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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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Nguyen DT, Donnelly M, Van Hoang M, O'Neill C. The case for individualised public health interventions: Smoking prevalence and inequalities in Northern Ireland 1985-2015. Health Policy 2023; 135:104879. [PMID: 37441920 DOI: 10.1016/j.healthpol.2023.104879] [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: 02/17/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND While smoking prevalence in high income countries has declined over time, socioeconomic inequalities in smoking have widened. This study is one of the few studies to examine the longitudinal pattern of income-related smoking inequalities and only the second using concentration indices in its analysis. METHOD Income-related smoking inequalities were measured using concentration indices using the Northern Ireland Continuous Household Survey data. Smoking inequalities were compared quantitatively and visually across three periods: 1985-1995, 1997-2005 and 2007-2015. Joinpoint analysis was used to measure the overall time trend of smoking inequalities. Subgroup analysis was used to examine the nature of change in smoking inequalities across population sub-groups. FINDINGS Throughout 1985-2015, smoking was more concentrated among the poor (standard concentration index of-0·131, p < 0·001). While prevalence declined sharply across population, income-related inequalities increased sharply in general and within subgroups. Income-related smoking inequalities were significantly larger among high educated group and those who were employed. No structural break was observed with respect to the adoption of any specific policy measures over the period. CONCLUSION Current approaches to tobacco control may be ill-suited to addressing smoking inequalities and may indeed be counterproductive. More tailored approaches that address the specific needs of population sub-groups or more draconian approaches such as extensions to prohibition may be required to reduce prevalence further while avoiding a widening of inequalities.
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Affiliation(s)
- Duyen Thuy Nguyen
- Center for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Institute of Clinical Science Block A, Royal Victoria Hospital, Belfast BT12 6BA, United Kingdom; Center for Population Health Sciences, Hanoi University of Public Health, no 1A Duc Thang street, North Tu Liem district, Hanoi 100000, Vietnam.
| | - Michael Donnelly
- Center for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Institute of Clinical Science Block A, Royal Victoria Hospital, Belfast BT12 6BA, United Kingdom
| | - Minh Van Hoang
- Center for Population Health Sciences, Hanoi University of Public Health, no 1A Duc Thang street, North Tu Liem district, Hanoi 100000, Vietnam
| | - Ciaran O'Neill
- Center for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Institute of Clinical Science Block A, Royal Victoria Hospital, Belfast BT12 6BA, United Kingdom
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Derette K, Rollet Q, Launay L, Launoy G, Bryere J. Evolution of socioeconomic inequalities in cancer incidence between 2006 and 2016 in France: a population-based study. Eur J Cancer Prev 2022; 31:473-481. [PMID: 35044985 DOI: 10.1097/cej.0000000000000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The existence of socioeconomic inequalities in cancer incidence is now well established and their reduction is a priority in many countries. This study aimed to measure the evolution of socioeconomic inequalities in the incidence of the most common cancers in France, over an 11-year period. METHODS The study focused on 19 cancer entities (16 solid tumors and 3 hematological malignancies). Data are obtained from the French Network of Cancer Registries, representing 604 205 cancer cases. Each patient address was geolocalized and assigned to an IRIS, the smallest geographic unit in France. The French version of the European Deprivation Index was used to measure the level of deprivation in each IRIS. A generalized linear mixed model was used to account for the longitudinal nature of the data and to assess the evolution of socioeconomic inequalities. RESULTS A significant evolution of the social gradient of incidence over time was highlighted for five cancer entities and all entities combined. For lung cancer for both sexes and bladder cancer in men, more frequent in deprived areas, the social gradient in incidence tended to decrease over time. For breast cancer in women and lymphocytic leukemia in men, more frequent in affluent areas, the gap continues to widen. CONCLUSION Cancer entities with large disparities continued to present social inequalities in incidence without exacerbation with time. The few temporal evolutions observed do not show a worsening of the social gradient of incidence to the disadvantage of the most deprived areas, but rather an increase in incidence that is greater in the most affluent areas.
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Affiliation(s)
- Krystaelle Derette
- ANTICIPE, Normandy University, Unicaen, INSERM, Centre François Baclesse, Avenue du Général Harris, Caen, France
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Piñeiro B, Trias-Llimós S, Spijker JJA, Blanes Llorens A, Permanyer I. Estimation of smoking-related mortality and its contribution to educational inequalities in life expectancy in Spain: an observational study, 2016-2019. BMJ Open 2022; 12:e059370. [PMID: 35948385 PMCID: PMC9379492 DOI: 10.1136/bmjopen-2021-059370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To estimate smoking-related mortality and its contribution to educational inequalities in life expectancy in Spain. DESIGN Nationwide, observational study from 2016 to 2019. Population-attributable fractions were used to estimate age, sex and education-specific cause-of-death smoking-attributable mortality. Life table techniques and decomposition methods were used to estimate potential gains in life expectancy at age 35 and the cause-specific contributions of smoking-related mortality to life expectancy differences across educational groups. SETTING Spain. PARTICIPANTS We use cause-specific mortality data from population registers and smoking prevalence from the National and the European Health Survey for Spain from 2017 and 2019/2020, respectively. RESULTS We estimated 219 086 smoking-related deaths during 2016-2019, equalling 13% of all deaths, 83.7% of those in men. In the absence of smoking, potential gains in male life expectancy were higher among the low-educated than the high-educated (3.1 vs 2.1 years). For women, educational differences were less and also in the opposite direction (0.6 vs 0.9 years). The contribution of smoking to life expectancy differences between high-educated and low-educated groups accounted for 1.5 years among men, and -0.2 years among women. For men, the contribution of smoking to these differences was mostly driven by cancer in middle age, cardiometabolic diseases at younger ages and respiratory diseases at older ages. For women, the contribution to this gap, although negligible, was driven by cancer at older ages among the higher educated. CONCLUSIONS Smoking remains a relevant preventable risk factor of premature mortality in Spain, disproportionately affecting life expectancy of low-educated men.
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Affiliation(s)
- Bárbara Piñeiro
- Centre d'Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra-Barcelona, Catalonia, Spain
| | - Sergi Trias-Llimós
- Centre d'Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra-Barcelona, Catalonia, Spain
| | - Jeroen J A Spijker
- Centre d'Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra-Barcelona, Catalonia, Spain
| | - Amand Blanes Llorens
- Centre d'Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra-Barcelona, Catalonia, Spain
| | - Iñaki Permanyer
- Centre d'Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra-Barcelona, Catalonia, Spain
- ICREA, Passeig de Lluís Companys 23, Barcelona, Spain
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Barros MBDA, Medina LDPB, Lima MG, Sousa NFDS, Malta DC. Changes in prevalence and in educational inequalities in Brazilian health behaviors between 2013 and 2019. CAD SAUDE PUBLICA 2022; 38Suppl 1:e00122221. [PMID: 35857955 DOI: 10.1590/0102-311x00122221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 04/28/2022] [Indexed: 11/22/2022] Open
Abstract
Considering the relevance of health behaviors for chronic diseases prevalence and mortality and the increase in income concentration observed in the world and in Brazil, this study aimed to evaluate the changes in the prevalence and in the educational inequalities of Brazilian adult health behaviors between 2013 and 2019. We analyzed data of 49,025 and 65,803 adults (18-59 years of age) from the Brazilian National Health Survey (PNS), 2013 and 2019. Prevalence of health behaviors (smoking, alcohol intake, diet, physical activity and sedentarism) were estimated for three educational strata, for both surveys. Prevalence ratios (PR) between year of survey and between educational strata were estimated by Poisson regression models. Significant reductions were found in the prevalence of smoking, physical inactivity, sedentarism, insufficient consumption of fruits, and the excessive consumption of sweetened beverages. However, an increase was observed in alcohol consumption and binge drinking; vegetable consumption remained stable. Contrasting the favorable change in some behaviors, inequalities among schooling strata remained very high in 2019, specially for smoking (PR = 2.82; 95%CI: 2.49-3.20), passive smoking (PR = 2.88; 95%CI: 2.56-3.23) and physical inactivity (PR = 2.02; 95%CI: 1.92-2.13). There was a significant increase in the educational inequality regarding physical inactivity (21%), insufficient intake of fruit (8%) and in the frequent consumption of sweetened beverages (32%). The persistence and enlargement of inequalities highlight the behaviors and social segments that should be special targets for policies and programs focused in promoting healthy lifestyles.
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Welsh J, Joshy G, Moran L, Soga K, Law HD, Butler D, Bishop K, Gourley M, Eynstone-Hinkins J, Booth H, Moon L, Biddle N, Blakely A, Banks E, Korda RJ. Education-related inequalities in cause-specific mortality: first estimates for Australia using individual-level linked census and mortality data. Int J Epidemiol 2022; 50:1981-1994. [PMID: 34999874 PMCID: PMC8743133 DOI: 10.1093/ije/dyab080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/25/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Socioeconomic inequalities in mortality are evident in all high-income countries, and ongoing monitoring is recommended using linked census-mortality data. Using such data, we provide the first estimates of education-related inequalities in cause-specific mortality in Australia, suitable for international comparisons. METHODS We used Australian Census (2016) linked to 13 months of Death Registrations (2016-17). We estimated relative rates (RR) and rate differences (RD, per 100 000 person-years), comparing rates in low (no qualifications) and intermediate (secondary school) with high (tertiary) education for individual causes of death (among those aged 25-84 years) and grouped according to preventability (25-74 years), separately by sex and age group, adjusting for age, using negative binomial regression. RESULTS Among 13.9 M people contributing 14 452 732 person-years, 84 743 deaths occurred. All-cause mortality rates among men and women aged 25-84 years with low education were 2.76 [95% confidence interval (CI): 2.61-2.91] and 2.13 (2.01-2.26) times the rates of those with high education, respectively. We observed inequalities in most causes of death in each age-sex group. Among men aged 25-44 years, relative and absolute inequalities were largest for injuries, e.g. transport accidents [RR = 10.1 (5.4-18.7), RD = 21.2 (14.5-27.9)]). Among those aged 45-64 years, inequalities were greatest for chronic diseases, e.g. lung cancer [men RR = 6.6 (4.9-8.9), RD = 57.7 (49.7-65.8)] and ischaemic heart disease [women RR = 5.8 (3.7-9.1), RD = 20.2 (15.8-24.6)], with similar patterns for people aged 65-84 years. When grouped according to preventability, inequalities were large for causes amenable to behaviour change and medical intervention for all ages and causes amenable to injury prevention among young men. CONCLUSIONS Australian education-related inequalities in mortality are substantial, generally higher than international estimates, and related to preventability. Findings highlight opportunities to reduce them and the potential to improve the health of the population.
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Affiliation(s)
- Jennifer Welsh
- Research School of Population Health, Australian National University
| | - Grace Joshy
- Research School of Population Health, Australian National University
| | | | - Kay Soga
- Research School of Population Health, Australian National University
| | - Hsei-Di Law
- Research School of Population Health, Australian National University
| | - Danielle Butler
- Research School of Population Health, Australian National University
| | - Karen Bishop
- Research School of Population Health, Australian National University
| | | | | | - Heather Booth
- School of Demography, Australian National University
| | | | - Nicholas Biddle
- Centre for Social Research and Methods, Australian National University
| | - Antony Blakely
- Melbourne School of Population and Global Health, University of Melbourne and
| | - Emily Banks
- Research School of Population Health, Australian National University
- The Sax Institute, Sydney, Australia
| | - Rosemary J Korda
- Research School of Population Health, Australian National University
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Barros MBDA, Medina LDPB, Lima MG, Azevedo RCSD, Sousa NFDS, Malta DC. Association between health behaviors and depression: findings from the 2019 Brazilian National Health Survey. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210010. [PMID: 34910064 DOI: 10.1590/1980-549720210010.supl.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/09/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the association of depression with various health behaviors and to verify if they differ according to gender or income. METHODS This is a cross-sectional study based on data of 65,803 Brazilian adults (18-59 years old) interviewed in the National Health Survey, conducted in 2019. Presence or absence of depression was evaluated using the Patient Health Questionnaire (PHQ)-9. The prevalence of smoking, alcohol consumption, physical activity, sedentary lifestyle and food indicators were estimated according to the presence of depression. Stratified analyses were made according to sex and income, and prevalence ratios were estimated using the Poisson Regression. RESULTS We found a significant association between depression and all indicators studied, except occasional alcohol consumption. Depression was associated with heavy episodic drinking and insufficient consumption of fruits and vegetables only in women. In men, the associations of depression with sedentary lifestyle and with being a former smoker were stronger than in women. The occasional consumption of alcohol was more prevalent only in men without depression. The analysis stratified by income showed that the association of depression with physical inactivity is stronger in the higher-income group, while with heavy episodic drinking is only significant in the lower-income stratum. CONCLUSION The results point to the need to consider mental health in programs aimed at reducing harmful health behaviors and the specificity of sociodemographic groups.
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