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Svalestuen S, Sari E, Langholz PL, Vo CQ. Exploring the variation in associations between socioeconomic indicators and non-communicable diseases in the Tromsø Study: an algorithmic approach. Scand J Public Health 2024:14034948241249519. [PMID: 38860312 DOI: 10.1177/14034948241249519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
AIMS We contribute to the methodological literature on the assessment of health inequalities by applying an algorithmic approach to evaluate the capabilities of socioeconomic variables in predicting the prevalence of non-communicable diseases in a Norwegian health survey. METHODS We use data from the seventh survey of the population based Tromsø Study (2015-2016), including 11,074 women and 10,009 men aged 40 years and above. We apply the random forest algorithm to predict four non-communicable disease outcomes (heart attack, cancer, diabetes and stroke) based on information on a number of social root causes and health behaviours. We evaluate our results using the classification error, the mean decrease in accuracy, partial dependence statistics. RESULTS Results suggest that education, household income and occupation to a variable extent contribute to predicting non-communicable disease outcomes. Prediction misclassification ranges between 25.1% and 35.4% depending on the non-communicable diseases under study. Partial dependences reveal mostly expected health gradients, with some examples of complex functional relationships. Out-of-sample model validation shows that predictions translate to new data input. CONCLUSIONS Algorithmic modelling can provide additional empirical detail and metrics for evaluating heterogeneous inequalities in morbidity. The extent to which education, income and occupation contribute to predicting binary non-communicable disease outcomes depends on both non-communicable diseases and socioeconomic indicator. Partial dependences reveal that social gradients in non-communicable disease outcomes vary in shape between combinations of non-communicable disease outcome and socioeconomic status indicator. Misclassification rates highlight the extent of variation within socioeconomic groups, suggesting that future studies may improve predictive accuracy by exploring further subpopulation heterogeneity.
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Affiliation(s)
- Sigbjørn Svalestuen
- Department of Social Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Health Services and Health Economics, NORCE Norwegian Research Centre AS, Tromsø, Norway
| | - Emre Sari
- Health Services and Health Economics, NORCE Norwegian Research Centre AS, Tromsø, Norway
| | - Petja Lyn Langholz
- Department of Archaeology, History, Religiuos Studies and Theology, UiT The Arctic University of Norway, Tromsø, Norway and
| | - Chi Quynh Vo
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Moltubakk SN, Jönsson B, Lukic M, Stangvaltaite-Mouhat L. The educational gradient in dental caries experience in Northern- Norway: a cross-sectional study from the seventh survey of the Tromsø study. BMC Oral Health 2023; 23:779. [PMID: 37875913 PMCID: PMC10594764 DOI: 10.1186/s12903-023-03487-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/04/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Although, studies from Norway indicate a reduction in dental caries experience, in Northern-Norway this non-communicable oral condition is still prevalent. There is conflicting evidence of presence of social inequalities in dental caries in an adult population. Therefore, the aim of this study was to assess an association between educational level and dental caries experience in adults in urban Tromsø municipality, Northern-Norway, using The World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) framework of health determinants. METHODS Data from 3752 participants having recorded dental caries status and educational level in the seventh survey of the Tromsø Study: Tromsø7 were included. Dental status was examined clinically as decayed-, missing-, filled-teeth (DMFT score). For statistical analyses DMFT score was grouped into lower (DMFT < 19) and higher (DMFT ≥ 20). Educational level was obtained from a questionnaire and categorized as primary/partly secondary education, upper secondary education, tertiary education, short and tertiary education, long. Data on social and intermediary determinants was also self-reported. Univariable and multivariable binary logistic regression analyses were applied. RESULT This study included 1939 (52%) women and the mean age of the participants was 57.11. The mean DMFT score was 18.03. The odds of having higher DMFT score followed a gradient based on educational level. Participants who reported lower than secondary education had 2.06 -fold increased odds of having higher DMFT score than those with tertiary education, long (OR: 2.06, 95% CI: 1.50-2.83). Those with upper secondary education had 60% higher odds of having higher DMFT score (OR: 1.60, 95% CI: 1.21-2.11), and those with tertiary education, short had 66% higher odds of having higher DMFT score (OR: 1.66, 95% CI: 1.24-2.22). CONCLUSION The current cross-sectional study suggested an educational gradient in dental caries experience in an adult population of Northern- Norway. Further studies validating our results and investigating mechanisms of educational inequalities in oral health are warranted.
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Affiliation(s)
- Silje Navjord Moltubakk
- Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Birgitta Jönsson
- The Public Dental Health Service Competence Centre of Northern Norway, Tromsø, Norway
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marko Lukic
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Gutacker N, Kinge JM, Olsen JA. Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational study. BMC Public Health 2023; 23:805. [PMID: 37138293 PMCID: PMC10155341 DOI: 10.1186/s12889-023-15663-2] [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: 11/20/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Health inequalities are often assessed in terms of life expectancy or health-related quality of life (HRQoL). Few studies combine both aspects into quality-adjusted life expectancy (QALE) to derive comprehensive estimates of lifetime health inequality. Furthermore, little is known about the sensitivity of estimated inequalities in QALE to different sources of HRQoL information. This study assesses inequalities in QALE by educational attainment in Norway using two different measures of HRQoL. METHODS We combine full population life tables from Statistics Norway with survey data from the Tromsø study, a representative sample of the Norwegian population aged ≥ 40. HRQoL is measured using the EQ-5D-5L and EQ-VAS instruments. Life expectancy and QALE at 40 years of age are calculated using the Sullivan-Chiang method and are stratified by educational attainment. Inequality is measured as the absolute and relative gap between individuals with lowest (i.e. primary school) and highest (university degree 4 + years) educational attainment. RESULTS People with the highest educational attainment can expect to live longer lives (men: + 17.9% (95%CI: 16.4 to 19.5%), women: + 13.0% (95%CI: 10.6 to 15.5%)) and have higher QALE (men: + 22.4% (95%CI: 20.4 to 24.4%), women: + 18.3% (95%CI: 15.2 to 21.6%); measured using EQ-5D-5L) than individuals with primary school education. Relative inequality is larger when HRQoL is measured using EQ-VAS. CONCLUSION Health inequalities by educational attainment become wider when measured in QALE rather than LE, and the degree of this widening is larger when measuring HRQoL by EQ-VAS than by EQ-5D-5L. We find a sizable educational gradient in lifetime health in Norway, one of the most developed and egalitarian societies in the world. Our estimates provide a benchmark against which other countries can be compared.
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Affiliation(s)
- Nils Gutacker
- Centre for Health Economics, University of York, Alcuin A Block, Heslington, YO10 5DD, UK.
| | - Jonas Minet Kinge
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Jan Abel Olsen
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
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Wang D, Xie S, Wu J, Sun B. The trend in quality of life of Chinese population: analysis based on population health surveys from 2008 to 2020. BMC Public Health 2023; 23:167. [PMID: 36694154 PMCID: PMC9873389 DOI: 10.1186/s12889-023-15075-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Quality of life (QoL) is one of the most important indicators for evaluating an individual's overall health status. However, evidence exploring the trend in QoL of the Chinese population is still lacking. This study aimed to investigate the trend in QoL of the Chinese population measured by the EQ-5D from 2008 to 2020, as well as compare the changing trends in QoL categorized by populations with different socio-demographic characteristics. METHODS Data were obtained from the 2008, 2013, and 2020 waves of the Health Services Surveys conducted in Tianjin, China. Respondents completed the EQ-5D (EQ-5D-3L in 2008 and 2013 and EQ-5D-5L in 2020) through face-to-face interviews or self-administration. Responses of the EQ-5D-3L in 2008 and 2013 were mapped onto the EQ-5D-5L responses, and then converted to utility values using the Chinese value set. The trend in QoL was explored by comparing the percentage of any reported problems on each EQ-5D dimension and the corresponding utility values across the three waves. Subgroup analyses were performed to compare trends in utility values stratified by socio-demographic indicators. The effect of the time variable (year) on utility values was assessed by multiple linear regression analyses using the pooled data. RESULTS By analyzing and comparing the three waves of the data (N = 25,939 in the 2008 wave, N = 22,138 in 2013, and N = 19,177 in 2020), an upward trend was observed in the percentages of reporting problems on all five dimensions (p < 0.001), resulting in a decreasing trend in utility values (2008: 0.948, 2013: 0.942, 2020: 0.939, p < 0.001). Utility values declined more over time among the female, the elder, the recipients of medical assistance, the widowed, the unemployed, and respondents with primary or lower education. The effect of the year (Coef. for 2013 = - 0.009, p < 0.001; Coef. for 2020 = - 0.010, p < 0.001) confirmed the downward trend in the utility values. CONCLUSIONS The overall QoL of the Chinese population decreased over the period from 2008 to 2020. The QoL of the disadvantaged or vulnerable populations in terms of socioeconomic characteristics declined more over time.
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Affiliation(s)
- Dingyao Wang
- grid.33763.320000 0004 1761 2484School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072 China ,grid.33763.320000 0004 1761 2484Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Shitong Xie
- grid.33763.320000 0004 1761 2484School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072 China ,grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China. .,Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
| | - Bei Sun
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, 300072, China.
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Svalestuen S. Is the mediating effect of psychosocial stress on the income–health relationship moderated by income inequality? SSM Popul Health 2022; 20:101302. [DOI: 10.1016/j.ssmph.2022.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
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Berthung E, Gutacker N, Abelsen B, Olsen JA. Inequality of opportunity in a land of equal opportunities: The impact of parents' health and wealth on their offspring's quality of life in Norway. BMC Public Health 2022; 22:1691. [PMID: 36068512 PMCID: PMC9450446 DOI: 10.1186/s12889-022-14084-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The literature on Inequality of opportunity (IOp) in health distinguishes between circumstances that lie outside of own control vs. efforts that - to varying extents - are within one's control. From the perspective of IOp, this paper aims to explain variations in individuals' health-related quality of life (HRQoL) by focusing on two separate sets of variables that clearly lie outside of own control: Parents' health is measured by their experience of somatic diseases, psychological problems and any substance abuse, while parents' wealth is indicated by childhood financial conditions (CFC). We further include own educational attainment which may represent a circumstance, or an effort, and examine associations of IOp for different health outcomes. HRQoL are measured by EQ-5D-5L utility scores, as well as the probability of reporting limitations on specific HRQoL-dimensions (mobility, self-care, usual-activities, pain & discomfort, and anxiety and depression). METHOD We use unique survey data (N = 20,150) from the egalitarian country of Norway to investigate if differences in circumstances produce unfair inequalities in health. We estimate cross-sectional regression models which include age and sex as covariates. We estimate two model specifications. The first represents a narrow IOp by estimating the contributions of parents' health and wealth on HRQoL, while the second includes own education and thus represents a broader IOp, alternatively it provides a comparison of the relative contributions of an effort variable and the two sets of circumstance variables. RESULTS We find strong associations between the circumstance variables and HRQoL. A more detailed examination showed particularly strong associations between parental psychological problems and respondents' anxiety and depression. Our Shapley decomposition analysis suggests that parents' health and wealth are each as important as own educational attainment for explaining inequalities in adult HRQoL. CONCLUSION We provide evidence for the presence of the lasting effect of early life circumstances on adult health that persists even in one of the most egalitarian countries in the world. This suggests that there may be an upper limit to how much a generous welfare state can contribute to equal opportunities.
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Affiliation(s)
- Espen Berthung
- Department of Community Medicine, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway.
| | - Nils Gutacker
- Centre of Health Economics, University of York, York, United Kingdom
| | - Birgit Abelsen
- Department of Community Medicine, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway
| | - Jan Abel Olsen
- Department of Community Medicine, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway
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Xie S, Wu J, Xie F. Population Norms for SF-6Dv2 and EQ-5D-5L in China. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:573-585. [PMID: 35132573 DOI: 10.1007/s40258-022-00715-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 05/02/2023]
Abstract
OBJECTIVES To derive the population norms for EQ-5D-5L and SF-6Dv2 among the Chinese general population. METHODS Data collected alongside the Chinese SF-6Dv2 valuation study conducted between June and September 2019 were used. SF-6Dv2 and EQ-5D-5L, as well as social-demographic characteristics and self-reported chronic conditions, were collected through face-to-face interviews among a representative sample of the general population stratified by age, gender, education, and area of residence (urban/rural) in China. SF-6Dv2 and EQ-5D-5L responses were converted to utility values using the corresponding Chinese value sets. Utility values for both measures and EQ VAS scores were summarized by age and gender, and then described by different social-demographic characteristics and chronic conditions. RESULTS A total of 3397 respondents (51.2% male, age range 18-90 years) were included. 420 (12.4%) and 1726 (50.8%) respondents reported no problems on all SF-6Dv2 and EQ-5D-5L dimensions, respectively. The mean [standard deviation (SD)] utility values were 0.827 (0.143) for SF-6Dv2 and 0.946 (0.096) for EQ-5D-5L. The mean (SD) EQ VAS score was 87.1 (11.5). Respondents who resided in rural areas, were married, and were employed had higher utility values. Respondents with memory-related diseases or stroke had lower utility values than those with other chronic conditions. Utility values decreased with the increase in the number of chronic conditions. CONCLUSION This study reports the first Chinese population norms for the EQ-5D-5L and SF-6Dv2 derived using a representative sample of the Chinese general population. The norms can be used as references for economic evaluations and healthcare decision-making in China.
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Affiliation(s)
- Shitong Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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Sole KB, Staff AC, Räisänen S, Laine K. Substantial decrease in preeclampsia prevalence and risk over two decades: A population-based study of 1,153,227 deliveries in Norway. Pregnancy Hypertens 2022; 28:21-27. [PMID: 35151209 DOI: 10.1016/j.preghy.2022.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Analyze secular trends of preeclampsia in Norway based on risk factors. STUDY DESIGN Population-based cohort study of 1,153,227 women using data from Medical Birth Registry of Norway from 1999 to 2018. Aggregated data from Norwegian Prescription Database from 2004 to 2018 were used. Main exposure variable was time period. Descriptive statistics identified the prevalence of preeclampsia, labor induction and aspirin use. Multiple logistic regression analysis was performed to estimate the risk of preeclampsia during the time periods. MAIN OUTCOME MEASURES Preeclampsia. RESULTS Overall preeclampsia prevalence decreased from 4.3% in 1999-2002 to 2.7% in 2015-2018. A reduction was observed in all subgroups of women with known risk factors (age, nulliparity, diabetes, chronic hypertension, assisted reproduction, twin pregnancy). Adjusted risk of preeclampsia was reduced by 44% from 1999-2002 to 2015-2018 (aOR = 0.56, 95%CI 0.54, 0.58), while the net prevalence of gestational hypertension remained stable over the study period. Labor induction increased 104%. Aspirin prescriptions increased among fertile women in the general Norwegian population. CONCLUSIONS Preeclampsia prevalence and risk were reduced regardless of risk factors and despite an increased proportion of high-risk parturients (advanced age, lower parity, use of assisted reproduction). A corresponding increase in aspirin prescriptions among fertile women and an overall increase in labor inductions were also observed, suggesting that clinical interventions may partly explain the observed reduction in preeclampsia prevalence. Lower average blood pressure and improved health in the population may also explain some of the reduction.
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Affiliation(s)
- Kristina B Sole
- Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway.
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway; Division of Obstetrics and Gynaecology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Sari Räisänen
- School of Health, Tampere University of Applied Sciences, Kuntokatu 3, 33520 Tampere, Finland
| | - Katariina Laine
- Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway; Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
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