Recent quantitative research on determinants of health in high income countries: A scoping review

Deciphering the mechanism of women's mental health: a perspective of urban-rural differences

Background

Mental health accounts for a significant proportion of holistic health and affects women more significantly than men. Livelihood capital, defined as an indicator of these sources available for individuals or households to survive and develop, is a cost-effective field for ameliorating women's mental health. However, the impact of these multiple factors of livelihood capital on mental health still requires further research Therefore, this study evaluates women's mental health and investigates the correlation between livelihood capital (including human capital, physical capital, social capital, and financial capital) and women's mental health.

Methods

Based on the 2018 China Labor-force Dynamics Survey, this study explores the relationship and pathways between livelihood capital and women's mental health, with the structural equation model. It also aimed to examine the impact of relative deprivation under the influence of livelihood capital on women's mental health, focusing on urban-rural differences.

Results

The results of this study are as follows: (1) Human capital, social capital and physical capital were positively correlated with women's mental health, while financial capital showed a negative correlation; (2) Relative deprivation mediates the impact of livelihood capital on women's mental health; (3) The impact of livelihood capital on women's mental health is different between urban and rural regions. Urban women were more likely to be influenced by financial capital, whereas human capital, social capital and physical capital were key factors affecting rural women's mental health. (4) Relative deprivation mediates the impact of livelihood capital on mental health in the rural sample, but not in the urban sample.

Discussion

This study shows a complex relationship among livelihood capital, relative deprivation, and women's mental health, with notable urban-rural differences. In rural areas, human, social, and physical capital positively affect women's mental well-being. For example, better education reduces relative deprivation. Social support and improved housing also help. Conversely, financial capital has a negative link with mental health, more so in urban areas, likely due to urban pressure and the wealth-mental health relationship. Based on the findings, several actions are warranted. In social welfare, allocate more resources to rural areas for stronger women's livelihood capital. Public services should improve rural housing and community integration. Expand and enhance mental health education for rural women. These steps can ease rural women's mental health challenges and promote fairness in mental health outcomes.

Determinants of COVID-19 vaccination coverage in European and Organisation for Economic Co-operation and Development (OECD) countries

Introduction

In relatively wealthy countries, substantial between-country variability in COVID-19 vaccination coverage occurred. We aimed to identify influential national-level determinants of COVID-19 vaccine uptake at different COVID-19 pandemic stages in such countries.

Methods

We considered over 50 macro-level demographic, healthcare resource, disease burden, political, socio-economic, labor, cultural, life-style indicators as explanatory factors and coverage with at least one dose by June 2021, completed initial vaccination protocols by December 2021, and booster doses by June 2022 as outcomes. Overall, we included 61 European or Organisation for Economic Co-operation and Development (OECD) countries. We performed 100 multiple imputations correcting for missing data and partial least squares regression for each imputed dataset. Regression estimates for the original covariates were pooled over the 100 results obtained for each outcome. Specific analyses focusing only on European Union (EU) or OECD countries were also conducted.

Results

Higher stringency of countermeasures, and proportionately more older adults, female and urban area residents, were each strongly and consistently associated with higher vaccination rates. Surprisingly, socio-economic indicators such as gross domestic product (GDP), democracy, and education had limited explanatory power. Overall and in the OECD, greater perceived corruption related strongly to lower vaccine uptake. In the OECD, social media played a noticeable positive role. In the EU, right-wing government ideology exhibited a consistently negative association, while cultural differences had strong overall influence.

Conclusion

Relationships between country-level factors and COVID-19 vaccination uptake depended on immunization stage and country reference group. Important determinants include stringency, population age, gender and urbanization, corruption, government ideology and cultural context.

The multifactorial approach and the food allergen-specific substitutive diet as a tool to manage and ameliorate adverse reactions to foodstuffs in adulthood: study protocol for a randomized controlled trial-the ALASKA study

BACKGROUND

Adverse reactions to foodstuffs (ARFS), specifically food allergy (FA) and food intolerance (FI), are increasing worldwide and represent a major public health concern. Thus, ARFS management, its identification, evaluation, and intervention, must provide a comprehensive solution.

OBJECTIVES

(a) To develop a multifactorial strategy for ARFS management in adults with FA and/or FI; (b) to describe the multiple influential variables in ARFS within the realm of ARFS management; and (c) to design a personalized food allergen-specific substitutive diet (FASSD), as a 6-month dietary treatment option for adults with ARFS and as a component of ARFS management.

METHODS

The ALASKA study will consider the following main variables as part of the ARFS management: (1) demographics and clinical information; (2) symptomatology, food and beverages intake and physical activity; (3) hematobiochemical study; (4) immunology; (5) enzymatic activity; (6) anthropometry, body composition, and physical fitness; (7) QoL; (8) 6-month intervention; (9) end of the study; and (10) other assessments. The FASSD will be designed with special emphasis on the commonly lacking micronutrients in the ARFS population: niacin, Mg, K, P, Ca, Zn, B12, folate, Fe, and fiber.

DISCUSSION

The ALASKA study protocol has been developed as a global strategy to manage and evaluate ARFS in Spanish adults older than 18 years of age. Approaching ARFS with multiple assessments, as influencing factors, will lead to a novel strategy for ARFS management. The FASSD has been designed as a personalized tool to avoid crucial micronutrient deficiencies that a current strict food allergen avoidance or elimination diet may provoke.

TRIAL REGISTRATION

The protocol has been approved by the Ethics Committee of the UPM (REF.20200602) and registered on ClinicalTrials.gov (NCT05802017).

Pregnancy and Childbirth Fear of Women from Poland, Greece, Turkey, Belarus, and Russia

Background/Objectives: Pregnancy and childbirth in many women cause various situations, from physical to emotional. The analysis of selected factors affecting pregnancy and childbirth in a group of women from Poland, Greece, Turkey, Belarus, and Russia and self-assessment of their impact on fear of pregnancy and childbirth. Material and Methods: A total of 2017 women were surveyed, including 584 pregnant women, 528 postpartum women, and 906 non-pregnant and never-pregnant women. The study used an original questionnaire, including questions on socio-demographics and the history of pregnancy and childbirth. The material status of the respondents was assessed using the Family Affluence Scale. Results: The age range of respondents was 19-50. The surveyed women most often reported (p < 0.001) fear (n = 928) and excitement (n = 901). A positive correlation was found between anemia, infections, and fear in women from Belarus. No correlation was found between low, average, or high material status and the perception of pregnancy in women from the studied countries. Significantly (p < 0.001), women from Turkey had more children (p < 0.001) than women from other countries. With the exception of Russia, statistical correlations were shown between the feeling of fear of pregnancy and childbirth and the way the previous/current pregnancy was delivered and the experience of an artificial/natural miscarriage in the past. In general, 630 women had given birth vaginally, and 283 women had given birth by cesarean section. In the group of currently pregnant women, 22 women had had natural miscarriages in Belarus, 37 in Poland, 27 in Greece, 29 in Turkey, and 9 in Russia. Conclusions: When thinking about pregnancy, respondents in all groups most often felt joy and excitement, as well as fear and excitement, about childbirth. Natural miscarriage was experienced most frequently by women in Poland and Greece and induced in Belarus. The largest number of women who had cesarean section were from Poland and Belarus.

Exploring trends and determinants of basic childhood vaccination coverage: Empirical evidence over 41 years

Vaccination is widely considered to be one of the most important prevention measures as a health strategy. This paper examines trends in basic childhood vaccination coverage and which country and time-dependent determinants may have influenced childhood immunization rates (1-dose BCG, 1- and 3-dose DTP (diphtheria, tetanus, pertussis), 1-dose measles, and 3-dose polio) between 1980 and 2020 across 94 countries. We identify economic, inequality, demographic, health, education, labor market, environmental, and political stability factors of immunization. To do this, we use data from the annual WHO and United Nations International Children's Emergency Fund (UNICEF) coverage estimates. The empirical analysis consists of generalized estimating equation models to assess relationships between immunization rates and socioeconomic factors. Additionally, we follow the Barro and Sala-i-Martín approach to identify conditional convergence. Our findings show the strongest positive statistically significant association between immunization rates and GDP per capita, as well as births attended by skilled health staff. Moreover, our research demonstrates conditional convergence, indicating that countries converge towards different steady states. The present study brings new insights to investigating the determinants of childhood vaccination coverage and provides significant implications for health policies.

Treatable mortality and health care related factors across European countries

Introduction

Despite the improvements in European health systems, a large number of premature deaths are attributable to treatable mortality. Men make up the majority of these deaths, with a significant gap existing between women and men's treatable mortality rate in the EU.

Aim

This study aims to identify the healthcare-related factors, including health expenditures, human and physical resources, and hospital services use associated with treatable mortality in women and men across European countries during the period 2011-2019.

Methods

We use Eurostat data for 28 EU countries in the period 2011-2019. We estimate a panel data linear regression with country fixed effects and quantile linear regression for men and women.

Results

The results found (i) differences in drivers for male and female treatable mortality, but common drivers hold the same direction for both sexes; (ii) favorable drivers are GDP per capita, health expenditures, number of physicians per capita, and (only for men) the average length of a hospital stay, (iii) unfavorable drivers are nurses and beds per capita, although nurses are not significant for explaining female mortality.

Conclusion

Policy recommendations may arise that involve an improvement in hospital bed management and the design of more specific policies aimed at healthcare professionals.

Financial Well-Being Among US Adults with Vascular Conditions: Differential Impacts Among Blacks and Hispanics

Background

The ability to meet current and ongoing financial obligations, known as financial well-being (FWB), is not only associated with the likelihood of adverse health events but is also affected by unexpected health care expenditures. However, the relationship between FWB and common health outcomes is not well understood. Using data available in the Financial Well-Being Scale from the Consumer Financial Protection Bureau, we evaluated the impact of four vascular conditions-cardiovascular disease (CVD), stroke, high blood pressure (BP), and high cholesterol-on FWB and how these impacts varied between racial and ethnic groups.

Methods

Using the Understanding America Survey-a nationally representative, longitudinal panel-we identified adults with self-reported diagnoses between 2014 and 2020 of high cholesterol, high BP, stroke, and CVD. We used stratified, longitudinal mixed regression models to assess the association between these diagnoses and FWB. Each condition was modeled separately and included sex, age, marital status, household size, income, education, race/ethnicity, insurance, body mass index, and an indicator of the condition. Racial and ethnic differentials were captured using group-condition interactions.

Results

On average, Whites had the highest FWB Scale score (69.0, SD=21.8), followed by other races (66.7, SD=21.0), Hispanics (59.3, SD=21.6), and Blacks (56.2, SD=21.4). In general, FWB of individuals with vascular conditions was lower than that of those without, but the impact varied between racial and ethnic groups. Compared with Whites (the reference group), Blacks with CVD (-7.4, SD=1.0), stroke (-8.1, SD=1.5), high cholesterol (-5.7, SD=0.7), and high BP (6.1, SD=0.7) had lower FWB. Similarly, Hispanics with high BP (-3.0, SD=0.6) and CVD (-6.3, SD=1.3) had lower FWB. Income, education, insurance, and marital status were also correlated with FWB.

Conclusions

These results indicated differences in the financial ramifications of vascular conditions among racial and ethnic groups. Findings suggest the need for interventions targeting FWB of individuals with vascular conditions, particularly those from minority groups.

Determinants of basic childhood vaccination coverage in European and OECD countries

Vaccination coverage varies between countries and over time. Using official databases, we extracted data on 50 national-level immunization, socio-economic, demographic, healthcare, and cultural factors, and the uptake of the third dose of diphtheria toxoid, tetanus toxoid, and pertussis vaccines (DTP3) and the first dose of measles-containing vaccines (MCV1) for 61 countries between 1990 and 2019. The main branch of the analysis included all covariates, while a secondary branch excluded life-expectancy and child mortality. The statistical analysis was completed in three stages: a variable-selection stage via random forests; multilevel multiple imputation for missing data in the reduced dataset; and generalized estimating equations (GEE) over all imputed datasets with pooled results. Less than 20 covariates were retained after variable-selection. Among a relatively small number of statistically significant (p-value <.05) effects in the pooled GEE results of our main branch, under-5 mortality and long-term orientation culture showed negative associations with both uptake outcomes and GDP per capita a positive association. For MCV1, whether a second dose was integrated into routine immunization appeared as the overall strongest negative correlate. In the secondary analytical branch, results were largely consistent, with a few additional statistically significant effects emerging, mainly related to immunization and healthcare system characteristics. These insights improve our understanding of the main factors influencing vaccine uptake, some of which are broadly contextual (e.g., GDP, socio-cultural factors), requiring bespoke vaccine program approaches, in order to maximize childhood vaccine uptake over time.

Associations between social determinants of health and abdominal solid organ transplant wait-lists in the United States

BACKGROUND

Societal factors that influence wait-listing for transplantation are complex and poorly understood. Social determinants of health (SDOH) affect rates of and outcomes after transplantation.

METHODS

This cross-sectional study investigated the impact of SDOH on additions to state-level, 2017-2018 kidney and liver wait-lists. Principal components analysis, starting with 127 variables among 3142 counties, was used to derive novel, comprehensive state-level composites, designated (1) health/economics and (2) community capital/urbanicity. Stepwise multivariate linear regression with backwards elimination (n = 51; 50 states and DC) tested the effects of these composites, Medicaid expansion, and center density on adult disease burden-adjusted wait-list additions.

RESULTS

SDOH related to increased community capital/urbanicity were independently associated with wait-listing (starting models: B = .40, P = .010 Kidney; B = .36, P = .038 Liver) (final models: B = .31, P = .027 Kidney, B = .34, P = .015 Liver). In contrast and surprisingly, no other covariates were associated with wait-listing (P ≥ .122).

CONCLUSIONS

These results suggest that deficits in community resources are important contributors to disparities in wait-list access. Our composite SDOH metrics may help identify at-risk communities, which can be the focus of local and national policy initiatives to improve access to organ transplantation.

An empirical analysis of the impact of income inequality and social capital on physical and mental health - take China's micro-database analysis as an example

BACKGROUND

Income inequality is one of the important reflections of the unbalanced development of the world economy and can have adverse effects on physical and mental health.

METHODS

This article used the 2018 China Family Panel Studies Database as an empirical analysis data source. The Kakwani index (KI) was used to measure income inequality, and social capital was broken into cognitive social capital and structural social capital. Our assessment was conducted by using STATA16 software for ordered logistic regression, verifying income inequality, social capital on correlation between physical and mental health firstly; then by gradual regression methods to verify intermediary effect, and demonstrate the social capital as an intermediary variable affecting physical and mental health as income inequality.

RESULT

The income inequality has a significant negative effect on physical and mental health (β = - 0.964, - 0.381; OR = 0.382, 0.758; P < 0.01), Social capital has a significant effect on physical and mental health (Cognitive SC(MH): β = 0.146 and 0.104, OR = 1.157 and 1.110, P < 0.01; Cognitive SC(PH): β = 0.046 and 0.069, OR = 1.047 and 1.071, P < 0.01; Structural SC(MH): β = - 0.005, 0.025 and 0.015, OR = 0.995, 1.025 and 1.015, P > 0.1, P < 0.01 and P < 0.01; Structural SC(PH): β = - 0.026, 0.009 and - 0.013, OR = 0.975, 1.009 and 0.987, P < 0.01, P > 0.1 and P < 0.01). Our analysis also showed that social capital (cognitive social capital and structural social capital) has an intermediary effect on physical and mental health due to income inequality.

CONCLUSION

This study shows that income inequality can not only directly affect physical and mental health, but also through social capital intermediary utility indirectly affect physical and mental health, social capital has positive effects on physical and mental health. At the same time, income inequality and social capital's effects on physical and mental health exist regional differences, urban-rural differences, and gender differences. Therefore, in the development of special policies to support and take care of vulnerable groups, special attention needs to be paid to poor rural areas and female groups.

Socioeconomic status in Danish transgender persons: a nationwide register-based cohort study

BACKGROUND

Gender dysphoria could be associated with low socioeconomic status (SES). SES could be modified by age, ethnic background, and medical morbidity.

AIM

To determine SES in a national study population including transgender persons in Denmark.

METHODS

National register-based cohort study in Danish transgender persons and age-matched controls. The transgender study cohort included persons with ICD-10 diagnosis code of 'gender identity disorder' and/or persons with legal sex change and persons who fulfiled the inclusion criteria during 2000-2018. The main outcome measure was SES including personal income, occupational status, and education.

RESULTS

The cohort included 2770 transgender persons and 27,700 controls. In the transgender study cohort, 1437 were assigned male at birth (AMAB), median age (interquartile range, IQR) 26.0 (17.3) years, and 1333 were assigned female at birth (AFAB), median age 22.5 (10.3) years. Adjusting for age and sex, the relative risk ratio (RRR) of low vs high personal income was 5.6 (95% CI: 4.9; 6.3) in transgender persons compared to controls. The RRR of low vs high income was 6.9 (5.8; 8.3) in persons AMAB compared to control males and 4.7 (3.9; 5.6) in persons AFAB compared to control females. The RRR of low vs high income was 3.7 (3.2; 4.3) in transgender persons of Danish origin compared to controls. The Charlson comorbidity index was comparable in transgender persons vs controls.

CONCLUSIONS

Being transgender was negatively associated with SES. In transgender persons, the risk of low vs high income could be more pronounced in transgender persons of foreign origin.

The Role of Public Health Expenditures in COVID-19 control: Evidence from Local Governments in England

For over 150 years the local health departments of England have been critical in controlling 19^th and 20^th century infectious epidemics. However, recent administrative changes have hollowed out their flexibility to serve communities. We use administrative data on past budgetary allocations per capita to public health departments at upper tier local areas (UTLAs) of England to examine whether public health funding levels were correlated with more rapid control of the first wave of the COVID-19 pandemic between March and July of 2020. The dependent variable was the number of days between a UTLA's 10th case of COVID-19 and the day when new cases per 100,000 peaked and began to decline. Our models controlled for regional socio-economic factors. We found no correlation between local public health expenditure and the speed of control of COVID-19. However, overall public expenditure allocated to improve local areas helped reduce time to reach peak. Contrary to expectation, more dense areas such as London experienced shorter duration. Higher income areas had more rapid success in accelerating the time of the first peak in the first wave of their local COVID-19 incidence. We contribute to understanding the impact of how public expenditure and socio-economic factors affect an epidemic.

A bio-ecological framing of evidence on the determinants of adolescent mental health - A scoping review of the international Health Behaviour in School-Aged Children (HBSC) study 1983-2020

This paper extracts, organises and summarises findings on adolescent mental health from a major international population study of young people using a scoping review methodology and applying a bio-ecological framework. Population data has been collected from more than 1.5 million adolescents over 37 years by the Health Behaviour in School-Aged Children: WHO Cross-National (HBSC) Study. The paper reviews the contribution that this long standing study has made to our understanding of the individual, developmental, social, economic, cultural determinants of adolescent mental health by organising the findings of 104 empirical papers that met inclusion criteria, into individual, microsystem, mesosystem and macrosystem levels of the framework. Of these selected papers, 68 were based on national data and the other 36 were based on international data, from varying numbers of countries. Each paper was allocated to a system level in the bio-ecological framework according to the level of its primary focus. The majority (51 papers) investigate individual level determinants. A further 28 concentrate primarily on the microsystem level, 6 on the mesosystem level, and 29 on the macrosystem level. The paper identifies where there is evidence on the determinants of mental health, summarises what we have learned, and highlights research gaps. Implications for the future development of this population health study are discussed in terms of how it may continue to illuminate our understanding of adolescent mental health in a changing world and where new directions are required.