Contrasting socioeconomic inequality with noncommunicable diseases: Insights from a population-based survey using the concentration index in Kong cohort study

Neighborhood deprivation and iodine levels influence air pollution effects on maternal thyroid function in early pregnancy

Exposure to air pollution during pregnancy that disrupts thyroid function can lead to adverse health outcomes in mother and child. We evaluated the overall effect and critical exposure window of residential ambient air pollution exposures on thyroid function in the MADRES pregnancy cohort. We also investigated whether these associations varied by iodine deficiency status and neighborhood deprivation. Early pregnancy (6-20 weeks) serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) were measured for 217 mothers. Daily residential ambient air pollution exposures (PM2.5, PM10, NO2 and O3 8hr max) were estimated using inverse-distance squared spatial interpolation from regulatory monitors. We used linear regression to assess effects of single ambient air pollutants on thyroid function, including exploration of effect modification by iodine deficiency and neighborhood deprivation (Area Deprivation Index and Gini Index of income inequality, dichotomized at the median). Distributed lag models (DLM) were used to assess critical windows of exposure for ambient air pollutants from 12 weeks preconception to first trimester. We found that one SD increase in PM2.5 (2.4 μg/m3) and PM10 (5.8 μg/m3) were associated with 18.9 % (95 % CI: 2.7, 37.8 %) and 16.8 % (95 % CI: 0.7, 35.6 %) higher TSH levels, respectively, with significant windows of susceptibility in the first trimester (GW 5-8 or 6-8). These associations were also modified by neighborhood deprivation, and iodine status. Our findings indicate that relatively low levels of PM exposures in early pregnancy are associated with increased TSH levels particularly among women with replete iodine levels and women living in neighborhoods with greater deprivation.

Chronic Pancreatitis in a Large Developing Country: Temporal Trends of Over 64,000 Hospitalizations from 2009 to 2019

BACKGROUND/OBJECTIVES

Chronic pancreatitis (CP) is a progressive inflammatory disorder associated with marked morbidity and mortality and frequently requires hospitalization. This study aimed to investigate the time trends and geographical distribution of hospital admissions, the lethality rate of CP across Brazil, and the potential relationship with social indicators and associated risk factors.

METHODS

Data were retrospectively obtained from the Brazilian Public Health System Registry between January 2009 and December 2019. The prevalence and lethality rates of CP per 100,000 inhabitants in each municipality were estimated from hospitalizations to in-hospital deaths and classified by age, sex, and demographic features.

RESULTS

During the study period, 64,609 admissions were retrieved, and most of the patients were males (63.54%). Hospitalization decreased by nearly half (-54.68%) in both sexes. CP rates in males were higher in all age groups. The greatest reduction in admissions (- 64%) was also noted in patients ≥ 70y. CP In-hospital lethality remained stable (5-6%) and similar for males and females. Patients ≥ 70y showed the highest lethality. The greatest increase in CP lethality rates (+ 10%) was observed in municipalities integrated into metropolises, which was mainly driven by small-sized municipalities (+ 124%).

CONCLUSIONS

CP hospitalizations decrease in both urban and rural areas, particularly in the North, Northeast, and Central-West regions, and in those above 70 years of age, but are not correlated with lethality rates in the South. This suggests ongoing changes in the environmental and socioeconomic factors in Brazil.