradby H, Knecht M, Padilla B, Brand T, Cheung SY, Pemberton S, Zeeb H. Understanding healthcare practices in superdiverse neighbourhoods and developing the concept of welfare bricolage: Protocol of a cross-national mixed-methods study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2015; 15:16. [PMID: 26117380 PMCID: PMC4501194 DOI: 10.1186/s12914-015-0055-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/25/2015] [Indexed: 11/10/2022]
Abstract
Background Diversity in Europe has both increased and become more complex posing challenges to both national and local welfare state regimes. Evidence indicates specific barriers for migrant, faith and minority ethnic groups when accessing healthcare. However, previous studies of health in diverse cities in European countries have mainly adopted an ethno-national focus. Taking into account the new complexity of diversity within cities, a deeper and multi-faceted understanding of everyday health practices in superdiverse contexts is needed to support appropriate healthcare provision. Methods/Design This protocol describes a mixed method study investigating how residents in superdiverse neighbourhoods access healthcare. The study will include participant observation and qualitative interviewing as well as a standardised health survey and will be carried out in eight superdiverse neighbourhoods – with varying deprivations levels and trajectories of change – in four European countries (Germany, Portugal, Sweden and UK). In each neighbourhood, trained polylingual community researchers together with university researchers will map formal and informal provision and infrastructures supportive to health and healthcare. In-depth interviews with residents and healthcare providers in each country will investigate local health-supportive practices. Thematic analysis will be used to identify different types of help-seeking behaviours and support structures across neighbourhoods and countries. Using categories identified from analyses of interview material, a health survey will be set up investigating determinants of access to healthcare. Complex models, such as structural equation modelling, will be applied to analyse commonalities and differences between population groups, neighbourhoods and countries. Discussion This study offers the potential to contribute to a deeper understanding of how residents in superdiverse neighbourhoods deal with health and healthcare in everyday practices. The findings will inform governmental authorities, formal and informal healthcare providers how to further refine health services and how to achieve equitable access in diverse population groups.
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Affiliation(s)
- Jenny Phillimore
- Institute for Research into Superdiversity (IRiS), School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, Great Britain.
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Box 624, Se-751 26, Uppsala, Sweden.
| | - Michi Knecht
- Department of Anthropology and Cultural Research, University of Bremen, Enrique-Schmidt-Straße 7, 28359, Bremen, Germany.
| | - Beatriz Padilla
- Interdisciplinary Centre of Social Sciences (CICS.NOVA), University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.
| | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Achterstraße 30, D-28359, Bremen, Germany.
| | - Sin Yi Cheung
- School of Social Sciences, Cardiff University, King Edward VII Avenue, Cardiff, CF10 3W, Great Britain.
| | - Simon Pemberton
- Institute for Research into Superdiversity (IRiS), School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, Great Britain. .,Keele University, Keele, Staffordshire, ST5 5UK, Great Britain.
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Achterstraße 30, D-28359, Bremen, Germany. .,Health Sciences Bremen, University of Bremen, Bremen, Germany.
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Hoffmann R, Eikemo TA, Kulhánová I, Kulik MC, Looman C, Menvielle G, Deboosere P, Martikainen P, Regidor E, Mackenbach JP. Obesity and the potential reduction of social inequalities in mortality: evidence from 21 European populations. Eur J Public Health 2015; 25:849-56. [PMID: 26009611 DOI: 10.1093/eurpub/ckv090] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Obesity contributes considerably to the problem of health inequalities in many countries, but quantitative estimates of this contribution and to what extent it is modifiable are scarce. We identify the potential for reducing educational inequalities in all-cause and obesity-related mortality in 21 European populations, by modifying educational differences in obesity and overweight. METHODS Prevalence data and mortality data come from 21 European populations. Mortality rate ratios come from literature reviews. We use the population attributable fraction (PAF) to estimate the impact of scenario-based changes in the social distribution of obesity on educational inequalities in mortality. RESULTS An elimination of differences in obesity between educational groups would decrease relative inequality in all-cause mortality between those with high and low education by up to 12% for men and 42% for women. About half of the relative inequality in mortality could be reduced for some causes of death in several countries, often in southern Europe. Absolute inequalities in all-cause mortality would be reduced by up to 69 (men) and 67 (women) deaths per 100,000 person-years. CONCLUSION The potential reduction of health inequality by an elimination of social inequalities in obesity might be substantial. The reductions differ by country, cause of death and gender, suggesting that the priority given to obesity as an entry-point for tackling health inequalities should differ between countries and gender.
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Affiliation(s)
- Rasmus Hoffmann
- 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Terje A Eikemo
- 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ivana Kulhánová
- 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Margarete C Kulik
- 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Caspar Looman
- 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gwenn Menvielle
- 2 Department of Social Epidemiology, INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France 3 Department of Social Epidemiology, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Patrick Deboosere
- 4 Department of Social Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Pekka Martikainen
- 5 Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Enrique Regidor
- 6 Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Johan P Mackenbach
- 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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