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Li X, Jansåker F, Sundquist J, Sundquist K. Neighbourhood deprivation and type 2 diabetes in patients with bipolar disorder: A nationwide follow-up study. Stress Health 2024; 40:e3302. [PMID: 37565544 DOI: 10.1002/smi.3302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/18/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
Patients with bipolar disorder have higher rates of type 2 diabetes (T2D) compared to the general population. Neighbourhood deprivation is associated with T2D and bipolar disorder. The aim of this study was to explore the potential effect of neighbourhood deprivation on incident T2D in patients with bipolar disorder. This nationwide open cohort study (1997-2018) included adults in Sweden ≥20 years with bipolar disorder (90,780 patients) to examine the subsequent risk of T2D. The association between neighbourhood deprivation and T2D was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). All models were conducted in both men and women and adjusted for individual-level sociodemographic factors and comorbidities. Neighbourhood deprivation was significantly associated with T2D in patients with bipolar disorder. The HRs were 1.61 (95% CI 1.40-1.86) for men and 1.83 (1.60-2.10) for women living in high deprivation neighbourhoods compared to those from low deprivation neighbourhoods. After adjustment, these results remained significant: 1.35 (1.17-1.56) in men and 1.39 (1.20-1.60) in women living in high deprivation neighbourhoods. The suggested graded association of higher incident T2D among patients with bipolar disorder, observed when levels of neighbourhood deprivation increased, raises important clinical and public health concerns. The results may help develop a contextual approach to prevention of T2D in patients with bipolar disorder that includes the neighbourhood environment.
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Affiliation(s)
- Xinjun Li
- Center for Primary Health Care Research, Lund University, Lund, Sweden
| | - Filip Jansåker
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Clinical Microbiology, Center of Diagnostic Investigations, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
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Xia M, An J, Safford MM, Colantonio LD, Sims M, Reynolds K, Moran AE, Zhang Y. Cardiovascular Risk Associated With Social Determinants of Health at Individual and Area Levels. JAMA Netw Open 2024; 7:e248584. [PMID: 38669015 PMCID: PMC11053380 DOI: 10.1001/jamanetworkopen.2024.8584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/28/2024] [Indexed: 04/29/2024] Open
Abstract
Importance The benefit of adding social determinants of health (SDOH) when estimating atherosclerotic cardiovascular disease (ASCVD) risk is unclear. Objective To examine the association of SDOH at both individual and area levels with ASCVD risks, and to assess if adding individual- and area-level SDOH to the pooled cohort equations (PCEs) or the Predicting Risk of CVD Events (PREVENT) equations improves the accuracy of risk estimates. Design, Setting, and Participants This cohort study included participants data from 4 large US cohort studies. Eligible participants were aged 40 to 79 years without a history of ASCVD. Baseline data were collected from 1995 to 2007; median (IQR) follow-up was 13.0 (9.3-15.0) years. Data were analyzed from September 2023 to February 2024. Exposures Individual- and area-level education, income, and employment status. Main outcomes and measures ASCVD was defined as the composite outcome of nonfatal myocardial infarction, death from coronary heart disease, and fatal or nonfatal stroke. Results A total of 26 316 participants were included (mean [SD] age, 61.0 [9.1] years; 15 494 women [58.9%]; 11 365 Black [43.2%], 703 Chinese American [2.7%], 1278 Hispanic [4.9%], and 12 970 White [49.3%]); 11 764 individuals (44.7%) had at least 1 adverse individual-level SDOH and 10 908 (41.5%) had at least 1 adverse area-level SDOH. A total of 2673 ASCVD events occurred during follow-up. SDOH were associated with increased risk of ASCVD at both the individual and area levels, including for low education (individual: hazard ratio [HR], 1.39 [95% CI, 1.25-1.55]; area: HR, 1.31 [95% CI, 1.20-1.42]), low income (individual: 1.35 [95% CI, 1.25-1.47]; area: HR, 1.28 [95% CI, 1.17-1.40]), and unemployment (individual: HR, 1.61 [95% CI, 1.24-2.10]; area: HR, 1.25 [95% CI, 1.14-1.37]). Adding area-level SDOH alone to the PCEs did not change model discrimination but modestly improved calibration. Furthermore, adding both individual- and area-level SDOH to the PCEs led to a modest improvement in both discrimination and calibration in non-Hispanic Black individuals (change in C index, 0.0051 [95% CI, 0.0011 to 0.0126]; change in scaled integrated Brier score [IBS], 0.396% [95% CI, 0.221% to 0.802%]), and improvement in calibration in White individuals (change in scaled IBS, 0.274% [95% CI, 0.095% to 0.665%]). Adding individual-level SDOH to the PREVENT plus area-level social deprivation index (SDI) equations did not improve discrimination but modestly improved calibration in White participants (change in scaled IBS, 0.182% [95% CI, 0.040% to 0.496%]), Black participants (0.187% [95% CI, 0.039% to 0.501%]), and women (0.289% [95% CI, 0.115% to 0.574%]). Conclusions and Relevance In this cohort study, both individual- and area-level SDOH were associated with ASCVD risk; adding both individual- and area-level SDOH to the PCEs modestly improved discrimination and calibration for estimating ASCVD risk for Black individuals, and adding individual-level SDOH to PREVENT plus SDI also modestly improved calibration. These findings suggest that both individual- and area-level SDOH may be considered in future development of ASCVD risk assessment tools, particularly among Black individuals.
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Affiliation(s)
- Mengying Xia
- Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Jaejin An
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Mario Sims
- Department of Social Medicine, Population, and Public Health, University of California, Riverside
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Andrew E. Moran
- Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Yiyi Zhang
- Division of General Medicine, Columbia University Irving Medical Center, New York, New York
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Li X, Jansåker F, Sundquist J, Crump C, Hamano T, Sundquist K. Neighborhood deprivation in relation to lung cancer in individuals with type 2 diabetes-A nationwide cohort study (2005-2018). PLoS One 2023; 18:e0288959. [PMID: 37478113 PMCID: PMC10361504 DOI: 10.1371/journal.pone.0288959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/07/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Neighborhood deprivation has been found associated with both type 2 diabetes and lung cancer. The aim of this study was to examine the potential association between neighborhood deprivation and lung cancer incidence or mortality in individuals diagnosed with type 2 diabetes. The results may identify a new risk or prognostic factor for lung cancer in this important subgroup and help develop a more contextual approach to prevention that includes neighborhood environment. METHODS AND FINDINGS The study population included adults (n = 613,650) aged ≥ 30 years with type 2 diabetes during 2005 to 2018 in Sweden. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incidence or mortality of lung cancer associated with neighborhood deprivation. All models were conducted in both men and women and adjusted for individual-level characteristics (e.g. age, smoking- and alcohol-related comorbidities, sociodemographic factors). The cumulative incidence and mortality for lung cancer were 1.08% (95% CI, 1.06 to 1.11) and 0.93% (0.90 to 0.95), respectively, in the study population during the study period. Neighborhood deprivation was associated with both incidence and mortality of lung cancer in patients with type 2 diabetes independently of the individual-level characteristics. In the fully adjusted models, comparing high- with low-deprivation neighborhoods, the HRs for lung cancer incidence were 1.21 (1.10 to 1.33) in men and 1.08 (0.95 to 1.21) in women. The corresponding HRs for lung cancer mortality were 1.04 (1.00 to 1.07) in men and 0.97 (0.94 to 1.00) in women. Competing risk analyses including cardiovascular mortality attenuated the results. CONCLUSION In this large cohort of individuals with type 2 diabetes, we found higher lung cancer incidence and mortality in patients living in areas with high neighborhood deprivation, even after adjusting for individual-level characteristics. These findings may help develop a more contextual approach that includes the neighborhood environment when allocating resources for disease prevention and care in patients with type 2 diabetes. These findings could also help inform clinical care for patients with type 2 diabetes, particularly those living in deprived neighborhoods.
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Affiliation(s)
- Xinjun Li
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Filip Jansåker
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Clinical Microbiology, Center of Diagnostic Investigations, Rigshospitalet, Copenhagen, Denmark
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Matsue, Shimane, Japan
| | - Casey Crump
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Tsuyoshi Hamano
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Matsue, Shimane, Japan
- Department of Sports Sociology and Health Sciences, Kyoto Sangyo University, Kyoto, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Matsue, Shimane, Japan
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Salvador C, Gullón P, Franco M, Vicedo-Cabrera AM. Heat-related first cardiovascular event incidence in the city of Madrid (Spain): Vulnerability assessment by demographic, socioeconomic, and health indicators. ENVIRONMENTAL RESEARCH 2023; 226:115698. [PMID: 36931379 DOI: 10.1016/j.envres.2023.115698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
While climate change and population ageing are expected to increase the exposure and vulnerability to extreme heat events, there is emerging evidence suggesting that social inequalities would additionally magnify the projected health impacts. However, limited evidence exists on how social determinants modify heat-related cardiovascular morbidity. This study aims to explore the association between heat and the incidence of first acute cardiovascular event (CVE) in adults in Madrid between 2015 and 2018, and to assess how social context and other individual characteristics modify the estimated association. We performed a case-crossover study using the individual information collected from electronic medical records of 6514 adults aged 40-75 living in Madrid city that suffered a first CVE during summer (June-September) between 2015 and 2018. We applied conditional logistic regression with a distributed lag non-linear model to analyse the heat-CVE association. Estimates were expressed as Odds Ratio (OR) for extreme heat (at 97.5th percentile of daily maximum temperature distribution), compared to the minimum risk temperature. We performed stratified analyses by specific diagnosis, sex, age (40-64, 65-75), country of origin, area-level deprivation, and presence of comorbidities. Overall, the risk of suffering CVE increased by 15.3% (OR: 1.153 [95%CI 1.010-1.317]) during extreme heat. Males were particularly more affected (1.248, [1.059-1.471]), vs 1.039 [0.810-1.331] in females), and non-Spanish population (1.869 [1.28-2.728]), vs 1.084 [0.940-1.250] in Spanish). Similar estimates were found by age groups. We observed a dose-response pattern across deprivation levels, with larger risks in populations with higher deprivation (1.228 [1.031-1.462]) and almost null association in the lowest deprivation group (1.062 [0.836-1.349]). No clear patterns of larger vulnerability were found by presence of comorbidity. We found that heat unequally increased the risk of suffering CVE in adults in Madrid, affecting mainly males and deprived populations. Local measures should pay special attention to vulnerable populations.
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Affiliation(s)
- Coral Salvador
- Centro de Investigación Mariña, Universidade de Vigo, Environmental Physics Laboratory (EPhysLab), Ourense, Spain; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Pedro Gullón
- Universidad de Alcalá, Grupo de Investigación en Epidemiología y Salud Pública Facultad de Medicina y Ciencias de La Salud, Alcalá de Henares, Madrid, Spain; Centre for Urban Research, RMIT University, Melbourne, Australia
| | - Manuel Franco
- Universidad de Alcalá, Grupo de Investigación en Epidemiología y Salud Pública Facultad de Medicina y Ciencias de La Salud, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md, 21205-2217, USA.
| | - Ana M Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
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Dowell S, Yun H, Curtis JR, Chen L, Xie F, Pedra-Nobre M, Wollaston D, Najmey S, Elliott CL, Ford TL, North H, Dore R, Dolatabadi S, Ramanujam T, Kennedy S, Ott S, Jileaeva I, Richardson A, Kaine J, Wright G, Kerr GS. Geographic Variation in Disease Burden and Mismatch in Care of Patients With Rheumatoid Arthritis in the United States. ACR Open Rheumatol 2023; 5:181-189. [PMID: 36811270 PMCID: PMC10100689 DOI: 10.1002/acr2.11532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/04/2023] [Accepted: 01/21/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE Our objective was to evaluate the factors associated with regional variation of rheumatoid arthritis (RA) disease burden in the US. METHODS In a retrospective cohort analysis of Rheumatology Informatics System for Effectiveness (RISE) registry data, seropositivity, RA disease activity (Clinical Disease Activity Index [CDAI], Routine Assessment of Patient Index Data-version 3 [RAPID3]), socioeconomic status (SES), geographic region, health insurance type, and comorbidity burden were recorded. An Area Deprivation Index score of more than 80 defined low SES. Median travel distance to practice sites' zip codes was calculated. Linear regression was used to analyze associations between RA disease activity and comorbidity adjusting for age, sex, geographic region, race, and insurance type. RESULTS Enrollment data for 184,722 patients with RA from 182 RISE sites were analyzed. Disease activity was higher in African American patients, in those from Southern regions, and in those with Medicaid or Medicare coverage. Greater comorbidity was prevalent in patients in the South and those with Medicare or Medicaid coverage. There was moderate correlation between comorbidity and disease activity (Pearson coefficient: RAPID3 0.28, CDAI 0.15). High-deprivation areas were mainly in the South. Less than 10% of all participating practices cared for more than 50% of all Medicaid recipients. Patients living more than 200 miles away from specialist care were located mainly in Southern and Western regions. CONCLUSION A disproportionately large portion of socially deprived, high comorbidity, and Medicaid-covered patients with RA were cared for by a minority of rheumatology practices. Studies are needed in high-deprivation areas to establish more equitable distribution of specialty care for patients with RA.
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Affiliation(s)
- Sharon Dowell
- Howard University College of Medicine, Washington, DC
| | | | | | | | | | | | | | - Sawsan Najmey
- Ocean University Medical Center at Hackensack Meridian Health, CentraState Medical Center, Freehold, New Jersey
| | | | | | - Heather North
- UNC Health, Pardee Hospital, Hendersonville, North Carolina
| | - Robin Dore
- David Geffen School of Medicine at University of California, Los Angeles
| | - Soha Dolatabadi
- Assistant Professor at UCLA Geffen School of Medicine, Los Angeles, California
| | | | - Stacy Kennedy
- Novant Health Rowan Medical Center, Salisbury, North Carolina
| | - Stephanie Ott
- Ohio University Heritage College of Osteopathic Medicine, Cleveland, and Fairfield Medical Center, Lancaster, Ohio
| | | | | | | | - Grace Wright
- Association of Women in Rheumatology, New York, New York
| | - Gail S Kerr
- Washington DC Veterans Affairs Medical Center, Georgetown University, and Howard University College of Medicine, Washington, DC
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Jansåker F, Nymberg VM, Sundquist J, Okuyama K, Hamano T, Sundquist K, Li X. Neighborhood deprivation and coronary heart disease in patients with bipolar disorder. Sci Rep 2022; 12:16763. [PMID: 36202912 PMCID: PMC9537303 DOI: 10.1038/s41598-022-21295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022] Open
Abstract
The aim was to study the potential effect of neighborhood deprivation on incident and fatal coronary heart disease (CHD) in patients with bipolar disorder. This was a nationwide cohort study which included all adults aged 30 years or older with bipolar disorder (n = 61,114) in Sweden (1997–2017). The association between neighborhood deprivation and the outcomes was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (CIs). Patients with bipolar disorder living in neighborhoods with high or moderate levels of deprivation were compared with those living in neighborhoods with low deprivation scores. There was an association between level of neighborhood deprivation and incident and fatal CHD among patients with bipolar disorder. The HRs were 1.24 (95% CI 1.07–1.44) for men and 1.31 (1.13–1.51) for women for incident CHD among patients with bipolar disorder living in high deprivation neighborhoods compared to those from low deprivation neighborhoods, after adjustments for potential confounders. The corresponding HR for fatal CHD were 1.35 (1.22–1.49) in men and 1.30 (1.19–1.41) in women living in high deprivation neighborhoods. Increased incident and fatal CHD among patients with bipolar disorder living in deprived neighborhoods raises important clinical and public health concerns.
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Affiliation(s)
- Filip Jansåker
- Center for Primary Health Care Research, Lund University, Skåne University Hospital, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden. .,Department of Clinical Microbiology, Center of Diagnostic Investigations, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Veronica Milos Nymberg
- Center for Primary Health Care Research, Lund University, Skåne University Hospital, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Skåne University Hospital, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Shimane, Japan
| | - Kenta Okuyama
- Center for Primary Health Care Research, Lund University, Skåne University Hospital, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden
| | - Tsuyoshi Hamano
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Shimane, Japan.,Department of Sports Sociology and Health Sciences, Kyoto Sangyo University, Kyoto, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Skåne University Hospital, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden.,Department of Clinical Microbiology, Center of Diagnostic Investigations, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Skåne University Hospital, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden
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Wan EYF, Fung WT, Yu EYT, Cheng WHG, Chan KS, Wang Y, Chan EWY, Wong ICK, Lam CLK. Association of genetic variants related to combined exposure to higher BMI and waist-to-hip ratio on lifelong cardiovascular risk in UK Biobank. Public Health Nutr 2022; 26:1-9. [PMID: 35621080 DOI: 10.1017/s1368980022001276] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study examines the individual and combined association of BMI and waist-to-hip ratio (WHR) with CVD risk using genetic scores of the obesity measurements as proxies. DESIGN A 2 × 2 factorial analysis approach was applied, with participants divided into four groups of lifetime exposure to low BMI and WHR, high BMI, high WHR, and high BMI and WHR based on weighted genetic risk scores. The difference in CVD risk across groups was evaluated using multivariable logistic regression. SETTING Cohort study. PARTICIPANTS A total of 408 003 participants were included from the prospective observational UK Biobank study. RESULTS A total of 58 429 CVD events were recorded. Compared to the low BMI and WHR genetic scores group, higher BMI or higher WHR genetic scores were associated with an increase in CVD risk (high WHR: OR, 1·07; 95 % CI (1·04, 1·10)); high BMI: OR, 1·12; 95 % CI (1·09, 1·16). A weak additive effect on CVD risk was found between BMI and WHR (high BMI and WHR: OR, 1·16; 95 % CI (1·12, 1·19)). Subgroup analysis showed similar patterns between different sex, age (<65, ≥65 years old), smoking status, Townsend deprivation index, fasting glucose level and medication uses, but lower systolic blood pressure was associated with higher CVD risk in obese participants. CONCLUSIONS High BMI and WHR were associated with increased CVD risk, and their effects are weakly additive. Even though there were overlapping of effect, both BMI and WHR are important in assessing the CVD risk in the general population.
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Affiliation(s)
- Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Special Administrative Region, China
| | - Wing Tung Fung
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Will Ho Gi Cheng
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kam Suen Chan
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yuan Wang
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Special Administrative Region, China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Special Administrative Region, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Family Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
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Healthy and unhealthy food environments are linked with neighbourhood socio-economic disadvantage: an innovative geospatial approach to understanding food access inequities. Public Health Nutr 2020; 23:3190-3196. [DOI: 10.1017/s1368980020002104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:This study examined the separate relationships between socio-economic disadvantage and the density of multiple types of food outlets, and relationships between socio-economic disadvantage and composite food environment indices.Design:Cross-sectional data were analysed using geospatial kernel density techniques. Food outlet data included convenience stores, discount stores, fast-food and fast casual restaurants, and grocery stores. Controlling for urbanicity and race/ethnicity, multivariate linear regression was used to examine the relationships between socio-economic disadvantage and density of food outlets.Setting:This study occurred in a large Southeastern US county containing 255 census block groups with a total population of 474 266, of which 77·1 % was Non-Hispanic White, the median household income was $48 886 and 15·0 % of residents lived below 125 % of the federal poverty line.Participants:The unit of analysis was block groups; all data about neighbourhood socio-economic disadvantage and food outlets were publicly available.Results:As block group socio-economic disadvantage increased, so too did access to all types of food outlets. The total food environment index, calculated as the ratio of unhealthy food outlets to all food outlets, decreased as block group disadvantage increased.Conclusions:Those who reside in more disadvantaged block groups have greater access to both healthy and unhealthy food outlets. The density of unhealthy establishments was greater in more disadvantaged areas; however, because of having greater access to grocery stores, disadvantaged populations have less obesogenic total food environments. Structural changes are needed to reduce access to unhealthy food outlets to ensure environmental injustice and reduce obesity risk.
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Neighborhood Deprivation and Risks of Autoimmune Disorders: A National Cohort Study in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203798. [PMID: 31601008 PMCID: PMC6843782 DOI: 10.3390/ijerph16203798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 11/24/2022]
Abstract
Background: No study to date, as far as we know, has analyzed the potential effect of neighborhood-level deprivation on autoimmune disorders (ADs), when adjusted for individual-level characteristics. Methods: A total of 5.4 million individuals from 8363 neighborhoods, comprising the whole Swedish population (ages 25–74 years), were followed for the period 1 January 2000, until admission due to diagnosis of ADs during the period of the study, or the conclusion of the study (31 December 2010). We used a neighborhood deprivation index, constructed from variables such as low education, low income, unemployment, and social welfare assistance, to assess the level of neighborhood deprivation. Multilevel logistic regression was used in the analysis with individual level characteristics at the first level and level of neighborhood deprivation at the second level. Results: A significant association between level of neighborhood deprivation and ADs was found. The crude odds were 1.32 (95% confidence interval 1.27–1.36) for those residing in the high-deprived neighborhoods compared to those living in low-deprivation neighborhoods. In the full model, where individual level characteristics were taken into account, the odds of ADs were 1.18 (1.14–1.22) in the most deprived neighborhoods. Certain Ads—angiitis hypersensitive (5.14), ankylosing spondylitis (1.66), celiac disease (1.65), Crohn’s disease (1.21), diabetes mellitus type 1 (1.45), Graves’s disease (1.13), Hashimoto thyroiditis (1.51), psoriasis (1.15), rheumatoid arthritis (1.15), sarcoidosis (1.20), and systemic sclerosis (1.27)—remained significantly associated with high level of neighborhood deprivation after adjustment for the individual-level variables. Conclusion: This study is the largest to date analyzing the potential influence of neighborhood deprivation on ADs. Our results indicate that neighborhood deprivation may affect risk of ADs, independent of individual level sociodemographic characteristics. For health care policies, both individual and neighborhood level approaches seem to be of importance.
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10
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Lönn SL, Melander O, Crump C, Sundquist K. Accumulated neighbourhood deprivation and coronary heart disease: a nationwide cohort study from Sweden. BMJ Open 2019; 9:e029248. [PMID: 31530598 PMCID: PMC6756571 DOI: 10.1136/bmjopen-2019-029248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Neighbourhood deprivation is a recognised predictor of coronary heart disease (CHD). The overall aim was to investigate if accumulated exposure to neighbourhood deprivation resulted in higher odds of CHD. DESIGN This is a longitudinal cohort study. Models based on repeated assessments of neighbourhood deprivation as well as single-point-in-time assessments were compared. SETTING Sweden. PARTICIPANTS 3 140 657 Swedish men and women without a history of CHD and who had neighbourhood deprivation exposure data over the past 15 years. PRIMARY OUTCOME MEASURES CHD within 5 years' follow-up. RESULTS The results suggested a gradient of stronger association with CHD risk by longer cumulative exposures to neighbourhood deprivation, particularly in the younger age cohorts. Neighbourhood deprivation was also highly correlated over time, especially in older age cohorts. CONCLUSIONS The effect of neighbourhood deprivation on CHD might depend on age. Accounting for individuals' baseline age may therefore be important for understanding neighbourhood environmental effects on the development of CHD over time. However, because of high correlation of neighbourhood deprivation over time, single-point-in-time assessments may be adequate for CHD risk prediction especially in older adults.
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Affiliation(s)
- Sara Larsson Lönn
- Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Olle Melander
- Cardiovascular Research - Hypertension, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Casey Crump
- Department of Clinical Sciences, Malmö, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
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11
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Berglund E, Lytsy P, Westerling R. Living environment, social support, and informal caregiving are associated with healthcare seeking behaviour and adherence to medication treatment: A cross-sectional population study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1260-1270. [PMID: 31016806 PMCID: PMC6850350 DOI: 10.1111/hsc.12758] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 03/06/2019] [Accepted: 03/21/2019] [Indexed: 05/06/2023]
Abstract
Despite the well-known associations between local environment and health, few studies have focused on environment and healthcare utilisation, for instance healthcare seeking behaviour or adherence. This study was aimed at analysing housing type, behaviour based on perceived local outdoor safety, social support, informal caregiving, demographics, socioeconomics, and long-term illness, and associations with health-seeking and adherence behaviours at a population level. This study used data from the Swedish National Public Health Survey 2004-2014, an annually repeated, large sample, cross-sectional, population-based survey study. In all, questionnaires from 100,433 individuals were returned by post, making the response rate 52.9% (100,433/190,000). Descriptive statistics and multiple logistic regressions were used to investigate associations between explanatory variables and the outcomes of refraining from seeking care and non-adherence behaviour. Living in rented apartment, lodger, a dorm or other was associated with reporting refraining from seeking care (adjusted OR 1.16, 95% CI 1.00-1.22), and non-adherence (adjusted OR 1.22; 95% CI 1.13-1.31). Refraining from going out due to a perceived unsafe neighbourhood was associated with refraining from seeking care (adjusted OR 1.59, 95% CI 1.51-1.67) and non-adherence (adjusted OR 1.26, 95% CI 1.17-1.36). Social support and status as an informal caregiver was associated with higher odds of refraining from seeking medical care and non-adherence. This study suggests that living in rental housing, refraining from going out due to neighbourhood safety concerns, lack of social support or informal caregiver status are associated with lower health-seeking behaviour and non-adherence to prescribed medication.
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Affiliation(s)
- Erik Berglund
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Per Lytsy
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
- Division of Insurance Medicine, Department of Clinical NeuroscienceKarolinska InstituteStockholmSweden
| | - Ragnar Westerling
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
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12
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Dornelles A. Impact of multiple food environments on body mass index. PLoS One 2019; 14:e0219365. [PMID: 31390365 PMCID: PMC6685601 DOI: 10.1371/journal.pone.0219365] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/23/2019] [Indexed: 12/02/2022] Open
Abstract
Background Although the relationship between residential food environments and health outcomes have been extensively studied, the relationship between body mass index (BMI) and multiple food environments have not been fully explored. We examined the relationship between characteristics of three distinct food environments and BMI among elementary school employees in the metropolitan area of New Orleans, LA. We assessed the food environments around the residential and worksite neighborhoods and the commuting corridors. Research methodology/principal findings This study combined data from three different sources: individual and worksite data (ACTION), food retailer database (Dunn and Bradstreet), and the U.S. Census TIGER/Line Files. Spatial and hierarchical analyses were performed to explore the impact of predictors at the individual and environmental levels on BMI. When the three food environments were combined, the number of supermarkets and the number of grocery stores at residential food environment had a significant association with BMI (β = 0.56 and β = 0.24, p < 0.01), whereas the number of full-service restaurants showed an inverse relationship with BMI (β = -0.15, p < 0.001). For the commute corridor food environment, it was found that each additional fast-food restaurant in a vicinity of one kilometer traveled contributed to a higher BMI (β = 0.80, p <0.05), while adjusting for other factors. No statistical associations were found between BMI and worksite food environment. Conclusions The current study was the first to examine the relationship between BMI and food environments around residential neighborhoods, work neighborhoods, and the commuting corridor. Significant results were found between BMI and the availability of food stores around residential neighborhoods and the commuting corridor, adjusted for individual-level factors. This study expands the analysis beyond residential neighborhoods, illustrating the importance of multiple environmental factors in relation to BMI.
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Affiliation(s)
- Adriana Dornelles
- Department of Economics, Arizona State University, Tempe, AZ, United States of America
- * E-mail:
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13
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Rachele JN, Schmid CJ, Brown WJ, Nathan A, Kamphuis CB, Turrell G. A multilevel study of neighborhood disadvantage, individual socioeconomic position, and body mass index: Exploring cross-level interaction effects. Prev Med Rep 2019; 14:100844. [PMID: 30997324 PMCID: PMC6453828 DOI: 10.1016/j.pmedr.2019.100844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/11/2019] [Accepted: 03/14/2019] [Indexed: 11/25/2022] Open
Abstract
This study examined associations between neighborhood disadvantage and body mass index (BMI), and tested whether this differed by level of individual socioeconomic position (SEP). Data were from 9953 residents living in 200 neighborhoods in Brisbane, Australia in 2007. Multilevel linear regression analyses were undertaken by gender to determine associations between neighborhood disadvantage, individual SEP (education, occupation and household income) and BMI (from self-reported height and weight); with cross-level interactions testing whether the relationship between neighborhood disadvantage and BMI differed by level of individual SEP. Both men (Quintile 4, where Quintile 5 is the most disadvantaged β = 0.66 95%CI 0.20, 1.12) and women (Quintile 5 β = 1.32 95%CI 0.76, 1.87) from more disadvantaged neighborhoods had a higher BMI. BMI was significantly higher for those with lower educational attainment (men β = 0.71 95%CI 0.36, 1.07 and women β = 1.66 95%CI 0.78, 1.54), and significantly lower for those in blue collar occupations (men β = -0.67 95%CI -1.09, -0.25 and women β = -0.71 95%CI -1.40, -0.01). Among men, those with a lower income had a significantly lower BMI, while the opposite was found among women. None of the interaction models had a significantly better fit than the random intercept models. The relationship between neighborhood disadvantage and BMI did not differ by level of education, occupation, or household income. This suggests that individual SEP is unlikely to be an effector modifier of the relationship between neighborhood disadvantage and BMI. Further research is required to assist policy-makers to make more informed decisions about where to intervene to counteract BMI-inequalities.
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Affiliation(s)
- Jerome N. Rachele
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Christina J. Schmid
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane 4059, Australia
| | - Wendy J. Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, Australia
| | - Andrea Nathan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Australia
| | - Carlijn B.M. Kamphuis
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Netherlands
| | - Gavin Turrell
- School of Health and Social Development, Centre for Population Health Research, Deakin University, Australia
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14
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Li X, Sundquist J, Forsberg PO, Sundquist K. Association Between Neighborhood Deprivation and Heart Failure Among Patients With Diabetes Mellitus: A 10-Year Follow-Up Study in Sweden. J Card Fail 2019; 26:193-199. [PMID: 31051260 DOI: 10.1016/j.cardfail.2019.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/07/2019] [Accepted: 04/29/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Our aim was to study the potential effect of neighborhood deprivation on incident heart failure (HF) in patients with diabetes mellitus (DM). METHODS The study population included adults (n = 434,542) aged 30 years or older with DM followed from 2005 to 2015 in Sweden for incident HF. The association between neighborhood deprivation and the outcome was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). All models were conducted in both men and women and adjusted for age, educational level, family income, employment status, region of residence, immigrant status, marital status, mobility, and comorbidities. DM patients living in neighborhoods with high or moderate levels of deprivation were compared with those living in neighborhoods with low deprivation scores (reference group). RESULTS There was an association between level of neighborhood deprivation and HF in DM patients. The HRs were 1.27, 95% CI 1.21-1.33, for men and 1.30, 95% CI 1.23-1.37, for women) among DM patients living in high deprivation neighborhoods compared with those from low deprivation neighborhoods. After adjustments for potential confounders, the higher HRs of HF remained significant: 1.11, 95% CI 1.06-1.16, in men and 1.15, 95% CI 1.09-1.21, in women living in high deprivation neighborhoods. CONCLUSIONS Increased incidence rates of HF among DM patients living in deprived neighborhoods raise important clinical and public health concerns. These findings could serve as an aid to policy-makers when allocating resources in primary health-care settings as well as to clinicians who encounter patients in deprived neighborhoods.
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Affiliation(s)
- Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA; Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan
| | - Per-Ola Forsberg
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA; Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan
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15
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Li X, Sundquist J, Hamano T, Sundquist K. Family and neighborhood socioeconomic inequality in cryptorchidism and hypospadias: A nationwide study from Sweden. Birth Defects Res 2019; 111:78-87. [PMID: 30561158 DOI: 10.1002/bdr2.1444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/15/2018] [Accepted: 10/21/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To examine whether there is an association between neighborhood deprivation and incidence of cryptorchidism and hypospadias, after accounting for family-level and individual-level sociodemographic characteristics. METHODS All boys born in Sweden between January 1, 2001 and December 31, 2010 were followed. Data were analyzed by multilevel logistic regression, with family-level and individual-level characteristics at the first level and level of neighborhood deprivation at the second level. RESULTS During the study period, among a total of 497,584 boys, 8,584 (1.7%) and 3,704 (0.7%) were diagnosed with cryptorchidism and hypospadias, respectively. Cumulative rates for cryptorchidism and hypospadias increased with increasing levels of neighborhood deprivation. In the study population, 1.5 per 100 and 2.0 per 100 boys, in the least and most deprived neighborhoods were diagnosed with cryptorchidism and 0.7 per 100 and 0.9 per 100 boys were diagnosed with hypospadias. Incidence of hospitalization for cryptorchidism and hypospadias increased with increasing neighborhood-level deprivation across all family-level and individual-level sociodemographic categories. The odds ratio (OR) for cryptorchidism and hypospadias for those living in high-deprivation neighborhoods versus those living in low-deprivation neighborhoods was 1.13 (95% confidence interval [CI] = 1.05-1.21) and 1.24 (95% CI = 1.12-1.37). High neighborhood deprivation remained significantly associated with higher odds of hypospadias after adjustment for family-level and individual-level sociodemographic characteristics (OR = 1.20, 95% CI = 1.08-1.35). CONCLUSIONS This study is the largest so far on neighborhood influences on cryptorchidism and hypospadias. Our results suggest that neighborhood deprivation is associated with a moderate incidence of hypospadias independent of family-level and individual-level sociodemographic characteristics.
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Affiliation(s)
- Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Functional Pathology, Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Izumo, Japan
| | - Tsuyoshi Hamano
- Department of Functional Pathology, Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Izumo, Japan.,Department of Sports Sociology and Health Sciences, Kyoto Sangyo University, Kyoto, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Functional Pathology, Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Izumo, Japan
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16
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Rachele JN, Kavanagh AM, Brown WJ, Healy AM, Turrell G. Neighborhood Disadvantage and Body Mass Index: A Study of Residential Relocation. Am J Epidemiol 2018; 187:1696-1703. [PMID: 29351569 DOI: 10.1093/aje/kwx390] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/22/2017] [Indexed: 11/12/2022] Open
Abstract
Natural experiments, such as longitudinal observational studies that follow-up residents as they relocate, provide a strong basis to infer causation between the neighborhood environment and health. In this study, we examined whether changes in the level of neighborhood disadvantage were associated with changes in body mass index (BMI) after residential relocation. This analysis included data from 928 residents who relocated between 2007 and 2013, across 4 waves of the How Areas in Brisbane Influence Health and Activity (HABITAT) study in Brisbane, Australia. Neighborhood disadvantage was measured using a census-derived composite index. For individual-level data, participants self-reported their height, weight, education, occupation, and household income. Data were analyzed using multilevel, hybrid linear models. Women residing in less disadvantaged neighborhoods had a lower BMI, but there was no association among men. Neighborhood disadvantage was not associated with within-individual changes in BMI among men or women when moving to a new neighborhood. Despite a growing body of literature suggesting an association between neighborhood disadvantage and BMI, we found this association may not be causal among middle-aged and older adults. Observing associations between neighborhood socioeconomic disadvantage and BMI over the life course, including the impact of residential relocation at younger ages, remains a priority for future research.
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Affiliation(s)
- Jerome N Rachele
- Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Anne M Kavanagh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Aislinn M Healy
- Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia
| | - Gavin Turrell
- Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia
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17
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Mamudu HM, Jones A, Paul T, Subedi P, Wang L, Alamian A, Alamin AE, Blackwell G, Budoff M. Geographic and Individual Correlates of Subclinical Atherosclerosis in an Asymptomatic Rural Appalachian Population. Am J Med Sci 2018; 355:140-148. [DOI: 10.1016/j.amjms.2017.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 06/26/2017] [Accepted: 08/18/2017] [Indexed: 01/13/2023]
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18
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Algren MH, Ekholm O, van Lenthe F, Mackenbach J, Bak CK, Andersen PT. Health-risk behaviour among residents in deprived neighbourhoods compared with those of the general population in Denmark: A cross-sectional study. Health Place 2017; 45:189-198. [PMID: 28412595 DOI: 10.1016/j.healthplace.2017.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
This study compares health-risk behaviours (including the co-occurrence of health-risk behaviours) of residents in the deprived neighbourhoods with those of the general population of Denmark. It also examines associations between sociodemographic and socioeconomic characteristics and health-risk behaviours in deprived neighbourhoods in Denmark. Even after adjustment for socioeconomic characteristics there were large differences in health-risk behaviours between residents in deprived neighbourhoods and the general population. In the deprived neighbourhoods large sociodemographic and socioeconomic differences in health-risk behaviours were found among the residents. Our findings highlight the need for health promotion programmes targeting residents in deprived neighbourhoods.
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Affiliation(s)
- Maria Holst Algren
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark.
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, 1353 Copenhagen, Denmark
| | - Frank van Lenthe
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Johan Mackenbach
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Carsten Kronborg Bak
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg, Denmark
| | - Pernille Tanggaard Andersen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
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19
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Myers CA, Denstel KD, Broyles ST. The context of context: Examining the associations between healthy and unhealthy measures of neighborhood food, physical activity, and social environments. Prev Med 2016; 93:21-26. [PMID: 27612577 PMCID: PMC5118080 DOI: 10.1016/j.ypmed.2016.09.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/26/2016] [Accepted: 09/05/2016] [Indexed: 11/15/2022]
Abstract
Multilevel health research often focuses on a singular dimension of the neighborhood environment in relation to individual-level health behaviors (e.g., diet, physical activity) and outcomes (e.g., obesity). This study examined associations between healthy and unhealthy neighborhood features across food, physical activity, and social environments. We used neighborhood-level (i.e., census block group) access (0/1) measures of the 1) food (grocery store, convenience store, fast food restaurant), 2) physical activity (fitness/recreation facility, park), and 3) social (crime, renter occupancy) environments to capture both healthy and unhealthy neighborhood features for a sample of neighborhoods (n=126) in East Baton Rouge Parish, Louisiana, United States. We employed a) bivariate correlations, or spatial regression where necessary, to identify significant associations between neighborhood access measures; and b) two-step cluster analysis to identify neighborhood typologies based upon neighborhood access measures. Results demonstrated multiple significant associations between healthy and unhealthy access measures across the three neighborhood environments. Cluster analysis further confirmed that neighborhoods are not completely healthy or unhealthy, but rather can be characterized by neighborhood features that are both health-promoting and health-constraining. This study elucidates a 'context of context' whereby no singular aspect of a neighborhood completely explains health in individuals. Rather, in order to effectively model the association between neighborhood and individual-level health, it may be necessary to account for the inter-related nature of neighborhood features.
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Affiliation(s)
- Candice A Myers
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.
| | - Kara D Denstel
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
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20
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Evans JD, Kaptoge S, Caleyachetty R, Di Angelantonio E, Lewis C, Parameshwar KJ, Pettit SJ. Socioeconomic Deprivation and Survival After Heart Transplantation in England. Circ Cardiovasc Qual Outcomes 2016; 9:695-703. [DOI: 10.1161/circoutcomes.116.002652] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022]
Abstract
Background—
Socioeconomic deprivation (SED) is associated with shorter survival across a range of cardiovascular and noncardiovascular diseases. The association of SED with survival after heart transplantation in England, where there is universal healthcare provision, is unknown.
Methods and Results—
Long-term follow-up data were obtained for all patients in England who underwent heart transplantation between 1995 and 2014. We used the United Kingdom Index of Multiple Deprivation (UK IMD), a neighborhood level measure of SED, to estimate the relative degree of deprivation for each recipient. Cox proportional hazard models were used to examine the association between SED and overall survival and conditional survival (dependant on survival at 1 year after transplantation) during follow-up. Models were stratified by transplant center and adjusted for donor and recipient age and sex, ethnicity, serum creatinine, diabetes mellitus, and heart failure cause. A total of 2384 patients underwent heart transplantation. There were 1101 deaths during 17 040 patient-year follow-up. Median overall survival was 12.6 years, and conditional survival was 15.6 years. Comparing the most deprived with the least deprived quintile, adjusted hazard ratios for all-cause mortality were 1.27 (1.04–1.55;
P
=0.021) and 1.59 (1.22–2.09;
P
=0.001) in the overall and conditional models, respectively. Median overall survival and conditional survival were 3.4 years shorter in the most deprived quintile than in the least deprived.
Conclusions—
Higher SED is associated with shorter survival in heart transplant recipients in England and should be considered when comparing outcomes between centers. Future research should seek to identify modifiable mediators of this association.
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Affiliation(s)
- Jonathan D.W. Evans
- From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.)
| | - Stephen Kaptoge
- From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.)
| | - Rishi Caleyachetty
- From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.)
| | - Emanuele Di Angelantonio
- From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.)
| | - Clive Lewis
- From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.)
| | - K. Jayan Parameshwar
- From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.)
| | - Stephen J. Pettit
- From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.)
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Cubbin C, Sundquist K, Ahlén H, Johansson SE, Winkleby MA, Sundquist J. Neighborhood deprivation and cardiovascular disease risk factors: Protective and harmful effects. ACTA ACUST UNITED AC 2016; 34:228-37. [PMID: 16754580 DOI: 10.1080/14034940500327935] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIMS To determine whether neighborhood-level deprivation is independently associated with cardiovascular disease (CVD) health behaviors/risk factors in the Swedish population. METHODS Pooled cross-sectional data, Swedish Annual Level of Living Survey (1996-2000) linked with indicators of neighborhood-level (i.e. Small Area Market Statistics areas) deprivation (1997), to examine the association between neighborhood-level deprivation and individual-level smoking, physical inactivity, obesity, diabetes, and hypertension among women and men, aged 25-64 (n = 18,081). Data were analyzed with a series of logistic regression models that adjusted for individual-level age, gender, marital status, immigration status, urbanization, and a comprehensive measure of socioeconomic status (SES). Interactions were tested to determine whether neighborhood effects varied by SES or length of neighborhood exposure. RESULTS Living in a neighborhood with low deprivation was protective (i.e. lower odds) for smoking, while living in a neighborhood with high deprivation was harmful (i.e. higher odds) for smoking, physical inactivity, and obesity (compared with living in a neighborhood with moderate deprivation). These associations were significant after adjustment for individual-level characteristics. There was no evidence that the neighborhood deprivation associations varied by individual-level SES or length of neighborhood exposure. CONCLUSIONS Neighborhood-level deprivation exerted important protective and harmful associations with health behaviors/risk factors related to CVD. The significance to public health is substantial because of the number of persons at risk as well as the serious health consequences of CVD. These results suggest that interventions focusing on changing contextual aspects of neighborhoods, in addition to changing individual behaviors, may have a greater impact on CVD than a sole focus on individuals.
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Affiliation(s)
- Catherine Cubbin
- Center on Social Disparities in Health, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California 94143-0900, USA.
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22
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Winkleby MA, Cubbin C. Changing Patterns in Health Behaviors and Risk Factors Related to Chronic Diseases, 1990–2000. Am J Health Promot 2016; 19:19-27. [PMID: 15460097 DOI: 10.4278/0890-1171-19.1.19] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose. Assess changes in chronic disease-related health behaviors and risk factors from 1990 to 2000, by race/ethnicity, age, and gender. Design. Stratified cross-sectional design. Setting. United States. Subjects. 16,948 black, 11,956 Hispanic, and 158,707 white women and men, ages 18 to 74. Measures. Cigarette smoking, obesity, sedentary behavior, low vegetable or fruit intake. From the Behavioral Risk Factor Surveillance System. Results. Young women and men, ages 18 to 24, had poor health profiles and experienced adverse changes from 1990 to 2000. After the variables were adjusted for education and income, these young people had the highest prevalence of smoking (34%–36% current smokers among white women and men), the largest increases in smoking (10%–12% increase among white women and men; 9% increase among Hispanic women), and large increases in obesity (4%–9% increase, all gender and racial/ethnic groups). Young women and men from each racial/ethnic group also had high levels of sedentary behavior (approximately 20%–30%) and low vegetable or fruit intake (approximately 35%–50%). In contrast, older Hispanic women and men and older black men, ages 65 to 74, showed some of the most positive changes. They had the largest decreases in smoking (Hispanic women), largest decreases in sedentary behavior (Hispanic women and black men), and largest increases in vegetable or fruit intake (Hispanic women and men, and black men). Conclusion. The poor and worsening health profile of young women and men is a particular concern, as they will soon enter the ages of high chronic disease burden.
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Affiliation(s)
- Marilyn A Winkleby
- Stanford Prevention Research Center, Stanford University School of Medicine, 211 Quarry Road, Room N229, Stanford, CA 94305-5705, USA.
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23
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Yen IH, Scherzer T, Cubbin C, Gonzalez A, Winkleby MA. Women's Perceptions of Neighborhood Resources and Hazards Related to Diet, Physical Activity, and Smoking: Focus Group Results from Economically Distinct Neighborhoods in a Mid-Sized U.S. City. Am J Health Promot 2016; 22:98-106. [DOI: 10.4278/0890-1171-22.2.98] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To investigate women's perceptions of neighborhood resources and hazards associated with poor diet, physical inactivity, and cigarette smoking. Design. After interviewing city officials and analyzing visual assessments, three economically distinct neighborhoods in a mid-sized city were selected. Setting. Salinas, California, a predominantly Latino city. Methods. Eight focus groups, conducted in Spanish or English in the three neighborhoods. Thematic coding of focus group transcripts identified key concepts. Women also mapped their perceived neighborhood boundaries. Participants. Women who had at least one child under age 18 living with them. Results. Women identified food stores, parks, recreation areas, and schools as key resources in their neighborhoods. They identified fast food restaurants, convenience stores, violent crime, gangs, and drug-associated issues as “hazards.” Distinctions between resources and hazards were not always clear cut. For example, parks were sometimes considered dangerous, and fast food restaurants were sometimes considered a convenient and inexpensive way to feed one's family. Women's perceptions of their neighborhood boundaries differed greatly by type of neighborhood—the perceived neighborhood area (in acres) drawn by women in the lower-income neighborhood was one-fourth the size of the area drawn by women in the higher-income neighborhood. Conclusion. This qualitative, exploratory study illustrates how resources and hazards in one's neighborhood cannot be viewed as having solely one dimension—each may influence health behaviors both positively and negatively.
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Affiliation(s)
- Irene H. Yen
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
| | - Teresa Scherzer
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
| | - Catherine Cubbin
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
| | - Alma Gonzalez
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
| | - Marilyn A. Winkleby
- Irene H. Yen, PhD; Teresa Scherzer, PhD; and Catherine Cubbin, PhD, are with the University of California San Francisco. Alma Gonzalez, MPH, and Marilyn A. Winkleby, PhD, MPH, are with the Stanford Prevention Research Center, Stanford University, California
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Calling S, Li X, Kawakami N, Hamano T, Sundquist K. Impact of neighborhood resources on cardiovascular disease: a nationwide six-year follow-up. BMC Public Health 2016; 16:634. [PMID: 27456491 PMCID: PMC4960746 DOI: 10.1186/s12889-016-3293-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 07/12/2016] [Indexed: 11/12/2022] Open
Abstract
Background Living in a socially deprived neighborhood is associated with lifestyle risk factors, e.g., smoking, physical inactivity and unhealthy diet, as well as an increased risk of cardiovascular disease, i.e., coronary heart disease and stroke. The aim was to study whether the odds of cardiovascular disease vary with the neighbourhood availability of potentially health-damaging and health-promoting resources. Methods A nationwide sample of 2 040 826 men and 2 153 426 women aged 35–80 years were followed for six years for first hospitalization of coronary heart disease or stroke. Neighborhood availability of health-damaging resources (i.e., fast-food restaurants and bars/pubs) and health-promoting resources (i.e., health care facilities and physical activity facilities) were determined by use of geographic information systems (GIS). Results We found small or modestly increased odds ratios (ORs) for both coronary heart disease and stroke, related to the availability of both health-damaging and health-promoting resources. For example, in women, the unadjusted OR (95 % confidence interval) for stroke in relation to availability of fast-food restaurants was 1.18 (1.15–1.21). Similar patterns were observed in men, with an OR = 1.08 (1.05–1.10). However, the associations became weaker or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income. Conclusions This six year follow-up study shows that neighborhood availability of potentially health-damaging as well as health-promoting resources may make a small contribution to the risk of coronary heart disease and stroke. However, most of these associations were attenuated or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income. Future studies are needed to further examine factors in the causal pathway between neighborhood deprivation and cardiovascular disease. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3293-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanna Calling
- Department of Clinical Sciences, Center for Primary Health Care Research, Skåne University Hospital, Lund University, Clinical Research Centre (CRC), Building 28, floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.
| | - Xinjun Li
- Department of Clinical Sciences, Center for Primary Health Care Research, Skåne University Hospital, Lund University, Clinical Research Centre (CRC), Building 28, floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
| | - Naomi Kawakami
- Waseda Institute of Sport Sciences, Waseda University, Tokorozawa Saitama, Japan
| | - Tsuyoshi Hamano
- Center for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan
| | - Kristina Sundquist
- Department of Clinical Sciences, Center for Primary Health Care Research, Skåne University Hospital, Lund University, Clinical Research Centre (CRC), Building 28, floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.,Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
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25
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Rezazadeh A, Omidvar N, Eini-Zinab H, Ghazi-Tabatabaie M, Majdzadeh R, Ghavamzadeh S, Nouri-Saeidlou S. General and Central Obesity in Two Iranian Ethnic Groups Living in Urmia, West Azerbaijan, Iran: Effect of the Neighborhood Environment. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e27591. [PMID: 27651949 PMCID: PMC5020783 DOI: 10.5812/ircmj.27591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 02/17/2015] [Accepted: 03/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emerging evidence suggests that neighborhood characteristics can have direct and indirect effects on the weight status of the residents. OBJECTIVES To assess the relationship between general and central obesity and the neighborhood environment in two ethnic groups (Azeri Turks and Kurds) living in Urmia city, Northwestern Iran. PATIENTS AND METHODS In this cross-sectional study, 723 participants (427 women and 296 men) aged 20 - 64 years from two ethnic groups (Azeri Turks, n = 445; Kurds, n = 278) were selected from 38 neighborhoods using a combination of cluster, random, and systematic sampling methods. Neighborhood characteristics were obtained by a validated 22-item neighborhood and a health observational checklist. General and central obesity were measured and evaluated using standard methods. Principal component analysis (PCA) was used to define the dominant neighborhood environment. The association of neighborhood characteristics with general and central obesity was analyzed by a logistic regression model. RESULTS Three common neighborhood environments were identified: 1) modern-affluent, 2) central-high access and 3) marginal. These three factors explained 73.2% of the total variance. Overall, the participants living in a higher tertile of the central-high access neighborhoods had an increased chance of central obesity (OR = 1.63, 95% CI: 1.13 - 2.34). Azeri Turks living in the highest tertile of the modern-affluent neighborhoods had a significantly higher likelihood of having general obesity (OR = 2.49, 95% CI: 1.37 - 4.01). Adjustment for age, gender, marital status, socioeconomic status (SES), energy intake, and physical activity did not change the results. However, after adjustment for educational level, the association was not significant. CONCLUSIONS The findings point to a relationship between neighborhood characteristics and obesity only in the Azeri Turks. However, educational level was more important than neighborhood quality in predicting the risk of obesity.
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Affiliation(s)
- Arezoo Rezazadeh
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Hassan Eini-Zinab
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | | | - Reza Majdzadeh
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Saeid Ghavamzadeh
- Nutrition Department, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, IR Iran
| | - Sakineh Nouri-Saeidlou
- Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia, IR Iran
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26
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van Deurzen I, Rod NH, Christensen U, Hansen ÅM, Lund R, Dich N. Neighborhood perceptions and allostatic load: Evidence from Denmark. Health Place 2016; 40:1-8. [DOI: 10.1016/j.healthplace.2016.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/04/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
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Spangler-Murphy E, Krummel DA, Morrison N, Gordon PM. Environmental Perceptions Related to Physical Activity in High- and Low-Risk Counties. Health Promot Pract 2016; 6:57-63. [PMID: 15574529 DOI: 10.1177/1524839903260157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To identify whether perceptions about the physical activity environment were related to the prevalence of sedentary lifestyle, residents from high-risk (n = 153) or low-risk (n = 100) counties were interviewed. County risk status was determined by the prevalence of cardiovascular mortality, overweight, and sedentary lifestyle. Key public officials in the same counties were also interviewed. Residents in the low-risk county were more likely to report having sidewalks in their community and that these sidewalks were safe and well lit than residents living in the high-risk counties. Low-risk county residents also reported more indoor recreation facilities being available than the residents in the high-risk counties. Residents supported allocating tax dollars toward improving sidewalks, lighting, and so on. Thus a more conducive environment for physical activity was found in the low-risk county. Improving physical environments and individual perceptions could help increase physical activity behavior.
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Affiliation(s)
- Emily Spangler-Murphy
- Division of Exercise Physiology in the School of Medicine at West Virginia University in Morgantown, USA
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28
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Rachele JN, Wood L, Nathan A, Giskes K, Turrell G. Neighbourhood disadvantage and smoking: Examining the role of neighbourhood-level psychosocial characteristics. Health Place 2016; 40:98-105. [PMID: 27228312 DOI: 10.1016/j.healthplace.2016.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE This study aims to determine if neighbourhood psychosocial characteristics contribute to inequalities in smoking among residents from neighbourhoods of differing socioeconomic disadvantage. METHODS This cross-sectional study includes 11,035 residents from 200 neighbourhoods in Brisbane, Australia in 2007. Self-reported measures were obtained for smoking and neighbourhood psychosocial characteristics (perceptions of incivilities, crime and safety, and social cohesion). Neighbourhood socioeconomic disadvantage was measured using a census-derived index. Data were analysed using multilevel logistic regression random intercept models. RESULTS Smoking was associated with neighbourhood disadvantage; this relationship remained after adjustment for individual-level socioeconomic position. Area-level perceptions of crime and safety and social cohesion were not independently associated with smoking, and did not explain the higher prevalence of smoking in disadvantaged areas; however, perceptions of incivilities showed an independent effect. CONCLUSIONS Some neighbourhood psychosocial characteristics seem to contribute to the higher rates of smoking in disadvantaged areas.
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Affiliation(s)
- Jerome N Rachele
- Institute for Health and Ageing, Australian Catholic University, Australia; School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia; School of Population and Global Health, University of Melbourne, Australia.
| | - Lisa Wood
- School of Population Health, University of Western Australia, Perth, Australia.
| | - Andrea Nathan
- Institute for Health and Ageing, Australian Catholic University, Australia; School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia.
| | - Katrina Giskes
- Faculty of Medicine, University of Sydney, Sydney, Australia.
| | - Gavin Turrell
- Institute for Health and Ageing, Australian Catholic University, Australia; School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia; School of Population and Global Health, University of Melbourne, Australia.
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29
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Kinge JM, Steingrímsdóttir ÓA, Strand BH, Kravdal Ø. Can socioeconomic factors explain geographic variation in overweight in Norway? SSM Popul Health 2016; 2:333-340. [PMID: 29349151 PMCID: PMC5757901 DOI: 10.1016/j.ssmph.2016.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/01/2016] [Accepted: 04/28/2016] [Indexed: 11/24/2022] Open
Abstract
We explore if the geographic variation in excess body-mass in Norway can be explained by socioeconomic status, as this has consequences for public policy. The analysis was based on individual height and weight for 198,311 Norwegian youth in 2011, 2012 and 2013, stemming from a compulsory screening for military service, which covers the whole population aged seventeen. These data were merged with municipality-level socioeconomic status (SES) variables and we estimated both ecological models and two-level models with a random term at the municipality level. Overweight was negatively associated with income, education and occupation at municipality level. Furthermore, the municipality-level variance in overweight was reduced by 57% in females and 40% in males, when SES factors were taken into account. This suggests that successful interventions aimed at reducing socioeconomic variation in overweight will also contribute to reducing the geographic variation in overweight, especially in females.
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Affiliation(s)
- Jonas Minet Kinge
- Norwegian Institute of Public Health (NIPH), Oslo 0170, Norway.,University of Oslo, Oslo, Norway
| | | | - Bjørn Heine Strand
- Norwegian Institute of Public Health (NIPH), Oslo 0170, Norway.,University of Oslo, Oslo, Norway
| | - Øystein Kravdal
- Norwegian Institute of Public Health (NIPH), Oslo 0170, Norway.,University of Oslo, Oslo, Norway
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30
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Hamano T, Li X, Tanito M, Nabika T, Shiwaku K, Sundquist J, Sundquist K. Neighborhood Deprivation and Risk of Age-Related Eye Diseases: A Follow-up Study in Sweden. Ophthalmic Epidemiol 2016; 22:308-20. [PMID: 26395658 DOI: 10.3109/09286586.2015.1056537] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine whether there is an association between neighborhood deprivation and age-related eye diseases, particularly macular degeneration, cataract, diabetes-related eye complications, and glaucoma. METHODS The study population comprised a nationwide sample of 2,060,887 men and 2,250,851 women aged 40 years or older living in Sweden who were followed from 1 January 2000 until the first hospitalization/outpatient registration for age-related eye disease during the study period, death, emigration, or the end of the study period on 31 December 2010. Multilevel logistic regression was used to estimate the association between neighborhood deprivation and age-related eye diseases. RESULTS In men, the odds ratio (OR) for age-related eye diseases for those living in high-deprivation neighborhoods compared to those living in low-deprivation neighborhoods remained significant after adjustment for potential confounding factors (macular degeneration, OR 1.08, 95% confidence interval [CI] 1.03-1.12; cataract, OR 1.31, 95% CI 1.26-1.35; diabetes-related eye complications, OR 1.36, 95% CI 1.30-1.43; glaucoma, OR 1.11, 95% CI 1.06-1.15). In women, similar patterns were observed (macular degeneration, OR 1.11, 95% CI 1.07-1.15; cataract, OR 1.36, 95% CI 1.31-1.40; diabetes-related eye complications, OR 1.50, 95% CI 1.42-1.59; glaucoma, OR 1.12, 95% CI 1.08-1.17). CONCLUSION Our results suggest that neighborhood deprivation is associated with age-related eye diseases in both men and women. These results implicate that individual- as well as neighborhood-level factors are important for preventing age-related eye diseases.
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Affiliation(s)
- Tsuyoshi Hamano
- a Centre for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University , Izumo , Japan
| | - Xinjun Li
- b Center for Primary Health Care Research, Lund University , Malmö , Sweden
| | - Masaki Tanito
- c Division of Ophthalmology , Matsue Red Cross Hospital , Matsue , Japan
| | - Toru Nabika
- a Centre for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University , Izumo , Japan .,d Department of Functional Pathology , Shimane University School of Medicine , Izumo , Japan
| | - Kuninori Shiwaku
- a Centre for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University , Izumo , Japan .,e Department of Environmental and Preventive Medicine , Shimane University School of Medicine , Izumo , Japan , and
| | - Jan Sundquist
- b Center for Primary Health Care Research, Lund University , Malmö , Sweden .,f Stanford Prevention Research Center, Stanford University School of Medicine , Stanford , CA , USA
| | - Kristina Sundquist
- b Center for Primary Health Care Research, Lund University , Malmö , Sweden .,f Stanford Prevention Research Center, Stanford University School of Medicine , Stanford , CA , USA
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31
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Bijker R, Agyemang C. The influence of early-life conditions on cardiovascular disease later in life among ethnic minority populations: a systematic review. Intern Emerg Med 2016; 11:341-53. [PMID: 26141120 DOI: 10.1007/s11739-015-1272-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/10/2015] [Indexed: 11/25/2022]
Abstract
Ethnic minority groups are disproportionately affected by cardiovascular diseases (CVDs). The reasons for the high prevalence of CVD in ethnic minority groups are not fully understood. Recently, the importance of early-life developmental factors and their impact on CVDs in adulthood is increasingly being recognised, but little is known about this among ethnic minority groups. Therefore, the current paper aimed to fill this knowledge gap by reviewing the available literature to assess the influence of early-life conditions on CVDs and its risk factors in ethnic minority populations residing in Western countries. A systematic search was performed in PubMed and EMBASE between 1989 and 2014. In total, 1418 studies were identified of which 19 met the inclusion criteria. Six studies investigated the relationship between early-life anthropometrics and CVD risk factors of which all except one found significant associations between the assessed anthropometric measures and CVD risk factors. Seven studies evaluated the influence of childhood socio-economic status (SES) on CVD and risk factors of which five found significant associations between childhood SES measures and CVD risk factors. Five studies investigated the relationship between other early-life conditions including early-life nutrition, physical development, and childhood psychosocial conditions, and CVD risk factors. Four of these studies found significant associations between the assessed childhood conditions and CVD risk factors. This review reinforces the importance of early-life conditions on adult CVD in ethnic minority groups. Improvement of early-life conditions among ethnic minority groups may contribute to reducing CVD risk in these populations.
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Affiliation(s)
- Rimke Bijker
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Castro Y, Heck K, Forster JL, Widome R, Cubbin C. Social and Environmental Factors Related to Smoking Cessation among Mothers: Findings from the Geographic Research on Wellbeing (GROW) Study. Am J Health Behav 2015; 39:809-22. [PMID: 26450549 DOI: 10.5993/ajhb.39.6.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The current study examined associations between race/ethnicity and psychosocial/environmental factors with current smoking status, and whether psychosocial/environmental factors accounted for racial differences in smoking status in a population-based sample of mothers in California. METHODS Cross-sectional data from 542 women with a history of smoking were used. Analyses adjusted for age, partner status, and educational attainment. RESULTS In models adjusted for sociodemographics, black women had significantly lower odds, and Latina immigrants had significantly higher odds of being a former smoker compared to white women. Persons smoking in the home, having a majority of friends who smoke, having perceptions of their neighborhood as being somewhat or very unsafe, and experiencing food insecurity were associated with decreased odds of being a former smoker. When these variables were entered into a single model, only being a Latina immigrant and having a majority of friends who smoke were significantly associated with smoking status. CONCLUSIONS Black women demonstrated a notable disparity compared with white women in smoking status, accounted for by psychosocial/environmental factors. Immigrant Latinas demonstrated notable success in ever quitting smoking. Social networks may be important barriers to smoking cessation among women.
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Affiliation(s)
- Yessenia Castro
- University of Texas at Austin, School of Social Work, Austin, TX, USA
| | - Katherine Heck
- University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA, USA
| | - Jean L Forster
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Catherine Cubbin
- University of Texas at Austin, School of Social Work, Austin, TX, USA.
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Health-Risk Behaviour in Deprived Neighbourhoods Compared with Non-Deprived Neighbourhoods: A Systematic Literature Review of Quantitative Observational Studies. PLoS One 2015; 10:e0139297. [PMID: 26506251 PMCID: PMC4624433 DOI: 10.1371/journal.pone.0139297] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 09/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There has been increasing interest in neighbourhoods' influence on individuals' health-risk behaviours, such as smoking, alcohol consumption, physical activity and diet. The aim of this review was to systematically review recent studies on health-risk behaviour among adults who live in deprived neighbourhoods compared with those who live in non-deprived neighbourhoods and to summarise what kind of operationalisations of neighbourhood deprivation that were used in the studies. METHODS PRISMA guidelines for systematic reviews were followed. Systematic searches were performed in PubMed, Embase, Web of Science and Sociological Abstracts using relevant search terms, Boolean operators, and truncation, and reference lists were scanned. Quantitative observational studies that examined health-risk behaviour in deprived neighbourhoods compared with non-deprived neighbourhoods were eligible for inclusion. RESULTS The inclusion criteria were met by 22 studies. The available literature showed a positive association between smoking and physical inactivity and living in deprived neighbourhoods compared with non-deprived neighbourhoods. In regard to low fruit and vegetable consumption and alcohol consumption, the results were ambiguous, and no clear differences were found. Numerous different operationalisations of neighbourhood deprivation were used in the studies. CONCLUSION Substantial evidence indicates that future health interventions in deprived neighbourhoods should focus on smoking and physical inactivity. We suggest that alcohol interventions should be population based rather than based on the specific needs of deprived neighbourhoods. More research is needed on fruit and vegetable consumption. In future studies, the lack of a uniform operationalisation of neighbourhood deprivation must be addressed.
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Sweatt SK, Willig AL, Agne AA, Powell JL, Cherrington AL. Physical Activity Patterns of Latina Immigrants Living in Alabama. J Racial Ethn Health Disparities 2015; 2:365-72. [PMID: 26413457 PMCID: PMC4581436 DOI: 10.1007/s40615-015-0083-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Latinos are the fastest growing minority group in the Southeastern USA. Latinos living in the USA have a higher prevalence of obesity, metabolic diseases, and physical inactivity compared to non-Latino Whites, particularly Latina women. The objective of this study is to assess the patterns of physical activity (PA) in overweight Latina immigrants in Alabama using a self-report and an accelerometer. METHODS Participants included foreign-born Latina women age ≥19 years with BMI ≥25 kg/m(2). The Global Physical Activity Questionnaire was used to assess self-reported physical activity. Accelerometers were used as an objective measure of physical activity. RESULTS Among 44 overweight/obese Latina immigrants (mean age 36.6 years and BMI 33.3 kg/m(2)), 36.4 % met PA recommendations by self-report while only 20.5 % met recommendations according to the accelerometer. Self-report sedentary activity was underestimated (186 min/day self-report vs. 575 min/day accelerometer) while moderate activity was overestimated (34 min/day self-report vs. 15 min/day accelerometer). While the number of years living in the USA was positively associated with vigorous activity (r=0.32, p= 0.03), the number of years living in Alabama tended to be positively associated with sedentary activity and negatively associated with moderate activity. CONCLUSIONS Latina immigrants living in Alabama overestimated the amount of time spent in moderate PA and underestimated time spent in sedentary activity.
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Hamano T, Li X, Lönn SL, Nabika T, Shiwaku K, Sundquist J, Sundquist K. Depression, stroke and gender: evidence of a stronger association in men. J Neurol Neurosurg Psychiatry 2015; 86:319-23. [PMID: 24970909 DOI: 10.1136/jnnp-2014-307616] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Depression is associated with an increased risk for stroke. The aim of this study was to examine whether demographic and socioeconomic factors modify this association. METHODS This follow-up study comprised 137 305 men and 188 924 women aged ≥30 years from a nationwide sample of primary healthcare centres in Sweden. We identified 4718 first-ever stroke cases (2217 men and 2501 women) during the follow-up period (2005-2007). Multilevel logistic regression models were used to calculate ORs and examine interactions in order to determine whether the association between depression and stroke differs by demographic or socioeconomic factors. RESULTS Depression was associated with significantly greater odds of stroke after adjustment for potential confounding factors (OR=1.22, 95% CI 1.08 to 1.38). Interaction tests showed that the effect of depression on stroke was higher in men compared with women (the difference in OR between men and women was 1.30, 95% CI 1.01 to 1.68), that is, the association between depression and stroke was modified by gender. CONCLUSIONS Our findings suggest that the depression-stroke association is modified by gender. Further studies are required to examine the underlying mechanisms in men and women.
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Affiliation(s)
- Tsuyoshi Hamano
- Centre for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Sara Larsson Lönn
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Toru Nabika
- Centre for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan Department of Functional Pathology, Shimane University School of Medicine, Izumo, Japan
| | - Kuninori Shiwaku
- Centre for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan Department of Environmental and Preventive Medicine, Shimane University School of Medicine, Izumo, Japan
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
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Yun WJ, Rhee JA, Kim SA, Kweon SS, Lee YH, Ryu SY, Park SW, Kim DH, Shin MH. Household and area income levels are associated with smoking status in the Korean adult population. BMC Public Health 2015; 15:39. [PMID: 25636365 PMCID: PMC4314795 DOI: 10.1186/s12889-015-1365-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/06/2015] [Indexed: 12/03/2022] Open
Abstract
Background Some previous studies have suggested that area-level characteristics have effects on smoking. The aim of this study was to evaluate the associations between household income and area income on smoking in Korean adults. Methods This study was based on the Korean Community Health Survey (KCHS) performed in South Korea, between September and November 2009. In total, 222,242 subjects (103,124 men and 119,118 women) were included in the analysis. Information on smoking status was collected using a standardized questionnaire. Income status was determined by monthly household income. Household income was categorized as: <1 million won; <2 million won; <3 million won; and ≥3 million won. Area-level income categorized as quartiles. Data were analyzed using multilevel regression models. The analysis was conducted separately urban and rural, by sex. Results The lowest household income group had a higher risk of smoking than the highest household income group in both urban and rural areas for both men and women after adjusting for individual characteristics (urban men: odds ration [OR], 1.44; 95% confidence interval [CI], 1.36–1.53; rural men: OR, 1.33; 95% CI, 1.25–1.42; urban women: OR, 2.38; 95% CI, 2.06–2.76; rural women: OR, 1.51; 95% CI, 1.25–1.83). In men, the lowest area-level income group had a higher risk for smoking than the highest area-level income group in urban areas after adjusting for individual characteristics and household income (OR, 1.17; 95% CI, 1.02–1.33). In women, the lowest area-level income group had a lower risk for smoking than the highest area-level income group in rural areas after adjusting for individual characteristics and household income (OR, 0.52; 95% CI, 0.39–0.70). However, no association was observed between area-level income and smoking in rural areas for men or in urban areas for women. Conclusions The results showed that smoking is strongly associated with household income status in both men and women, and area-level income is partly associated with smoking. Effects of area-level income on smoking differed by sex and region. These findings suggest that area characteristics have contextual effects on health related behavior independent of individual characteristics.
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Affiliation(s)
- Woo-Jun Yun
- Department of Preventive Medicine, Chonnam National University Medical School, Hak-1-dong, Dong-gu, Gwangju, 501-746, Republic of Korea.
| | - Jung-Ae Rhee
- Department of Preventive Medicine, Chonnam National University Medical School, Hak-1-dong, Dong-gu, Gwangju, 501-746, Republic of Korea.
| | - Sun A Kim
- Department of Preventive Medicine, Chonnam National University Medical School, Hak-1-dong, Dong-gu, Gwangju, 501-746, Republic of Korea.
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Hak-1-dong, Dong-gu, Gwangju, 501-746, Republic of Korea. .,Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Jeollanamdo, 519-809, Republic of Korea.
| | - Young-Hoon Lee
- Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, 570-711, Republic of Korea.
| | - So-Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, 501-759, Republic of Korea.
| | - Soon-Woo Park
- Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu, 705-718, Republic of Korea.
| | - Dong Hyun Kim
- Department of Social Medicine, Hallym University College of Medicine, Chuncheon, 200-702, Republic of Korea.
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Hak-1-dong, Dong-gu, Gwangju, 501-746, Republic of Korea. .,Center for Creative Biomedical Scientists, Chonnam National University, Gwangju, 501-809, Republic of Korea.
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Yoon NH, Kwon S. The effects of community environmental factors on obesity among Korean adults: a multilevel analysis. Epidemiol Health 2014; 36:e2014036. [PMID: 25666167 PMCID: PMC4322521 DOI: 10.4178/epih/e2014036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 12/24/2014] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES: This study explored multidimensional factors related to obesity by dividing them into individual and environmental factors, and performed multilevel analysis to investigate community environmental effects. METHODS: Data from the 2011 and 2012 Community Health Surveys were used for the analysis. Community-level variables, constructed from various regional statistics, were included in the model as environmental factors. Respondents with body mass index (BMI)≥25 were defined as obese, and a multilevel logistic regression analysis was conducted to analyze individual and environmental factors related to obesity. Moreover, a stratified analysis was conducted to compare factors related to obesity between men and women. RESULTS: Of 337,136 samples, 82,887 (24.6%) were obese, with BMI≥25. Sociodemographic characteristics at the individual level were mostly significantly related to obesity; however, while there were more obese men subjects among those with high socioeconomic status, there were more obese women among those with low socioeconomic status. There were fewer obese respondents among those who regularly walked and more obese respondents among those who reported short sleep duration or were highly stressed. At the community level, people living in areas with high socioeconomic status, high satisfaction with safety and public transportation, and high accessibility to sports facilities in their community had lower obesity risks. CONCLUSIONS: Community-level environmental factors affected obesity, especially perceived community environment, more significant than physical environment. Thus, it is necessary to develop effective obesity prevention and management strategies by considering potential community environmental factors that affect obesity.
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Affiliation(s)
- Nan-He Yoon
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Soonman Kwon
- Graduate School of Public Health, Seoul National University, Seoul, Korea
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Akrawi DS, Li X, Sundquist J, Sundquist K, Zöller B. End stage renal disease risk and neighbourhood deprivation: a nationwide cohort study in Sweden. Eur J Intern Med 2014; 25:853-9. [PMID: 25294596 PMCID: PMC4374981 DOI: 10.1016/j.ejim.2014.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/13/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Chronic kidney disease has been associated with socioeconomic disparities and neighbourhood deprivation. We aimed to determine whether there is an association between neighbourhood deprivation and end stage renal disease (ESRD), and whether this association is independent of individual-level sociodemographic factors and comorbidities. METHODS National Swedish data registers were used. The entire Swedish population aged 20-69 years was followed from January 1, 2001 until December 31, 2010. Data were analysed by multilevel logistic regression, with individual-level sociodemographic factors (age, marital status, family income, education level, country of birth, urban/rural status, and mobility) and comorbidities at the first level and neighbourhood deprivation at the second level. RESULTS Neighbourhood deprivation was significantly associated with ESRD (age-adjusted odds ratio [OR] 1.45, 95% confidence interval [CI] 1.34-1.56 in men and OR 1.59, 95% CI 1.44-1.75 in women). The ORs for ESRD in men and women living in the most deprived neighbourhoods remained significantly increased when adjusted for age and individual-level sociodemographic factors (OR 1.25, 95% CI 1.15-1.35 in men and OR 1.30, 95% CI 1.17-1.44 in women). In the full model, which took account of sociodemographic factors and comorbidities, the ORs for ESRD remained significantly increased (OR 1.17, 95% CI 1.07-1.27 in men and OR 1.18, 95% CI 1.06-1.31 in women). CONCLUSION Neighbourhood deprivation is independently associated with ESRD in both men and women irrespective of individual-level sociodemographic factors and comorbidities.
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Affiliation(s)
- Delshad Saleh Akrawi
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Bengt Zöller
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
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Souza RAD, Oliveira CDL, Lima-Costa MF, Proietti FA. Satisfaction with physical and social surroundings and the habit of smoking cigarettes in the metropolitan area of Belo Horizonte, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2014; 17:775-86. [PMID: 25272268 DOI: 10.1590/1809-4503201400030016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 05/09/2014] [Indexed: 11/21/2022] Open
Abstract
The objective of this study was to examine the association between individual satisfaction with social and physical surroundings and the habit of smoking cigarettes. Data from the Health Survey of Adults from the metropolitan area of Belo Horizonte, Minas Gerais, Brazil, were used. Based on a probability sample, participants (n = 12,299) were selected among residents aged 20 years old or more. The response variable was the smoking habit and the explanatory variable of interest was the neighborhood perception. Potential confounding variables included demographic characteristics, health behaviors and other indicators of socioeconomic position. The prevalence of current smokers, former smokers and never smokers were 20.8, 14.1 and 65.1%, respectively; 74.4 and 25.5% of the participants were categorized as being more satisfied and less satisfied with the neighborhood, respectively. Compared to those who never smoked, former smokers (adjusted odds ratio = 1.40, 95% confidence interval 1.20 - 1.62) and current smokers (adjusted odds ratio = 1.17, 95% confidence interval 1.03 - 1.34) were less satisfied with the neighborhood compared to those who never smoked. The results of this study indicate there is an independent association between the smoking habit and a less satisfying neighborhood perception in the metropolitan region of Belo Horizonte, which does not depend on individual characteristics, traditionally reported as being associated with smoking.
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Hall MG, Fleischer NL, Reynales-Shigematsu LM, Arillo-Santillán E, Thrasher JF. Increasing availability and consumption of single cigarettes: trends and implications for smoking cessation from the ITC Mexico Survey. Tob Control 2014; 24 Suppl 3:iii64-iii70. [PMID: 25192772 DOI: 10.1136/tobaccocontrol-2014-051690] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/19/2014] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Determine (1) trends in single cigarette availability and purchasing in Mexico and (2) the association between neighbourhood access to singles and cessation behaviour among adult Mexican smokers. METHODS We analysed data from Wave 4 (2010), Wave 5 (2011) and Wave 6 (2012) of the Mexican International Tobacco Control Policy Evaluation Survey. We used data from all three waves to examine time trends in singles availability and purchasing. To explore the association between neighbourhood access to singles and cessation behaviour, we used data from participants who were smokers at Wave 5 and followed up at Wave 6 (n=1272). FINDINGS The percentage of participants who saw singles sold daily (45.2% in 2010; 51.4% in 2011; 64.9% in 2012), who bought singles at least once a week (22.3% in 2010; 29.1% in 2011; 29.1% in 2012) and whose last cigarette purchase was a single (16.6% in 2010; 20.7% in 2011; 25.8% in 2012) increased significantly from 2010 to 2012 (all p<0.001). The average percentage of residents who reported seeing singles sold daily in their neighbourhood in 2012 was 60% (SD=25%). In adjusted analyses, smokers living in neighbourhoods with higher access to singles were less likely to make a quit attempt (risk ratio (RR)=0.72; 95% CI 0.46 to 1.12), and more likely to relapse (RR=1.30; CI 0.94 to 1.82), but these results were not statistically significant. CONCLUSIONS Single cigarettes appear widely accessible in Mexico and growing in availability. Future research should explore potential explanations, consequences and effective methods for reducing the availability of single cigarettes.
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Affiliation(s)
- Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nancy L Fleischer
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | | | - Edna Arillo-Santillán
- Tobacco Control Research Department, National Institute of Public Health Mexico, Cuernavaca, Mexico
| | - James F Thrasher
- Tobacco Control Research Department, National Institute of Public Health Mexico, Cuernavaca, Mexico Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina
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Fleischer NL, Thrasher JF, Sáenz de Miera Juárez B, Reynales-Shigematsu LM, Arillo-Santillán E, Osman A, Siahpush M, Fong GT. Neighbourhood deprivation and smoking and quit behaviour among smokers in Mexico: findings from the ITC Mexico Survey. Tob Control 2014; 24 Suppl 3:iii56-iii63. [PMID: 25170022 DOI: 10.1136/tobaccocontrol-2013-051495] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 08/08/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND In high-income countries (HICs), higher neighbourhood socioeconomic deprivation is associated with higher levels of smoking. Few studies in low-income and middle-income countries (LMICs) have investigated the role of the neighbourhood environment on smoking behaviour. OBJECTIVE To determine whether neighbourhood socioeconomic deprivation is related to smoking intensity, quit attempts, quit success and smoking relapse among a cohort of smokers in Mexico from 2010 to 2012. METHODS Data were analysed from adult smokers and recent ex-smokers who participated in waves 4-6 of the International Tobacco Control (ITC) Mexico Survey. Data were linked to the Mexican government's composite index of neighbourhood socioeconomic deprivation, which is based on 2010 Mexican Census data. We used generalised estimating equations to determine associations between neighbourhood deprivation and individual smoking behaviours. FINDINGS Contrary to past findings in HICs, higher neighbourhood socioeconomic deprivation was associated with lower smoking intensity. Quit attempts showed a U-shaped pattern whereby smokers living in high/very high deprivation neighbourhoods and smokers living in very low deprivation neighbourhoods were more likely to make a quit attempt than smokers living in other neighbourhoods. We did not find significant differences in neighbourhood deprivation on relapse or successful quitting, with the possible exception of people living in medium-deprivation neighbourhoods having a higher likelihood of successful quitting than people living in very low deprivation neighbourhoods (p=0.06). CONCLUSIONS Neighbourhood socioeconomic environments in Mexico appear to operate in an opposing manner to those in HICs. Further research should investigate whether rapid implementation of strong tobacco control policies in LMICs, as occurred in Mexico during the follow-up period, avoids the concentration of tobacco-related disparities among socioeconomically disadvantaged groups.
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Affiliation(s)
- Nancy L Fleischer
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA Departamento de Investigación sobre Tabaco, Instituto Nacional de Salud Pública, Cuernavaca, México
| | | | | | - Edna Arillo-Santillán
- Departamento de Investigación sobre Tabaco, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Amira Osman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada School of Public health and Health Systems, University of Waterloo, Ontario, Canada Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Li X, Sjöstedt C, Sundquist K, Zöller B, Sundquist J. Neighborhood deprivation and childhood autism: a nationwide study from Sweden. J Psychiatr Res 2014; 53:187-92. [PMID: 24613033 DOI: 10.1016/j.jpsychires.2014.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine whether there is an association between neighborhood deprivation and childhood autism, after accounting for family- and individual-level sociodemographic characteristics. METHODS An open cohort of all children aged 2-11 years was followed between January 1, 2000 and December 31, 2010. Childhood residential locations were geocoded and classified according to neighborhood deprivation (an index of low education, low income, unemployment, and receipt of welfare assistance). Data were analyzed by multilevel logistic regression, with family- and individual-level characteristics at the first level and level of neighborhood deprivation at the second level. RESULTS During the study period, among a total of 643,456 children, 1699 (0.3%) were diagnosed with childhood autism. Age-standardized cumulative incidence, defined as first registration for childhood autism during the study period, increased with increasing level of neighborhood deprivation. In the study population, 2.2 per 1000 and 3.6 per 1000 children in the least and most deprived neighborhoods, respectively, were diagnosed with childhood autism. Incidence of childhood autism increased with increasing neighborhood-level deprivation across all family and individual-level sociodemographic categories. The odds ratio (OR) for childhood autism for those living in high-deprivation neighborhoods versus those living in low-deprivation neighborhoods was 1.59 (95% confidence interval = 1.35-1.88). High neighborhood deprivation remained significantly associated with odds of childhood autism after adjustment for family- and individual-level sociodemographic characteristics (OR = 1.28, 95% confidence interval = 1.07-1.53, P = 0.007). CONCLUSIONS This study is the largest so far on potential neighborhood influences on childhood autism. Our results show that neighborhood deprivation is associated with childhood autism, independently of family- and individual-level sociodemographic characteristics.
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Affiliation(s)
- Xinjun Li
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden.
| | - Cecilia Sjöstedt
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, California, USA
| | - Bengt Zöller
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, California, USA
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Kim JH, Jeong MH, Park IH, Choi JS, Rhee JA, Lee DH, Park SH, Kim IS, Jeong HC, Cho JY, Jang SY, Lee KH, Park KH, Sim DS, Kim KH, Hong YJ, Park HW, Kim JH, Ahn Y, Cho JG, Park JC. The association of socioeconomic status with three-year clinical outcomes in patients with acute myocardial infarction who underwent percutaneous coronary intervention. J Korean Med Sci 2014; 29:536-43. [PMID: 24753701 PMCID: PMC3991797 DOI: 10.3346/jkms.2014.29.4.536] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 02/03/2014] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to evaluate whether the clinical outcomes were associated with socioeconomic status (SES) in patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI). The author analyzed 2,358 patients (64.9 ± 12.3 yr old, 71.5% male) hospitalized with AMI between November 2005 and June 2010. SES was measured by the self-reported education (years of schooling), the residential address (social deprivation index), and the national health insurance status (medical aid beneficiaries). Sequential multivariable modeling assessed the relationship of SES factors with 3-yr major adverse cardiovascular events (MACEs) and mortality after the adjustment for demographic and clinical factors. During the 3-yr follow-up, 630 (26.7%) MACEs and 322 (13.7%) all-cause deaths occurred in 2,358 patients. In multivariate Cox proportional hazards regression modeling, the only lower education of SES variables was associated with MACEs (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.04-1.91) and mortality (HR, 1.93; 95% CI, 1.16-3.20) in the patients with AMI who underwent PCI. The study results indicate that the lower education is a significant associated factor to increased poor clinical outcomes in patients with AMI who underwent PCI.
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Affiliation(s)
- Jeong Hun Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
- Department of Public Health, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
- Department of Public Health, Chonnam National University Medical School, Gwangju, Korea
| | - In Hyae Park
- Department of Public Health, Chonnam National University Medical School, Gwangju, Korea
| | - Jin Soo Choi
- Department of Public Health, Chonnam National University Medical School, Gwangju, Korea
| | - Jung Ae Rhee
- Department of Public Health, Chonnam National University Medical School, Gwangju, Korea
| | - Doo Hwan Lee
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Soo Hwan Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - In Soo Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Hae Chang Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jae Yeong Cho
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Soo Young Jang
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Ki hong Lee
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Keun-Ho Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Kye Hun Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Hyung Wook Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
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Li X, Memarian E, Sundquist J, Zöller B, Sundquist K. Neighbourhood deprivation, individual-level familial and socio-demographic factors and diagnosed childhood obesity: a nationwide multilevel study from Sweden. Obes Facts 2014; 7:253-63. [PMID: 25096052 PMCID: PMC5644866 DOI: 10.1159/000365955] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/04/2014] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To examine whether there is an association between neighbourhood deprivation and diagnosed childhood obesity, after accounting for family- and individual-level socio-demographic characteristics. METHODS An open cohort of all children aged 0-14 years was followed between January 1, 2000 and December 31, 2010. Childhood residential locations were geocoded and classified according to neighbourhood deprivation. Data were analysed by multilevel logistic regression, with family- and individual-level characteristics at the first level and level of neighbourhood deprivation at the second level. RESULTS During the study period, among a total of 948,062 children, 10,799 were diagnosed with childhood obesity. Age-adjusted cumulative incidence for diagnosed childhood obesity increased with increasing level of neighbourhood deprivation. Incidence of diagnosed childhood obesity increased with increasing neighbourhood-level deprivation across all family and individual-level socio-demographic categories. The odds ratio (OR) for diagnosed childhood obesity for those living in high-deprivation neighbourhoods versus those living in low-deprivation neighbourhoods was 2.44 (95% confidence interval (CI) = 2.22-2.68). High neighbourhood deprivation remained significantly associated with higher odds of diagnosed childhood obesity after adjustment for family- and individual-level socio-demographic characteristics (OR = 1.70, 95% CI = 1.55-1.89). Age, middle level family income, maternal marital status, low level education, living in large cities, advanced paternal and maternal age, family history of obesity, parental history of diabetes, chronic obstructive pulmonary disease, alcoholism and personal history of diabetes were all associated with higher odds of diagnosed childhood obesity. CONCLUSIONS Our results suggest that neighbourhood characteristics affect the odds of diagnosed childhood obesity independently of family- and individual-level socio-demographic characteristics.
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Affiliation(s)
- Xinjun Li
- Centre for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- *Dr. Xinjun Li, Centre for Primary Health Care Research, Lund University/Region Skåne, CRC, building 28, floor 11, Skåne University Hospital, Jan Waldenströms gata 35, 205 02 Malmö (Sweden),
| | - Ensieh Memarian
- Centre for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Jan Sundquist
- Centre for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Bengt Zöller
- Centre for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Kristina Sundquist
- Centre for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
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Neighborhood, family, and childhood and adolescent epilepsy: A nationwide epidemiological study from Sweden. Seizure 2014; 23:62-8. [DOI: 10.1016/j.seizure.2013.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 09/24/2013] [Accepted: 09/24/2013] [Indexed: 12/31/2022] Open
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46
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Neighbourhood deprivation and the cost of accessing gyms and fitness centres: National study in Wales. Health Place 2013; 24:16-9. [DOI: 10.1016/j.healthplace.2013.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/22/2013] [Accepted: 08/01/2013] [Indexed: 11/23/2022]
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47
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Influence of Municipal- and Individual-level Socioeconomic Conditions on Mortality in Japan. Int J Behav Med 2013; 21:737-49. [DOI: 10.1007/s12529-013-9337-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chang TS, Chang CM, Hsu TW, Lin YS, Lai NS, Su YC, Huang KY, Lin HL, Lee CC. The combined effect of individual and neighborhood socioeconomic status on nasopharyngeal cancer survival. PLoS One 2013; 8:e73889. [PMID: 24069242 PMCID: PMC3771923 DOI: 10.1371/journal.pone.0073889] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/23/2013] [Indexed: 11/26/2022] Open
Abstract
Background The relationship between individual and neighborhood socioeconomic status (SES) and mortality rates in patients with nasopharyngeal carcinoma (NPC) is unknown. This population-based study aimed to examine the association between SES and survival of patients with NPC in Taiwan. Materials and Methods A population-based follow-up study was conducted of 4691 patients diagnosed with NPC between 2002 and 2006. Each patient was traced to death or for 5 years. Individual SES was defined by enrollee job category. Neighborhood SES was based on household income dichotomized into advantaged and disadvantaged areas. Cox proportional hazards model was used to compare the death-free survival rates between the different SES groups after adjusting for possible confounding factors and risk factors. Results In NPC patients below the age of 65 years, 5-year overall survival rates were worst for those with low individual SES living in disadvantaged neighborhoods. After adjusting for patient characteristics (age, gender, Charlson Comorbidity Index Score), NPC patients with low individual SES residing in disadvantaged neighborhoods were found to have a 2-fold higher risk of mortality than patients with high individual SES residing in advantaged neighborhoods. We found no significant difference in mortality rates between different SES groups in NPC patients aged 65 and above. Conclusions Our findings indicate that NPC patients with low individual SES who live in disadvantaged neighborhoods have the higher risk of mortality than their more privileged counterparts. Public health strategies and welfare policies would be well advised to try to offset the inequalities in health care and pay more attention to addressing the needs of this vulnerable group.
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Affiliation(s)
- Ting-Shou Chang
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Ming Chang
- Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Ta-Wen Hsu
- Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Yaoh-Shiang Lin
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ning-Sheng Lai
- Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Yu-Chieh Su
- Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Cancer Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Kuang-Yung Huang
- Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Division of Rheumatology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Hung-Lung Lin
- Department of Research, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Ching-Chih Lee
- Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Center for Clinical Epidemiology and Biostatistics, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
- Community Medicine Research Center and the Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Department of Education, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- * E-mail:
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Duran AC, Diez Roux AV, Latorre MDRDO, Jaime PC. Neighborhood socioeconomic characteristics and differences in the availability of healthy food stores and restaurants in Sao Paulo, Brazil. Health Place 2013; 23:39-47. [PMID: 23747923 PMCID: PMC3758426 DOI: 10.1016/j.healthplace.2013.05.001] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 04/18/2013] [Accepted: 05/04/2013] [Indexed: 10/26/2022]
Abstract
Differential access to healthy foods has been hypothesized to contribute to health disparities, but evidence from low and middle-income countries is still scarce. This study examines whether the access of healthy foods varies across store types and neighborhoods of different socioeconomic statuses (SES) in a large Brazilian city. A cross-sectional study was conducted in 2010-2011 across 52 census tracts. Healthy food access was measured by a comprehensive in-store data collection, summarized into two indexes developed for retail food stores (HFSI) and restaurants (HMRI). Descriptive analyses and multilevel models were used to examine associations of store type and neighborhood SES with healthy food access. Fast food restaurants were more likely to be located in low SES neighborhoods whereas supermarkets and full service restaurants were more likely to be found in higher SES neighborhoods. Multilevel analyses showed that both store type and neighborhood SES were independently associated with in-store food measures. We found differences in the availability of healthy food stores and restaurants in Sao Paulo city favoring middle and high SES neighborhoods.
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Affiliation(s)
- Ana Clara Duran
- Public Health Nutrition Graduate Program, School of Public Health, University of Sao Paulo, Av Dr Arnaldo 715, Cerqueira Cesar Sao Paulo, Sao Paulo 01246-904, Brazil.
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Murray ET, Ben-Shlomo Y, Tilling K, Southall H, Aucott P, Kuh D, Hardy R. Area deprivation across the life course and physical capability in midlife: findings from the 1946 British Birth cohort. Am J Epidemiol 2013; 178:441-50. [PMID: 23788665 PMCID: PMC3727343 DOI: 10.1093/aje/kwt003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Physical capability in later life is influenced by factors occurring across the life course, yet exposures to area conditions have only been examined cross-sectionally. Data from the National Survey of Health and Development, a longitudinal study of a 1946 British birth cohort, were used to estimate associations of area deprivation (defined as percentage of employed people working in partly skilled or unskilled occupations) at ages 4, 26, and 53 years (residential addresses linked to census data in 1950, 1972, and 1999) with 3 measures of physical capability at age 53 years: grip strength, standing balance, and chair-rise time. Cross-classified multilevel models with individuals nested within areas at the 3 ages showed that models assessing a single time point underestimate total area contributions to physical capability. For balance and chair-rise performance, associations with area deprivation in midlife were robust to adjustment for individual socioeconomic position and prior area deprivation (mean change for a 1-standard-deviation increase: balance, -7.4% (95% confidence interval (CI): -12.8, -2.8); chair rise, 2.1% (95% CI: -0.1, 4.3)). In addition, area deprivation in childhood was related to balance after adjustment for childhood socioeconomic position (-5.1%, 95% CI: -8.7, -1.6). Interventions aimed at reducing midlife disparities in physical capability should target the socioeconomic environment of individuals-for standing balance, as early as childhood.
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Affiliation(s)
- Emily T Murray
- MRC Unit for Lifelong Health and Ageing, University College and Royal Free Medical School, 33 Bedford Place, London WC1B 5JU, United Kingdom.
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