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Newton D, Stephenson J, Azevedo L, Sah RK, Poudel AN, Richardson O. The impact of social determinants on health outcomes in a region in the North of England: a structural equation modelling analysis. Public Health 2024; 231:198-203. [PMID: 38703494 DOI: 10.1016/j.puhe.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES The aim of this study was to identify the impact of social determinants of health on physical and mental health outcomes in a UK population. STUDY DESIGN Structural equation modelling was used to hypothesise a model of relationships between health determinants and outcomes within a region in the North of England using large-scale population survey data (6208 responses). METHODS We analysed responses from a population survey to assess the influence of a deprivation-based index at the environmental level, education and income on a behaviour index (smoking, alcohol consumption, physical activity, and dietary habits) and the influence of all these factors on self-reported physical health and the influence of the behaviour index and income on mental wellbeing. RESULTS The proposed model was well supported by the data. Goodness-of-fit statistics, most notably a low value of the root mean square error of approximation (RMSEA), supported the validity of the proposed relationships (RMSEA = 0.054). The model revealed all examined paths to be statistically significant. Income and education were influential in determining an individual's behaviour index score, which, with income was the most important predictor of both the correlated outcomes of physical health and mental wellbeing (P < 0.001 in all cases). CONCLUSIONS Findings challenge the traditional view of singular causal pathways, emphasising that interventions should consider the underlying influencing socio-economic conditions, which would influence behaviour and therefore physical and mental wellbeing. The extent to which the model is supported by the data, and the statistical significance of individual relationships accentuates the imperative for comprehensive public health strategies that integrate multiple socio-economic factors.
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Affiliation(s)
- D Newton
- University of Huddersfield, Huddersfield, United Kingdom.
| | - J Stephenson
- University of Huddersfield, Huddersfield, United Kingdom
| | - L Azevedo
- University of Huddersfield, Huddersfield, United Kingdom; Sheffield Hallam University, Sheffield, United Kingdom
| | - R K Sah
- University of Huddersfield, Huddersfield, United Kingdom
| | - A N Poudel
- University of Huddersfield, Huddersfield, United Kingdom
| | - O Richardson
- University of Huddersfield, Huddersfield, United Kingdom
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Khan N, Javed Z, Acquah I, Hagan K, Khan M, Valero-Elizondo J, Chang R, Javed U, Taha MB, Blaha MJ, Virani SS, Sharma G, Blankstein R, Gulati M, Mossialos E, Hyder AA, Achirica MC, Nasir K. Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population. BMC Public Health 2023; 23:900. [PMID: 37193999 DOI: 10.1186/s12889-023-15621-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 04/06/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Educational attainment is an important social determinant of health (SDOH) for cardiovascular disease (CVD). However, the association between educational attainment and all-cause and CVD mortality has not been longitudinally evaluated on a population-level in the US, especially in individuals with atherosclerotic cardiovascular disease (ASCVD). In this nationally representative study, we assessed the association between educational attainment and the risk of all-cause and cardiovascular (CVD) mortality in the general adult population and in adults with ASCVD in the US. METHODS We used data from the 2006-2014 National Death Index-linked National Health Interview Survey for adults ≥ 18 years. We generated age-adjusted mortality rates (AAMR) by levels of educational attainment (< high school (HS), HS/General Education Development (GED), some college, and ≥ College) in the overall population and in adults with ASCVD. Cox proportional hazards models were used to examine the multivariable-adjusted associations between educational attainment and all-cause and CVD mortality. RESULTS The sample comprised 210,853 participants (mean age 46.3), representing ~ 189 million adults annually, of which 8% had ASCVD. Overall, 14.7%, 27%, 20.3%, and 38% of the population had educational attainment < HS, HS/GED, Some College, and ≥ College, respectively. During a median follow-up of 4.5 years, all-cause age-adjusted mortality rates were 400.6 vs. 208.6 and 1446.7 vs. 984.0 for the total and ASCVD populations for < HS vs ≥ College education, respectively. CVD age adjusted mortality rates were 82.1 vs. 38.7 and 456.4 vs 279.5 for the total and ASCVD populations for < HS vs ≥ College education, respectively. In models adjusting for demographics and SDOH, < HS (reference = ≥ College) was associated with 40-50% increased risk of mortality in the total population and 20-40% increased risk of mortality in the ASCVD population, for both all-cause and CVD mortality. Further adjustment for traditional risk factors attenuated the associations but remained statistically significant for < HS in the overall population. Similar trends were seen across sociodemographic subgroups including age, sex, race/ethnicity, income, and insurance status. CONCLUSIONS Lower educational attainment is independently associated with increased risk of all-cause and CVD mortality in both the total and ASCVD populations, with the highest risk observed for individuals with < HS education. Future efforts to understand persistent disparities in CVD and all-cause mortality should pay close attention to the role of education, and include educational attainment as an independent predictor in mortality risk prediction algorithms.
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Affiliation(s)
- Najah Khan
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX), USA
- Center for Cardiovascular Computational Health and Precision Medicine (C3-PH) , Houston Methodist, Houston, TX), USA
- Houston Methodist Academic Institute, Houston Methodist, Houston, TX), USA
| | - Zulqarnain Javed
- Center for Cardiovascular Computational Health and Precision Medicine (C3-PH) , Houston Methodist, Houston, TX), USA
- Houston Methodist Academic Institute, Houston Methodist, Houston, TX), USA
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA
| | - Isaac Acquah
- Houston Methodist Academic Institute, Houston Methodist, Houston, TX), USA
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, 21218, USA
| | - Kobina Hagan
- Houston Methodist Academic Institute, Houston Methodist, Houston, TX), USA
| | - Madiha Khan
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX), USA
| | | | - Ryan Chang
- Washington University in St. Louis, St. Louis, MO), USA
| | - Umair Javed
- National University of Medical Sciences, Rawalpindi, Pakistan
| | - Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD), USA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX), USA
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD), USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA), USA
| | - Martha Gulati
- Department of Preventive Cardiology, Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Adnan A Hyder
- Center On Commercial Determinants of Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Miguel Cainzos Achirica
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD), USA
- Department of Cardiology, Hospital del Mar / Parc de Salut Mar, Barcelona, Spain
| | - Khurram Nasir
- Center for Cardiovascular Computational Health and Precision Medicine (C3-PH) , Houston Methodist, Houston, TX), USA.
- Houston Methodist Academic Institute, Houston Methodist, Houston, TX), USA.
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA.
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Baluran DA. Life expectancy, life disparity, and differential racialization among Chinese, Asian Indians, and Filipinos in the United States. SSM Popul Health 2022; 21:101306. [PMID: 36567799 PMCID: PMC9772563 DOI: 10.1016/j.ssmph.2022.101306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
This article advances differential racialization as a lens to frame health disparity trends within the Asian racial category. Using formal demographic methods, I analyzed data from the Multiple Cause of Death File and the American Community Survey to examine the trends in life expectancy and life disparity among Chinese, Asian Indians, and Filipinos in the United States between 2005 and 2019. While Chinese, Asian Indian, and Filipino life expectancy oscillated between each period under study, those oscillations contributed to an overall widening advantage for Chinese over their Asian Indian and Filipino counterparts. I posit that widening inequalities between the three groups are suggestive of their increasingly disparate racial statuses. These findings underscore the importance of contextualizing disaggregated health data within the social conditions that produce inequalities, namely race/racialization/racism.
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Lleras-Muney A, Price J, Yue D. The association between educational attainment and longevity using individual-level data from the 1940 census. JOURNAL OF HEALTH ECONOMICS 2022; 84:102649. [PMID: 35793610 DOI: 10.1016/j.jhealeco.2022.102649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
We combine individual data from the 1940 full-count census with death records and other information available on the Family Tree at familysearch.org to create the largest individual dataset to date (17 million) to study the association between years of schooling and age at death. Conditional on surviving to age 35, one additional year of education is associated with roughly 0.4 more years of life for both men and women for cohorts born 1906-1915 and smaller for earlier cohorts. Focusing on the 1906-1915 cohort we find that this association is identical when we use sibling or twin fixed effects. This association varies substantially by place of birth. For men, the association is stronger in places with greater incomes, higher quality of school, and larger investments in public health. Women also exhibit great heterogeneity in the association, but our measures of the childhood environment do not explain it.
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Affiliation(s)
- Adriana Lleras-Muney
- Department of Economics, University of California Los Angeles, Los Angeles, CA, United States
| | - Joseph Price
- Department of Economics, Brigham Young University, Provo, UT, United States
| | - Dahai Yue
- Department of Health Policy and Management, University of Maryland, College Park, MD, United States.
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Plass D, Hilderink H, Lehtomäki H, Øverland S, Eikemo TA, Lai T, Gorasso V, Devleesschauwer B. Estimating risk factor attributable burden - challenges and potential solutions when using the comparative risk assessment methodology. Arch Public Health 2022; 80:148. [PMID: 35624479 PMCID: PMC9137119 DOI: 10.1186/s13690-022-00900-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/12/2022] [Indexed: 03/21/2024] Open
Abstract
Background Burden of disease analyses quantify population health and provide comprehensive overviews of the health status of countries or specific population groups. The comparative risk assessment (CRA) methodology is commonly used to estimate the share of the burden attributable to risk factors. The aim of this paper is to identify and address some selected important challenges associated with CRA, illustrated by examples, and to discuss ways to handle them. Further, the main challenges are addressed and finally, similarities and differences between CRA and health impact assessments (HIA) are discussed, as these concepts are sometimes referred to synonymously but have distinctly different applications. Results CRAs are very data demanding. One key element is the exposure-response relationship described e.g. by a mathematical function. Combining estimates to arrive at coherent functions is challenging due to the large variability in risk exposure definitions and data quality. Also, the uncertainty attached to this data is difficult to account for. Another key issue along the CRA-steps is to define a theoretical minimal risk exposure level for each risk factor. In some cases, this level is evident and self-explanatory (e.g., zero smoking), but often more difficult to define and justify (e.g., ideal consumption of whole grains). CRA combine all relevant information and allow to estimate population attributable fractions (PAFs) quantifying the proportion of disease burden attributable to exposure. Among many available formulae for PAFs, it is important to use the one that allows consistency between definitions, units of the exposure data, and the exposure response functions. When combined effects of different risk factors are of interest, the non-additive nature of PAFs and possible mediation effects need to be reflected. Further, as attributable burden is typically calculated based on current exposure and current health outcomes, the time dimensions of risk and outcomes may become inconsistent. Finally, the evidence of the association between exposure and outcome can be heterogeneous which needs to be considered when interpreting CRA results. Conclusions The methodological challenges make transparent reporting of input and process data in CRA a necessary prerequisite. The evidence for causality between included risk-outcome pairs has to be well established to inform public health practice.
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Affiliation(s)
- Dietrich Plass
- German Environment Agency, Section Exposure Assessment and Environmental Health Indicators, Berlin, Germany.
| | - Henk Hilderink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Heli Lehtomäki
- Finnish Institute for Health and Welfare (THL), Health Security, Environmental Health, Helsinki, Finland.,University of Eastern Finland (UEF), Faculty of Health Sciences, School of Pharmacy, Kuopio, Finland
| | - Simon Øverland
- Section for Health Care Collaboration, Haukeland University Hospital, Bergen, Norway
| | - Terje A Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Taavi Lai
- Fourth View Consulting, Tallinn, Estonia
| | - Vanessa Gorasso
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
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Stingone JA, Sedlar S, Lim S, McVeigh KH. Receipt of Early Intervention Services Before Age 3 Years and Performance on Third-Grade Standardized Tests Among Children Exposed to Lead. JAMA Pediatr 2022; 176:478-485. [PMID: 35254399 PMCID: PMC8902692 DOI: 10.1001/jamapediatrics.2022.0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Research has shown that early intervention programs can improve academic outcomes of children with developmental delays. It has been suggested that similar programs may combat the deleterious effects of lead on children's neurodevelopment. However, to our knowledge, there are no published studies examining this possibility. OBJECTIVE The objective of this study was to estimate the association between receipt of early intervention services and third-grade standardized test scores among children exposed to lead before age 3 years. DESIGN, SETTING, AND PARTICIPANTS Cohort study including children born in New York City, New York, from 1994 to 1998 within an administrative data linkage of birth, lead monitoring, early intervention, and education data systems. Participants had a blood lead level of 4 μg/dL or greater at any point before age 3 years and later attended public school in New York City. EXPOSURES Any use of early intervention services from birth through age 3 years. MAIN OUTCOMES AND MEASURES Children who did or did not receive early intervention services were matched using propensity scores. Linear and log-binomial regression were used to estimate the association between receipt of early intervention services before age 3 years and standardized test scores in math and English-language arts in third grade. RESULTS There were 2986 children exposed to lead who received early intervention services before age 36 months. Of these children, 2757 were propensity score-matched to 8160 children who did not receive services. Children who received early intervention services did 7% (95% CI, 3%-12%) of an SD better on math and 10% (95% CI, 5%-14%) of an SD better on English-language arts tests than children who did not receive services. In addition, children who received services were 14% (95% CI, 9%-19%) and 16% (95% CI, 9%-23%) more likely to meet test-based standards in math and English-language arts, respectively, than children who did not receive services. These associations became larger in magnitude when analyses were restricted to children with higher blood lead levels. CONCLUSIONS AND RELEVANCE By leveraging existing public health data, this study found evidence that receipt of early intervention services may benefit the academic performance of children exposed to lead early in life.
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Affiliation(s)
- Jeanette A Stingone
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Slavenka Sedlar
- Bureau of Environmental Disease and Injury Prevention, NYC Department of Health and Mental Hygiene, New York, New York
| | - Sungwoo Lim
- Bureau of Epidemiology Services, NYC Department of Health and Mental Hygiene, New York, New York
| | - Katharine H McVeigh
- Bureau of Early Intervention, NYC Department of Health and Mental Hygiene, New York, New York
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Sangaramoorthy M, Shariff-Marco S, Conroy SM, Yang J, Inamdar PP, Wu AH, Haiman CA, Wilkens LR, Gomez SL, Le Marchand L, Cheng I. Joint Associations of Race, Ethnicity, and Socioeconomic Status With Mortality in the Multiethnic Cohort Study. JAMA Netw Open 2022; 5:e226370. [PMID: 35404461 PMCID: PMC9002338 DOI: 10.1001/jamanetworkopen.2022.6370] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Socioeconomic status may help delineate racial and ethnic inequities in mortality. OBJECTIVE To investigate the joint associations of race, ethnicity, and neighborhood and individual socioeconomic status with mortality. DESIGN, SETTING, AND PARTICIPANTS This prospective analysis used data from the Multiethnic Cohort Study. A population-based sample of participants recruited from California (mainly Los Angeles County) and Hawaii from 1993 to 1996 was followed up until 2013. African American, European American, Japanese American, Latino American, and Native Hawaiian men and women were included. Participants with baseline residential addresses that could not be geocoded or who were missing information on education or adjustment variables were excluded. Data analyses were conducted from January 2018 to December 2020. EXPOSURES Neighborhood socioeconomic status (nSES) was derived using US Census block group data on education, occupation, unemployment, household income, poverty, rent, and house values. Participants self-reported their highest education attainment. Five racial and ethnic groups, 2 states of residence, 2 nSES, and 2 education categories were combined to create a joint exposure variable. Low and high nSES were defined as quintiles 1 to 3 and 4 to 5, respectively. Low and high education levels were defined as high school or less and greater than high school graduate, respectively. MAIN OUTCOMES AND MEASURES All-cause, cardiovascular disease (CVD), cancer, and non-CVD and noncancer deaths were ascertained through 2013 via linkage to death certificates and the US National Death Index. Multivariable Cox proportional hazards regression analyses were conducted. RESULTS Among 182 912 participants (100 785 [55.1%] women and 82 127 [44.9%] men; mean [SD] age, 60.0 [8.9] years; 31 138 African American, 45 796 European American, 52 993 Japanese American, 39 844 Latino American, and 13 141 Native Hawaiian participants) with a mean (SD) follow-up of 17 (5) years, there were 63 799 total deaths, including 23 191 CVD deaths, 19 008 cancer deaths, and 21 235 non-CVD and noncancer deaths. The lowest all-cause mortality was found among 15 104 Japanese American participants in Hawaii with high nSES and high education (eg, 2870 all-cause deaths [19.0%]), and this population served as the reference group for all regression analyses. Native Hawaiian participants in Hawaii with low nSES and low education had the highest all-cause mortality HR (2.38; 95% CI, 2.21-2.57). African American and European American participants in California with low nSES and low education had the next highest all-cause mortality HRs (2.01; 95% CI, 1.91-2.11 and 1.98; 95% CI, 1.85-2.12, respectively). Latino American participants in California with low nSES had equivalent all-cause mortality HRs regardless of education level (high education: 1.57; 95% CI, 1.48-1.66; low education: 1.57; 95% CI, 1.50-1.65). Patterns for cause-specific mortality were similar to those for all-cause mortality. For example, Native Hawaiian participants in Hawaii with low nSES and low education had highest CVD mortality HR (2.92; 95% CI, 2.60-3.27) and cancer mortality HR (2.01; 95% CI, 1.77-2.29). CONCLUSIONS AND RELEVANCE These results suggest that joint associations of nSES and education may further delineate racial and ethnic inequities in mortality and that future investigations of racial and ethnic inequities in mortality should consider differences by measures of socioeconomic status, especially for underserved populations.
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Affiliation(s)
- Meera Sangaramoorthy
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - Shannon M. Conroy
- Department of Public Health Sciences, University of California, Davis
| | - Juan Yang
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
| | - Pushkar P. Inamdar
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
| | - Anna H. Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Christopher A. Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Lynne R. Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu
| | - Scarlett L. Gomez
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
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Ashida T, Fujiwara T, Kondo K. Childhood socioeconomic status and social integration in later life: Results of the Japan gerontological evaluation study. SSM Popul Health 2022; 18:101090. [PMID: 35572783 PMCID: PMC9092519 DOI: 10.1016/j.ssmph.2022.101090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/05/2022] Open
Abstract
Older people's social integration is important for their health and well-being. However, few studies have investigated the determinants of older adults' social integration through childhood socioeconomic status (SES). This study investigated the association between childhood SES and each aspect of social integration among Japanese older people. We used data from the Japan Gerontological Evaluation Study 2010, a self-reported survey of 23,320 functionally independent people aged 65 or older across Japan (response rate: 66.3%). Childhood SES was assessed based on respondents' subjective assessment of their SES at the age of 15. Social integration was identified as participation in community groups, social networks, being homebound, and being married. We used Poisson regression analysis with robust variance to investigate the association between childhood SES and each social integration measurement, adjusted for potential mediators; namely, adult sociodemographic characteristics, health status, health behavior (smoking), living status, and personality. Lower childhood SES had long-lasting impact on the social integration of this older Japanese cohort. In the fully adjusted model, older people with lower childhood SES were less likely to participate in community groups (Non-membership sports group or club, adjusted prevalence ratio [APR]: 1.03, 95% confidence interval [CI]: 1.00–1.06; (Non-membership hobby group, APR: 1.04; 95% CI: 1.00–1.09), almost never met friends (APR: 1.17, 95% CI: 1.11–1.24), had a smaller social network (APR: 1.13; 95% CI: 1.08–1.19), and were more likely to be homebound (APR: 1.24; 95% CI: 1.05–1.45) than those with high childhood SES. Lower childhood SES negatively affected social integration in older age. Mitigating childhood poverty might be important to increase social integration in later life, thereby improving health outcomes. Low childhood socioeconomic status impacts social integration in old age. Social networks were the most prevalent indicator of social integration. Mitigating childhood poverty could improve health outcomes in later life.
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Lleras-Muney A. EDUCATION AND INCOME GRADIENTS IN LONGEVITY: THE ROLE OF POLICY. THE CANADIAN JOURNAL OF ECONOMICS. REVUE CANADIENNE D'ECONOMIQUE 2022; 55:5-37. [PMID: 37987018 PMCID: PMC10659761 DOI: 10.1111/caje.12582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Education and income are strong predictors of health and longevity. In the last 20 years many efforts have been made to understand if these relationships are causal and what the possible role of policy should be as a result. The evidence from various studies is ambiguous: the effects of education and income policies on health are heterogeneous and vary over time, and across places and populations. I discuss explanations for these disparate results and suggest directions for future research.
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Affiliation(s)
- Adriana Lleras-Muney
- NATIONAL BUREAU OF ECONOMIC RESEARCH, 1050 Massachusetts Avenue, Cambridge, MA 02138
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10
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Deng J, Hu X, Xiao C, Pan F. The association between gaseous pollutants and non-accidental mortality: a time series study. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2021; 43:2887-2897. [PMID: 33411120 DOI: 10.1007/s10653-020-00800-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/15/2020] [Indexed: 05/22/2023]
Abstract
To evaluate the effects of gaseous pollutants (SO2, NO2) on non-accidental mortality of residents in Hefei city, we collected non-accidental deaths, air pollutants and meteorological data of Hefei city from 2014 to 2017. After controlling confounding factors with Poisson generalized additive model, we analyzed the relationship between air pollutants and non-accidental mortality and used subgroup analysis to identify susceptible groups. The number of non-accidental deaths during the study period was 42,116, with an average of 28.83 per day. The average concentrations of SO2 and NO2 were 16.08 μg/m3 and 39.10 μg/m3, respectively. In the single-pollutant model, every 10 μg/m3 increase in SO2 and NO2 concentrations was significantly associated with non-accidental mortality, and there was a significant lag effect. SO2 increased the risk of non-accidental death by 4.93% (95% CI: 1.94% ~ 8.00%) at lag0-3. In addition, male, the elderly, non-elderly and low-education people were more susceptible (P < 0.05). NO2 increased the risk of non-accidental death by 2.11% (95% CI: 1.18% ~ 3.05%) at lag0-1 and had an effect on all subgroups (P < 0.05). For every 10 μg/m3 increase in SO2 and NO2, the two-pollutant model showed that the risk of non-accidental death, respectively, increased by 3.34% (95% CI: 0.29% ~ 6.50%) and 1.82% (95% CI: 0.85% ~ 2.79%), suggesting that the effect was weakened. Our study suggested that SO2 and NO2 were associated with non-accidental mortality, and there were lag effects. Therefore, environmental management should be strengthened and health protection education should be carried out for different groups.
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Affiliation(s)
- Jixiang Deng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China
| | - Xingxing Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China
| | - Changchun Xiao
- Hefei Center for Disease Control and Prevention, 86 Luan Road, Hefei, 230032, Anhui Province, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China.
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11
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Hill WD. Environmental Influences on Genetic Contributions to Intelligence and Education. Am J Psychiatry 2021; 178:582-583. [PMID: 34270340 DOI: 10.1176/appi.ajp.2021.21050545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- W David Hill
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, U.K
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Perkkiö Y, Auvinen J, Timonen M, Jokelainen J, Valkeapää N, Koiranen M, Saltevo J, Keinänen-Kiukaanniemi S. Factors predicting 31-year survival among a population cohort in Northern Finland. Int J Circumpolar Health 2021; 80:1909334. [PMID: 33858289 PMCID: PMC8057088 DOI: 10.1080/22423982.2021.1909334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
We evaluated the survival of a subarctic population and the significance of traditional risk factors for mortality, causes of death and their seasonal variation from the period of 1984-2014. By the end of 2014 (follow-up), 644 (34.4% from 1,869) participants had died (42.1% of cardiovascular causes, 22.4% of neoplastic diseases). The average age at death±SD was 74.6±11.4 years for women (n=284) and 70.2±12.0 years for men (n=360). After adjusting for baseline age, the major risk factors predicting death were male sex (hazard ratio [HR] 1.80; 95% confidence interval [CI] 1.54-2.10), current smoking (HR 1.85; 95% CI 1.58-2.17), obesity (HR 1.75; 95% CI 1.45-2.12), high blood pressure (HR 1.46; 95% CI 1.24-1.72), cardiovascular disease (HR 1.62; 95% CI 1.36-1.93) and depression (HR 1.61; 95% CI 1.21-2.14) at baseline.The most common causes of death and the main risk factors predicting death in this population were the same as reported globally. Lifestyle factors had an important impact in predicting survival. The most common causes of death were the same for men and women. There was no significant difference in overall mortality rate between winter and summer, but cerebrovascular and pulmonary causes of death were more common during winter.
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Affiliation(s)
- Yrjö Perkkiö
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Primary Health Care in Lapland Central Hospital, Health Centre of Muonio-Enontekiö, Rovaniemi, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Health Center of Oulunkaari, Ii, Finland
| | - Markku Timonen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Jari Jokelainen
- Unit of General Practice, Oulu University Hospital, Oulu, Finland.,Infrastructure for Population Studies, University of Oulu, Finland
| | | | - Markku Koiranen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Juha Saltevo
- Central Finland Central Hospital, Jyväskylä, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Health Center of Selänne, Pyhäjärvi, Finland
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13
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Deary IJ, Hill WD, Gale CR. Intelligence, health and death. Nat Hum Behav 2021; 5:416-430. [PMID: 33795857 DOI: 10.1038/s41562-021-01078-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/15/2021] [Indexed: 02/06/2023]
Abstract
The field of cognitive epidemiology studies the prospective associations between cognitive abilities and health outcomes. We review research in this field over the past decade and describe how our understanding of the association between intelligence and all-cause mortality has consolidated with the appearance of new, population-scale data. To try to understand the association better, we discuss how intelligence relates to specific causes of death, diseases/diagnoses and biomarkers of health through the adult life course. We examine the extent to which mortality and health associations with intelligence might be attributable to people's differences in education, other indicators of socioeconomic status, health literacy and adult environments and behaviours. Finally, we discuss whether genetic data provide new tools to understand parts of the intelligence-health associations. Social epidemiologists, differential psychologists and behavioural and statistical geneticists, among others, contribute to cognitive epidemiology; advances will occur by building on a common cross-disciplinary knowledge base.
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Affiliation(s)
- Ian J Deary
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK.
| | - W David Hill
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Catharine R Gale
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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14
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Pinchas-Mizrachi R, Naparstek Y, Nirel R, Kukia E. The "Sick immigrant" and "Healthy immigrant" phenomenon among Jews migrating from the USSR to Israel. SSM Popul Health 2020; 12:100694. [PMID: 33294584 PMCID: PMC7689518 DOI: 10.1016/j.ssmph.2020.100694] [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: 02/23/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022] Open
Abstract
The “healthy immigrant” phenomenon finds that immigrants are in better health than natives, while the “sick immigrant” phenomenon finds the opposite. We examined this phenomenon using the relationship between immigration and mortality, stratified by income level, among Soviet immigrants to Israel in the 1990s, compared to veteran immigrants with similar ethnic origin. A retrospective cohort study of mortality during 1990–2016 was conducted among 63,847 immigrants born during 1940–1950 in the USSR or Eastern Europe, and who immigrated to Israel during 1990–1995. They were compared to a control group of 75,347 Israeli Jews born during the same period in the same countries or second-generation immigrants with parents from these countries and who immigrated by 1960. After adjusting for sex, age, income, and marital status, we found higher mortality rates among immigrants than non-immigrants for the total study population (adjusted hazard ratio (AHR) = 1.399, 99% confidence intervals (CI) = 1.341, 1.459) and among 19,033 men (AHR = 2.852, 99%CI = 2.619, 3.107) and 24,355 women (AHR = 1.705, 99%CI = 1.566, 1.857) with low incomes. The opposite relationship was found for 25,436 men (AHR = 0.710,99%CI = 0.617, 0.0.816) and for 12,922 women (AHR = 0.693,99%CI = 0.534, 0.900) with high incomes. When examining the total study population, we found evidence to support the “sick immigrant” phenomenon. However, both men and women in the high-income subgroup, and women in the middle-income subgroup, demonstrated the “healthy immigrant” phenomenon. Decision-makers in Israel should pay particular attention to immigrants from a low socioeconomic level. Our results emphasize the need for social stratification when examining the relationships between immigration and health outcomes. This retrospective cohort study of mortality follows immigrants from the USSR, who immigrated to Israel during 1990–1995. Immigration is a risk factor for mortality among both sexes, but more so among men. Whenstratified by sex and income level, we found that among low-income men and women, immigration was associated with increased mortality. Among high-income men and middle- and high-income women, the risk of mortality was lower among immigrants. The study has implications for the health care of immigrants at different stages and from different backgrounds.
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15
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Duan W, Xu C, Liu Q, Xu J, Weng Z, Zhang X, Basnet TB, Dahal M, Gu A. Levels of a mixture of heavy metals in blood and urine and all-cause, cardiovascular disease and cancer mortality: A population-based cohort study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 263:114630. [PMID: 33618481 DOI: 10.1016/j.envpol.2020.114630] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/31/2020] [Accepted: 04/16/2020] [Indexed: 05/25/2023]
Abstract
People are exposed to heavy metals in many ways during the course of their daily life. However, the effect of mixtures of heavy metals on mortality in the U.S. general population is unclear. We aimed to investigate the association between heavy metal concentrations (blood [lead, cadmium and mercury] and urine [barium, cadmium, cobalt, cesium, molybdenum, lead, antimony, titanium, tungsten and uranium]) and all-cause, cardiovascular disease (CVD) and cancer mortality. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999-2014. Poisson regression was performed to analyze the associations between single-metal and multimetal exposure and mortality. The following variables were adjusted as covariates: demographic variables (age, education, sex and ethnicity), anthropometric variables (body mass index), lifestyle variables (family income, serum cotinine category and physical activity) and medical comorbidities (CVD and diabetes). A total of 26,056 subjects from the NHANES were included in the present study (mean follow-up, 7.4 years). The age of the participants ranged from 20 to 85 years. The blood metal mixture was associated with all-cause mortality (RR = 1.38, 95% CI 1.25, 1.51), CVD mortality (RR = 1.43, 95% CI 1.06, 1.94) and cancer mortality (RR = 1.41, 95% CI 1.12, 1.76) and cadmium had the highest weight in the weighted quantile sum (WQS) regression for all associations. The urinary metal mixture was associated with an increased risk of all-cause (RR = 1.48, 95% CI 1.30, 1.68) and cancer mortality (RR = 1.60, 95% CI 1.02, 2.52). Sex differences were found in the associations of both blood and urine metal mixtures with cancer mortality. Our study suggests a potential positive association for the concentrations of heavy metal mixtures with overall, CVD and cancer mortality based on a large sample of the U.S. general population. Nevertheless, further studies are needed to confirm these important findings.
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Affiliation(s)
- Weiwei Duan
- Department of Bioinformatics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Cheng Xu
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China
| | - Qian Liu
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China
| | - Jin Xu
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China; Department of Maternal, Child, and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhenkun Weng
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China
| | - Xin Zhang
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China
| | - Til Bahadur Basnet
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China
| | - Maginsh Dahal
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China
| | - Aihua Gu
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China.
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Wairoto KG, Joseph NK, Macharia PM, Okiro EA. Determinants of subnational disparities in antenatal care utilisation: a spatial analysis of demographic and health survey data in Kenya. BMC Health Serv Res 2020; 20:665. [PMID: 32682421 PMCID: PMC7368739 DOI: 10.1186/s12913-020-05531-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The spatial variation in antenatal care (ANC) utilisation is likely associated with disparities observed in maternal and neonatal deaths. Most maternal deaths are preventable through services offered during ANC; however, estimates of ANC coverage at lower decision-making units (sub-county) is mostly lacking. In this study, we aimed to estimate the coverage of at least four ANC (ANC4) visits at the sub-county level using the 2014 Kenya Demographic and Health Survey (KDHS 2014) and identify factors associated with ANC utilisation in Kenya. METHODS Data from the KDHS 2014 was used to compute sub-county estimates of ANC4 using small area estimation (SAE) techniques which relied on spatial relatedness to yield precise and reliable estimates at each of the 295 sub-counties. Hierarchical mixed-effect logistic regression was used to identify factors influencing ANC4 utilisation. Sub-county estimates of factors significantly associated with ANC utilisation were produced using SAE techniques and mapped to visualise disparities. RESULTS The coverage of ANC4 across sub-counties was heterogeneous, ranging from a low of 17% in Mandera West sub-county to over 77% in Nakuru Town West and Ruiru sub-counties. Thirty-one per cent of the 295 sub-counties had coverage of less than 50%. Maternal education, household wealth, place of delivery, marital status, age at first marriage, and birth order were all associated with ANC utilisation. The areas with low ANC4 utilisation rates corresponded to areas of low socioeconomic status, fewer educated women and a small number of health facility deliveries. CONCLUSION Suboptimal coverage of ANC4 and its heterogeneity at sub-county level calls for urgent, focused and localised approaches to improve access to antenatal care services. Policy formulation and resources allocation should rely on data-driven strategies to guide national and county governments achieve equity in access and utilisation of health interventions.
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Affiliation(s)
- Kefa G. Wairoto
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Noel K. Joseph
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Emelda A. Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LJ UK
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de Campos Gomes F, de Melo-Neto JS, Goloni-Bertollo EM, Pavarino ÉC. Trends and predictions for survival and mortality in individuals with Down syndrome in Brazil: A 21-year analysis. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:551-560. [PMID: 32378275 DOI: 10.1111/jir.12735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 04/03/2020] [Accepted: 04/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Regional heterogeneities and sociodemographic characteristics affect mortality and population survival in Brazil. However, for individuals with Down syndrome (DS) this information remains unknown. In this study, we analysed survival and mortality rates among DS individuals in the five Brazilian geographic regions. In addition, we investigated whether there is an association between mortality and sociodemographic factors across administrative regions. METHODS Data between 1996 and 2016, comprising 10 028 records of deaths of individuals with DS, were collected from database records of the Department of Informatics of the Unified Health System. Data on race/ethnicity, sex, age and years of schooling were defined for the association analyses. Survival data were analysed according to the Kaplan-Meier method and Cox regression model. RESULTS The number of deaths among people with DS has increased in recent years. Children are more susceptible to death, especially in the first years of life. Individuals living in the northern region, Indigenous women and people with no years of schooling have higher mortality. In the Southeast and South region, for White and Yellow, survival is related to a higher level of education. Ethnic factors and years of schooling influence risk for mortality across the administrative regions. CONCLUSIONS These findings show that sociodemographic characteristics affect survival and are associated with the risk of mortality for people with DS. In addition, this suggests that differences in access to health services among Brazilian regions, especially in the first years of life, may affect the survival of individuals with DS.
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Affiliation(s)
- F de Campos Gomes
- Genetics and Molecular Biology Research Unit (UPGEM), São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, Brazil
| | - J S de Melo-Neto
- Institute of Health Sciences, Federal University of Pará (UFPA), Belém, Brazil
| | - E M Goloni-Bertollo
- Genetics and Molecular Biology Research Unit (UPGEM), São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, Brazil
| | - É C Pavarino
- Genetics and Molecular Biology Research Unit (UPGEM), São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, Brazil
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Murray ET, Lacey R, Maughan B, Sacker A. Association of childhood out-of-home care status with all-cause mortality up to 42-years later: Office of National Statistics Longitudinal Study. BMC Public Health 2020; 20:735. [PMID: 32434479 PMCID: PMC7238620 DOI: 10.1186/s12889-020-08867-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 05/07/2020] [Indexed: 12/11/2022] Open
Abstract
Background The adverse life-long consequences of being looked-after as a child are well recognised, but follow-up periods for mortality risk have mostly ended in young adulthood and mortality suggested to differ by age of placement, gender and cohort in small samples. Methods Data on 353,601 Office for National Statistics Longitudinal Study (LS) members during census years 1971–2001, and Cox proportional hazards regression models with time-varying covariates (age as the timescale), were used to examine whether childhood out-of-home care was associated with all-cause mortality until the end of 2013. After adjusting for baseline age and age2, gender, born outside the United Kingdom, number of census observations in childhood and baseline census year we tested whether mortality risk varied for those in care by age, gender and baseline census year, by separate assessment of interaction terms. Supplementary analyses assessed robustness of findings. Results Adults who had been in care at any census (maximum of two) had an adjusted all-cause mortality hazard ratio 1.62 (95% CI 1.43, 1.86) times higher than adults who had never been in care. The excess mortality was mainly attributable to deaths categorised as self-harm, accidents and mental & behavioural causes. Mortality risk was elevated if the LS member was initially assessed in 1981 or 2001, compared to 1971. There was no significant variation in mortality risk for those in care by age or gender. The main findings were consistent irrespective of choice of comparison group (whole population, disadvantaged population), care placement (residential, non-residential) and age at death (all ages, adulthood only). Conclusions In this large, nationally representative study of dependent children resident in England and Wales, those who had been in care during childhood had a higher risk of mortality long after they had left care on average, mainly from unnatural causes. No differences by age or gender were found. Children in care have not benefitted from the general decline in mortality risk over time.
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Affiliation(s)
- Emily T Murray
- Department of Epidemiology & Public Health, University College London, 1-19 Torrington Place, LONDON, WC1E 6BT, United Kingdom
| | - Rebecca Lacey
- Department of Epidemiology & Public Health, University College London, 1-19 Torrington Place, LONDON, WC1E 6BT, United Kingdom
| | - Barbara Maughan
- MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Amanda Sacker
- Department of Epidemiology & Public Health, University College London, 1-19 Torrington Place, LONDON, WC1E 6BT, United Kingdom.
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Association between childhood socioeconomic position and sports group participation among Japanese older adults: A cross-sectional study from the JAGES 2010 survey. Prev Med Rep 2020; 18:101065. [PMID: 32123650 PMCID: PMC7038007 DOI: 10.1016/j.pmedr.2020.101065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 01/28/2020] [Accepted: 02/08/2020] [Indexed: 11/24/2022] Open
Abstract
Low childhood socioeconomic position was linked to lower sports participation in Japanese older adults. This association was attenuated by education. Education had a stronger association than adult socioeconomic position. Reducing child poverty and enriching education may increase sports group participation.
Sports group participation may have greater effects on health outcomes than exercising alone. Unhealthy lifestyles were reported to be specifically associated with lower socioeconomic positions (SEPs), and child poverty and the bipolarization of sports participation are currently major policy concerns in children. However, it remains unclear whether childhood SEP has any long-latency effect on sports group participation among older Japanese. Data were obtained from the Japan Gerontological Evaluation Study 2010 project, which used self-report questionnaires to survey individuals aged ≥65 years without disability from 27 municipalities (n = 23,320). According to their answers, respondents were assigned to one of three SEP groups: high, middle, or low. Poisson regression with robust variance and multiple imputations was used to examine the association between childhood SEP and sports group participation. After adjusting for health-related factors, low childhood SEP was negatively associated with sports group participation in men (prevalence ratio [PR] = 0.82, 95% confidence interval [CI] = 0.74–0.91) and women (PR = 0.88, 95% CI = 0.80–0.97). The PR was greatly attenuated after adjusting for educational attainment in both men (PR = 0.92, 95% CI = 0.83–1.02) and women (PR = 0.98, 95% CI = 0.89–1.08), and the significant association disappeared. Low childhood SEP is thus associated with lower sports group participation among older Japanese, though this may be attenuated by education. These findings suggest that it may be necessary to consider childhood SEP and the importance of education to increase sports group participation at an older age.
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Kino S, Kawachi I. How much do preventive health behaviors explain education- and income-related inequalities in health? Results of Oaxaca–Blinder decomposition analysis. Ann Epidemiol 2020; 43:44-50. [DOI: 10.1016/j.annepidem.2020.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/09/2020] [Accepted: 01/16/2020] [Indexed: 11/17/2022]
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Finger JD, Hoebel J, Kuntz B, Kuhnert R, Zeiher J, Mensink GBM, Lampert T. Educational differences in the prevalence of behavioural risk factors in Germany and the EU - Results from the European Health Interview Survey (EHIS) 2. JOURNAL OF HEALTH MONITORING 2019; 4:29-47. [PMID: 35146256 PMCID: PMC8790794 DOI: 10.25646/6225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022]
Abstract
This article examines educational differences in the prevalence of behavioural risk factors among adults and compares the results for Germany with the average from the European Union (EU). Data were derived from the second wave of the European Health Interview Survey, which took place between 2013 and 2015 (EHIS 2). Analyses were conducted using a regression-based calculation of relative and absolute educational differences in the prevalence of behavioural risk factors, based on self-reported data from women and men aged between 25 and 69 (n=217,215). Current smoking, obesity, physical activity lasting less than 150 minutes per week, heavy episodic drinking and non-daily fruit or vegetable intake are more prevalent among people with a low education level than those with a high education level. This applies to Germany as well as the EU average. Overall, the relative educational differences identified for these risk factors place Germany in the mid-range compared to the EU average. However, relative educational differences in current smoking and heavy episodic drinking are more manifest among women in Germany than the EU average, with the same applying to low physical activity among men. In contrast, relative educational differences in non-daily fruit or vegetable intake are less pronounced among women and men in Germany than the average across the EU. Increased efforts are needed in various policy fields to improve the structural conditions underlying health behaviour, particularly for socially disadvantaged groups, and increase health equity.
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Affiliation(s)
- Jonas D. Finger
- Formerly Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Jens Hoebel
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Benjamin Kuntz
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Ronny Kuhnert
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Johannes Zeiher
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Gert B. M. Mensink
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Thomas Lampert
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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