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Ohno M, Dzurova D, Smejkal P. Health inequalities in post-COVID-19 outcomes among adults aged 50+ in Europe: has COVID-19 exposed divide between postcommunist countries and Western Europe? J Epidemiol Community Health 2023; 77:601-608. [PMID: 37423747 PMCID: PMC10423549 DOI: 10.1136/jech-2023-220771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/10/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND COVID-19 affected people and countries disproportionately and continues to impact the health of people. The aim is to investigate protective health and socio-geographical factors for post-COVID-19 conditions in adults aged 50 years and older in Europe. METHODS Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe, collected from June to August 2021, protective factors against post-COVID-19 condition among 1909 respondents who self-reported a positive COVID-19 test result were investigated using multiple logistic regression models. RESULTS Male adults living outside of Czechia, Poland, Hungary and Slovakia (Visegrad group, V4), who received the COVID-19 vaccination, tertiary or higher education, had a healthy weight (body mass index, BMI 18.5-24.9 kg/m2) and no underlying health condition/s, showed protective effects against post-COVID-19 condition. Health inequalities associated with BMI were observed in education attainment and comorbidities, with higher BMI having lower education attainment and higher comorbidities. Health inequality was particularly evident in individuals in V4 with higher obesity prevalence and lower attainment of higher education than those living in other regions in the study. CONCLUSION Our study suggests that healthy weight and higher education attainment are predictors associated with a lower incidence of post-COVID-19 condition. Health inequality associated with education attainment was particularly relevant in V4. Our results highlight health inequality in which BMI was associated with comorbidities and educational attainment. To reduce obesity prevalence among older people with lower education, raising awareness about the risks of obesity and providing assistance in maintaining a healthy weight are needed.
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Affiliation(s)
- Maika Ohno
- Research Centre on Health, Quality of Life and Lifestyle in a Geodemographic and Socioeconomic Context (GeoQol), Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Dagmar Dzurova
- Research Centre on Health, Quality of Life and Lifestyle in a Geodemographic and Socioeconomic Context (GeoQol), Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Petr Smejkal
- Infectious Disease and Infection Control, IKEM Hospital, Prague, Czech Republic
- Hospitalist and Infection Control, Mount Desert Island Hospital, Bar Harbor, Maine, USA
- 1st Medical Faculty, Institute of Hygiene and Epidemiology, Charles University, Prague, Czech Republic
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2
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Borrell C, Palència L, Marí Dell'Olmo M, Morrisson J, Deboosere P, Gotsens M, Dzurova D, Costa C, Lustigova M, Burstrom B, Rodríguez-Sanz M, Bosakova L, Zengarini N, Katsouyanni K, Santana P. Socioeconomic inequalities in suicide mortality in European urban areas before and during the economic recession. Eur J Public Health 2021; 30:92-98. [PMID: 31410446 DOI: 10.1093/eurpub/ckz125] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Few studies have assessed the impact of the financial crisis on inequalities in suicide mortality in European urban areas. The objective of the study was to analyse the trend in area socioeconomic inequalities in suicide mortality in nine European urban areas before and after the beginning of the financial crisis. METHODS This ecological study of trends was based on three periods, two before the economic crisis (2000-2003, 2004-2008) and one during the crisis (2009-2014). The units of analysis were the small areas of nine European cities or metropolitan areas, with a median population ranging from 271 (Turin) to 193 630 (Berlin). For each small area and sex, we analysed smoothed standardized mortality ratios of suicide mortality and their relationship with a socioeconomic deprivation index using a hierarchical Bayesian model. RESULTS Among men, the relative risk (RR) comparing suicide mortality of the 95th percentile value of socioeconomic deprivation (severe deprivation) to its 5th percentile value (low deprivation) were higher than 1 in Stockholm and Lisbon in the three periods. In Barcelona, the RR was 2.06 (95% credible interval: 1.24-3.21) in the first period, decreasing in the other periods. No significant changes were observed across the periods. Among women, a positive significant association was identified only in Stockholm (RR around 2 in the three periods). There were no significant changes across the periods except in London with a RR of 0.49 (95% CI: 0.35-0.68) in the third period. CONCLUSIONS Area socioeconomic inequalities in suicide mortality did not change significantly after the onset of the crisis in the areas studied.
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Affiliation(s)
- Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Laia Palència
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Service of Health Information Systems, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Marc Marí Dell'Olmo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Service of Environmental Quality and Intervention, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Joana Morrisson
- Institute of Health Equity at the Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Patrick Deboosere
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mercè Gotsens
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Service of Prevention and Attention of Drug Use, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czechia
| | - Claudia Costa
- Department of Geography and Tourism, Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, Coimbra, Portugal
| | - Michala Lustigova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czechia
| | - Bo Burstrom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Maica Rodríguez-Sanz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Unit of Research, Training and Communication, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Lucia Bosakova
- Department of Health Psychology, Medical Faculty, P. J. Safarik University in Kosice, Kosice, Slovak Republic.,Olomouc University Social Health Institute (OUSHI), Palacky University in Olomouc, Olomouc, Czech Republic
| | | | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian, University of Athens Medical School, Athens, Greece.,Department of Population Health Sciences, and Department of Analytical, Environmental & Forensic Sciences, School of Population Health & Environmental Sciences, King's College, London, UK
| | - Paula Santana
- Department of Geography and Tourism, Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, Coimbra, Portugal
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3
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Palència L, Ferrando J, Marí-Dell'Olmo M, Gotsens M, Morrison J, Dzurova D, Lustigova M, Costa C, Rodríguez-Sanz M, Bosakova L, Santana P, Borrell C. Socio-economic inequalities on cancer mortality in nine European areas: The effect of the last economic recession. Cancer Epidemiol 2020; 69:101827. [PMID: 33038640 DOI: 10.1016/j.canep.2020.101827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The effect of inequalities aggravated by economic recessions in the mortality rates of certain diseases has been previously described. In this study, we analyzed the relationship between socio-economic deprivation and cancer mortality. We focused on lung, colon, prostate, and breast cancers in nine European urban areas over three periods: two before (2000-2003 and 2004-2008) and one after (2009-2014) the onset of the 2008 financial crisis. METHODS This is an ecological study of trends. The units of analysis were small areas within nine European urban areas. We used a composite deprivation index as a socio-economic indicator. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollié. To analyze the evolution of socio-economic inequalities, we fitted an ecological regression model that included the socio-economic indicator, the period of time, and the interaction between these terms. RESULTS In men, socio-economic inequalities in all-cancer and lung cancer mortality were observed in most of the cities studied, but did not increase after the onset of the economic crisis. In women, only two cities (Stockholm and London) showed socio-economic inequalities in all-cancer and lung cancer mortality; there was also no increase in inequalities. CONCLUSIONS Our results did not validate our hypothesis that inequalities increase in times of crisis. However, they emphasize the importance of socio-economic measurements for understanding mortality inequalities, and can be used to inform prevention strategies and help plan local health programs aimed at reducing health inequalities.
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Affiliation(s)
- Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | | | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Joana Morrison
- Institute of Health Equity at the Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czechia
| | - Michala Lustigova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czechia
| | - Claudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | - Lucia Bosakova
- Department of Health Psychology and Research Methodology, Medical Faculty, P. J. Safarik University in Kosice, Kosice, Slovak Republic; Olomouc University Social Health Institute (OUSHI), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
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4
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Palència L, Gotsens M, Marí-Dell'Olmo M, Bosakova L, Burström B, Costa C, Deboosere P, Dzurova D, Lustigova M, Morrison J, Santana P, Borrell C. Effect of the recent economic crisis on socioeconomic inequalities in mortality in nine urban areas in Europe. Gac Sanit 2020; 34:253-260. [PMID: 31983478 DOI: 10.1016/j.gaceta.2019.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To analyse socioeconomic inequalities in all-cause mortality among men and women in nine European urban areas during the recent economic crisis, and to compare the results to those from two periods before the crisis. METHOD This is an ecological study of trends based on three time periods (2000-2003, 2004-2008 and 2009-2014). The units of analysis were the small areas of nine European urban areas. We used a composite deprivation index as a socioeconomic indicator, along with other single indicators. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollié. To analyse the evolution of socioeconomic inequalities, we fitted an ecological regression model that included the socioeconomic indicator, the period of time, and the interaction between these terms. RESULTS We observed significant inequalities in mortality among men for almost all the socioeconomic indicators, periods, and urban areas studied. However, no significant changes occurred during the period of the economic crisis. While inequalities among women were less common, there was a statistically significant increase in inequality during the crisis period in terms of unemployment and the deprivation index in Prague and Stockholm, respectively. CONCLUSIONS Future analyses should also consider time-lag in the effect of crises on mortality and specific causes of death, and differential effects between genders.
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Affiliation(s)
- Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Lucia Bosakova
- Department of Health Psychology, Medical Faculty, P.J. Safarik University in Kosice, Kosice, Slovak Republic; Olomouc University Social Health Institute, Palacky University in Olomouc, Olomouc, Czech Republic
| | - Bo Burström
- Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
| | - Cláudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Patrick Deboosere
- Interface Demography, Section Social Research, Vrije Universiteit Brussels, Brussels, Belgium
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Michala Lustigova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Joana Morrison
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal; Department of Geography and Tourism, Humanities Faculty, University of Coimbra, Coimbra, Portugal
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
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5
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Lustigova M, Dzurova D, Costa C, Santana P. Health Disparities in Czechia and Portugal at Country and Municipality Levels. Int J Environ Res Public Health 2019; 16:ijerph16071139. [PMID: 30934925 PMCID: PMC6480706 DOI: 10.3390/ijerph16071139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/22/2019] [Accepted: 03/24/2019] [Indexed: 02/06/2023]
Abstract
This article investigates the health outcomes and determinants between two different European populations, Portuguese and Czech, on two hierarchical levels: country and metropolitan area. At first, the decomposition method of age and cause of death were compared on the country level, and then health was examined based on a factor analysis at the municipality level of Prague and Lisbon. The results clearly indicate problematic diabetes mortality among the Portuguese population, and especially in the Lisbon Metropolitan Area, and confirm the dominant role of circulatory mortality and cancer mortality among Czech, especially the Prague population. The social and economic deprivations were revealed as the major drivers for both metropolitan areas, although with differences between them, requiring interventions that go beyond the health sector.
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Affiliation(s)
- Michala Lustigova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, 128 43 Prague, Czech Republic.
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, 128 43 Prague, Czech Republic.
| | - Claudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal.
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal.
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6
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Costa C, Santana P, Dimitroulopoulou S, Burstrom B, Borrell C, Schweikart J, Dzurova D, Zangarini N, Katsouyanni K, Deboseree P, Freitas Â, Mitsakou C, Samoli E, Vardoulakis S, Marí Dell'Olmo M, Gotsens M, Lustigova M, Corman D, Costa G. Population Health Inequalities Across and Within European Metropolitan Areas through the Lens of the EURO-HEALTHY Population Health Index. Int J Environ Res Public Health 2019; 16:E836. [PMID: 30866549 PMCID: PMC6427561 DOI: 10.3390/ijerph16050836] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/25/2019] [Accepted: 03/02/2019] [Indexed: 12/12/2022]
Abstract
The different geographical contexts seen in European metropolitan areas are reflected in the uneven distribution of health risk factors for the population. Accumulating evidence on multiple health determinants point to the importance of individual, social, economic, physical and built environment features, which can be shaped by the local authorities. The complexity of measuring health, which at the same time underscores the level of intra-urban inequalities, calls for integrated and multidimensional approaches. The aim of this study is to analyse inequalities in health determinants and health outcomes across and within nine metropolitan areas: Athens, Barcelona, Berlin-Brandenburg, Brussels, Lisbon, London, Prague, Stockholm and Turin. We use the EURO-HEALTHY Population Health Index (PHI), a tool that measures health in two components: Health Determinants and Health Outcomes. The application of this tool revealed important inequalities between metropolitan areas: Better scores were found in Northern cities when compared with their Southern and Eastern counterparts in both components. The analysis of geographical patterns within metropolitan areas showed that there are intra-urban inequalities, and, in most cities, they appear to form spatial clusters. Identifying which urban areas are measurably worse off, in either Health Determinants or Health Outcomes, or both, provides a basis for redirecting local action and for ongoing comparisons with other metropolitan areas.
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Affiliation(s)
- Claudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal.
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal.
- Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal.
| | - Sani Dimitroulopoulou
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton OX11 0RQ, Oxon, UK.
| | - Bo Burstrom
- Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, 171 77 Stockholm, Sweden.
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
- Institut d'Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain.
- Universitat Pompeu Fabra, 08002 Barcelona, Spain.
| | - Jürgen Schweikart
- Department of Civil Engineering and Geoinformation, Beuth University of Applied Sciences Berlin, 13437 Berlin, Germany.
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, 128 43 Prague, Czech Republic.
| | - Nicolás Zangarini
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy.
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece.
| | - Patrick Deboseree
- Interface Demography, University of Brussels, 1050 Brussels, Belgium.
| | - Ângela Freitas
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal.
| | - Christina Mitsakou
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton OX11 0RQ, Oxon, UK.
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece.
| | | | - Marc Marí Dell'Olmo
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
- Institut d'Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain.
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
- Institut d'Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain.
- Universitat Pompeu Fabra, 08002 Barcelona, Spain.
| | - Michala Lustigova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, 128 43 Prague, Czech Republic.
| | - Diana Corman
- The National Board of Health and Welfare, 106 30 Stockholm, Sweden.
| | - Giuseppe Costa
- Medical School of the University of Turin, University of Turin, 10124 Turin, Italy.
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Drbohlav D, Dzurova D. 7.10-P16Health and social hazards in the workplace: Vietnamese and Ukrainian migrants in Czechia. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Drbohlav
- Charles University, Faculty of Science, Prague, Czech Republic
| | - D Dzurova
- Charles University, Faculty of Science, Prague, Czech Republic
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8
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Lustigova M, Dzurova D, Pikhart H, Kubinova R, Bobak M. Cardiovascular health among the Czech population at the beginning of the 21st century: a 12-year follow-up study. J Epidemiol Community Health 2018; 72:442-448. [PMID: 29439193 PMCID: PMC5909738 DOI: 10.1136/jech-2017-209967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/03/2018] [Accepted: 01/20/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND In the late 1980s, Czechia was among the countries which had the highest cardiovascular mortality in the world. In spite of enormous improvements since that time, there are still large opportunities in further improving cardiovascular health. METHODS Based on the Czech Health, Alcohol and Psychosocial Factors in Eastern Europe sample (n=8449 at baseline, 12 years of follow-up, 494 cardiovascular disease (CVD) deaths up to 2015-events), the impact of selected covariates such as education, smoking habits, high blood pressure, blood cholesterol level, diabetes, obesity, physical activity and binge drinking and their multifactorial effects on cardiovascular mortality was evaluated by Cox regression. In addition, population attributable fractions (PAFs) were used to quantify the impact of these factors on CVD mortality in the population. RESULTS Education was found as the strongest determinant of CVD mortality (primary vs university, HR 2.77, P<0.001; PAF=50.5%). CVD risk was two times higher for persons with diabetes compared with those without (HR 2.02, P<0.001, PAF=23.2%). Furthermore, significant factors found were smoking (smoker vs non-smoker, HR 1.91, P<0.001; PAF=26.5%), high blood pressure (HR 1.73, P<0.001; PAF=35.3%) and physical inactivity (none vs sufficient, HR 1.60, P<0.001; PAF=22.9%). Conversely, the effect of obesity was low (HR 1.29, P value =0.020), and binge drinking and high blood cholesterol level were not significant at all. CONCLUSIONS Education had the largest impact on cardiovascular mortality among the Czech population. More than 50% of CVD death would be prevented if the whole population had the same risk values as the highest educated population. Reducing disparities in health related to education should benefit from attention to cardiovascular health literacy.
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Affiliation(s)
- Michala Lustigova
- Environmental and Population Health Monitoring Centre, National Institute of Public Health, Prague, Czech Republic.,Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ruzena Kubinova
- Environmental and Population Health Monitoring Centre, National Institute of Public Health, Prague, Czech Republic
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
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9
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Morrison J, Bosakova L, Dzurova D, Rosicova K, Lustigova M, Santana P, Pikhart H. Regional mortality in countries of Central and Eastern Europe: findings from Euro-Healthy project. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - D Dzurova
- Charles University, Prague, Czech Republic
| | - K Rosicova
- Department of Regional Development, Kosice, Slovakia
| | | | - P Santana
- University of Coimbra, Coimbra, Portugal
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10
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Jarolímek J, Urban P, Pavlínek P, Dzurova D. Occupational diseases in the automotive industry in Czechia - Geographic and medical context. Int J Occup Med Environ Health 2017; 30:455-468. [PMID: 28481378 DOI: 10.13075/ijomeh.1896.00919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES The automotive industry represents the most important industrial sector in Czechia. The objective of this study has been to analyze the occurrence of occupational diseases (OD) in the automotive industry during the period from 2001 till 2014. MATERIAL AND METHODS Data on OD cases was retrieved from the National Registry of OD. Further, we conducted a survey in automotive companies with focus on occupational health services and positions of the companies in global production networks (GPNs). An analysis of OD distribution in the automotive industry was performed (age, gender, company size and its role in GPNs, regional distribution of studied companies, and regional unemployment rate), and was accompanied by assessment of the quality and range of occupational health services. RESULTS Employees older than 40 years old have nearly 2.5 times higher probability of OD occurrence as compared with employees younger than 40 years old (odds ratio (OR) = 2.41, 95% confidence interval (CI): 2.05-2.85). Occupational diseases occurrence probability was 3 times higher for women than for men (OR = 3.01, 95% CI: 2.55-3.55). Occupational diseases incidence rates increased with the size of the company (0 OD/10 000 employees in micro enterprises to 57 OD/10 000 employees in large enterprises). A particularly steep rise in OD incidents in the automotive industry was observed in the Plzeň Region between 2001 and 2011. An association between OD incidents and the unemployment rate was not statistically confirmed. CONCLUSIONS A statistically significant increase in OD incidents dependent on company size may be arguably attributed to a higher quality of occupational medical services in bigger companies, which ensures better detection and diagnosis of OD. In the Plzeň Region, the rapid increase in OD incidents was mainly caused by a change in the production process of automobile textiles in one factory due to the introduction of a glue containing isocyanates, which are potent allergising agents. This led to an increase in occupational allergic diseases - bronchial asthma in particular. Int J Occup Med Environ Health 2017;30(3):455-468.
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Affiliation(s)
- Jan Jarolímek
- Charles University, Prague, Czechia (Faculty of Science, Department of Social Geography and Regional Development).
| | - Pavel Urban
- National Institute of Public Health, Prague, Czechia.
| | - Petr Pavlínek
- Charles University, Prague, Czechia (Faculty of Science, Department of Social Geography and Regional Development).
| | - Dagmar Dzurova
- Charles University, Prague, Czechia (Faculty of Science, Department of Social Geography and Regional Development).
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Dzurova D, Spilkova J, Lustigova M, Štych P. Does quality of school outdoor environment support healthier behaviour of adolescents? Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lustigova M, Dzurova D, Bobak M, Kubinova R. The HAPIEE study – Does the ideal cardiovascular health exist? Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lustigova M, Dzurova D, Pikhart H, Kubinova R. Education remains the strongest determinant of cardiovascular health in the Czech population. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv169.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rodin D, Stirbu I, Ekholm O, Dzurova D, Costa G, Mackenbach JP, Kunst AE. Educational inequalities in blood pressure and cholesterol screening in nine European countries. J Epidemiol Community Health 2012; 66:1050-5. [DOI: 10.1136/jech-2011-200273] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Roskam AJR, Kunst AE, Van Oyen H, Demarest S, Klumbiene J, Regidor E, Helmert U, Jusot F, Dzurova D, Mackenbach JP. Comparative appraisal of educational inequalities in overweight and obesity among adults in 19 European countries. Int J Epidemiol 2009; 39:392-404. [PMID: 19926664 DOI: 10.1093/ije/dyp329] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In Western societies, a lower educational level is often associated with a higher prevalence of overweight and obesity. However, there may be important international differences in the strength and direction of this relationship, perhaps in respect of differing levels of socio-economic development. We aimed to describe educational inequalities in overweight and obesity across Europe, and to explore the contribution of level of socio-economic development to cross-national differences in educational inequalities in overweight and obese adults in Europe. METHODS Cross-sectional data, based on self-reports, were derived from national health interview surveys from 19 European countries (N = 127 018; age range = 25-44 years). Height and weight data were used to calculate the body mass index (BMI). Multivariate regression analysis was employed to measure educational inequalities in overweight and obesity, based on BMI. Gross domestic product (GDP) per capita was used as a measure of level of socio-economic development. RESULTS Inverse educational gradients in overweight and obesity (i.e. higher education, less overweight and obesity) are a generalized phenomenon among European men and even more so among women. Baltic and eastern European men were the exceptions, with weak positive associations between education and overweight and obesity. Educational inequalities in overweight and obesity were largest in Mediterranean women. A 10 000-euro increase in GDP was related to a 3% increase in overweight and obesity for low-educated men, but a 4% decrease for high-educated men. No associations with GDP were observed for women. CONCLUSION In most European countries, people of lower educational attainment are now most likely to be overweight or obese. An increasing level of socio-economic development was associated with an emergence of inequalities among men, and a persistence of these inequalities among women.
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Affiliation(s)
- Albert-Jan R Roskam
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
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Espelt A, Borrell C, Roskam AJ, Rodríguez-Sanz M, Stirbu I, Dalmau-Bueno A, Regidor E, Bopp M, Martikainen P, Leinsalu M, Artnik B, Rychtarikova J, Kalediene R, Dzurova D, Mackenbach J, Kunst AE. Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century. Diabetologia 2008; 51:1971-9. [PMID: 18779946 DOI: 10.1007/s00125-008-1146-1] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 08/07/2008] [Indexed: 10/21/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to determine and quantify socioeconomic position (SEP) inequalities in diabetes mellitus in different areas of Europe, at the turn of the century, for men and women. METHODS We analysed data from ten representative national health surveys and 13 mortality registers. For national health surveys the dependent variable was the presence of diabetes by self-report and for mortality registers it was death from diabetes. Educational level (SEP), age and sex were independent variables, and age-adjusted prevalence ratios (PRs) and risk ratios (RRs) were calculated. RESULTS In the overall study population, low SEP was related to a higher prevalence of diabetes, for example men who attained a level of education equivalent to lower secondary school or less had a PR of 1.6 (95% CI 1.4-1.9) compared with those who attained tertiary level education, whereas the corresponding value in women was 2.2 (95% CI 1.9-2.7). Moreover, in all countries, having a disadvantaged SEP is related to a higher rate of mortality from diabetes and a linear relationship is observed. Eastern European countries have higher relative inequalities in mortality by SEP. According to our data, the RR of dying from diabetes for women with low a SEP is 3.4 (95% CI 2.6-4.6), while in men it is 2.0 (95% CI 1.7-2.4). CONCLUSIONS/INTERPRETATION In Europe, educational attainment and diabetes are inversely related, in terms of both morbidity and mortality rates. This underlines the importance of targeting interventions towards low SEP groups. Access and use of healthcare services by people with diabetes also need to be improved.
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Affiliation(s)
- A Espelt
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Spain.
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Schaap MM, Kunst AE, Leinsalu M, Regidor E, Ekholm O, Dzurova D, Helmert U, Klumbiene J, Santana P, Mackenbach JP. Effect of nationwide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries. Tob Control 2008; 17:248-55. [PMID: 18483129 DOI: 10.1136/tc.2007.024265] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Recently a scale was introduced to quantify the implementation of tobacco control policies at country level. Our study used this scale to examine the potential impact of these policies on quit ratios in European countries. Special attention was given to smoking cessation among lower educational groups. METHODS Cross-sectional data were derived from national health surveys from 18 European countries. In the analyses we distinguished between country, sex, two age groups (25-39 and 40-59 years) and educational level. Age-standardised quit ratios were calculated as total former-smokers divided by total ever-smokers. In regression analyses we explored the correlation between national quit ratios and the national score on the Tobacco Control Scale (TCS). RESULTS Quit ratios were especially high (>45%) in Sweden, England, The Netherlands, Belgium and France and relatively low (<30%) in Lithuania and Latvia. Higher educated smokers were more likely to have quit smoking than lower educated smokers in all age-sex groups in all countries. National score on the tobacco control scale was positively associated with quit ratios in all age-sex groups. The association of quit ratios with score on TCS did not show consistent differences between high and low education. Of all tobacco control policies of which the TCS is constructed, price policies showed the strongest association with quit ratios, followed by an advertising ban. CONCLUSION Countries with more developed tobacco control policies have higher quit ratios than countries with less developed tobacco control policies. High and low educated smokers benefit about equally from the nationwide tobacco control policies.
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Affiliation(s)
- M M Schaap
- Department of Public Health, Erasmus Medical Centre, 3000 CA Rotterdam, The Netherlands.
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Dzurova D, Jelinkova J. [Quality of atmosphere and mortality level: selected towns of the Czech Republic, daily values, 1992]. Demografie 2002; 39:81-93. [PMID: 12321144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Dzurova D. Relationship between environment quality and mortality in Czechoslovakia. Acta Univ Carol Geogr 1992; 27:91-103. [PMID: 12291393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
"Our paper concentrates on a regional analysis of the relationship between living environment and public health.... We utilized the collected data concerning the relationship between environment and public health and worked out an application of these data to be implemented in Czechoslovakia (CSFR)....Czechoslovakia's extremely disturbed areas usually correspond to regions with high mortality rates. However, the relationship between the two phenomena is not explicit because these ¿disrupted' areas also have different ethnic and social structures. The education standards of their populations are usually lower, in addition to other adverse characteristics which can be described as socio-pathological." (SUMMARY IN CZE)
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Dzurova D. [Typology of districts in the Czech Socialist Republic by causes of death]. Demografie 1989; 31:128-36. [PMID: 12282104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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