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Martínez-Marcos M, Reñé-Reñé A, Zabaleta-Del-Olmo E, Guiriguet C, Gómez-Durán EL, Cabezas-Peña C. Measles, mumps, and rubella vaccination coverage: an ecological study of primary health care and socio-economic factors in Catalonia, Spain. J Public Health Policy 2024; 45:299-318. [PMID: 38664542 DOI: 10.1057/s41271-024-00484-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 06/16/2024]
Abstract
This study examined the association of socio-economic factors and the structure of primary care centres (PCCs) with measles, mumps, and rubella (MMR) vaccination coverage among the 8-year-old population in Catalonia, Spain. We conducted an ecological study to retrospectively assess the MMR vaccination-recorded status of children born in 2012, using public health data extracted in December 2020. For each of 300 PCCs serving 70,498 children, we calculated vaccination coverage rates from electronic health records and linked these rates to a composite deprivation index corresponding to the territory served by each PCC. We identified a relationship between unfavourable socio-economic factors and higher recorded vaccination coverage. On average, directly managed PCCs had higher vaccination coverage rates than indirectly managed PCCs. Greater utilisation of primary care services by the population was also associated with higher vaccination coverage rates. Further research is needed to generate knowledge valuable for informing more equitable child-vaccination service delivery models.
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Affiliation(s)
- Montse Martínez-Marcos
- Preventive Medicine Service, Sub-directorate General for Health Promotion, Secretariat of Public Health, Department of Health, Generalitat de Catalunya, Barcelona, Spain
- School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anna Reñé-Reñé
- Central Vaccine Registry Management Team, Institut Català de la Salut, Girona, Spain
| | - Edurne Zabaleta-Del-Olmo
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via Corts Catalanes 587 àtic, 08007, Barcelona, Spain.
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain.
- Nursing Department, Faculty of Nursing, Universitat de Girona, Girona, Spain.
| | - Carolina Guiriguet
- Sistema d'Informació dels Serveis d'Atenció Primària (SISAP), Healthcare Management, Information Systems Directorate, Institut Català de la Salut, Barcelona, Spain
- Gotic Primary Care Centre, Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | | | - Carmen Cabezas-Peña
- Sub-directorate General for Health Promotion, Secretariat of Public Health, Department of Health, Generalitat de Catalunya, Barcelona, Spain
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Jia Y, Xu Q, Zhu Y, Li C, Qi C, She K, Liu T, Zhang Y, Li X. Estimation of the relationship between meteorological factors and measles using spatiotemporal Bayesian model in Shandong Province, China. BMC Public Health 2023; 23:1422. [PMID: 37491220 PMCID: PMC10369697 DOI: 10.1186/s12889-023-16350-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/19/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Measles-containing vaccine (MCV) has been effective in controlling the spread of measles. Some countries have declared measles elimination. But recently years, the number of cases worldwide has increased, posing a challenge to the global goal of measles eradication. This study estimated the relationship between meteorological factors and measles using spatiotemporal Bayesian model, aiming to provide scientific evidence for public health policy to eliminate measles. METHODS Descriptive statistical analysis was performed on monthly data of measles and meteorological variables in 136 counties of Shandong Province from 2009 to 2017. Spatiotemporal Bayesian model was used to estimate the effects of meteorological factors on measles, and to evaluate measles risk areas at county level. Case population was divided into multiple subgroups according to gender, age and occupation. The effects of meteorological factors on measles in subgroups were compared. RESULTS Specific meteorological conditions increased the risk of measles, including lower relative humidity, temperature, and atmospheric pressure; higher wind velocity, sunshine duration, and diurnal temperature variation. Taking lowest value (Q1) as reference, RR (95%CI) for higher temperatures (Q2-Q4) were 0.79 (0.69-0.91), 0.54 (0.44-0.65), and 0.48 (0.38-0.61), respectively; RR (95%CI) for higher relative humidity (Q2-Q4) were 0.76 (0.66-0.88), 0.56 (0.47-0.67), and 0.49 (0.38-0.63), respectively; RR (95%CI) for higher wind velocity (Q2-Q4) were 1.43 (1.25-1.64), 1.85 (1.57-2.18), 2.00 (1.59-2.52), respectively. 22 medium-to-high risk counties were identified, mainly in northwestern, southwestern and central Shandong Province. The trend was basically same in the effects of meteorological factors on measles in subgroups, but the magnitude of the effects was different. CONCLUSIONS Meteorological factors have an important impact on measles. It is crucial to integrate these factors into public health policies for measles prevention and control in China.
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Affiliation(s)
- Yan Jia
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Qing Xu
- Institute of Immunization and Preventive Management, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Yuchen Zhu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Chunyu Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Chang Qi
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Kaili She
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Tingxuan Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Ying Zhang
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Xiujun Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
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Ye X, Wang Y, Zou Y, Tu J, Tang W, Yu R, Yang S, Huang P. Associations of socioeconomic status with infectious diseases mediated by lifestyle, environmental pollution and chronic comorbidities: a comprehensive evaluation based on UK Biobank. Infect Dis Poverty 2023; 12:5. [PMID: 36717939 PMCID: PMC9885698 DOI: 10.1186/s40249-023-01056-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Socioeconomic status (SES) inequity was recognized as a driver of some certain infectious diseases. However, few studies evaluated the association between SES and the burden of overall infections, and even fewer identified preventable mediators. This study aimed to assess the association between SES and overall infectious diseases burden, and the potential roles of factors including lifestyle, environmental pollution, chronic disease history. METHODS We included 401,009 participants from the UK Biobank (UKB) and defined the infection status for each participant according to their diagnosis records. Latent class analysis (LCA) was used to define SES for each participant. We further defined healthy lifestyle score, environment pollution score (EPS) and four types of chronic comorbidities. We used multivariate logistic regression to test the associations between the four above covariates and infectious diseases. Then, we performed the mediation and interaction analysis to explain the relationships between SES and other variables on infectious diseases. Finally, we employed seven types of sensitivity analyses, including considering the Townsend deprivation index as an area level SES variable, repeating our main analysis for some individual or composite factors and in some subgroups, as well as in an external data from the US National Health and Nutrition Examination Survey, to verify the main results. RESULTS In UKB, 60,771 (15.2%) participants were diagnosed with infectious diseases during follow-up. Lower SES [odds ratio (OR) = 1.5570] were associated with higher risk of overall infections. Lifestyle score mediated 2.9% of effects from SES, which ranged from 2.9 to 4.0% in different infection subtypes, while cardiovascular disease (CVD) mediated a proportion of 6.2% with a range from 2.1 to 6.8%. In addition, SES showed significant negative interaction with lifestyle score (OR = 0.8650) and a history of cancer (OR = 0.9096), while a significant synergy interaction was observed between SES and EPS (OR = 1.0024). In subgroup analysis, we found that males and African (AFR) with lower SES showed much higher infection risk. Results from sensitivity and validation analyses showed relative consistent with the main analysis. CONCLUSIONS Low SES is shown to be an important risk factor for infectious disease, part of which may be mediated by poor lifestyle and chronic comorbidities. Efforts to enhance health education and improve the quality of living environment may help reduce burden of infectious disease, especially for people with low SES.
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Affiliation(s)
- Xiangyu Ye
- grid.89957.3a0000 0000 9255 8984Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yidi Wang
- grid.89957.3a0000 0000 9255 8984Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yixin Zou
- grid.89957.3a0000 0000 9255 8984Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Junlan Tu
- grid.89957.3a0000 0000 9255 8984Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Weiming Tang
- grid.89957.3a0000 0000 9255 8984Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China ,grid.410711.20000 0001 1034 1720Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, CA USA
| | - Rongbin Yu
- grid.89957.3a0000 0000 9255 8984Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Sheng Yang
- grid.89957.3a0000 0000 9255 8984Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Peng Huang
- grid.89957.3a0000 0000 9255 8984Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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Michalski N, Reis M, Tetzlaff F, Herber M, Kroll LE, Hövener C, Nowossadeck E, Hoebel J. German Index of Socioeconomic Deprivation (GISD): Revision, update and applications. JOURNAL OF HEALTH MONITORING 2022; 7:2-23. [PMID: 36628258 PMCID: PMC9768633 DOI: 10.25646/10641] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/12/2022] [Indexed: 01/12/2023]
Abstract
Background Regional deprivation indices enable researchers to analyse associations between socioeconomic disadvantages and health outcomes even if the health data of interest does not include information on the individuals' socioeconomic position. This article introduces the recent revision of the German Index of Socioeconomic Deprivation (GISD) and presents associations with life expectancy as well as age-standardised cardiovascular mortality rates and cancer incidences as applications. Methods The GISD measures the level of socioeconomic deprivation using administrative data of education, employment, and income situations at the district and municipality level from the INKAR database. The indicators are weighted via principal component analyses. The regional distribution is depicted cartographically, regional level associations with health outcomes are presented. Results The principal component analysis indicates medium to high correlations of the indicators with the index subdimensions. Correlation analyses show that in districts with the lowest deprivation, the average life expectancy of men is approximately six years longer (up to three years longer for women) than for those from districts with the highest deprivation. A similar social gradient is observed for cardiovascular mortality and lung cancer incidence. Conclusions The GISD provides a valuable tool to analyse socioeconomic inequalities in health conditions, diseases, and their determinants at the regional level.
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Affiliation(s)
- Niels Michalski
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring,Corresponding author Dr Niels Michalski, Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62–66, 12101 Berlin, Germany, E-mail:
| | - Marvin Reis
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Fabian Tetzlaff
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Meik Herber
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Lars Eric Kroll
- Zentralinstitut für die kassenärztliche Versorgung in Deutschland, Fachbereich Data Science und Versorgungsanalysen
| | - Claudia Hövener
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Enno Nowossadeck
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Jens Hoebel
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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Sepúlveda-Peñaloza A, Cumsille F, Garrido M, Matus P, Vera-Concha G, Urquidi C. Geographical disparities in obesity prevalence: small-area analysis of the Chilean National Health Surveys. BMC Public Health 2022; 22:1443. [PMID: 35906592 PMCID: PMC9335969 DOI: 10.1186/s12889-022-13841-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous representative health surveys conducted in Chile evidenced a high obesity prevalence rate among adults, especially in female and urban areas. Nevertheless, these have limited utility for targeted interventions and local source allocation for prevention. This study analyzes the increments in obesity prevalence rates in populations ≥15 years of age and the geographic variation at the regional level. We also assessed whether the obesity rates have different patterns on a smaller geographic level than national and regional ones. METHODS This ecological study analyzed data from two representative national samples of adolescents and adults ≥15 years old, who participated in the last Chilean health surveys, 2009 (n = 5412) and 2016 (n = 6233). Obesity (body mass index≥30 kg/m2) rates were calculated on the national, regional, and Health service (HS) levels, being HS the smallest unit of analysis available. Obesity rates and relative increase to early identify target populations and geographic areas, with 95% confidence intervals (95% CI), were calculated using the sampling design of the national surveys, at the national and regional level, and by gender, age groups, and socioeconomic status. The Fay-Herriot (FH) models, using auxiliary data, were fitted for obesity rate estimates at the HS level. RESULTS The relative increase in obesity rate was 37.1% (95%CI 23.3-52.9) at the national level, with a heterogeneous geographic distribution at the regional one. Southern regions had the highest obesity rates in both surveys (Aysén: 35.2, 95%CI 26.9-43.5 in 2009, 44.3 95%CI 37-51.7 in 2016), but higher increases were predominantly in the northern and central areas of the country (relative increase 91.1 95%CI 39.6-110.1 in Valparaiso and 81.6 95%CI 14.4-196.2 in Tarapacá). Obesity rates were higher in females, older age, and lower socioeconomic groups; nevertheless, relative increases were higher in the opposite ones. The FH estimates showed an obesity rates variation at the HS level, where higher rates tend to converge to specific HS areas of each region. CONCLUSION Obesity rates and relative increase are diverse across subnational levels and substantially differ from the national estimates, highlighting a pattern that converges to areas with low-middle income households. Our results emphasize geographical disparities in obesity prevalence among adults and adolescents.
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Affiliation(s)
- Alejandro Sepúlveda-Peñaloza
- Department of Epidemiology and Health Studies, Universidad de Los Andes, San Carlos de Apoquindo 2200, Las Condes, 7620001, Santiago, Chile
| | | | - Marcela Garrido
- Department of Epidemiology and Health Studies, Universidad de Los Andes, San Carlos de Apoquindo 2200, Las Condes, 7620001, Santiago, Chile
| | - Patricia Matus
- Department of Epidemiology and Health Studies, Universidad de Los Andes, San Carlos de Apoquindo 2200, Las Condes, 7620001, Santiago, Chile
| | - Germán Vera-Concha
- Department of Epidemiology and Health Studies, Universidad de Los Andes, San Carlos de Apoquindo 2200, Las Condes, 7620001, Santiago, Chile
| | - Cinthya Urquidi
- Department of Epidemiology and Health Studies, Universidad de Los Andes, San Carlos de Apoquindo 2200, Las Condes, 7620001, Santiago, Chile.
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Rohleder S, Costa DD, Bozorgmehr PK. Area-level socioeconomic deprivation, non-national residency, and Covid-19 incidence: A longitudinal spatiotemporal analysis in Germany. EClinicalMedicine 2022; 49:101485. [PMID: 35719293 PMCID: PMC9189383 DOI: 10.1016/j.eclinm.2022.101485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Socioeconomic conditions affect the dynamics of the Covid-19 pandemic. We analysed the association between area-level socioeconomic deprivation, proportion of non-nationals, and incidence of Covid-19 infections in Germany. METHODS Using linked nationally representative data at the level of 401 German districts from three waves of infection (January-2020 to May-2021), we fitted Bayesian spatiotemporal models to assess the association between socioeconomic deprivation, and proportion of non-nationals with Covid-19 incidence, controlling for age, sex, vaccination coverage, settlement structure, and spatial and temporal effects. We estimated risk ratios (RR) and corresponding 95% credible intervals (95% CrI). We further examined the deprivation domains (education, income, occupation), interactions between deprivation, sex and the proportion of non-nationals, and explored potential pathways from deprivation to Covid-19 incidence. FINDINGS Covid-19 incidence risk was 15% higher (RR=1·15, 95%-CrI=1·06-1·24) in areas classified with the highest deprivation quintile (Q5) compared to the least deprived areas (Q1). Medium-low (Q2), medium (Q3), and medium-high (Q4) deprived districts showed 6% (1·06, 1·00-1·12), 8% (1·08, 1·01-1·15), and 5% (1·05, 0·98-1·13) higher risk, respectively, compared to the least deprived. Districts with higher proportion of non-nationals showed higher incidence risk compared to districts with lowest proportion, but the association weakened across the three waves. During the first wave, an inverse association was observed with highest incidence risk in least deprived areas (Q1). Deprivation interacted with sex, but not with the proportion of non-nationals. INTERPRETATION Socioeconomic deprivation, and proportion of non-nationals are independently associated with the incidence of Covid-19. Regional planning of non-pharmaceutical interventions and vaccination strategies would benefit from consideration of area-level deprivation and non-national residency. FUNDING The study was funded by the German Ministry of Health (ZMV I 1 - 25 20 COR 410).
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Affiliation(s)
- Sven Rohleder
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501 Bielefeld, Bielefeld, Germany
- Section Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Heidelberg, Germany
| | - Dr Diogo Costa
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501 Bielefeld, Bielefeld, Germany
| | - Prof Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501 Bielefeld, Bielefeld, Germany
- Section Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Heidelberg, Germany
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Johansen K, Nohynek H. No country or continent is on its own in the ongoing COVID-19 pandemic. Euro Surveill 2021; 26:2100430. [PMID: 33928901 PMCID: PMC8086248 DOI: 10.2807/1560-7917.es.2021.26.17.2100430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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