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Khedmati Morasae E, Derbyshire DW, Amini P, Ebrahimi T. Social determinants of spatial inequalities in COVID-19 outcomes across England: A multiscale geographically weighted regression analysis. SSM Popul Health 2024; 25:101621. [PMID: 38420111 PMCID: PMC10899060 DOI: 10.1016/j.ssmph.2024.101621] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
A variety of factors are associated with greater COVID-19 morbidity or mortality, due to how these factors influence exposure to (in the case of morbidity) or severity of (in the case of mortality) COVID-19 infections. We use multiscale geographically weighted regression to study spatial variation in the factors associated with COVID-19 morbidity and mortality rates at the local authority level across England (UK). We investigate the period between March 2020 and March 2021, prior to the rollout of the COVID-19 vaccination program. We consider a variety of factors including demographic (e.g. age, gender, and ethnicity), health (e.g. rates of smoking, obesity, and diabetes), social (e.g. Index of Multiple Deprivation), and economic (e.g. the Gini coefficient and economic complexity index) factors that have previously been found to impact COVID-19 morbidity and mortality. The Index of Multiple Deprivation has a significant impact on COVID-19 cases and deaths in all local authorities, although the effect is the strongest in the south of England. Higher proportions of ethnic minorities are associated with higher levels of COVID-19 mortality, with the strongest effect being found in the west of England. There is again a similar pattern in terms of cases, but strongest in the north of the country. Other factors including age and gender are also found to have significant effects on COVID-19 morbidity and mortality, with differential spatial effects across the country. The results provide insights into how national and local policymakers can take account of localized factors to address spatial health inequalities and address future infectious disease pandemics.
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Affiliation(s)
- Esmaeil Khedmati Morasae
- Research Fellow in Operational Research, Exeter University Business School, University of Exeter, UK
| | - Daniel W. Derbyshire
- Department of Public Health and Sports Science, Faculty of Health and Life Science, University of Exeter, UK
| | - Payam Amini
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Tahera Ebrahimi
- Lecturer in Finance, Business School, Manchester Metropolitan University, UK
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Maldonado N, Camacho S, Prada SI, Hormaza-Jaramillo A, Soto V, García W, Paredes N, Cardona F. Scarcity in abundance? Spatial inequalities in Rheumatoid Arthritis in a health system with financial equity. BMC Rheumatol 2023; 7:19. [PMID: 37434237 DOI: 10.1186/s41927-023-00332-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 04/13/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND This paper estimates spatial inequalities of Rheumatoid Arthritis (RA) in Colombia and explores correlates of those disparities from a health system perspective. METHODS We apply descriptive epidemiology to healthcare administrative records for estimation of crude and age-standardized prevalences, and health systems thinking for identification of barriers to effective access in RA diagnosis. RESULTS The crude and age-standardized RA prevalence for Colombia in 2018 is estimated at 0.43% and 0.36%, respectively. In the contributory regime, the binding constraint is effective access to rheumatologists in rural and sparsely populated areas; this constraint in workforce affects service delivery, and ultimately comes from the lack of a differentiated model for effective provision of healthcare in those areas (governance). CONCLUSIONS There are opportunities for implementation of public health policies and health system interventions that would lead to a better identification of RA patients and the subsequent more precise estimation of RA prevalence, and most importantly, to reduce exposition to risk factors and accurate diagnosis and treatment of RA patients.
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Affiliation(s)
- Norman Maldonado
- PROESA - Research Center on Health Economics and Social Protection, Universidad Icesi, Cali, Colombia
| | - Sandra Camacho
- PROESA - Research Center on Health Economics and Social Protection, Universidad Icesi, Cali, Colombia
| | - Sergio I Prada
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 # 18-49, 760032, Cali, Colombia
| | | | - Victoria Soto
- PROESA - Research Center on Health Economics and Social Protection, Universidad Icesi, Cali, Colombia
| | - William García
- PROESA - Research Center on Health Economics and Social Protection, Universidad Icesi, Cali, Colombia
| | - Nelcy Paredes
- Asociación Colombiana de Empresas de Medicina Integral (ACEMI), Bogotá, Colombia
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Muchiri SK, Muthee R, Kiarie H, Sitienei J, Agweyu A, Atkinson PM, Edson Utazi C, Tatem AJ, Alegana VA. Unmet need for COVID-19 vaccination coverage in Kenya. Vaccine 2022; 40:2011-2019. [PMID: 35184925 PMCID: PMC8841160 DOI: 10.1016/j.vaccine.2022.02.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
COVID-19 has impacted the health and livelihoods of billions of people since it emerged in 2019. Vaccination for COVID-19 is a critical intervention that is being rolled out globally to end the pandemic. Understanding the spatial inequalities in vaccination coverage and access to vaccination centres is important for planning this intervention nationally. Here, COVID-19 vaccination data, representing the number of people given at least one dose of vaccine, a list of the approved vaccination sites, population data and ancillary GIS data were used to assess vaccination coverage, using Kenya as an example. Firstly, physical access was modelled using travel time to estimate the proportion of population within 1 hour of a vaccination site. Secondly, a Bayesian conditional autoregressive (CAR) model was used to estimate the COVID-19 vaccination coverage and the same framework used to forecast coverage rates for the first quarter of 2022. Nationally, the average travel time to a designated COVID-19 vaccination site (n = 622) was 75.5 min (Range: 62.9 - 94.5 min) and over 87% of the population >18 years reside within 1 hour to a vaccination site. The COVID-19 vaccination coverage in December 2021 was 16.70% (95% CI: 16.66 - 16.74) - 4.4 million people and was forecasted to be 30.75% (95% CI: 25.04 - 36.96) - 8.1 million people by the end of March 2022. Approximately 21 million adults were still unvaccinated in December 2021 and, in the absence of accelerated vaccine uptake, over 17.2 million adults may not be vaccinated by end March 2022 nationally. Our results highlight geographic inequalities at sub-national level and are important in targeting and improving vaccination coverage in hard-to-reach populations. Similar mapping efforts could help other countries identify and increase vaccination coverage for such populations.
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Affiliation(s)
- Samuel K Muchiri
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.
| | - Rose Muthee
- Department of Health Informatics, Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Hellen Kiarie
- Department of Health Informatics, Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Joseph Sitienei
- Department of Health Informatics, Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Ambrose Agweyu
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme Nairobi, Kenya
| | - Peter M Atkinson
- Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, UK; Geography and Environmental Science, University of Southampton, Highfield, Southampton SO17 1BJ, UK; Institute of Geographic Sciences and Natural Resource Research, Chinese Academy of Sciences, Beijing 100101, China
| | - C Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK; Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Andrew J Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Victor A Alegana
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Geography and Environmental Science, University of Southampton, Highfield, Southampton SO17 1BJ, UK
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Costa C, Santana P. Trends of amenable deaths due to healthcare within the European Union countries. Exploring the association with the economic crisis and education. SSM Popul Health 2021; 16:100982. [PMID: 34926783 PMCID: PMC8648806 DOI: 10.1016/j.ssmph.2021.100982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/15/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 02/03/2023] Open
Abstract
The study of premature deaths from causes that are generally preventable given the current availability of healthcare - called amenable deaths due to healthcare - provides information on the quality of services. However, they are not only impacted by healthcare characteristics: other factors are also likely to influence. Therefore, identifying the association between amenable deaths due to healthcare and health determinants, such as education, might be the key to preventing these deaths in the future. Still unclear however, is how this works and how amenable deaths due to healthcare are distributed and evolve within the European Union (EU) below the national level. We therefore studied the geographical and temporal patterns of amenable deaths due to healthcare in the 259 EU regions from 1999 to 2016, including the 2007-2008 financial crisis and the post-2008 economic downturn, and identified whether any association with education exists. A cross-sectional ecological study was carried out. Using a hierarchical Bayesian model, we estimated the average smoothed Standardized Mortality Ratios (sSMR). A regression model was also applied to measure the relative risks (RR) at 95% credible intervals for cause-specific mortality association with education. Results show that amenable deaths due to healthcare decreased globally. Nevertheless, the decrease is not the same across all regions, and inequalities within countries do persist, with lower mortality ratios seen in regions from Central European countries and higher mortality ratios in regions from Eastern European countries. Also, the evolution trend reveals that after the financial crisis, the number of these deaths increased in regions across almost all EU countries. Moreover, educational disparities in mortality emerged, and a statistical association was found between amenable deaths due to healthcare and early exit from education and training. These results confirm that identifying and understanding the background of regional differences may lead to a better understanding of the amenable deaths due to healthcare and allow for the application of more effective policies.
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Affiliation(s)
- Claudia Costa
- Centre of Studies in Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, Portugal
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, Portugal
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Abstract
The Covid-19 pandemic has reached almost every corner of the world. Despite the historical development, approval, and distribution of vaccines in some countries, non-pharmaceutical interventions will remain an essential strategy to control the pandemic until a substantial proportion of the population has immunity. There is increasing evidence of the devastating social and economic effects of the pandemic, particularly on vulnerable communities. Individuals living in urban informal settlements are in a structurally disadvantaged position to cope with a health crisis such as the Covid-19 pandemic. Estimates of this impact are needed to inform and prioritize policy decisions and actions. We study employment loss in informal settlements before and during the Covid-19 pandemic in Chile, using a longitudinal panel study of households living in Chile's informal settlements before and during the health crisis. We show that before the pandemic, 75% of respondents reported being employed. There is a decrease of 30 and 40 percentage points in May and September 2020, respectively. We show that the employment loss is substantially higher for individuals in informal settlements than for the general population and has particularly affected the immigrant population. We also show that the pandemic has triggered neighborhood cooperation within the settlements and that targeted government assistance programs have reached these communities in a limited way. Our results suggest that individuals living in informal settlements are facing severe hardship as a consequence of the pandemic. In addition to providing much-needed support, this crisis presents a unique opportunity for long-term improvements in these marginalized communities.
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Affiliation(s)
- Diego Gil
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul CP, 7820436, Santiago, Region Metropolitana, Chile.
| | - Patricio Domínguez
- Departamento de Ingeniería Industrial y de Sistemas, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul CP, Region Metropolitana, 7820436, Santiago, Chile
| | - Eduardo A Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul CP, 7820436, Santiago, Region Metropolitana, Chile
- Millennium Nucleus for the Study of the Life Course and Vulnerability, Av. Vicuña Mackenna 4860, Macul CP, 7820436, Santiago, Region Metropolitana, Chile
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Av. Vicuña Mackenna 4860, Macul CP, 7820436, Santiago, Region Metropolitana, Chile
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, ON, M5G 1M1, Canada
| | - Eduardo Valenzuela
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul CP, 7820436, Santiago, Region Metropolitana, Chile
- Instituto de Sociología, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul CP, 7820436, Santiago, Region Metropolitana, Chile
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Fayet Y, Tétreau R, Honoré C, Le Nail LR, Dalban C, Gouin F, Causeret S, Piperno-Neumann S, Mathoulin-Pelissier S, Karanian M, Italiano A, Chaigneau L, Gantzer J, Bertucci F, Ropars M, Saada-Bouzid E, Cordoba A, Ruzic JC, Varatharajah S, Ducimetière F, Chabaud S, Dubray-Longeras P, Fiorenza F, De Percin S, Lebbé C, Soibinet P, Michelin P, Rios M, Farsi F, Penel N, Bompas E, Duffaud F, Chevreau C, Le Cesne A, Blay JY, Le Loarer F, Ray-Coquard I. Determinants of the access to remote specialised services provided by national sarcoma reference centres. BMC Cancer 2021; 21:631. [PMID: 34049529 PMCID: PMC8164290 DOI: 10.1186/s12885-021-08393-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 02/10/2021] [Accepted: 05/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background Spatial inequalities in cancer management have been evidenced by studies reporting lower quality of care or/and lower survival for patients living in remote or socially deprived areas. NETSARC+ is a national reference network implemented to improve the outcome of sarcoma patients in France since 2010, providing remote access to specialized diagnosis and Multidisciplinary Tumour Board (MTB). The IGéAS research program aims to assess the potential of this innovative organization, with remote management of cancers including rare tumours, to go through geographical barriers usually impeding the optimal management of cancer patients. Methods Using the nationwide NETSARC+ databases, the individual, clinical and geographical determinants of the access to sarcoma-specialized diagnosis and MTB were analysed. The IGéAS cohort (n = 20,590) includes all patients living in France with first sarcoma diagnosis between 2011 and 2014. Early access was defined as specialised review performed before 30 days of sampling and as first sarcoma MTB discussion performed before the first surgery. Results Some clinical populations are at highest risk of initial management without access to sarcoma specialized services, such as patients with non-GIST visceral sarcoma for diagnosis [OR 1.96, 95% CI 1.78 to 2.15] and MTB discussion [OR 3.56, 95% CI 3.16 to 4.01]. Social deprivation of the municipality is not associated with early access on NETSARC+ remote services. The quintile of patients furthest away from reference centres have lower chances of early access to specialized diagnosis [OR 1.18, 95% CI 1.06 to 1.31] and MTB discussion [OR 1.24, 95% CI 1.10 to 1.40] but this influence of the distance is slight in comparison with clinical factors and previous studies on the access to cancer-specialized facilities. Conclusions In the context of national organization driven by reference network, distance to reference centres slightly alters the early access to sarcoma specialized services and social deprivation has no impact on it. The reference networks’ organization, designed to improve the access to specialized services and the quality of cancer management, can be considered as an interesting device to reduce social and spatial inequalities in cancer management. The potential of this organization must be confirmed by further studies, including survival analysis.
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Affiliation(s)
- Yohan Fayet
- Equipe EMS - Département de Sciences Humaines et Sociales, Centre Léon Bérard, F-69008, Lyon, France. .,Univ Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, HESPER EA 7425, F-69008 Lyon, F-42023, Saint-Etienne, France.
| | - Raphaël Tétreau
- Medical Imaging Center, Institut du Cancer, Montpellier, France
| | - Charles Honoré
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Louis-Romée Le Nail
- Department of Orthopaedic Surgery, CHU de Tours, Faculte de médecine, Université de Tours, Tours, France
| | - Cécile Dalban
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | | | - Sylvain Causeret
- Department of Surgery, Centre Georges-Francois Leclerc, Dijon, Bourgogne, France
| | | | - Simone Mathoulin-Pelissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, F-33000, Bordeaux, France.,Clinical and Epidemiological Research Unit, INSERM CIC1401, Institut Bergonié, F-33000, Bordeaux, France
| | - Marie Karanian
- Department of Pathology, Lyon University Hospital, Lyon, France
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonié, 33000, Bordeaux, France
| | - Loïc Chaigneau
- Department of Medical Oncology, CHRU Jean Minjoz, Besançon, France
| | | | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Mickael Ropars
- Orthopaedic and trauma department, Rennes1 University Pontchaillou University Hospital, Rennes, France
| | - Esma Saada-Bouzid
- Medical Oncology Department, University Côte d'Azur, Centre Antoine Lacassagne, Nice, France
| | - Abel Cordoba
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | | | | | | | - Sylvie Chabaud
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | | | - Fabrice Fiorenza
- Department of Orthopedics Traumatology, CHU de Dupuytren, F-87042, Limoges, France
| | - Sixtine De Percin
- Medical Oncology Department, Hôpital Cochin; AP-HP, Cancer Research for PErsonalized Medicine (CARPEM); Paris University, Paris, France
| | - Céleste Lebbé
- AP-HP Dermatology Department, Saint-Louis Hospital, INSERM U976, Université de Paris Diderot, Paris, France
| | - Pauline Soibinet
- Department of Hepato-Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
| | - Paul Michelin
- Department of Radiology and Medical Imaging, CHU-hôpitaux de Rouen, Rouen, France
| | - Maria Rios
- Department of Medical Oncology, Cancer Institute of Lorraine, Alexis Vautrin, Vandoeuvre Les Nancy, France
| | - Fadila Farsi
- CRLCC Léon Berard - Lyon, Oncology Regional Network ONCO-AURA, Lyon, France
| | - Nicolas Penel
- Lille University Medical School and Centre Oscar Lambret, Lille, France
| | - Emmanuelle Bompas
- Medical Oncology Department, ICO, Saint Herblain, Pays de la Loire, France
| | - Florence Duffaud
- Department of Medical Oncology, CHU La Timone and Aix-Marseille Université (AMU), Marseille, France
| | - Christine Chevreau
- Department of Medical Oncology, ICR IUCT- Oncopole Toulouse, Toulouse, France
| | - Axel Le Cesne
- Medical Oncology, Insitut Gustave Roussy, Villejuif, Ile-de-France, France
| | - Jean-Yves Blay
- Departement of Medical Oncology, Centre Léon Bérard, Université de Lyon and Unicancer Paris, Lyon, France
| | | | - Isabelle Ray-Coquard
- Equipe EMS, Centre Léon Bérard, F-69008, Lyon, France.,Department of Medical Oncology, Centre Leon Berard, Lyon, Rhône-Alpes, France
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Kenyon A, Pearce J. The socio-spatial distribution of walkable environments in urban scotland: A case study from Glasgow and Edinburgh. SSM Popul Health 2019; 9:100461. [PMID: 31463354 PMCID: PMC6706651 DOI: 10.1016/j.ssmph.2019.100461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/21/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 11/01/2022] Open
Abstract
Increasingly, evidence shows that built environments (BEs) can encourage walking. Not only does walking have the potential to benefit health, it can also be used as a form of transport, reducing reliance on motorised transport and reducing CO2 emissions. However, little is known about the distribution of such features within urban environments. Furthermore, debate surrounds whether people living in areas with high deprivation face the 'double jeopardy' of high deprivation and environments that are unsupportive of walking. This study aims to address this knowledge gap by developing measures of the built environment considered to support walking and assessing and whether there is a relationship between these with area-level deprivation in urban Scotland. It also examines the geographic distribution of these measures in two of Scotland's biggest conurbations. Three aspects of the physical built environment considered to reflect Area Walking Potential (AWP) were created which are considered to show good walking environments, there were residential density, intersection density and destination accessibility, as well as an overall walkability index (a combination of the three measures). The results showed no evidence of deprivation amplification with higher concentrations of the AWP measures in more deprived areas. Those living in the least deprived areas having the lowest levels of the measures. However, spatial analysis showed unequal distribution of these measures, with concentrations of high AWP clustered together with lower AWP scores in peripheral areas. These results support the growing evidence base of unequal geographic distribution of AWP. These results matter for developing built environments to support walking because it is important to understand how existing patterns of AWP to target interventions appropriately. Awareness of associations between AWP and deprivation is important for policies aimed at ameliorating multi-level inequalities demonstrating where people are likely to be experiencing both low AWP and high deprivation.
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Helbich M, Blüml V, de Jong T, Plener PL, Kwan MP, Kapusta ND. Urban-rural inequalities in suicide mortality: a comparison of urbanicity indicators. Int J Health Geogr 2017; 16:39. [PMID: 29084555 PMCID: PMC5663034 DOI: 10.1186/s12942-017-0112-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 07/14/2017] [Accepted: 10/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background Urban–rural disparities in suicide mortality have received considerable attention. Varying conceptualizations of urbanity may contribute to the conflicting findings. This ecological study on Germany assessed how and to what extent urban–rural suicide associations are affected by 14 different urban–rural indicators. Methods Indicators were based on continuous or k-means classified population data, land-use data, planning typologies, or represented population-based accessibility indicators. Agreements between indicators were tested with correlation analyses. Spatial Bayesian Poisson regressions were estimated to examine urban–rural suicide associations while adjusting for risk and protective factors. Results Urban–rural differences in suicide rates per 100,000 persons were found irrespective of the indicator. Strong and significant correlation was observed between different urban–rural indicators. Although the effect sign consistently referred to a reduced risk in urban areas, statistical significance was not universally confirmed by all regressions. Goodness-of-fit statistics suggested that the population potential score performs best, and that population density is the second best indicator of urbanicity. Numerical indicators are favored over classified ones. Regional planning typologies are not supported. Conclusions The strength of suicide urban–rural associations varies with respect to the applied indicator of urbanicity. Future studies that put urban–rural inequalities central are recommended to apply either unclassified population potentials or population density indicators, but sensitivity analyses are advised. Electronic supplementary material The online version of this article (10.1186/s12942-017-0112-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Helbich
- Department of Human Geography and Spatial Planning, Utrecht University, Heidelberglaan 2, 3584 CS, Utrecht, The Netherlands.
| | - V Blüml
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, 1090, Vienna, Austria
| | - T de Jong
- Department of Logistics, University of Stellenbosch, Van der Sterrbuilding 3017, Bosmanstreet, Matieland, Stellenbosch, South Africa
| | - P L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, 89075, Ulm, Germany
| | - M-P Kwan
- Department of Human Geography and Spatial Planning, Utrecht University, Heidelberglaan 2, 3584 CS, Utrecht, The Netherlands.,Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - N D Kapusta
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, 1090, Vienna, Austria
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Präg P, Subramanian SV. Educational inequalities in self-rated health across US states and European countries. Int J Public Health 2017; 62:709-716. [PMID: 28534061 PMCID: PMC5487890 DOI: 10.1007/s00038-017-0981-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 01/31/2017] [Accepted: 05/12/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The US shows a distinct health disadvantage when compared to other high-income nations. A potential lever to reduce this disadvantage is to improve the health situation of lower socioeconomic groups. Our objective is to explore how the considerable within-US variation in health inequalities compares to the health inequalities across other Western countries. METHODS Representative survey data from 44 European countries and the US federal states were obtained from the fourth wave of the European Values Study (EVS) and the 2008 wave of the Behavioral Risk Factor Surveillance System. Using binary logistic regression, we analyze different forms of educational inequalities in self-rated health (SRH), adjusted for age and sex. RESULTS The extent of educational inequalities in SRH varies considerably over European countries and US states; with US states in general showing greater inequality, however, differences between US states and European countries are less clear than commonly assumed. CONCLUSIONS The US has considerable differences in educational inequalities in SRH across geographic locations. To understand the reasons for the US health disadvantage, comparative research has to take into account the vast variation in health inequalities within the US.
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Affiliation(s)
- Patrick Präg
- Department of Sociology and Nuffield College, University of Oxford, Oxford, UK.
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard Chan School of Public Health, Boston, MA, US
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