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Wilkie RZ, Ho JY. Life expectancy and geographic variation in mortality: an observational comparison study of six high-income Anglophone countries. BMJ Open 2024; 14:e079365. [PMID: 39138004 DOI: 10.1136/bmjopen-2023-079365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE To compare life expectancy levels and within-country geographic variation in life expectancy across six high-income Anglophone countries between 1990 and 2018. DESIGN Demographic analysis using aggregated mortality data. SETTING Six high-income Anglophone countries (USA, UK, Canada, Australia, Ireland and New Zealand), by sex, including an analysis of subnational geographic inequality in mortality within each country. POPULATION Data come from the Human Mortality Database, the WHO Mortality Database and the vital statistics agencies of six high-income Anglophone countries. MAIN OUTCOME MEASURES Life expectancy at birth and age 65; age and cause of death contributions to life expectancy differences between countries; index of dissimilarity for within-country geographic variation in mortality. RESULTS Among six high-income Anglophone countries, Australia is the clear best performer in life expectancy at birth, leading its peer countries by 1.26-3.95 years for women and by 0.97-4.88 years for men in 2018. While Australians experience lower mortality across the age range, most of their life expectancy advantage accrues between ages 45 and 84. Australia performs particularly well in terms of mortality from external causes (including drug- and alcohol-related deaths), screenable/treatable cancers, cardiovascular disease and influenza/pneumonia and other respiratory diseases compared with other countries. Considering life expectancy differences across geographic regions within each country, Australia tends to experience the lowest levels of inequality, while Ireland, New Zealand and the USA tend to experience the highest levels. CONCLUSIONS Australia has achieved the highest life expectancy among Anglophone countries and tends to rank well in international comparisons of life expectancy overall. It serves as a potential model for lower-performing countries to follow to reduce premature mortality and inequalities in life expectancy.
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Affiliation(s)
- Rachel Z Wilkie
- Spatial Sciences Institute, University of Southern California, Los Angeles, California, USA
| | - Jessica Y Ho
- Department of Sociology and Population Research Institute, The Pennsylvania State University, University Park, Pennsylvania, USA
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2
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Tanaka H, Nusselder WJ, Kobayashi Y, Mackenbach JP. Socioeconomic inequalities in self-rated health in Japan, 32 European countries and the United States: an international comparative study. Scand J Public Health 2023; 51:1161-1172. [PMID: 35538617 PMCID: PMC10642222 DOI: 10.1177/14034948221092285] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 02/13/2021] [Accepted: 03/16/2022] [Indexed: 11/16/2022]
Abstract
AIMS Japan is known as a country with low self-rated health despite high life expectancy. We compared socioeconomic inequalities in self-rated health in Japan with those in 32 European countries and the US using nationally representative samples. METHODS We analysed individual data from the Comprehensive Survey of Living Conditions (Japan), the European Union Statistics on Income and Living Conditions, and the Behavioral Risk Factor Surveillance System (US) in 2016. We used ordered logistic regression models with four ordinal categories of self-rated health as an outcome, and educational level or occupational class as independent variables, controlling for age. RESULTS In Japan, about half the population perceived their health as 'fair', which was much higher than in Europe (≈20-40%). The odds ratios of lower self-rated health among less educated men compared with more educated were 1.72 (95% confidence interval (CI) 1.61-1.85) in Japan, and ranged from 1.67 to 4.74 in Europe (pooled; 2.10 (95% CI 2.01-2.20)), and 6.65 (95% CI 6.22-7.12) in the US. The odds ratios of lower self-rated health among less educated women were 1.79 (95% CI 1.65-1.95) in Japan, and ranged from 1.89 to 5.30 in Europe (pooled; 2.43 (95% CI 2.33-2.54)), and 8.82 (95% CI 8.29-9.38) in the US. Socioeconomic inequalities were large when self-rated health was low for European countries, but Japan and the US did not follow the pattern. CONCLUSIONS Japan has similar socioeconomic gradient patterns to European countries for self-rated health, and our findings revealed smaller socioeconomic inequalities in self-rated health in Japan compared with those in western countries.
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Affiliation(s)
- Hirokazu Tanaka
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Public Health and Occupational Medicine, Mie University, Mie, Japan
- Department of Public Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Wilma J. Nusselder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Johan P. Mackenbach
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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3
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Johnson KF, Hood KB, Moreno O, Fuentes L, Williams CD, Vassileva J, Amstadter AB, Dick DM. COVID-19-Induced Inequalities and Mental Health: Testing the Moderating Roles of Self-rated Health and Race/Ethnicity. J Racial Ethn Health Disparities 2023; 10:2093-2103. [PMID: 36018451 PMCID: PMC9415252 DOI: 10.1007/s40615-022-01389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/20/2022] [Accepted: 08/05/2022] [Indexed: 11/05/2022]
Abstract
This study examines the relationship among COVID-19-induced social, economic, and educational inequalities on mental health (i.e., anxiety and depression). This study also examines if levels of self-rated health (SRH) moderate the relationship (i.e., COVID-induced inequalities [CII] and mental health), as well as examines the racial/ethnic group differences among 567 young adults in the mid-Atlantic region. Using a moderation model, results indicate that CII were significantly related to depression (b = .221, t(554) = 4.59, p = .000) and anxiety (b = .140, t(555) = 3.23, p = .001). SRH and race/ethnicity also moderated both relationships. At above-average SRH (i.e., moderator), higher CII were also significantly related to lower anxiety (Asian young adults only) and lower depression (Asian and White young adults only). Overall, SRH and race/ethnicity are important factors in the mental health impact of COVID-19 on young adults.
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Affiliation(s)
- Kaprea F Johnson
- Department of Educational Studies, The Ohio State University, Columbus, OH, USA
| | - Kristina B Hood
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin Street, Richmond, VA, 23284-2018, USA.
| | - Oswaldo Moreno
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin Street, Richmond, VA, 23284-2018, USA
| | - Lisa Fuentes
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin Street, Richmond, VA, 23284-2018, USA
| | - Chelsea Derlan Williams
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin Street, Richmond, VA, 23284-2018, USA
| | - Jasmin Vassileva
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin Street, Richmond, VA, 23284-2018, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Ananda B Amstadter
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin Street, Richmond, VA, 23284-2018, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Danielle M Dick
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin Street, Richmond, VA, 23284-2018, USA
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Lübker C, Murtin F. Changes in longevity inequality by education among OECD countries before the COVID-19 pandemic. BMC Public Health 2023; 23:1646. [PMID: 37641026 PMCID: PMC10464106 DOI: 10.1186/s12889-023-16492-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Disparities in life expectancy between socioeconomic groups are one of the main challenges for health policy, and their reduction over time is an important policy objective. METHODS Observational study using routinely registered data on mortality around 2011 and 2016 by sex, age, educational attainment level, and cause of death in 13 member countries of the Organization for Economic Cooperation and Development (OECD). The main outcome measures are life expectancy by education at the ages of 25 and 65 in 2011 and 2016. RESULTS Between 2011 and 2016, the life expectancy gap has increased by 0·2 years among men and 0·3 years among women from 13 available countries. The United States recorded one the largest increases in the absolute life expectancy gap, 1·3 years for women and 1·1 years for men respectively. CONCLUSION Inequality in longevity has increased in over half of the countries surveyed and starkly so in the United States in a context of deteriorating health. TRIAL REGISTRATION Not applicable.
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Shakya S, Silva SG, McConnell ES, McLaughlin SJ, Cary MP. Does cumulative psychosocial stress explain frailty disparities in community-dwelling older adults? Arch Gerontol Geriatr 2023; 113:105055. [PMID: 37167754 DOI: 10.1016/j.archger.2023.105055] [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: 02/26/2023] [Revised: 04/20/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Frailty is a leading predictor of adverse outcomes in older adults. Although disparities in frailty are well-documented, it is unclear whether psychosocial stressors explain these disparities. This study aimed to examine the potential mediating role of psychosocial stress. METHODS This cross-sectional study included 7,679 community-dwelling older adults (≥ 65) from Health and Retirement Study in the US (2006 and 2008). We used six dichotomized psychosocial stressors: a) loneliness, b) discrimination, c) financial strain, d) low subjective status, e) poor neighborhood cohesion, and f) traumatic life events to compute cumulative psychosocial stress. The Fried frailty phenotype defined frailty based on three features: slowness, poor strength, weight loss, fatigue, and low physical activity. Multivariable regressions were used to examine the structural determinants (gender, education, race, and ethnicity) frailty relationship and test whether cumulative psychosocial stress has a mediating role. RESULTS The frailty prevalence was 22%. Females, Hispanics, Blacks, and those with less education had higher odds of frailty (p<.01). Race and ethnic minorities and non-college graduates experienced greater cumulative psychosocial stress relative to their White and college graduate counterparts (p<.05), respectively. Greater cumulative psychosocial stress was associated with increased odds of frailty (p < .001); however, it did not mediate the structural determinants and frailty relationship. CONCLUSION Contrary to expectations, cumulative psychosocial stress did not mediate the relationship between structural determinants and frailty. Rather, high cumulative psychosocial stress was independently associated with frailty. Further research should examine other psychosocial mediators to inform interventions to prevent/delay frailty.
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Affiliation(s)
| | | | - Eleanor S McConnell
- Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, Durham, NC, USA
| | - Sara J McLaughlin
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
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6
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Ho JY. Causes of America's Lagging Life Expectancy: An International Comparative Perspective. J Gerontol B Psychol Sci Soc Sci 2022; 77:S117-S126. [PMID: 35188201 PMCID: PMC9154274 DOI: 10.1093/geronb/gbab129] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study assesses how American life expectancy compares to other high-income countries and identifies key age groups and causes of death responsible for the U.S. life expectancy shortfall. METHODS Data from the Human Mortality Database, World Health Organization Mortality Database, and vital statistics agencies for 18 high-income countries are used to examine trends in U.S. life expectancy gaps and how American age-specific death rates compare to other countries. Decomposition is used to estimate the contribution of 19 age groups and 16 causes to the U.S. life expectancy shortfall. RESULTS In 2018, life expectancy for American men and women was 5.18 and 5.82 years lower than the world leaders and 3.60 and 3.48 years lower than the average of the comparison countries. Americans aged 25-29 experience death rates nearly 3 times higher than their counterparts. Together, injuries (drug overdose, firearm-related deaths, motor vehicle accidents, homicide), circulatory diseases, and mental disorders/nervous system diseases (including Alzheimer's disease) account for 86% and 67% of American men's and women's life expectancy shortfall, respectively. DISCUSSION American life expectancy has fallen far behind its peer countries. The U.S.'s worsening mortality at the prime adult ages and eroding old-age mortality advantage drive its deteriorating performance in international comparisons.
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Affiliation(s)
- Jessica Y Ho
- Leonard Davis School of Gerontology and Department of Sociology, University of Southern California, Los Angeles, USA
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7
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Tanaka H, Mackenbach JP, Kobayashi Y. Estimation of socioeconomic inequalities in mortality in Japan using national census-linked longitudinal mortality data. J Epidemiol 2021; 33:246-255. [PMID: 34629363 PMCID: PMC10043154 DOI: 10.2188/jea.je20210106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We aimed to develop census-linked longitudinal mortality data for Japan and assess its validity as a new resource for estimating socioeconomic inequalities in health. METHODS Using deterministic linkage, we identified, from national censuses for 2000 and 2010 and national death records, persons and deceased persons who had unique personal identifiers (generated using sex, birth year/month, address, and marital status). For the period 2010-2015, 1 537 337 Japanese men and women aged 30-79 years (1.9% in national census) were extracted to represent the sample population. This population was weighted to adjust for confounding factors. We estimated age-standardized mortality rates (ASMRs) by education level and occupational class. The slope index of inequality (SII) and relative index inequality (RII) by educational level were calculated as inequality measures. RESULTS The reweighted sample population's mortality rates were somewhat higher than those of the complete registry, especially in younger age-groups and for external causes. All-cause ASMRs (per 100 000 person-years) for individuals aged 40-79 years with high, middle, and low education levels were 1078 (95% confidence interval: 1051-1105), 1299 (1279-1320), and 1670 (1634-1707) for men, and 561 (536-587), 601 (589-613), and 777 (745-808) for women, respectively, during 2010-2015. SII and RII by educational level increased among both sexes between 2000-2005 and 2010-2015, which indicates mortality inequalities increased. CONCLUSIONS The developed census-linked longitudinal mortality data provide new estimates of socioeconomic inequalities in Japan that can be triangulated with estimates obtained with other methods.
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Affiliation(s)
- Hirokazu Tanaka
- Department of Public Health, Erasmus University Medical Center.,Department of Public Health and Occupational Medicine, Graduate School of Medicine, Mie University.,Department of Public Health, Graduate School of Medicine, the University of Tokyo
| | | | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, the University of Tokyo
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Choi H, Steptoe A, Heisler M, Clarke P, Schoeni RF, Jivraj S, Cho TC, Langa KM. Comparison of Health Outcomes Among High- and Low-Income Adults Aged 55 to 64 Years in the US vs England. JAMA Intern Med 2020; 180:1185-1193. [PMID: 32897385 PMCID: PMC7358980 DOI: 10.1001/jamainternmed.2020.2802] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Socioeconomic differences in life expectancy, health, and disability have been found in European countries as well as in the US. Identifying the extent and pattern of health disparities, both within and across the US and England, may be important for informing public health and public policy aimed at reducing these disparities. OBJECTIVE To compare the health of US adults aged 55 to 64 years with the health of their peers in England across the high and low ranges of income in each country. DESIGN, SETTING, AND PARTICIPANTS Using data from the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) for 2008-2016, a pooled cross-sectional analysis of comparably measured health outcomes, with adjustment for demographic characteristics and socioeconomic status, was conducted. The analysis sample included community-dwelling adults aged 55 to 64 years from the HRS and ELSA, resulting in 46 887 person-years of observations. Data analysis was conducted from September 17, 2019, to May 12, 2020. EXPOSURES Residence in the US or England and yearly income. MAIN OUTCOMES AND MEASURES Sixteen health outcomes were compared, including 5 self-assessed outcomes, 3 directly measured outcomes, and 8 self-reported physician-diagnosed health conditions. RESULTS This cross-sectional study included 12 879 individuals and 31 928 person-years from HRS (mean [SD] age, 59.2 [2.8] years; 51.9% women) and 5693 individuals and 14 959 person-years from ELSA (mean [SD] age, 59.3 [2.9] years; 51.0% women). After adjusting for individual-level demographic characteristics and socioeconomic status, a substantial health gap between lower-income and higher-income adults was found in both countries, but the health gap between the bottom 20% and the top 20% of the income distribution was significantly greater in the US than England on 13 of 16 measures. The adjusted US-England difference in the prevalence gap between the bottom 20% and the top 20% ranged from 3.6 percentage points (95% CI, 2.0-5.2 percentage points) in stroke to 9.7 percentage points (95% CI, 5.4-13.9 percentage points) for functional limitation. Among individuals in the lowest income group in each country, those in the US group vs the England group had significantly worse outcomes on many health measures (10 of 16 outcomes in the bottom income decile); the significant differences in adjusted prevalence of health problems in the US vs England for the bottom income decile ranged from 7.6% (95% CI, 6.0%-9.3%) vs 3.8% (95% CI, 2.6%-4.9%) for stroke to 75.7% (95% CI, 72.7%-78.8%) vs 59.5% (95% CI, 56.3%-62.7%) for functional limitation. Among individuals in the highest income group, those in the US group vs England group had worse outcomes on fewer health measures (4 of 16 outcomes in the top income decile); the significant differences in adjusted prevalence of health problems in the US vs England for the top income decile ranged from 36.9% (95% CI, 33.4%-40.4%) vs 30.0% (95% CI, 27.2%-32.7%) for hypertension to 35.4% (95% CI, 32.0%-38.7%) vs 22.5% (95% CI, 19.9%-25.1%) for arthritis. CONCLUSIONS AND RELEVANCE For most health outcomes examined in this cross-sectional study, the health gap between adults with low vs high income appeared to be larger in the US than in England, and the health disadvantages in the US compared with England are apparently more pronounced among individuals with low income. Public policy and public health interventions aimed at improving the health of adults with lower income should be a priority in the US.
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Affiliation(s)
- HwaJung Choi
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Michele Heisler
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor
| | - Philippa Clarke
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor.,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Robert F Schoeni
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor.,Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor
| | - Stephen Jivraj
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Tsai-Chin Cho
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor
| | - Kenneth M Langa
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor.,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
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Saito T, Oksanen T, Shirai K, Fujiwara T, Pentti J, Vahtera J. Combined Effect of Marriage and Education on Mortality: A Cross-national Study of Older Japanese and Finnish Men and Women. J Epidemiol 2019; 30:442-449. [PMID: 31495811 PMCID: PMC7492707 DOI: 10.2188/jea.je20190061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background While marriage and education help maintain older adults’ health, their joint association with mortality remains unclear. This cross-national study examined the combined effect of marriage and education on the mortality of older Japanese and Finnish adults. Methods Data on 22,415 Japanese and 11,993 Finnish adults, aged 65–74 years, were obtained from the Japan Gerontological Evaluation Study of 2010–2012 and the Finnish Public Sector Study of 2008–2009 and 2012–2013. We followed up on respondents’ survival status for 5 years using public records. Marital status, educational level, and other variables in both datasets were harmonized. Results The Cox proportional hazards model showed that unmarried men had a higher mortality risk than married men in both countries (hazard ratio [HR] 1.47; 95% confidence interval [CI], 1.21–1.79 for Japanese and HR 1.94; 95% CI, 1.29–2.91 for Finnish); no such difference was observed in women. The highest mortality risk was observed in unmarried men with tertiary education in both Japan (HR 1.85; 95% CI, 1.21–2.83) and Finland (HR 2.21; 95% CI, 1.26–3.89), when adjusted for baseline age, health-related behaviors, and illnesses. Conclusions Our findings showed similarity in the combined effect of marriage and education between Japan and Finland, differing from observations in countries with more apparent socioeconomic health disparities. Further studies should examine the reasons for the excessive mortality risk in highly educated, unmarried men in both countries and consider whether selection bias led to underestimation of the true risk in unmarried older adults with lower education.
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Affiliation(s)
- Tami Saito
- Department of Social Science, National Center for Geriatrics and Gerontology
| | | | | | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University
| | - Jaana Pentti
- Department of Public Health, University of Turku and Turku University Hospital
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital
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10
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Engelgau MM, Narayan KMV, Ezzati M, Salicrup LA, Belis D, Aron LY, Beaglehole R, Beaudet A, Briss PA, Chambers DA, Devaux M, Fiscella K, Gottlieb M, Hakkinen U, Henderson R, Hennis AJ, Hochman JS, Jan S, Koroshetz WJ, Mackenbach JP, Marmot MG, Martikainen P, McClellan M, Meyers D, Parsons PE, Rehnberg C, Sanghavi D, Sidney S, Siega-Riz AM, Straus S, Woolf SH, Constant S, Creazzo TL, de Jesus JM, Gavini N, Lerner NB, Mishoe HO, Nelson C, Peprah E, Punturieri A, Sampson U, Tracy RL, Mensah GA. Implementation Research to Address the United States Health Disadvantage: Report of a National Heart, Lung, and Blood Institute Workshop. Glob Heart 2018; 13:65-72. [PMID: 29716847 PMCID: PMC6504971 DOI: 10.1016/j.gheart.2018.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/20/2018] [Accepted: 03/19/2018] [Indexed: 12/30/2022] Open
Abstract
Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health-a health disadvantage. The National Heart, Lung, and Blood Institute convened a panel of national and international health experts and stakeholders for a Think Tank meeting to explore the U.S. health disadvantage and to seek specific recommendations for implementation research opportunities for heart, lung, blood, and sleep disorders. Recommendations for National Heart, Lung, and Blood Institute consideration were made in several areas including understanding the drivers of the disadvantage, identifying potential solutions, creating strategic partnerships with common goals, and finally enhancing and fostering a research workforce for implementation research. Key recommendations included exploring why the United States is doing better for health indicators in a few areas compared with peer countries; targeting populations across the entire socioeconomic spectrum with interventions at all levels in order to prevent missing a substantial proportion of the disadvantage; assuring partnership have high-level goals that can create systemic change through collective impact; and finally, increasing opportunities for implementation research training to meet the current needs. Connecting with the research community at large and building on ongoing research efforts will be an important strategy. Broad partnerships and collaboration across the social, political, economic, and private sectors and all civil society will be critical-not only for implementation research but also for implementing the findings to have the desired population impact. Developing the relevant knowledge to tackle the U.S. health disadvantage is the necessary first step to improve U.S. health outcomes.
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Affiliation(s)
- Michael M Engelgau
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
| | | | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Medical Research Council (MRC) and Public Health England (PHE) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; World Health Organisation Collaborating Centre on Noncommunicable Disease Surveillance and Epidemiology, Imperial College London, London, UK
| | - Luis A Salicrup
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Deshiree Belis
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laudan Y Aron
- Center on Labor, Human Services, and Population, The Urban Institute, Washington, DC, USA
| | | | - Alain Beaudet
- Canadian Institutes of Health Research, Ottawa, Ontario, Canada
| | - Peter A Briss
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marion Devaux
- Organization for Economic Cooperation and Development, Paris, France
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Gottlieb
- Foundation for the National Institutes of Health, Bethesda, MD, USA
| | - Unto Hakkinen
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Rain Henderson
- Clinton Health Matters Initiative, Clinton Foundation, New York, NY, USA
| | - Anselm J Hennis
- Department of Noncommunicable Disease and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Judith S Hochman
- Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Stephen Jan
- The George Institute for Global Health, Sydney, Australia; University of Sydney, Sydney, New South Wales, Australia
| | - Walter J Koroshetz
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - M G Marmot
- Institute of Health Equity and Department of Epidemiology and Public Health, University College London, London, UK
| | - Pekka Martikainen
- Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Mark McClellan
- Duke-Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC, USA
| | - David Meyers
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Polly E Parsons
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Clas Rehnberg
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - Darshak Sanghavi
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD, USA
| | | | - Anna Maria Siega-Riz
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sharon Straus
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Knowledge Translation Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Steven H Woolf
- Center on Society and Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephanie Constant
- Office of Scientific Review, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tony L Creazzo
- Office of Scientific Review, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Janet M de Jesus
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nara Gavini
- Division of Extramural Science Programs, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Norma B Lerner
- Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Helena O Mishoe
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cheryl Nelson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Emmanuel Peprah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Antonello Punturieri
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Uchechukwu Sampson
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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11
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Mackenbach JP, Hu Y, Artnik B, Bopp M, Costa G, Kalediene R, Martikainen P, Menvielle G, Strand BH, Wojtyniak B, Nusselder WJ. Trends In Inequalities In Mortality Amenable To Health Care In 17 European Countries. Health Aff (Millwood) 2018; 36:1110-1118. [PMID: 28583971 DOI: 10.1377/hlthaff.2016.1674] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Little is known about the effectiveness of health care in reducing inequalities in health. We assessed trends in inequalities in mortality from conditions amenable to health care in seventeen European countries in the period 1980-2010 and used models that included country fixed effects to study the determinants of these trends. Our findings show remarkable declines over the study period in amenable mortality among people with a low level of education. We also found stable absolute inequalities in amenable mortality over time between people with low and high levels of education, but widening relative inequalities. Higher health care expenditure was associated with lower mortality from amenable causes, but not from nonamenable causes. The effect of health care expenditure on amenable mortality was equally strong, in relative terms, among people with low levels of education and those with high levels. As a result, higher health care expenditure was associated with a narrowing of absolute inequalities in amenable mortality. Our findings suggest that in the European context, more generous health care funding provides some protection against inequalities in amenable mortality.
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Affiliation(s)
- Johan P Mackenbach
- Johan P. Mackenbach is a professor of public health and chair of the Department of Public Health, Erasmus University Medical Center, in Rotterdam, the Netherlands
| | - Yannan Hu
- Yannan Hu is a postdoctoral fellow in the Department of Public Health, Erasmus University Medical Center
| | - Barbara Artnik
- Barbara Artnik is on the Faculty of Medicine, Department of Public Health, University of Ljubljana, in Slovenia
| | - Matthias Bopp
- Matthias Bopp is a senior researcher at the Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, in Switzerland
| | - Giuseppe Costa
- Giuseppe Costa is a professor of public health at the Turin University Medical School and chair of the San Luigi Hospital Epidemiology Unit and of the Azienda Sanitaria Locale (Regional Epidemiology Unit) in Turin, Italy
| | - Ramune Kalediene
- Ramune Kalediene is dean of the Faculty of Public Health and head of the Department of Health Management at Lithuanian University of Health Sciences, in Kaunas
| | - Pekka Martikainen
- Pekka Martikainen is a professor of demography in the Department of Sociology, University of Helsinki, in Finland
| | - Gwenn Menvielle
- Gwenn Menvielle is a senior researcher at the Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Institut Nationale de la Santé et de la Recherche Médicale, in Villejuif, France
| | - Bjørn H Strand
- Bjørn H. Strand is a senior researcher in the Division of Epidemiology, Norwegian Institute of Public Health, in Oslo
| | - Bogdan Wojtyniak
- Bogdan Wojtyniak is head of the Department of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, in Warsaw, Poland
| | - Wilma J Nusselder
- Wilma J. Nusselder is an assistant professor in the Department of Public Health, Erasmus University Medical Center
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12
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Kindig D, Nobles J, Zidan M. Meeting the Institute of Medicine's 2030 US Life Expectancy Target. Am J Public Health 2018; 108:87-92. [PMID: 29161064 PMCID: PMC5719677 DOI: 10.2105/ajph.2017.304099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To quantify the improvement in US life expectancy required to reach parity with high-resource nations by 2030, to document historical precedent of this rate, and to discuss the plausibility of achieving this rate in the United States. METHODS We performed a demographic analysis of secondary data in 5-year periods from 1985 to 2015. RESULTS To achieve the United Nations projected mortality estimates for Western Europe in 2030, the US life expectancy must grow at 0.32% a year between 2016 and 2030. This rate has precedent, even in low-mortality populations. Over 204 country-periods examined, nearly half exhibited life-expectancy growth greater than 0.32%. Of the 51 US states observed, 8.2% of state-periods demonstrated life-expectancy growth that exceeded the 0.32% target. CONCLUSIONS Achieving necessary growth in life expectancy over the next 15 years despite historical precedent will be challenging. Much all-cause mortality is structured decades earlier and, at present, older-age mortality reductions in the United States are decelerating. Addressing mortality decline at all ages will require enhanced political will and a strong commitment to equity improvement in the US population.
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Affiliation(s)
- David Kindig
- David Kindig is with the Department of Population Health Sciences, University of Wisconsin-Madison. Jenna Nobles is with the Department of Sociology, University of Wisconsin-Madison. Moheb Zidan is with the Department of Economics, University of Wisconsin-Madison
| | - Jenna Nobles
- David Kindig is with the Department of Population Health Sciences, University of Wisconsin-Madison. Jenna Nobles is with the Department of Sociology, University of Wisconsin-Madison. Moheb Zidan is with the Department of Economics, University of Wisconsin-Madison
| | - Moheb Zidan
- David Kindig is with the Department of Population Health Sciences, University of Wisconsin-Madison. Jenna Nobles is with the Department of Sociology, University of Wisconsin-Madison. Moheb Zidan is with the Department of Economics, University of Wisconsin-Madison
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13
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Moberg JY, Magyari M, Koch-Henriksen N, Thygesen LC, Laursen B, Soelberg Sørensen P. Educational achievements of children of parents with multiple sclerosis: A nationwide register-based cohort study. J Neurol 2016; 263:2229-2237. [PMID: 27541043 DOI: 10.1007/s00415-016-8255-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/28/2022]
Abstract
Little is known about the impact of parental multiple sclerosis (MS) on offspring's educational attainment. The objective of the study was to examine educational achievements in offspring of parents with MS compared with matched children of parents without MS in a nationwide register-based cohort study. Children of all Danish-born residents with onset between 1950 and 1986 were identified by linking the Danish Multiple Sclerosis Registry with the Civil Registration System. Twins, children with MS, and emigrated persons were excluded. The reference cohort consisted of randomly drawn individuals from the Civil Registration System without parental MS matched 8:1 to the MS offspring by sex and year of birth. Information about education was linked to the cohorts from nationwide educational registries. We included 4177 children of MS parents and 33,416 reference persons. Children of MS parents achieved statistically significant higher average grades than the reference cohort in their final exam of basic school with a mean grade difference of 0.46 (95 % CI 0.22-0.69; p = 0.0002). We found no difference in achievement of educational level above basic school (OR 1.04; 95 % CI 0.98-1.10; p = 0.20). There was a trend toward more MS offspring attaining health-related educations (OR 1.10; 95 % CI 1.00-1.21; p = 0.06). In conclusion, children of MS parents showed a small advantage in grade point average in final examinations in basic school, and they more often tended toward health-related educations. This study revealed no negative consequences of parental MS on grades and highest educational level achieved.
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Affiliation(s)
- J Y Moberg
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,University of Copenhagen, Norregade 10, 1165, Copenhagen, Denmark.
| | - M Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,The Danish Multiple Sclerosis Registry, Rigshospitalet, Tagensvej 22, 2200, Copenhagen, Denmark
| | - N Koch-Henriksen
- The Danish Multiple Sclerosis Registry, Rigshospitalet, Tagensvej 22, 2200, Copenhagen, Denmark.,Department of Clinical Epidemiology, Clinical Institute, University of Aarhus, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - L C Thygesen
- National Institute of Public Health, University of Southern Denmark, Oster Farimagsgade 5A, 1353, Copenhagen, Denmark
| | - B Laursen
- National Institute of Public Health, University of Southern Denmark, Oster Farimagsgade 5A, 1353, Copenhagen, Denmark
| | - P Soelberg Sørensen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,University of Copenhagen, Norregade 10, 1165, Copenhagen, Denmark
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14
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van Hedel K, Mejía-Guevara I, Avendaño M, Sabbath EL, Berkman LF, Mackenbach JP, van Lenthe FJ. Work-Family Trajectories and the Higher Cardiovascular Risk of American Women Relative to Women in 13 European Countries. Am J Public Health 2016; 106:1449-56. [PMID: 27310346 PMCID: PMC4940665 DOI: 10.2105/ajph.2016.303264] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate whether less-healthy work-family life histories contribute to the higher cardiovascular disease prevalence in older American compared with European women. METHODS We used sequence analysis to identify distinct work-family typologies for women born between 1935 and 1956 in the United States and 13 European countries. Data came from the US Health and Retirement Study (1992-2006) and the Survey of Health, Aging, and Retirement in Europe (2004-2009). RESULTS Work-family typologies were similarly distributed in the United States and Europe. Being a lone working mother predicted a higher risk of heart disease, stroke, and smoking among American women, and smoking for European women. Lone working motherhood was more common and had a marginally stronger association with stroke in the United States than in Europe. Simulations indicated that the higher stroke risk among American women would only be marginally reduced if American women had experienced the same work-family trajectories as European women. CONCLUSIONS Combining work and lone motherhood was more common in the United States, but differences in work-family trajectories explained only a small fraction of the higher cardiovascular risk of American relative to European women.
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Affiliation(s)
- Karen van Hedel
- Karen van Hedel, Johan P. Mackenbach, and Frank J. van Lenthe are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Iván Mejía-Guevara and Lisa F. Berkman are with the Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. Mauricio Avendaño is with the Department of Global Health and Social Medicine, King's College London, London, UK. Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA
| | - Iván Mejía-Guevara
- Karen van Hedel, Johan P. Mackenbach, and Frank J. van Lenthe are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Iván Mejía-Guevara and Lisa F. Berkman are with the Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. Mauricio Avendaño is with the Department of Global Health and Social Medicine, King's College London, London, UK. Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA
| | - Mauricio Avendaño
- Karen van Hedel, Johan P. Mackenbach, and Frank J. van Lenthe are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Iván Mejía-Guevara and Lisa F. Berkman are with the Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. Mauricio Avendaño is with the Department of Global Health and Social Medicine, King's College London, London, UK. Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA
| | - Erika L Sabbath
- Karen van Hedel, Johan P. Mackenbach, and Frank J. van Lenthe are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Iván Mejía-Guevara and Lisa F. Berkman are with the Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. Mauricio Avendaño is with the Department of Global Health and Social Medicine, King's College London, London, UK. Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA
| | - Lisa F Berkman
- Karen van Hedel, Johan P. Mackenbach, and Frank J. van Lenthe are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Iván Mejía-Guevara and Lisa F. Berkman are with the Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. Mauricio Avendaño is with the Department of Global Health and Social Medicine, King's College London, London, UK. Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA
| | - Johan P Mackenbach
- Karen van Hedel, Johan P. Mackenbach, and Frank J. van Lenthe are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Iván Mejía-Guevara and Lisa F. Berkman are with the Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. Mauricio Avendaño is with the Department of Global Health and Social Medicine, King's College London, London, UK. Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA
| | - Frank J van Lenthe
- Karen van Hedel, Johan P. Mackenbach, and Frank J. van Lenthe are with the Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Iván Mejía-Guevara and Lisa F. Berkman are with the Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. Mauricio Avendaño is with the Department of Global Health and Social Medicine, King's College London, London, UK. Erika L. Sabbath is with the School of Social Work, Boston College, Chestnut Hill, MA
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15
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Skyrud KD, Bray F, Eriksen MT, Nilssen Y, Møller B. Regional variations in cancer survival: Impact of tumour stage, socioeconomic status, comorbidity and type of treatment in Norway. Int J Cancer 2016; 138:2190-200. [PMID: 26679150 DOI: 10.1002/ijc.29967] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/23/2015] [Accepted: 12/09/2015] [Indexed: 11/05/2022]
Abstract
Cancer survival varies by place of residence, but it remains uncertain whether this reflects differences in tumour, patient and treatment characteristics (including tumour stage, indicators of socioeconomic status (SES), comorbidity and information on received surgery and radiotherapy) or possibly regional differences in the quality of delivered health care. National population-based data from the Cancer Registry of Norway were used to identify cancer patients diagnosed in 2002-2011 (n = 258,675). We investigated survival from any type of cancer (all cancer sites combined), as well as for the six most common cancers. The effect of adjusting for prognostic factors on regional variations in cancer survival was examined by calculating the mean deviation, defined by the mean absolute deviation of the relative excess risks across health services regions. For prostate cancer, the mean deviation across regions was 1.78 when adjusting for age and sex only, but decreased to 1.27 after further adjustment for tumour stage. For breast cancer, the corresponding mean deviations were 1.34 and 1.27. Additional adjustment for other prognostic factors did not materially change the regional variation in any of the other sites. Adjustment for tumour stage explained most of the regional variations in prostate cancer survival, but had little impact for other sites. Unexplained regional variations after adjusting for tumour stage, SES indicators, comorbidity and type of treatment in Norway may be related to regional inequalities in the quality of cancer care.
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Affiliation(s)
- Katrine Damgaard Skyrud
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon Cedex 08, France
| | | | - Yngvar Nilssen
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway
| | - Bjørn Møller
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway
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16
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Education programs are likely to improve health, but will they improve health equity? Am J Prev Med 2015; 48:e5-6. [PMID: 25823565 DOI: 10.1016/j.amepre.2015.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 01/07/2015] [Accepted: 01/23/2015] [Indexed: 11/21/2022]
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