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Di Girolamo C, Cammarata G, Giordano L, Zengarini N, Ferracin E, Vergini V, Ferrante G, Ricceri F. Contextual and individual inequalities in breast cancer screening participation and outcomes in Turin (North-West Italy). NPJ Breast Cancer 2024; 10:51. [PMID: 38937476 PMCID: PMC11211318 DOI: 10.1038/s41523-024-00660-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
Breast cancer incidence and screening participation exhibit an unequal distribution in the population. This study aims to investigate the impact of socioeconomic position (SEP) on three breast screening indicators (participation, recall, and cancer detection rates) among women aged 50-69 in the city of Turin between 2010 and 2019. The study also aims to determine whether contextual factors (deprivation index) or individual factors (educational level) have a greater influence. The data used in this study are sourced from the Turin Breast Screening Program (TBSP) and the Turin Longitudinal Study (TLS). To test the hypothesis and account for the hierarchical structure of the data, multilevel models were used. Both contextual and individual SEP were found to be associated with screening participation. Participation increased with higher levels of deprivation (odds ratio for most deprived: 1.13; 95% CI 1.11-1.16) and decreased with higher educational levels (OR for low educated: 1.37; 95% CI 1.34-1.40). Contextual SEP did not show any association with recall or cancer detection rates, but individual SEP had an impact. Women with lower educational levels had a statistically significant 19% lower odds of being recalled and a statistically significant 20% lower odds of being diagnosed with cancer. Additionally, immigrant women were less likely to participate in screening, be recalled, or receive a cancer diagnosis. Educational level consistently influenced the analyzed screening indicators, while contextual deprivation appeared to have less importance. It is likely that women living in less deprived areas and with higher education have greater access to opportunistic screening.
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Affiliation(s)
- Chiara Di Girolamo
- Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH) - Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | | | - Livia Giordano
- SSD Epidemiologia Screening - CRPT, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Nicolás Zengarini
- Epidemiology Department, Local Health Unit TO3, Via Sabaudia, 164, 10095, Grugliasco, Italy
| | - Elisa Ferracin
- Epidemiology Department, Local Health Unit TO3, Via Sabaudia, 164, 10095, Grugliasco, Italy
| | - Viviana Vergini
- SSD Epidemiologia Screening - CRPT, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Gianluigi Ferrante
- SSD Epidemiologia Screening - CRPT, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy.
| | - Fulvio Ricceri
- Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH) - Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
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Kanmodi KK, Amzat J, Aminu K. Theories, determinants, and intervention models and approaches on inequalities of undernutrition amongst under fives: A literature review. Health Sci Rep 2024; 7:e2078. [PMID: 38690007 PMCID: PMC11058263 DOI: 10.1002/hsr2.2078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024] Open
Abstract
Background and Aims One of the greatest public health problems of the 21st century is undernutrition in children under the age of 5 years (CAUFY). Globally, over 232 million CUAFY are undernourished and approximately 45% of mortality in this population are undernutrition-induced. This paper reviewed and critically explained the factors perpetuating undernutrition in CUAFY in the global space. It further explained the multi-level determinants that influence health inequalities and consequently exacerbate undernutrition amongst CUAFY globally. It also went further to explain the intervention models and approaches that can be used to tackle undernutrition in CUAFY. Methods/Literature Search Strategy Demiris et al.'s approach to narrative review was utilized for this paper. Relevant articles on child nutrition were retrieved from multiple credible databases and websites of foremost health organizations. Using an iterative process, multiple combinations of search terms were done by stringing relevant key terms and their synonyms with Boolean Operators. This process was constantly refined to align search results with the study aim. Database search produced relevant and resourceful publications which were utilized to develop this review. Results The global burden of undernutrition remains high, especially in Oceania with the highest prevalence of stunting and wasting (41.4% and 12.5%), with Africa and Asia following closely. Malnutrition eradication is a global health issue of high priority as demonstrated by the "Goal 2" of the Sustainable Development Goals (SDGs), and the United Nations (UN) Decade of Action on Nutrition 2016-2025. The review identified no significant positive outcome from previous interventions due to the endemic health inequalities. Determinants of the multi-level health inequalities associated with undernutrition in CUAFY, and probable solutions are explained with theoretical models of health inequalities. A diagonal intervention approach was proposed as a viable solution to ending undernutrition in CUAFY. Conclusion The application of relevant theoretical models and context-specific intervention approaches can be utilized by stakeholders to close the existing inequality gaps, thereby reducing undernutrition amongst CUAFY globally.
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Affiliation(s)
- Kehinde Kazeem Kanmodi
- School of DentistryUniversity of RwandaKigaliRwanda
- Child Health and Wellbeing (CHAW) ProgramCephas Health Research Initiative IncIbadanNigeria
- Faculty of DentistryUniversity of PuthisastraPhnom PenhCambodia
- School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
| | - Jimoh Amzat
- Department of SociologyUsmanu Danfodiyo UniversitySokotoNigeria
| | - Kafayat Aminu
- Center for Child and Adolescent Mental HealthUniversity College HospitalIbadanNigeria
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3
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Jensen HAR, Møller SR, Christensen AI, Davidsen M, Juel K, Petersen CB. Trends in social inequality in mortality in Denmark 1995-2019: the contribution of smoking- and alcohol-related deaths. J Epidemiol Community Health 2023; 78:18-24. [PMID: 37451846 PMCID: PMC10715496 DOI: 10.1136/jech-2023-220599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND During the past decades, social inequality in mortality has increased in several countries, including Denmark. Modifiable risk factors, such as smoking and harmful alcohol consumption, have been suggested to moderate the association between socioeconomic position and health-related outcomes. The present study aims to investigate the contribution of smoking- and alcohol-related deaths to the trends in educational inequality in mortality in Denmark 1995-2019 among individuals aged 30-74 years. METHODS Nationwide data on mortality and highest attained educational level divided into quartiles were derived from administrative registers. Alcohol-related mortality was directly estimated using information on alcohol-related deaths from death certificates. Smoking-related mortality was indirectly estimated using the Peto-Lopez method. The contribution of smoking- and alcohol-related deaths to the social inequality gap in mortality 1995-2019 was calculated. RESULTS Alongside a decrease in all-cause mortality in Denmark 1995-2019, absolute differences in the mortality rate (per 100 000 person-year) between the lowest and the highest educational quartile increased from 494 to 607 among men and from 268 to 376 among women. Among both men and women, smoking- and alcohol-related deaths explained around 60% of the social inequality in mortality and around 50% of the increase in mortality inequality. CONCLUSION Smoking and harmful alcohol consumption continue to be important risk factors and causes of social inequality in mortality, with around half of the increase in Denmark 1995-2019 being attributable to smoking- and alcohol-related deaths. Future healthcare planning and policy development should aim at reducing social inequality in modifiable health risk behaviours and their negative consequences.
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Affiliation(s)
| | - Sofie Rossen Møller
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Musheiguza E, Mbegalo T, Mbukwa JN. Bayesian multilevel modelling of the association between socio-economic status and stunting among under-five-year children in Tanzania. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:135. [PMID: 38031170 PMCID: PMC10685585 DOI: 10.1186/s41043-023-00474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Stunting is associated with socioeconomic status (SES) which is multidimensional. This study aimed to compare different SES indices in predicting stunting. METHODS This was the secondary data analysis using Tanzania Demographics and Health Surveys (TDHS). The study used 7492, 6668, and 8790 under-five-year children from TDHS 2004/5, 2010, and 2015/16, respectively. The Household Wealth Index (HWI); Water and Sanitation, Assets, Maternal education and Income (WAMI); Wealth Assets, Education, and Occupation (WEO); and the Multidimensional Poverty Index (MPI) indices were compared. The summated scores, principal component analysis (PCA), and random forest (RF) approaches were used to construct indices. The Bayesian and maximum likelihood multilevel generalized linear mixed models (MGLMM) were constructed to determine the association between each SES index and stunting. RESULTS The study revealed that 42.3%, 38.4%, and 32.4% of the studied under-five-year children were stunted in 2004/5, 2010, and 2015/16, respectively. Compared to other indicators of SES, the MPI had a better prediction of stunting for the TDHS 2004/5 and 2015/16, while the WAMI had a better prediction in 2010. For each score increase in WAMI, the odds of stunting were 64% [BPOR = 0.36; 95% CCI 0.3, 0.4] lower in 2010, while for each score increase in MPI there was 1 [BPOR = 1.1; 95% CCI 1.1, 1.2] times higher odds of stunting in 2015/16. CONCLUSION The MPI and WAMI under PCA were the best measures of SES that predict stunting. Because MPI was the best predictor of stunting for two surveys (TDHS 2004/5 and 2015/16), studies dealing with stunting should use MPI as a proxy measure of SES. Use of BE-MGLMM in modelling stunting is encouraged. Strengthened availability of items forming MPI is inevitable for child growth potentials. Further studies should investigate the determinants of stunting using Bayesian spatial models to take into account spatial heterogeneity.
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Affiliation(s)
- Edwin Musheiguza
- Department of Mathematics and Information Communication Technology, College of Business Education, P.O. Box 1968, Dar es Salaam, Tanzania.
- Department of Mathematics and Statistics Studies, Mzumbe University, P.O Box 87, Mzumbe, Tanzania.
| | - Tukae Mbegalo
- Department of Mathematics and Statistics Studies, Mzumbe University, P.O Box 87, Mzumbe, Tanzania
| | - Justine N Mbukwa
- Department of Mathematics and Statistics Studies, Mzumbe University, P.O Box 87, Mzumbe, Tanzania
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Priest N, Guo S, Gondek D, O'Connor M, Moreno-Betancur M, Gray S, Lacey R, Burgner DP, Woolfenden S, Badland H, Redmond G, Juonala M, Lange K, Goldfeld S. The potential of intervening on childhood adversity to reduce socioeconomic inequities in body mass index and inflammation among Australian and UK children: A causal mediation analysis. J Epidemiol Community Health 2023; 77:632-640. [PMID: 37536921 PMCID: PMC10527996 DOI: 10.1136/jech-2022-219617] [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: 07/25/2022] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Lower maternal education is associated with higher body mass index (BMI) and higher chronic inflammation in offspring. Childhood adversity potentially mediates these associations. We examined the extent to which addressing childhood adversity could reduce socioeconomic inequities in these outcomes. METHODS We analysed data from two early-life longitudinal cohorts: the Longitudinal Study of Australian Children (LSAC; n=1873) and the UK Avon Longitudinal Study of Parents and Children (ALSPAC; n=7085). EXPOSURE low/medium (below university degree) versus high maternal education, as a key indicator of family socioeconomic position (0-1 year). OUTCOMES BMI and log-transformed glycoprotein acetyls (GlycA) (LSAC: 11-12 years; ALSPAC: 15.5 years). Mediator: multiple adversities (≥2/<2) indicated by family violence, mental illness, substance abuse and harsh parenting (LSAC: 2-11 years; ALSPAC: 1-12 years). A causal mediation analysis was conducted. RESULTS Low/medium maternal education was associated with up to 1.03 kg/m2 higher BMI (95% CI: 0.95 to 1.10) and up to 1.69% higher GlycA (95% CI: 1.68 to 1.71) compared with high maternal education, adjusting for confounders. Causal mediation analysis estimated that decreasing the levels of multiple adversities in children with low/medium maternal education to be like their high maternal education peers could reduce BMI inequalities by up to 1.8% and up to 3.3% in GlycA. CONCLUSIONS Our findings in both cohorts suggest that slight reductions in socioeconomic inequities in children's BMI and inflammation could be achieved by addressing childhood adversities. Public health and social policy efforts should help those affected by childhood adversity, but also consider underlying socioeconomic conditions that drive health inequities.
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Affiliation(s)
- Naomi Priest
- Centre for Social Research and Methods, Australian National University, Canberra, Australian Capital Territory, Australia
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Shuaijun Guo
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dawid Gondek
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Meredith O'Connor
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Children's LifeCourse Initiative, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne Graduate School of Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Margarita Moreno-Betancur
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sarah Gray
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Lacey
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - David P Burgner
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Inflammatory Origins Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Pediatrics, Monash University, Melbourne, Victoria, Australia
| | - Sue Woolfenden
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Hannah Badland
- Centre for Urban Research, RMIT University, Melbourne, Victoria, Australia
| | - Gerry Redmond
- College of Business, Government and Law, Flinders University, Adelaide, South Australia, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, TYKS Turku University Hospital, Turku, Finland
| | - Katherine Lange
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Molecular Immunity Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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van Etten S, Jansen L, Bal M, Dermody BJ, Müller E, de Wit J, Stok M. The FLY-project: study protocol for mixed methods research to explore the complex social dynamics of sustainable food-related lifestyles in youth in practical education. BMC Nutr 2023; 9:100. [PMID: 37633984 PMCID: PMC10463318 DOI: 10.1186/s40795-023-00757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The present-day food system is a key driver of climate change and biodiversity loss, making it imperative for populations to shift towards more sustainable diets. The involvement of youth in this transition is vital because they are in a formative period where their identities, values, and norms, including their food behaviours, are being shaped. Special attention should be paid to youth in practical education because they are often overlooked in existing studies, yet evidence suggests they may lack the necessary resources to support dietary changes, resulting in lower levels of pro-environmental food-related behaviours. The aim of the FLY (Food-related Lifestyles in Youth) project is to study how sustainable food-related lifestyles and underlying factors develop in early adolescence, particularly in Dutch youth in practical education, how these spread in social networks, and to develop community-level intervention strategies to support youths' transition to sustainable food-related behaviours. METHODS/DESIGN The FLY-project adopts a mixed-method approach. First, two literature reviews are conducted. A systematic review assesses how capabilities, opportunities and motivation are associated with sustainable food behaviours in youth, and how these elements interrelate in determining sustainable food-related lifestyles. A scoping review studies community-level interventions that target sustainable and healthy food-related behaviours. Second, focus groups are conducted to explore the barriers and facilitating factors concerning capabilities, opportunities, and motivations that Dutch youth in practical-level education experience to transition to more sustainable food-related lifestyles. Third, a cohort survey study is conducted to track the dynamic interplay between capabilities, opportunities, motivation, and changes in specific sustainable food behaviours over time, and to assess the diffusion of sustainable food-related lifestyles via social (media) networks. Fourth, an experimental research programme tests promising intervention approaches, some of which are co-created with youth, targeting relevant underlying factors. DISCUSSION This paper describes the rationale, conceptual framework, design and methods of the FLY-project. The FLY-project contributes to an understanding of underlying factors of sustainable food-related behaviours in adolescence and results in a multi-component intervention toolkit, with a particular focus on youth in practical education programmes.
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Affiliation(s)
- Soraya van Etten
- Department of Interdisciplinary Social Science, Faculty of Social & Behavioural Sciences, Utrecht University, Utrecht, The Netherlands.
| | - Lonneke Jansen
- Department of Interdisciplinary Social Science, Faculty of Social & Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Michèlle Bal
- Department of Interdisciplinary Social Science, Faculty of Social & Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Brian J Dermody
- Faculty of Geosciences, Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Eggo Müller
- Department of Media and Culture Studies, Faculty of Humanities, Utrecht University, Utrecht, The Netherlands
| | - John de Wit
- Department of Interdisciplinary Social Science, Faculty of Social & Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Marijn Stok
- Department of Interdisciplinary Social Science, Faculty of Social & Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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Liu J, Cerutti J, Lussier AA, Zhu Y, Smith BJ, Smith ADAC, Dunn EC. Socioeconomic changes predict genome-wide DNA methylation in childhood. Hum Mol Genet 2023; 32:709-719. [PMID: 35899434 PMCID: PMC10365844 DOI: 10.1093/hmg/ddac171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/01/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023] Open
Abstract
Childhood socioeconomic position (SEP) is a major determinant of health and well-being across the entire life course. To effectively prevent and reduce health risks related to SEP, it is critical to better understand when and under what circumstances socioeconomic adversity shapes biological processes. DNA methylation (DNAm) is one such mechanism for how early life adversity 'gets under the skin'. In this study, we evaluated the dynamic relationship between SEP and DNAm across childhood using data from 946 mother-child pairs in the Avon Longitudinal Study of Parents and Children. We assessed six SEP indicators spanning financial, occupational and residential domains during very early childhood (ages 0-2), early childhood (ages 3-5) and middle childhood (ages 6-7). Epigenome-wide DNAm was measured at 412 956 cytosine-guanines (CpGs) from peripheral blood at age 7. Using an innovative two-stage structured life-course modeling approach, we tested three life-course hypotheses for how SEP shapes DNAm profiles-accumulation, sensitive period and mobility. We showed that changes in the socioeconomic environment were associated with the greatest differences in DNAm, and that middle childhood may be a potential sensitive period when socioeconomic instability is especially important in shaping DNAm. Top SEP-related DNAm CpGs were overrepresented in genes involved in pathways important for neural development, immune function and metabolic processes. Our findings highlight the importance of socioeconomic stability during childhood and if replicated, may emphasize the need for public programs to help children and families experiencing socioeconomic instability and other forms of socioeconomic adversity.
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Affiliation(s)
- Jiaxuan Liu
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Janine Cerutti
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Alexandre A Lussier
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Yiwen Zhu
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Brooke J Smith
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Andrew D A C Smith
- Mathematics and Statistics Research Group, University of the West of England, Bristol BS8 1QU, UK
| | - Erin C Dunn
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Harvard Center on the Developing Child, Harvard University, Cambridge, MA 02138, USA
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8
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Macciotta A, Catalano A, Giraudo MT, Weiderpass E, Ferrari P, Freisling H, Colorado-Yohar SM, Santiuste C, Amiano P, Heath AK, Ward HA, Christakoudi S, Vineis P, Singh D, Vaccarella S, Schulze MB, Hiensch AE, Monninkhof EM, Katzke V, Kaaks R, Tumino R, Lazzarato F, Milani L, Agudo A, Dahm CC, Baglietto L, Perduca V, Severi G, Grioni S, Panico S, Ardanaz E, Borch KB, Benebo FO, Braaten T, Sánchez MJ, Giachino C, Sacerdote C, Ricceri F. Mediating Role of Lifestyle Behaviors in the Association between Education and Cancer: Results from the European Prospective Investigation into Cancer and Nutrition. Cancer Epidemiol Biomarkers Prev 2023; 32:132-140. [PMID: 36306379 DOI: 10.1158/1055-9965.epi-22-0777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/07/2022] [Accepted: 10/25/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Many studies have shown that socioeconomic position (SEP) is associated with the incidence of malignant tumors at different sites. This study aims to estimate the association between educational level (as proxy for SEP) and cancer incidence and to understand whether the observed associations might be partially explained by lifestyle behaviors. METHODS The analyses were performed on data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study, globally and by sex. We used Cox proportional hazards models together with mediation analysis to disentangle the total effect (TE) of educational level [measured through the Relative Index of Inequality (RII)] on cancer incidence into pure direct (PDE) and total indirect (TIE) effect, unexplained and explained by mediators, respectively. PDE and TIE were then combined to compute the proportions mediated (PM). RESULTS After an average of 14 years of follow-up, 52,422 malignant tumors were ascertained. Low educated participants showed higher risk of developing stomach, lung, kidney (in women), and bladder (in men) cancers, and, conversely, lower risk of melanoma and breast cancer (in post-menopausal women), when compared with more educated participants. Mediation analyses showed that portions of the TE of RII on cancer could be explained by site-specific related lifestyle behaviors for stomach, lung, and breast (in women). CONCLUSIONS Cancer incidence in Europe is determined at least in part by a socioeconomically stratified distribution of risk factors. IMPACT These observational findings support policies to reduce cancer occurrence by altering mediators, such as lifestyle behaviors, particularly focusing on underprivileged strata of the population.
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Affiliation(s)
- Alessandra Macciotta
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Alberto Catalano
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | | | - Pietro Ferrari
- International Agency for Cancer Research (IARC-WHO), Lyon, France
| | - Heinz Freisling
- International Agency for Cancer Research (IARC-WHO), Lyon, France
| | - Sandra M Colorado-Yohar
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
| | - Carmen Santiuste
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Pilar Amiano
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, Biodonostia Health Research Institute, San Sebastian, Spain
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Heather A Ward
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Sofia Christakoudi
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London, United Kingdom
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Deependra Singh
- International Agency for Cancer Research (IARC-WHO), Lyon, France
| | | | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Anouk E Hiensch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rosario Tumino
- Hyblean Association for Epidemiological Research, AIRE-ONLUS, Ragusa, Italy
| | - Fulvio Lazzarato
- Unit of Cancer Epidemiology, "Città della salute e della scienza" University-Hospital, Turin, Italy
| | - Lorenzo Milani
- Department of Medical Science, University of Turin, Turin, Italy
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, Villejuif, France
| | - Vittorio Perduca
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, Villejuif, France
- Laboratoire MAP5 (UMR CNRS 8145), Université de Paris, Paris, France
| | - Gianluca Severi
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, Villejuif, France
- Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Florence, Italy
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Salvatore Panico
- Dipartmento Di Medicina Clinica E Chirurgia Federico II University, Naples, Italy
| | - Eva Ardanaz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarre Public Health Institute, Pamplona, Spain
| | - Kristin B Borch
- Department of Community Medicine, UiT, the Arctic University of Norway, Tromsø, Norway
| | - Faith O Benebo
- Department of Community Medicine, UiT, the Arctic University of Norway, Tromsø, Norway
| | - Tonje Braaten
- Department of Community Medicine, UiT, the Arctic University of Norway, Tromsø, Norway
| | - Maria-Jose Sánchez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Claudia Giachino
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, "Città della salute e della scienza" University-Hospital, Turin, Italy
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
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9
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Cristaldi MA, Catry T, Pottier A, Herbreteau V, Roux E, Jacob P, Previtali MA. Determining the spatial distribution of environmental and socio-economic suitability for human leptospirosis in the face of limited epidemiological data. Infect Dis Poverty 2022; 11:86. [PMID: 35927739 PMCID: PMC9351081 DOI: 10.1186/s40249-022-01010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/19/2022] [Indexed: 12/03/2022] Open
Abstract
Background Leptospirosis is among the leading zoonotic causes of morbidity and mortality worldwide. Knowledge about spatial patterns of diseases and their underlying processes have the potential to guide intervention efforts. However, leptospirosis is often an underreported and misdiagnosed disease and consequently, spatial patterns of the disease remain unclear. In the absence of accurate epidemiological data in the urban agglomeration of Santa Fe, we used a knowledge-based index and cluster analysis to identify spatial patterns of environmental and socioeconomic suitability for the disease and potential underlying processes that shape them. Methods We geocoded human leptospirosis cases derived from the Argentinian surveillance system during the period 2010 to 2019. Environmental and socioeconomic databases were obtained from satellite images and publicly available platforms on the web. Two sets of human leptospirosis determinants were considered according to the level of their support by the literature and expert knowledge. We used the Zonation algorithm to build a knowledge-based index and a clustering approach to identify distinct potential sets of determinants. Spatial similarity and correlations between index, clusters, and incidence rates were evaluated. Results We were able to geocode 56.36% of the human leptospirosis cases reported in the national epidemiological database. The knowledge-based index showed the suitability for human leptospirosis in the UA Santa Fe increased from downtown areas of the largest cities towards peri-urban and suburban areas. Cluster analysis revealed downtown areas were characterized by higher levels of socioeconomic conditions. Peri-urban and suburban areas encompassed two clusters which differed in terms of environmental determinants. The highest incidence rates overlapped areas with the highest suitability scores, the strength of association was low though (CSc r = 0.21, P < 0.001 and ESc r = 0.19, P < 0.001). Conclusions We present a method to analyze the environmental and socioeconomic suitability for human leptospirosis based on literature and expert knowledge. The methodology can be thought as an evolutive and perfectible scheme as more studies are performed in the area and novel information regarding determinants of the disease become available. Our approach can be a valuable tool for decision-makers since it can serve as a baseline to plan intervention measures. Supplementary Information The online version contains supplementary material available at 10.1186/s40249-022-01010-x.
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Affiliation(s)
- Maximiliano A Cristaldi
- Department of Natural Sciences, College of Humanities and Sciences, National University of Litoral, Santa Fe, Argentina.
| | - Thibault Catry
- ESPACE-DEV, French National Research Institute for Sustainable Development (IRD), University of Montpellier, University of French West Indies, University of French Guiana, University of La Reunion, Montpellier, France
| | - Auréa Pottier
- ESPACE-DEV, French National Research Institute for Sustainable Development (IRD), University of Montpellier, University of French West Indies, University of French Guiana, University of La Reunion, Montpellier, France
| | - Vincent Herbreteau
- ESPACE-DEV, French National Research Institute for Sustainable Development (IRD), University of Montpellier, University of French West Indies, University of French Guiana, University of La Reunion, Montpellier, France
| | - Emmanuel Roux
- ESPACE-DEV, French National Research Institute for Sustainable Development (IRD), University of Montpellier, University of French West Indies, University of French Guiana, University of La Reunion, Montpellier, France.,Sentinela International Joint Laboratory, French National Research Institute for Sustainable Development (IRD), University of Brasilia (UnB), Oswaldo Cruz Foundation (Fiocruz), Brasília, Brazil.,Sentinela International Joint Laboratory, French National Research Institute for Sustainable Development (IRD), University of Brasilia (UnB), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Paulina Jacob
- National Institute of Respiratory Diseases (INER) "Dr. E. Coni"/National Administration of Health Institutes (ANLIS "Dr. C.G. Malbrán"), Santa Fe, Argentina.,Leptospirosis Laboratory, College of Biochemistry and Biological Sciences, National University of Litoral, Santa Fe, Argentina
| | - M Andrea Previtali
- Department of Natural Sciences, College of Humanities and Sciences, National University of Litoral, Santa Fe, Argentina. .,National Scientific and Technical Research Council (CONICET), Santa Fe, Argentina.
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10
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Garcia L, Birckhead B, Krishnamurthy P, Mackey I, Sackman J, Salmasi V, Louis R, Castro C, Maddox R, Maddox T, Darnall BD. Durability of the Treatment Effects of an 8-Week Self-administered Home-Based Virtual Reality Program for Chronic Low Back Pain: Follow-up Study of a Randomized Clinical Trial. J Med Internet Res 2022; 24:e37480. [PMID: 35612905 PMCID: PMC9177046 DOI: 10.2196/37480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/22/2022] [Accepted: 04/26/2022] [Indexed: 12/19/2022] Open
Abstract
Background We previously reported the efficacy of an 8-week home-based therapeutic immersive virtual reality (VR) program in a double-blind randomized placebo-controlled study. Community-based adults with self-reported chronic low back pain were randomized 1:1 to receive either (1) a 56-day immersive therapeutic pain relief skills VR program (EaseVRx) or (2) a 56-day sham VR program. Immediate posttreatment results revealed the superiority of therapeutic VR over sham VR for reducing pain intensity; pain-related interference with activity, mood, and stress (but not sleep); physical function; and sleep disturbance. At 3 months posttreatment, therapeutic VR maintained superiority for reducing pain intensity and pain-related interference with activity, stress, and sleep (new finding). Objective This study assessed between-group and within-group treatment effects 6 months posttreatment to determine the extended efficacy, magnitude of efficacy, and clinical importance of home-based therapeutic VR. Methods E-surveys were deployed at pretreatment, end-of-treatment, and posttreatment months 1, 2, 3, and 6. Self-reported data for 188 participants were analyzed in a mixed-model framework using a marginal model to allow for correlated responses across the repeated measures. Primary outcomes were pain intensity and pain-related interference with activity, mood, stress, and sleep at 6 months posttreatment. Secondary outcomes were Patient-Reported Outcome Measurement Information System (PROMIS) sleep disturbance and physical function. Results Therapeutic VR maintained significant and clinically meaningful effects 6 months posttreatment and remained superior to sham VR for reducing pain intensity and pain-related interference with activity, stress, and sleep (ds=0.44-0.54; P<.003). Between-group comparisons for physical function and sleep disturbance showed superiority of EaseVRx over sham VR (ds=0.34; P=.02 and ds=0.46; P<.001, respectively). Participants were encouraged to contact study staff with any problems experienced during treatment; however, no participants contacted study staff to report adverse events of any type, including nausea and motion sickness. Conclusions Our 8-week home-based VR pain management program caused important reductions in pain intensity and interference up to 6 months after treatment. Additional studies are needed in diverse samples. Trial Registration ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177 International Registered Report Identifier (IRRID) RR2-10.2196/25291
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Affiliation(s)
| | | | | | | | | | - Vafi Salmasi
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Robert Louis
- Hoag Memorial Hospital, Newport Beach, CA, United States
| | | | | | | | - Beth D Darnall
- Stanford School of Medicine, Palo Alto, CA, United States
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11
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Ekholm O, Diasso PDK, Davidsen M, Kurita GP, Sjøgren P. Increasing prevalence of chronic non-cancer pain in Denmark from 2000 to 2017: A population-based survey. Eur J Pain 2021; 26:624-633. [PMID: 34748254 DOI: 10.1002/ejp.1886] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/29/2021] [Accepted: 11/06/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND This investigation comprised information from the Danish population to analyse the development of chronic non-cancer pain (CNCP) prevalence according to sex, age, physical job demand and educational level. METHODS Data derives from the Danish Health and Morbidity Surveys based on random samples of adults living in Denmark. The analysed samples were composed by 10,457 in 2000 (response rate: 62.7%), 5686 in 2005 (52.1%), 15,165 in 2010 (60.1%), 14,265 in 2013 (57.1%) and 14,022 in 2017 (56.1%). CNCP was defined as pain lasting 6 months or more. Individuals with a self-reported history of cancer were excluded. Calibration weighting was applied to reduce the impact of potential non-response bias. The Relative and the Absolute Concentration Index were calculated to measure educational inequalities. RESULTS CNCP prevalence has increased 8.3 percentage points during 2000-2017 (19.5%-27.8%) and is highest among women (22.1% to 30.8%). Higher CNCP prevalence among men aged 45-64 years exceeded the men aged >65 years in 2017 (31.9% and 29.8%, respectively). There was a continuous increase in CNCP prevalence in individuals with sedentary work or low physical demand at job from 2000 to 2017; among those with moderate or high physical demand at job the prevalence increased sharply from 2000 to 2010 after which the prevalence remained stable. Higher CNCP prevalence persisted among individuals with lower level of education regardless of gender and the inequalities remained stable over time. CONCLUSION The Danish prevalence of chronic pain has increased in the last two decades and higher numbers are observed in some sociodemographic groups. SIGNIFICANCE This study provides an overview of the development of chronic non-cancer pain in a country and analyses the trends with socioeconomic inequalities. The continuous increasing prevalence may have huge social and economic implications. This study reveals an urgent need for measures to attenuate the increasing prevalence, which should be a priority for public health policy.
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Affiliation(s)
- Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Geana Paula Kurita
- Department of Oncology, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.,Multidisciplinary Pain Centre, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Sjøgren
- Department of Oncology, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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12
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Byhamre ML, Araghi M, Alfredsson L, Bellocco R, Engström G, Eriksson M, Galanti MR, Jansson JH, Lager A, Lundberg M, Östergren PO, Pedersen NL, Trolle Lagerros Y, Ye W, Wennberg P, Magnusson C. Swedish snus use is associated with mortality: a pooled analysis of eight prospective studies. Int J Epidemiol 2021; 49:2041-2050. [PMID: 33347584 PMCID: PMC7825961 DOI: 10.1093/ije/dyaa197] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The health consequences of the use of Swedish snus, including its relationship with mortality, have not been fully established. We investigated the relationship between snus use and all-cause and cause-specific mortality (death due to cardiovascular diseases, cancer diseases and all other reasons, respectively) in a nationwide collaborative pooling project. METHODS We followed 169 103 never-smoking men from eight Swedish cohort studies, recruited in 1978-2010. Shared frailty models with random effects at the study level were used in order to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of mortality associated with snus use. RESULTS Exclusive current snus users had an increased risk of all-cause mortality (aHR 1.28, 95% CI 1.20-1.35), cardiovascular mortality (aHR 1.27, 95% CI 1.15-1.41) and other cause mortality (aHR 1.37, 95% CI 1.24-1.52) compared with never-users of tobacco. The risk of cancer mortality was also increased (aHR 1.12, 95% CI 1.00-1.26). These mortality risks increased with duration of snus use, but not with weekly amount. CONCLUSIONS Snus use among men is associated with increased all-cause mortality, cardiovascular mortality, with death from other causes and possibly with increased cancer mortality.
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Affiliation(s)
- Marja Lisa Byhamre
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Marzieh Araghi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Marie Eriksson
- Department of Statistics, Umeå School of Business, Economics, and Statistics, Umeå University, Umeå, Sweden
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Jan-Håkan Jansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Skellefteå, Sweden
| | - Anton Lager
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Michael Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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13
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Wendt FR, Pathak GA, Lencz T, Krystal JH, Gelernter J, Polimanti R. Multivariate genome-wide analysis of education, socioeconomic status and brain phenome. Nat Hum Behav 2021; 5:482-496. [PMID: 33349686 PMCID: PMC8068566 DOI: 10.1038/s41562-020-00980-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/21/2020] [Indexed: 01/10/2023]
Abstract
Socioeconomic status (SES) and education (EDU) are phenotypically associated with psychiatric disorders and behaviours. It remains unclear how these associations influence genetic risk for psychopathology, psychosocial factors and EDU and/or SES (EDU/SES) individually. Using information from >1 million individuals, we conditioned the genetic risk for psychiatric disorders, personality traits, brain imaging phenotypes and externalizing behaviours with genome-wide data for EDU/SES. Accounting for EDU/SES significantly affected the observed heritability of psychiatric traits, ranging from 2.44% h2 decrease for bipolar disorder to 14.2% h2 decrease for Tourette syndrome. Neuroticism h2 significantly increased by 20.23% after conditioning with SES. After EDU/SES conditioning, neuronal cell types were identified for risky behaviour (excitatory), major depression (inhibitory), schizophrenia (excitatory and γ-aminobutyric acid (GABA) mediated) and bipolar disorder (excitatory). Conditioning with EDU/SES also revealed unidirectional causality between brain morphology, psychopathology and psychosocial factors. Our results indicate that genetic discoveries related to psychopathology and psychosocial factors may be limited by genetic overlap with EDU/SES.
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Affiliation(s)
- Frank R Wendt
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA CT Healthcare System, West Haven, CT, USA
| | - Gita A Pathak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA CT Healthcare System, West Haven, CT, USA
| | - Todd Lencz
- Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Heampstead, NY, USA
- Institute for Behavioral Science, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - John H Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA CT Healthcare System, West Haven, CT, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- VA CT Healthcare System, West Haven, CT, USA.
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14
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Laine JE, Baltar VT, Stringhini S, Gandini M, Chadeau-Hyam M, Kivimaki M, Severi G, Perduca V, Hodge AM, Dugué PA, Giles GG, Milne RL, Barros H, Sacerdote C, Krogh V, Panico S, Tumino R, Goldberg M, Zins M, Delpierre C, Vineis P. Reducing socio-economic inequalities in all-cause mortality: a counterfactual mediation approach. Int J Epidemiol 2021; 49:497-510. [PMID: 31855265 PMCID: PMC7266549 DOI: 10.1093/ije/dyz248] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/27/2019] [Indexed: 12/05/2022] Open
Abstract
Background Socio-economic inequalities in mortality are well established, yet the contribution of intermediate risk factors that may underlie these relationships remains unclear. We evaluated the role of multiple modifiable intermediate risk factors underlying socio-economic-associated mortality and quantified the potential impact of reducing early all-cause mortality by hypothetically altering socio-economic risk factors. Methods Data were from seven cohort studies participating in the LIFEPATH Consortium (total n = 179 090). Using both socio-economic position (SEP) (based on occupation) and education, we estimated the natural direct effect on all-cause mortality and the natural indirect effect via the joint mediating role of smoking, alcohol intake, dietary patterns, physical activity, body mass index, hypertension, diabetes and coronary artery disease. Hazard ratios (HRs) were estimated, using counterfactual natural effect models under different hypothetical actions of either lower or higher SEP or education. Results Lower SEP and education were associated with an increase in all-cause mortality within an average follow-up time of 17.5 years. Mortality was reduced via modelled hypothetical actions of increasing SEP or education. Through higher education, the HR was 0.85 [95% confidence interval (CI) 0.84, 0.86] for women and 0.71 (95% CI 0.70, 0.74) for men, compared with lower education. In addition, 34% and 38% of the effect was jointly mediated for women and men, respectively. The benefits from altering SEP were slightly more modest. Conclusions These observational findings support policies to reduce mortality both through improving socio-economic circumstances and increasing education, and by altering intermediaries, such as lifestyle behaviours and morbidities.
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Affiliation(s)
- Jessica E Laine
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Valéria T Baltar
- Department of Epidemiology and Biostatistics, Instituto de Saúde Coletiva, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Silvia Stringhini
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Martina Gandini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, Italy
| | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Gianluca Severi
- Centre de Recherche en Épidémiologie et Santé des Populations (CESP, UMR Inserm 1018) Facultés de Medicine, Université Paris-Saclay, Université Paris-Sud, Saint-Aubin, France
| | - Vittorio Perduca
- Centre de Recherche en Épidémiologie et Santé des Populations (CESP, UMR Inserm 1018) Facultés de Medicine, Université Paris-Saclay, Université Paris-Sud, Saint-Aubin, France
| | - Allison M Hodge
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Pierre-Antoine Dugué
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Graham G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Roger L Milne
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Henrique Barros
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza-University of Turin and Center for Cancer Prevention, Turin, Italy
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Rosario Tumino
- Provincial Healthcare Company (ASP) Ragusa, Vittoria, Italy
| | - Marcel Goldberg
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
| | - Marie Zins
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
| | - Cyrille Delpierre
- LEASP, UMR 1027, Inserm-Université Toulouse III Paul Sabatier, Toulouse, France
| | | | - Paolo Vineis
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
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15
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Berger E, Maitre N, Romana Mancini F, Baglietto L, Perduca V, Colineaux H, Sieri S, Panico S, Sacerdote C, Tumino R, Vineis P, Boutron-Ruault MC, Severi G, Castagné R, Delpierre C. The impact of lifecourse socio-economic position and individual social mobility on breast cancer risk. BMC Cancer 2020; 20:1138. [PMID: 33228587 PMCID: PMC7684912 DOI: 10.1186/s12885-020-07648-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/17/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Women with an advantaged socioeconomic position (SEP) have a higher risk of developing breast cancer (BC). The reasons for this association do not seem to be limited to reproductive factors and remain to be understood. We aimed to investigate the impact of lifecourse SEP from childhood and social mobility on the risk of BC considering a broad set of potential mediators. METHODS We used a discovery-replication strategy in two European prospective cohorts, E3N (N = 83,436) and EPIC-Italy (N = 20,530). In E3N, 7877 women were diagnosed with BC during a median 24.4 years of follow-up, while in EPIC-Italy, 893 BC cases were diagnosed within 15.1 years. Hazard ratios (HR) were estimated using Cox proportional hazard models on imputed data. RESULTS In E3N, women with higher education had a higher risk of BC (HR [95%CI] = 1.21 [1.12, 1.30]). This association was attenuated by adjusting for reproductive factors, in particular age at first childbirth (HR[95%CI] = 1.13 [1.04, 1.22]). Health behaviours, anthropometric variables, and BC screening had a weaker effect on the association. Women who remained in a stable advantaged SEP had a higher risk of BC (HR [95%CI] = 1.24 [1.07; 1.43]) attenuated after adjustment for potential mediators (HR [95%CI] = 1.13 [0.98; 1.31]). These results were replicated in EPIC-Italy. CONCLUSIONS These results confirm the important role of reproductive factors in the social gradient in BC risk, which does not appear to be fully explained by the large set of potential mediators, including cancer screening, suggesting that further research is needed to identify additional mechanisms.
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Affiliation(s)
- Eloïse Berger
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France.
| | - Noële Maitre
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Francesca Romana Mancini
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Laura Baglietto
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Vittorio Perduca
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
- Université de Paris, CNRS, MAP5 UMR 8145, F-75006, Paris, France
| | - Hélène Colineaux
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
- Epidemiology Department, Toulouse Teaching Hospital, Toulouse, France
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provicial Health Authority (ASP) Ragusa, Ragusa, Italy
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, Imperial College London, MRC-PHE Centre for Environment and Health, School of Public Health, London, UK
- Italian Institute for Genomic Medicine, Torino, Italy
| | - Marie-Christine Boutron-Ruault
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Gianluca Severi
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
- Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Florence, Italy
| | - Raphaële Castagné
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Cyrille Delpierre
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
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16
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d'Errico A, Ricceri F, Descatha A, Leclerc A, Roquelaure Y, Goldberg M. Lifetime Duration of Exposure to Biomechanical Factors at Work as a Mediator of the Relationship Between Socioeconomic Position and Walking Speed. Front Public Health 2020; 8:412. [PMID: 33282805 PMCID: PMC7689267 DOI: 10.3389/fpubh.2020.00412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 07/10/2020] [Indexed: 11/13/2022] Open
Abstract
The study aimed to assess the proportion mediated by the duration of exposure to ergonomic factors at work on the relationship between socioeconomic position (SEP) and low walking speed. This cross-sectional study was performed on data collected at baseline on 19,704 men and 20,273 women 45-70 years old, currently or previously employed, enrolled in the Constances cohort. SEP was assigned through current or last occupation, categorized in three classes, based on the European Socioeconomic Classification. Walking speed was assessed through one measurement of normal walking for 3 m and dichotomized at the lowest quintile of the sex- and age- (5-year) specific distribution. Self-reported workplace exposure throughout working life to repetitive work, intense physical work, and lifting/carrying heavy loads was used to assess the duration of exposure to each factor, categorized in four classes. Through Poisson regression models, adjusted for BMI, smoking, alcohol intake, hypertension, physical activity, diabetes, cardiovascular diseases, and a cognitive score, the attenuation in the prevalence ratio (PR) of low walking speed by SEP produced by the inclusion of duration of exposure to each factor was evaluated. The mediating effect of work ergonomic exposures on the relationship between SEP and low walking speed was assessed using the weighted method by Vanderweele. In the fully adjusted model without ergonomic exposures, both men and women in the middle and the lowest SEP had a significantly increased risk of low walking speed compared with those in the highest SEP (men: PR = 1.30 and PR = 1.46, respectively; women: PR = 1.24 and PR = 1.45, respectively). The inclusion in separate regression models of exposure duration to repetitive work, intense physical work, and handling of heavy loads produced modest risk attenuations in both men and women, all smaller or around 10%. Mediation analysis revealed in both sexes significant mediation effects for most ergonomic exposures considered, although also with low mediation effects. Significant differences in walking speed by SEP were observed in this large sample, but the proportion of such differences explained by the duration of exposure to ergonomic factors at work was low using either the risk attenuation or the mediation analysis methods.
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Affiliation(s)
- Angelo d'Errico
- Local Health Unit TO3, Epidemiology Department, Turin, Italy
| | - Fulvio Ricceri
- Local Health Unit TO3, Epidemiology Department, Turin, Italy.,Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Alexis Descatha
- Inserm, Population-Based Epidemiologic Cohorts Unit, UMS 011, Paris, France.,University of Angers, Angers, France
| | - Annette Leclerc
- Inserm, Population-Based Epidemiologic Cohorts Unit, UMS 011, Paris, France.,Paris Descartes University, Paris, France
| | | | - Marcel Goldberg
- Inserm, Population-Based Epidemiologic Cohorts Unit, UMS 011, Paris, France.,Paris Descartes University, Paris, France
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17
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Maurel M, Castagné R, Berger E, Bochud M, Chadeau-Hyam M, Fraga S, Gandini M, Hutri-Kähönen N, Jalkanen S, Kivimäki M, Marmot M, McCrory C, Preisig M, Raitakari O, Ricceri F, Salmi M, Steptoe A, Vineis P, Delpierre C, Kelly-Irving M. Patterning of educational attainment across inflammatory markers: Findings from a multi-cohort study. Brain Behav Immun 2020; 90:303-310. [PMID: 32919037 PMCID: PMC8140486 DOI: 10.1016/j.bbi.2020.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/21/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Evidence suggests that the inflammatory reaction, an adaptive response triggered by a variety of harmful stimuli and conditions involved in the risk and development of many chronic diseases, is a potential pathway through which the socioeconomic environment is biologically embedded. Difficulty in interpreting the role of the inflammatory system in the embodiment dynamic arises because of heterogeneity across studies that use a limited but varied number of inflammatory markers. There is no consensus in the literature as to which inflammatory markers beyond the C-reactive protein and to a lesser extent interleukin 6 are related to the social environment. Accordingly, we aimed to investigate the association between educational attainment, and several markers of inflammation - C-reactive protein, fibrinogen, interleukin 6, interleukin 1β and tumor necrosis factor α- in 6 European cohort studies. METHODS Up to 17,470 participants from six European cohort studies with data on educational attainment, health behaviors and lifestyle factors, and at least two different inflammatory markers. Four sub-datasets were drawn with varying numbers of participants to allow pairwise comparison of the social patterning of C-reactive protein and any other inflammatory markers. To evaluate within each sub-dataset the importance of the context and cohort specificities, linear regression-based analyses were performed separately for each cohort and combined in a random effect meta-analysis to determine the relationship between educational attainment and inflammation. RESULTS We found that the magnitude of the relationship between educational attainment and five inflammatory biomarkers (C-reactive protein, fibrinogen, interleukin 6 and 1β and tumor necrosis factor α) was variable. By far the most socially patterned biomarker was C-reactive protein, followed by fibrinogen and to lesser extent interleukin 6, where a low educational attainment was associated with higher inflammation even after adjusting for health behaviours and body mass index. No association was found with interleukin 1β and tumor necrosis factor α. CONCLUSIONS Our study suggests different educational patterning of inflammatory biomarkers. Further large-scale research is needed to explore social differences in the inflammatory cascade in greater detail and the extent to which these differences contribute to social inequalities in health.
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Affiliation(s)
- Marine Maurel
- UMR1027, Université de Toulouse, UPS, Inserm, Toulouse, France
| | | | - Eloïse Berger
- UMR1027, Université de Toulouse, UPS, Inserm, Toulouse, France
| | - Murielle Bochud
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne 1004, Switzerland
| | - Marc Chadeau-Hyam
- MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UK
| | - Silvia Fraga
- EPIUnit-Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Martina Gandini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco 10095, Italy,Environmental Epidemiological Unit, Regional Environmental Protection Agency, Piedmont Region, Via Pio VII 9, 10135 Turin, Italy
| | - Nina Hutri-Kähönen
- Department of Pediatrics, Tampere University Hospital and Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
| | - Sirpa Jalkanen
- MediCity Research Laboratory, University of Turku, Turku, Finland,Institute of Biomedicine, University of Turku, Turku, Finland
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK,Clinicum, Faculty of Medicine, University of Helsinki, P. O. Box 20, Helsinki FI-00014, Finland
| | - Michael Marmot
- UCL Institute of Health Equity, Department of Epidemiology and Public Health, UCL, 1-19 Torrington Place, WC1E 6BT, London
| | - Cathal McCrory
- Department of Medical Gerontology, Trinity College Dublin, Ireland
| | - Martin Preisig
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne 1004, Switzerland
| | - Olli Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Fulvio Ricceri
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco 10095, Italy,Department of Clinical and Biological Sciences, University of Turin, Italy
| | - Marko Salmi
- MediCity Research Laboratory, University of Turku, Turku, Finland,Institute of Biomedicine, University of Turku, Turku, Finland
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UK,Italian Institute for Genomic Medicine, Torino, Italy
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Adherence to the Mediterranean diet partially mediates socioeconomic differences in leukocyte LINE-1 methylation: evidence from a cross-sectional study in Italian women. Sci Rep 2020; 10:14360. [PMID: 32873815 PMCID: PMC7463235 DOI: 10.1038/s41598-020-71352-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/07/2020] [Indexed: 12/11/2022] Open
Abstract
Although previous research demonstrated that socioeconomic status (SES) might affect DNA methylation, social inequalities alone do not completely explain this relationship. We conducted a cross-sectional study on 349 women (Catania, Italy) to investigate whether behaviors might mediate the association between SES and long interspersed nuclear elements (LINE-1) methylation, a surrogate marker of global DNA methylation. Educational level, used as an indicator of SES, and data on behaviors (i.e. diet, smoking habits, physical activity, and weight status) were collected using structured questionnaires. Adherence to Mediterranean diet (MD) was assessed by the Mediterranean Diet Score (MDS). Leukocyte LINE-1 methylation was assessed by pyrosequencing. Mediation analysis was conducted using the procedure described by Preacher and Hayes. Women with high educational level exhibited higher MDS (β = 0.669; 95%CI 0.173-1.165; p < 0.01) and LINE-1 methylation level (β = 0.033; 95%CI 0.022-0.043; p < 0.001) than their less educated counterpart. In line with this, mediation analysis demonstrated a significant indirect effect of high educational level on LINE-1 methylation through the adherence to MD (β = 0.003; 95%CI 0.001-0.006). Specifically, the mediator could account for 9.5% of the total effect. To our knowledge, this is the first study demonstrating the mediating effect of diet in the relationship between SES and DNA methylation. Although these findings should be confirmed by prospective research, they add value to the promotion of healthy dietary habits in social disadvantaged people.
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Petrovic D, Haba-Rubio J, de Mestral Vargas C, Kelly-Irving M, Vineis P, Kivimäki M, Nyberg S, Gandini M, Bochud M, Vollenweider P, d’Errico A, Barros H, Fraga S, Goldberg M, Zins M, Steptoe A, Delpierre C, Heinzer R, Carmeli C, Chadeau-Hyam M, Stringhini S. The contribution of sleep to social inequalities in cardiovascular disorders: a multi-cohort study. Cardiovasc Res 2020; 116:1514-1524. [PMID: 31754700 PMCID: PMC7425783 DOI: 10.1093/cvr/cvz267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/28/2019] [Accepted: 10/30/2019] [Indexed: 12/12/2022] Open
Abstract
AIMS Sleep disturbances exhibit a strong social patterning, and inadequate sleep has been associated with adverse health outcomes, including cardiovascular disorders (CVD). However, the contribution of sleep to socioeconomic inequalities in CVD is unclear. This study pools data from eight European cohorts to investigate the role of sleep duration in the association between life-course socioeconomic status (SES) and CVD. METHODS AND RESULTS We used cross-sectional data from eight European cohorts, totalling 111 205 participants. Life-course SES was assessed using father's and adult occupational position. Self-reported sleep duration was categorized into recommended (6-8.5 h/night), long (>8.5 h/night), and short (<6 h/night). We examined two cardiovascular outcomes: coronary heart disease (CHD) and stroke. Main analyses were conducted using pooled data and examined the association between life-course SES and CVD, and the contribution of sleep duration to this gradient using counterfactual mediation. Low father's occupational position was associated with an increased risk of CHD (men: OR = 1.19, 95% CI [1.04; 1.37]; women: OR = 1.25, 95% CI [1.02; 1.54]), with marginal decrease of the gradient after accounting for adult occupational position (men: OR = 1.17, 95% CI [1.02; 1.35]; women: OR = 1.22, 95% CI [0.99; 1.52]), and no mediating effect by short sleep duration. Low adult occupational position was associated with an increased risk of CHD in both men and women (men: OR = 1.48, 95% CI [1.14; 1.92]; women: OR = 1.53, 95% CI [1.04; 2.21]). Short sleep duration meaningfully contributed to the association between adult occupational position and CHD in men, with 13.4% mediation. Stroke did not exhibit a social patterning with any of the variables examined. CONCLUSION This study suggests that inadequate sleep accounts to a meaningful proportion of the association between adult occupational position and CHD, at least in men. With sleep increasingly being considered an important cardiovascular risk factor in its own terms, our study additionally points to its potential role in social inequalities in cardiovascular disease.
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Affiliation(s)
- Dusan Petrovic
- Centre universitaire de médecine Générale et santé publique (UNISANTÉ), Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlos de Mestral Vargas
- Centre universitaire de médecine Générale et santé publique (UNISANTÉ), Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Michelle Kelly-Irving
- INSERM, UMR 1027, Toulouse, France
- Université Toulouse III Paul-Sabatier, UMR1027, Toulouse, France
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Solja Nyberg
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Martina Gandini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, Italy
| | - Murielle Bochud
- Centre universitaire de médecine Générale et santé publique (UNISANTÉ), Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Peter Vollenweider
- Centre universitaire de médecine Générale et santé publique (UNISANTÉ), Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Angelo d’Errico
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, Italy
| | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Silvia Fraga
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Marcel Goldberg
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
- Paris Descartes University, Paris, France
| | - Marie Zins
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
- Paris Descartes University, Paris, France
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Cyrille Delpierre
- INSERM, UMR 1027, Toulouse, France
- Université Toulouse III Paul-Sabatier, UMR1027, Toulouse, France
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Cristian Carmeli
- Centre universitaire de médecine Générale et santé publique (UNISANTÉ), Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Silvia Stringhini
- Centre universitaire de médecine Générale et santé publique (UNISANTÉ), Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne, Switzerland
- Unit of Population Epidemiology, Primary Care Division, Geneva University Hospital, Geneva, Switzerland
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20
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Ribeiro AI, Barros H. Affordable, Social, and Substandard Housing and Mortality: The EPIPorto Cohort Study, 1999-2019. Am J Public Health 2020; 110:1060-1067. [PMID: 32437286 DOI: 10.2105/ajph.2020.305661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine the association between residence in different housing typologies and all-cause and cause-specific mortality, and to compare with the 25 × 25 risk factors defined by the World Health Organization.Methods. We used data from EPIPorto cohort (Porto, Portugal; n = 2485). We georeferenced and matched participants to a housing type-conventional, affordable, social, or substandard housing (locally called ilhas). We used Poisson regression models to estimate mortality rates and associations.Results. Age- and sex-adjusted mortality rates (per 100 000 person-years) were 713 (95% confidence interval [CI] = 584, 863) for individuals residing in conventional housing, and 1019 (95% CI = 637, 1551), 1200 (95% CI = 916, 1551), and 1239 (95% CI = 839, 1772) for individuals residing in affordable housing, social housing, and ilhas, respectively. After further adjustment, the associations between mortality and residence in social housing (rate ratio [RR] = 1.59; 95% CI = 1.22, 2.06) and in ilhas (RR = 1.64; 95% CI = 1.12, 2.33) remained. The association between disadvantaged housing and mortality was stronger than that observed for well-established risk factors such as hypertension, sedentariness, heavy drinking, manual occupation, or obesity.Conclusions. Disadvantaged housing is a major risk factor for mortality that should be accounted for by health policies and surveillance systems.
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Affiliation(s)
- Ana Isabel Ribeiro
- The authors are with EPIUnit-Instituto de Saúde Pública and Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Henrique Barros
- The authors are with EPIUnit-Instituto de Saúde Pública and Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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21
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Vineis P, Avendano-Pabon M, Barros H, Bartley M, Carmeli C, Carra L, Chadeau-Hyam M, Costa G, Delpierre C, D'Errico A, Fraga S, Giles G, Goldberg M, Kelly-Irving M, Kivimaki M, Lepage B, Lang T, Layte R, MacGuire F, Mackenbach JP, Marmot M, McCrory C, Milne RL, Muennig P, Nusselder W, Petrovic D, Polidoro S, Ricceri F, Robinson O, Stringhini S, Zins M. Special Report: The Biology of Inequalities in Health: The Lifepath Consortium. Front Public Health 2020; 8:118. [PMID: 32478023 PMCID: PMC7235337 DOI: 10.3389/fpubh.2020.00118] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/24/2020] [Indexed: 12/16/2022] Open
Abstract
Funded by the European Commission Horizon 2020 programme, the Lifepath research consortium aimed to investigate the effects of socioeconomic inequalities on the biology of healthy aging. The main research questions included the impact of inequalities on health, the role of behavioral and other risk factors, the underlying biological mechanisms, the efficacy of selected policies, and the general implications of our findings for theories and policies. The project adopted a life-course and comparative approach, considering lifetime effects from childhood and adulthood, and pooled data on up to 1.7 million participants of longitudinal cohort studies from Europe, USA, and Australia. These data showed that socioeconomic circumstances predicted mortality and functional decline as strongly as established risk factors currently targeted by global prevention programmes. Analyses also looked at socioeconomically patterned biological markers, allostatic load, and DNA methylation using richly phenotyped cohorts, unraveling their association with aging processes across the life-course. Lifepath studies suggest that socioeconomic circumstances are embedded in our biology from the outset-i.e., disadvantage influences biological systems from molecules to organs. Our findings have important implications for policy, suggesting that (a) intervening on unfavorable socioeconomic conditions is complementary and as important as targeting well-known risk factors, such as tobacco and alcohol consumption, low fruit and vegetable intake, obesity and a sedentary lifestyle, and that (b) effects of preventive interventions in early life integrate interventions in adulthood. The report has an executive summary that refers to the different sections of the main paper.
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Affiliation(s)
- Paolo Vineis
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Mauricio Avendano-Pabon
- Department of Social Sciences, Health and Medicine, King's College London, London, United Kingdom
| | - Henrique Barros
- EPIUnit – Institute of Public Health University of Porto, Porto, Portugal
| | - Mel Bartley
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Cristian Carmeli
- Center for Primary Care and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
| | | | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Giuseppe Costa
- Department of Clinical Science & Biology, Turin University Medical School, Turin, Italy
| | - Cyrille Delpierre
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | | | - Silvia Fraga
- EPIUnit – Institute of Public Health University of Porto, Porto, Portugal
| | - Graham Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Marcel Goldberg
- UMS 011 Inserm - UVSQ ≪ Cohortes épidémiologiques en population ≫, Villejuif, France
| | | | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Benoit Lepage
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Thierry Lang
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Richard Layte
- Department of Sociology, School of Social Sciences and Philosophy, Trinity College Dublin, Dublin, Ireland
| | - Frances MacGuire
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Johan P. Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Michael Marmot
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Cathal McCrory
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Roger L. Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Peter Muennig
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dusan Petrovic
- Center for Primary Care and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
| | - Silvia Polidoro
- Molecular Epidemiology and Exposomics Unit, Italian Institute for Genomic Medicine, Turin, Italy
| | - Fulvio Ricceri
- Department of Clinical Science & Biology, Turin University Medical School, Turin, Italy
- Department of Epidemiology, ASL TO3, Turin, Italy
| | - Oliver Robinson
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Zins
- UMS 011 Inserm - UVSQ ≪ Cohortes épidémiologiques en population ≫, Villejuif, France
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Measuring Child Socio-Economic Position in Birth Cohort Research: The Development of a Novel Standardized Household Income Indicator. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051700. [PMID: 32150940 PMCID: PMC7084936 DOI: 10.3390/ijerph17051700] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
The assessment of early life socioeconomic position (SEP) is essential to the tackling of social inequalities in health. Although different indicators capture different SEP dimensions, maternal education is often used as the only indicator in birth cohort research, especially in multi-cohort analyses. Household income, as a direct measure of material resources, is one of the most important indicators, but one that is underused because it is difficult to measure through questionnaires. We propose a method to construct a standardized, cross-cohort comparable income indicator, the “Equivalized Household Income Indicator (EHII)”, which measures the equivalized disposable household income, using external data from the pan-European Union Statistics on Income and Living Conditions (EUSILC) surveys, and data from the cohorts. We apply this method to four studies, Piccolipiù and NINFEA from Italy and ELFE and EDEN from France, comparing the distribution of EHII with other SEP-related variables available in the cohorts, and estimating the association between EHII and child body mass index (BMI). We found that basic parental and household characteristics may be used, with a fairly good performance, to predict the household income. We observed a strong correlation between EHII and both the self-reported income, whenever available, and other individual socioeconomic-related variables, and an inverse association with child BMI. EHII could contribute to improving research on social inequalities in health, in particular in the context of European birth cohort collaborative studies.
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Atti Le giornate della ricerca scientificae delle esperienze professionali dei giovani: Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica (SItI) Roma 20-21 dicembre 2019. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 60:E1-E85. [PMID: 32258536 PMCID: PMC7105054 DOI: 10.15167/2421-4248/jpmh2019.60.4s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Vineis P, Avendano-Pabon M, Barros H, Bartley M, Carmeli C, Carra L, Chadeau-Hyam M, Costa G, Delpierre C, D'Errico A, Fraga S, Giles G, Goldberg M, Kelly-Irving M, Kivimaki M, Lepage B, Lang T, Layte R, MacGuire F, Mackenbach JP, Marmot M, McCrory C, Milne RL, Muennig P, Nusselder W, Petrovic D, Polidoro S, Ricceri F, Robinson O, Stringhini S, Zins M. Special Report: The Biology of Inequalities in Health: The Lifepath Consortium. Front Public Health 2020. [PMID: 32478023 DOI: 10.3389/fpubh.2020.00118/full] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Funded by the European Commission Horizon 2020 programme, the Lifepath research consortium aimed to investigate the effects of socioeconomic inequalities on the biology of healthy aging. The main research questions included the impact of inequalities on health, the role of behavioral and other risk factors, the underlying biological mechanisms, the efficacy of selected policies, and the general implications of our findings for theories and policies. The project adopted a life-course and comparative approach, considering lifetime effects from childhood and adulthood, and pooled data on up to 1.7 million participants of longitudinal cohort studies from Europe, USA, and Australia. These data showed that socioeconomic circumstances predicted mortality and functional decline as strongly as established risk factors currently targeted by global prevention programmes. Analyses also looked at socioeconomically patterned biological markers, allostatic load, and DNA methylation using richly phenotyped cohorts, unraveling their association with aging processes across the life-course. Lifepath studies suggest that socioeconomic circumstances are embedded in our biology from the outset-i.e., disadvantage influences biological systems from molecules to organs. Our findings have important implications for policy, suggesting that (a) intervening on unfavorable socioeconomic conditions is complementary and as important as targeting well-known risk factors, such as tobacco and alcohol consumption, low fruit and vegetable intake, obesity and a sedentary lifestyle, and that (b) effects of preventive interventions in early life integrate interventions in adulthood. The report has an executive summary that refers to the different sections of the main paper.
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Affiliation(s)
- Paolo Vineis
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Mauricio Avendano-Pabon
- Department of Social Sciences, Health and Medicine, King's College London, London, United Kingdom
| | - Henrique Barros
- EPIUnit - Institute of Public Health University of Porto, Porto, Portugal
| | - Mel Bartley
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Cristian Carmeli
- Center for Primary Care and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
| | | | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Giuseppe Costa
- Department of Clinical Science & Biology, Turin University Medical School, Turin, Italy
| | - Cyrille Delpierre
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | | | - Silvia Fraga
- EPIUnit - Institute of Public Health University of Porto, Porto, Portugal
| | - Graham Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Marcel Goldberg
- UMS 011 Inserm - UVSQ ≪ Cohortes épidémiologiques en population ≫, Villejuif, France
| | | | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Benoit Lepage
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Thierry Lang
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Richard Layte
- Department of Sociology, School of Social Sciences and Philosophy, Trinity College Dublin, Dublin, Ireland
| | - Frances MacGuire
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Johan P Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Michael Marmot
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Cathal McCrory
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Peter Muennig
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dusan Petrovic
- Center for Primary Care and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
| | - Silvia Polidoro
- Molecular Epidemiology and Exposomics Unit, Italian Institute for Genomic Medicine, Turin, Italy
| | - Fulvio Ricceri
- Department of Clinical Science & Biology, Turin University Medical School, Turin, Italy
- Department of Epidemiology, ASL TO3, Turin, Italy
| | - Oliver Robinson
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Zins
- UMS 011 Inserm - UVSQ ≪ Cohortes épidémiologiques en population ≫, Villejuif, France
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Jensen HAR, Rasmussen B, Ekholm O. Neighbour noise annoyance is associated with various mental and physical health symptoms: results from a nationwide study among individuals living in multi-storey housing. BMC Public Health 2019; 19:1508. [PMID: 31718590 PMCID: PMC6849169 DOI: 10.1186/s12889-019-7893-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/01/2019] [Indexed: 12/03/2022] Open
Abstract
Background Noise exposure is considered a stressor that may potentially exert negative health effects among the exposed individuals. On a population basis, the most prevalent and immediate response to noise is annoyance, which is an individually experienced phenomenon that may activate physiological stress-responses and result in both physical and mental symptoms. Health implications of traffic noise have been investigated thoroughly, but not of neighbour noise. The aim of the present study was to examine the associations between neighbour noise annoyance and eight different physical and mental health symptoms. Methods Cross-sectional data from the Danish Health and Morbidity Survey 2017 were used. The present study included a random sample of 3893 adults living in multi-storey housing. Information on neighbour noise annoyance and various health symptoms (e.g. pain in various body parts, headache, sleeping problems, depression, and anxiety) during the past two weeks was obtained by self-administered questionnaires. The question on neighbour noise annoyance and health symptoms, respectively, had three possible response options: ‘Yes, very annoyed/bothered’, ‘Yes, slightly annoyed/bothered’, ‘No’. The associations between neighbour noise annoyance and very bothering physical and mental health symptoms were investigated using multiple logistic regression models. Results Being very annoyed by neighbour noise was significantly associated with higher odds of being very bothered by all eight health symptoms (adjusted OR = 1.73–3.32, all p-values < 0.05) compared to individuals not annoyed by noise from neighbours. Statistically significant interactions were observed between sex and two of the eight health symptoms. Among women, a strong association was observed between neighbour noise annoyance and being very bothered by pain or discomfort in the shoulder or neck, and in the arms, hands, legs, knees, hips or joints. Among men, no associations were observed. Conclusions Based on the findings from this study, neighbour noise annoyance is strongly associated with eight different physical and mental health symptoms. Future studies are encouraged to 1) determine the direction of causality using a longitudinal design, 2) explore the biological mechanisms explaining the sex-specific impact of neighbour noise annoyance on symptoms of musculoskeletal pain or discomfort and the other outcomes as well.
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Affiliation(s)
- Heidi A R Jensen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Birgit Rasmussen
- Danish Building Research Institute, Aalborg University, A.C. Meyers Vænge 15, 2450, Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.
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Ferrante G, Fasanelli F, Gigantesco A, Ferracin E, Contoli B, Costa G, Gargiulo L, Marra M, Masocco M, Minardi V, Violani C, Zengarini N, d'Errico A, Ricceri F. Is the association between precarious employment and mental health mediated by economic difficulties in males? Results from two Italian studies. BMC Public Health 2019; 19:869. [PMID: 31269944 PMCID: PMC6609380 DOI: 10.1186/s12889-019-7243-x] [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] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/26/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Flexible employment is increasing across Europe and recent studies show an association with poor mental health. The goal of the current study is to examine this association in the Italian population to assess the possible mediating role of financial strain. METHODS Data were obtained by two Italian cross-sectional studies (PASSI and HIS) aimed at monitoring the general population health status, health behaviours and determinants. Mental health status was assessed using alternatively two validated questionnaires (the PHQ-2 and the MCS-12 score) and Poisson regression models were performed to assess if precarious work was associated with poor mental health. A formal mediation analysis was conducted to evaluate if the association between precarious work and mental health was mediated by financial strain. RESULTS The analyses were performed on 31,948 subjects in PASSI and on 21,894 subjects in HIS. A nearly two-fold risk of depression and poor mental health was found among precarious workers, compared to workers with a permanent contract, which was strongly mediated by financial strain. CONCLUSIONS Even with the limitations of a cross-sectional design, this research supports that precarious employment contributes through financial strain to reduce the mental health related quality of life and to increase mental disorders such as symptoms of depression or dysthymia. This suggests that when stability in work cannot be guaranteed, it would be appropriate to intervene on the wages of precarious jobs and to provide social safety nets for ensuring adequate income.
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Affiliation(s)
- Gianluigi Ferrante
- National Centre for Drug Research and Evaluation, National Institute of Health (ISS), Rome, Italy
- Epidemiologia&Precariato, Group for the study of precarious work of the Italian Association of Epidemiology (AIE), Rome, Italy
| | - Francesca Fasanelli
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and University of Turin, Turin, Italy
| | - Antonella Gigantesco
- Centre of Behavioural Sciences and Mental Health, Italian National Institute of Health (ISS), Rome, Italy
| | - Elisa Ferracin
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
| | - Benedetta Contoli
- National Center for Disease Prevention and Health Promotion, National Institute of Health (ISS), Rome, Italy
| | - Giuseppe Costa
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
- Department of Clinical and Biological Sciences, University of Turin , Grugliasco (TO), Italy
| | | | - Michele Marra
- Epidemiologia&Precariato, Group for the study of precarious work of the Italian Association of Epidemiology (AIE), Rome, Italy
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
| | - Maria Masocco
- National Center for Disease Prevention and Health Promotion, National Institute of Health (ISS), Rome, Italy
| | - Valentina Minardi
- National Center for Disease Prevention and Health Promotion, National Institute of Health (ISS), Rome, Italy
| | - Cristiano Violani
- Department of Psychology, Faculty of Medicine and Psychology, University Sapienza, Rome, Italy
| | - Nicolás Zengarini
- Epidemiologia&Precariato, Group for the study of precarious work of the Italian Association of Epidemiology (AIE), Rome, Italy
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
| | - Angelo d'Errico
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
| | - Fulvio Ricceri
- Epidemiologia&Precariato, Group for the study of precarious work of the Italian Association of Epidemiology (AIE), Rome, Italy.
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy.
- Department of Clinical and Biological Sciences, University of Turin , Grugliasco (TO), Italy.
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27
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Ribeiro AI, Fraga S, Kelly-Irving M, Delpierre C, Stringhini S, Kivimaki M, Joost S, Guessous I, Gandini M, Vineis P, Barros H. Neighbourhood socioeconomic deprivation and allostatic load: a multi-cohort study. Sci Rep 2019; 9:8790. [PMID: 31217447 PMCID: PMC6584573 DOI: 10.1038/s41598-019-45432-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/06/2019] [Indexed: 11/09/2022] Open
Abstract
Living in deprived neighbourhoods may have biological consequences, but few studies have assessed this empirically. We examined the association between neighbourhood deprivation and allostatic load, a biological marker of wear and tear, taking into account individual's socioeconomic position. We analysed data from three cohort studies (CoLaus-Switzerland; EPIPorto-Portugal; Whitehall II-UK) comprising 16,364 participants. We defined allostatic load using ten biomarkers of dysregulated metabolic, cardiovascular, and inflammatory systems (body mass index; waist circumference; total, high and low density lipoprotein cholesterol; triglycerides; glucose; systolic and diastolic blood pressure; C-reactive protein). Mixed Poisson regression models were fitted to examine associations with neighbourhood deprivation (in quintiles, Q1-least deprived as reference). After adjustment for confounding variables, participants living in the most deprived quintile had 1.13 times higher allostatic load than those living in the least deprived quintile (Relative Risk, RR, for Q2 RR = 1.06, 95% CI 1.03-1.09; Q3 = 1.06, 1.03-1.10; Q4 = 1.09, 1.06-1.12; Q5 = 1.13, 1.09-1.16). This association was partially modified by individual's socioeconomic position, such that the relative risk was higher in participants with low socioeconomic position (Q5 vs Q1 1.16, 1.11-1.22) than those with high socioeconomic position (Q5 vs Q1 1.07, 1.01-1.13). Neighbourhood deprivation is associated with biological wear and tear, suggesting that neighbourhood-level interventions may yield health gains.
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Grants
- MR/L01341X/1 Medical Research Council
- MR/R024227/1 Medical Research Council
- MR/S011676/1 Medical Research Council
- K013351 Medical Research Council
- This study was supported by the European Commission (Horizon 2020 grant number 633666) and by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology &#x2013; FCT (Portuguese Ministry of Science, Technology and Higher Education) under the Unidade de Investiga&#x00E7;&#x00E3;o em Epidemiologia - Instituto de Sa&#x00FA;de P&#x00FA;blica da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013). This article is a result of the project DOCnet (NORTE-01-0145-FEDER-000003),supported by Norte Portugal Regional Operational Programme (NORTE 2020),under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF).
- This study was supported by the European Commission (Horizon 2020 grant number 633666) and by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology &#x2013; FCT (Portuguese Ministry of Science, Technology and Higher Education) under the Unidade de Investiga&#x00E7;&#x00E3;o em Epidemiologia - Instituto de Sa&#x00FA;de P&#x00FA;blica da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013); and the Postdoc grant SFRH/BPD/97015/2013 (Silvia Fraga), co-funded by the FCT and the POPH/FSE Program. This article is a result of the project DOCnet (NORTE-01-0145-FEDER-000003), supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF).
- MK is supported by the UK Medical Research Council (K013351, MR/R024227), NordForsk, the Nordic Programme on Health and Welfare, the Academy of Finland (311492), and a Helsinki Institute of Life Science fellowship This study was supported by the European Commission (Horizon 2020 grant number 633666)
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Affiliation(s)
- Ana Isabel Ribeiro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no. 135, 4050-600, Porto, Portugal.
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Silvia Fraga
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no. 135, 4050-600, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Michelle Kelly-Irving
- INSERM, UMR1027, Toulouse, France, and Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Cyrille Delpierre
- INSERM, UMR1027, Toulouse, France, and Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Biopôle 2-Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Mika Kivimaki
- University College London, Department of Epidemiology and Public Health, London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Stéphane Joost
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Biopôle 2-Route de la Corniche 10, 1010, Lausanne, Switzerland
- Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
- GIRAPH Lab (Geographic information for research and analysis in public health), Geneva, Switzerland
- La Source, School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
- GIRAPH Lab (Geographic information for research and analysis in public health), Geneva, Switzerland
| | - Martina Gandini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, (TO), Italy
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no. 135, 4050-600, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Qi Y, Koster A, van Boxtel M, Köhler S, Schram M, Schaper N, Stehouwer C, Bosma H. Adulthood Socioeconomic Position and Type 2 Diabetes Mellitus-A Comparison of Education, Occupation, Income, and Material Deprivation: The Maastricht Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1435. [PMID: 31018480 PMCID: PMC6517950 DOI: 10.3390/ijerph16081435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/10/2019] [Accepted: 04/20/2019] [Indexed: 01/24/2023]
Abstract
In an effort to better quantify the impact of adulthood socioeconomic circumstances on prediabetes and type 2 diabetes (T2DM), we set out to examine the relative importance of four adulthood socioeconomic indicators. Using cross-sectional data from The Maastricht Study on 2011 middle-aged older men and women, our findings indicate that low educational level (OR = 1.81, 95% CI = 1.24-2.64), low occupational level (OR = 1.42, 95% CI = 0.98-2.05), and material deprivation (OR = 1.78, 95% CI = 1.33-2.38) were independently associated with T2DM. Low income (OR = 1.28, 95% CI = 0.88-1.87) was the strongest, albeit not significant, SEP (socioeconomic position) correlate of prediabetes. This association confirms SEP as a multifaceted concept and indicates the need to measure SEP accordingly. In order to tackle the social gradient in prediabetes and T2DM, one should, therefore, address multiple SEP indicators and their possible pathways.
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Affiliation(s)
- Yuwei Qi
- Department of Social Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
| | - Martin van Boxtel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands.
| | - Sebastian Köhler
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, 6229 ER Maastricht, The Netherlands.
| | - Miranda Schram
- Department of Medicine, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.
| | - Nicolaas Schaper
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Centre, Randwycksingel 35, 6229 EG Maastricht, The Netherlands.
| | - Coen Stehouwer
- Department of Medicine, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
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29
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Multi-cohort study identifies social determinants of systemic inflammation over the life course. Nat Commun 2019; 10:773. [PMID: 30770820 PMCID: PMC6377676 DOI: 10.1038/s41467-019-08732-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 01/28/2019] [Indexed: 12/17/2022] Open
Abstract
Chronic inflammation has been proposed as having a prominent role in the construction of social inequalities in health. Disentangling the effects of early life and adulthood social disadvantage on inflammation is key in elucidating biological mechanisms underlying socioeconomic disparities. Here we explore the relationship between socioeconomic position (SEP) across the life course and inflammation (as measured by CRP levels) in up to 23,008 participants from six European cohort studies from three countries conducted between 1958 and 2013. We find a consistent inverse association between SEP and CRP across cohorts, where participants with a less advantaged SEP have higher levels of inflammation. Educational attainment is most strongly related to inflammation, after adjusting for health behaviours, body mass index and later-in-life SEP. These findings suggest socioeconomic disadvantage in young adulthood is independently associated with later life inflammation calling for further studies of the pathways operating through educational processes. Here, the authors explore the relationship between socioeconomic position (SEP) across the life course and inflammation in a multi-cohort study and show that educational attainment is most strongly related to inflammation, suggesting that socioeconomic disadvantage in young adulthood is independently associated with later life inflammation.
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30
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Mortality by occupation-based social class in Italy from 2012 to 2014. Int J Public Health 2018; 63:865-874. [PMID: 30051314 DOI: 10.1007/s00038-018-1149-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 06/26/2018] [Accepted: 07/19/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Evaluating socio-economic inequality in cause-specific mortality among the working population requires large cohort studies. Through this census-based study, we aimed to quantify disparities in mortality across occupation-based social classes in Italy. METHODS We conducted a historical cohort study on a sample of more than 16 million workers. We estimated the mortality rate ratios for each social class, considering upper non-manual workers as reference. RESULTS Non-skilled manual workers showed an increased mortality from upper aero-digestive tract, stomach and liver cancers, and from diseases of the circulatory system, transport accidents and suicides in both sexes, and from infectious diseases, diabetes, lung and bladder cancers only in men. Among women, an excess mortality emerged for cervical cancer, whereas mortality from breast and ovarian cancers was lower. When education was taken into account, the excess mortality decreased in men while was no longer significant in women. CONCLUSIONS There are remarkable disparities across occupation-based social classes in the Italian working population that favour the upper non-manual workers. Our data could be useful in planning policies for a more effective health and social security system.
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31
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Stronks K, Hoeymans N, Haverkamp B, den Hertog FRJ, van Bon-Martens MJH, Galenkamp H, Verweij M, van Oers HAM. Do conceptualisations of health differ across social strata? A concept mapping study among lay people. BMJ Open 2018; 8:e020210. [PMID: 29674369 PMCID: PMC5914775 DOI: 10.1136/bmjopen-2017-020210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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
OBJECTIVES The legitimacy of policies that aim at tackling socioeconomic inequalities in health can be challenged if they do not reflect the conceptualisations of health that are valued in all strata. Therefore, this study analyses how different socioeconomic groups formulate their own answers regarding: what does health mean to you? DESIGN Concept mapping procedures were performed in three groups that differ in educational level. All procedures followed exactly the same design. SETTING Area of the city of Utrecht, the Netherlands. PARTICIPANTS Lay persons with a lower, intermediate and higher educational level (±15/group). RESULTS The concept maps for the three groups consisted of nine, eight and seven clusters each, respectively. Four clusters occurred in all groups: absence of disease/disabilities, health-related behaviours, social life, attitude towards life. The content of some of these differed between groups, for example, behaviours were interpreted as having opportunities to behave healthily in the lower education group, and in terms of their impact on health in the higher education group. Other clusters appeared to be specific for particular groups, such as autonomy (intermediate/higher education group). Finally, ranking ranged from a higher ranking of the positively formulated aspects in the higher education group (eg, lust for life) to that of the negatively formulated aspects in the lower education group (eg, having no chronic disease). CONCLUSION Our results provide indications to suggest that people in lower socioeconomic groups are more likely to show a conceptualisation of health that refers to (1) the absence of health threats (vs positive aspects), (2) a person within his/her circumstances (vs quality of own body/mind), (3) the value of functional (vs hedonistic) notions and (4) an accepting (vs active) attitude towards life.
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Affiliation(s)
- Karien Stronks
- Department of Public Health, Amsterdam Public Health (APH) Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nancy Hoeymans
- Department of Public Health, City of Utrecht, Utrecht, The Netherlands
| | - Beatrijs Haverkamp
- Department of Social Sciences, section Communication, Philosophy and Technology, Wageningen University, Wageningen, The Netherlands
| | - Frank R J den Hertog
- National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - Henrike Galenkamp
- Department of Public Health, Amsterdam Public Health (APH) Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel Verweij
- Department of Social Sciences, section Communication, Philosophy and Technology, Wageningen University, Wageningen, The Netherlands
| | - Hans A M van Oers
- National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Amsterdam, The Netherlands
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Stringhini S, Carmeli C, Jokela M, Avendaño M, McCrory C, d'Errico A, Bochud M, Barros H, Costa G, Chadeau-Hyam M, Delpierre C, Gandini M, Fraga S, Goldberg M, Giles GG, Lassale C, Kenny RA, Kelly-Irving M, Paccaud F, Layte R, Muennig P, Marmot MG, Ribeiro AI, Severi G, Steptoe A, Shipley MJ, Zins M, Mackenbach JP, Vineis P, Kivimäki M. Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study. BMJ 2018; 360:k1046. [PMID: 29572376 PMCID: PMC5865179 DOI: 10.1136/bmj.k1046] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the association of low socioeconomic status and risk factors for non-communicable diseases (diabetes, high alcohol intake, high blood pressure, obesity, physical inactivity, smoking) with loss of physical functioning at older ages. DESIGN Multi-cohort population based study. SETTING 37 cohort studies from 24 countries in Europe, the United States, Latin America, Africa, and Asia, 1990-2017. PARTICIPANTS 109 107 men and women aged 45-90 years. MAIN OUTCOME MEASURE Physical functioning assessed using the walking speed test, a valid index of overall functional capacity. Years of functioning lost was computed as a metric to quantify the difference in walking speed between those exposed and unexposed to low socioeconomic status and risk factors. RESULTS According to mixed model estimations, men aged 60 and of low socioeconomic status had the same walking speed as men aged 66.6 of high socioeconomic status (years of functioning lost 6.6 years, 95% confidence interval 5.0 to 9.4). The years of functioning lost for women were 4.6 (3.6 to 6.2). In men and women, respectively, 5.7 (4.4 to 8.1) and 5.4 (4.3 to 7.3) years of functioning were lost by age 60 due to insufficient physical activity, 5.1 (3.9 to 7.0) and 7.5 (6.1 to 9.5) due to obesity, 2.3 (1.6 to 3.4) and 3.0 (2.3 to 4.0) due to hypertension, 5.6 (4.2 to 8.0) and 6.3 (4.9 to 8.4) due to diabetes, and 3.0 (2.2 to 4.3) and 0.7 (0.1 to 1.5) due to tobacco use. In analyses restricted to high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was 8.0 (5.7 to 13.1) for men and 5.4 (4.0 to 8.0) for women, whereas in low and middle income countries it was 2.6 (0.2 to 6.8) for men and 2.7 (1.0 to 5.5) for women. Within high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was greater in the United States than in Europe. Physical functioning continued to decline as a function of unfavourable risk factors between ages 60 and 85. Years of functioning lost were greater than years of life lost due to low socioeconomic status and non-communicable disease risk factors. CONCLUSIONS The independent association between socioeconomic status and physical functioning in old age is comparable in strength and consistency with those for established non-communicable disease risk factors. The results of this study suggest that tackling all these risk factors might substantially increase life years spent in good physical functioning.
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Affiliation(s)
- Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Biopôle 2-Route de la Corniche 10, 1010 Switzerland
| | - Cristian Carmeli
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Biopôle 2-Route de la Corniche 10, 1010 Switzerland
| | - Markus Jokela
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mauricio Avendaño
- Department of Global Health and Social Medicine, King's College London, London, UK
- Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - Cathal McCrory
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - Angelo d'Errico
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy
| | - Murielle Bochud
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Biopôle 2-Route de la Corniche 10, 1010 Switzerland
| | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Giuseppe Costa
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy
| | - Marc Chadeau-Hyam
- MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Cyrille Delpierre
- INSERM, UMR1027, Toulouse, France, and Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Martina Gandini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy
| | - Silvia Fraga
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Marcel Goldberg
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France, and Paris Descartes University, Paris, France
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Camille Lassale
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - Michelle Kelly-Irving
- INSERM, UMR1027, Toulouse, France, and Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Fred Paccaud
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Biopôle 2-Route de la Corniche 10, 1010 Switzerland
| | - Richard Layte
- Department of Sociology, Trinity College Dublin, Dublin, Ireland
| | - Peter Muennig
- Global Research Analytics for Population Health, Health Policy and Management, Columbia University, New York, NY, USA
| | - Michael G Marmot
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Ana Isabel Ribeiro
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Gianluca Severi
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
- CESP, Inserm U1018, Université Paris-Saclay, Villejuif, France
- Human Genetics Foundation (HuGeF), Turin, Italy
| | - Andrew Steptoe
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Martin J Shipley
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Marie Zins
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France, and Paris Descartes University, Paris, France
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Mika Kivimäki
- University College London, Department of Epidemiology and Public Health, London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Finland
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33
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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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