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Balaj M, Henson CA, Aronsson A, Aravkin A, Beck K, Degail C, Donadello L, Eikemo K, Friedman J, Giouleka A, Gradeci I, Hay SI, Jensen MR, Mclaughlin SA, Mullany EC, O'connell EM, Sripada K, Stonkute D, Sorensen RJ, Solhaug S, Vonen HD, Westby C, Zheng P, Mohammad T, Eikemo TA, Gakidou E. Effects of education on adult mortality: a global systematic review and meta-analysis. Lancet Public Health 2024; 9:e155-e165. [PMID: 38278172 PMCID: PMC10901745 DOI: 10.1016/s2468-2667(23)00306-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND The positive effect of education on reducing all-cause adult mortality is known; however, the relative magnitude of this effect has not been systematically quantified. The aim of our study was to estimate the reduction in all-cause adult mortality associated with each year of schooling at a global level. METHODS In this systematic review and meta-analysis, we assessed the effect of education on all-cause adult mortality. We searched PubMed, Web of Science, Scopus, Embase, Global Health (CAB), EconLit, and Sociology Source Ultimate databases from Jan 1, 1980, to May 31, 2023. Reviewers (LD, TM, HDV, CW, IG, AG, CD, DS, KB, KE, and AA) assessed each record for individual-level data on educational attainment and mortality. Data were extracted by a single reviewer into a standard template from the Global Burden of Diseases, Injuries, and Risk Factors Study. We excluded studies that relied on case-crossover or ecological study designs to reduce the risk of bias from unlinked data and studies that did not report key measures of interest (all-cause adult mortality). Mixed-effects meta-regression models were implemented to address heterogeneity in referent and exposure measures among studies and to adjust for study-level covariates. This study was registered with PROSPERO (CRD42020183923). FINDINGS 17 094 unique records were identified, 603 of which were eligible for analysis and included data from 70 locations in 59 countries, producing a final dataset of 10 355 observations. Education showed a dose-response relationship with all-cause adult mortality, with an average reduction in mortality risk of 1·9% (95% uncertainty interval 1·8-2·0) per additional year of education. The effect was greater in younger age groups than in older age groups, with an average reduction in mortality risk of 2·9% (2·8-3·0) associated with each additional year of education for adults aged 18-49 years, compared with a 0·8% (0·6-1·0) reduction for adults older than 70 years. We found no differential effect of education on all-cause mortality by sex or Socio-demographic Index level. We identified publication bias (p<0·0001) and identified and reported estimates of between-study heterogeneity. INTERPRETATION To our knowledge, this is the first systematic review and meta-analysis to quantify the importance of years of schooling in reducing adult mortality, the benefits of which extend into older age and are substantial across sexes and economic contexts. This work provides compelling evidence of the importance of education in improving life expectancy and supports calls for increased investment in education as a crucial pathway for reducing global inequities in mortality. FUNDING Research Council of Norway and the Bill & Melinda Gates Foundation.
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Chen-Xu J, Varga O, Mahrouseh N, Eikemo TA, Grad DA, Wyper GMA, Badache A, Balaj M, Charalampous P, Economou M, Haagsma JA, Haneef R, Mechili EA, Unim B, von der Lippe E, Baravelli CM. Subnational inequalities in years of life lost and associations with socioeconomic factors in pre-pandemic Europe, 2009-19: an ecological study. Lancet Public Health 2024; 9:e166-e177. [PMID: 38429016 DOI: 10.1016/s2468-2667(24)00004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Health inequalities have been associated with shorter lifespans. We aimed to investigate subnational geographical inequalities in all-cause years of life lost (YLLs) and the association between YLLs and socioeconomic factors, such as household income, risk of poverty, and educational attainment, in countries within the European Economic Area (EEA) before the COVID-19 pandemic. METHODS In this ecological study, we extracted demographic and socioeconomic data from Eurostat for 1390 small regions and 285 basic regions for 32 countries in the EEA, which was complemented by a time-trend analysis of subnational regions within the EEA. Age-standardised YLL rates per 100 000 population were estimated from 2009 to 2019 based on methods from the Global Burden of Disease study. Geographical inequalities were assessed using the Gini coefficient and slope index of inequality. Socioeconomic inequalities were assessed by investigating the association between socioeconomic factors (educational attainment, household income, and risk of poverty) and YLLs in 2019 using negative binomial mixed models. FINDINGS Between Jan 1, 2009, and Dec 31, 2019, YLLs lowered in almost all subnational regions. The Gini coefficient of YLLs across all EEA regions was 14·2% (95% CI 13·6-14·8) for females and 17·0% (16·3 to 17·7) for males. Relative geographical inequalities in YLLs among women were highest in the UK (Gini coefficient 11·2% [95% CI 10·1-12·3]) and among men were highest in Belgium (10·8% [9·3-12·2]). The highest YLLs were observed in subnational regions with the lowest levels of educational attainment (incident rate ratio [IRR] 1·19 [1·13-1·26] for females; 1·22 [1·16-1·28] for males), household income (1·35 [95% CI 1·19-1·53]), and the highest poverty risk (1·25 [1·18-1·34]). INTERPRETATION Differences in YLLs remain within, and between, EEA countries and are associated with socioeconomic factors. This evidence can assist stakeholders in addressing health inequities to improve overall disease burden within the EEA. FUNDING Research Council of Norway; Development, and Innovation Fund of Hungary; Norwegian Institute of Public Medicine; and COST Action 18218 European Burden of Disease Network.
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Affiliation(s)
- José Chen-Xu
- Comprehensive Health Research Centre, Public Health Research Centre, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal; Public Health Unit, Local Health Unit Baixo Mondego, Figueira da Foz, Portugal
| | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Syreon Research Institute, Budapest, Hungary
| | - Nour Mahrouseh
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Terje Andreas Eikemo
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Diana A Grad
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Grant M A Wyper
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK; Population Health and Wellbeing, Public Health Scotland, Glasgow, Scotland
| | - Andreea Badache
- Swedish Institute of Disability Research, School of Health Sciences, Örebro University, Örebro, Sweden; School of Health Sciences, Örebro University, Örebro, Sweden
| | - Mirza Balaj
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Periklis Charalampous
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Mary Economou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Romana Haneef
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France
| | - Enkeleint A Mechili
- Department of Healthcare, Faculty of Health, University of Vlora, Vlora, Albania; School of Medicine, University of Crete, Crete, Greece
| | - Brigid Unim
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Italian National Institute of Health, Rome, Italy
| | - Elena von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Balaj M, Sjöqvist H, van der Velde L, Allebeck PA, Shaaban AN, Swartling Peterson S, Eikemo TA, Agardh EE. Does educational mobility in mid-life affect mortality? A cohort study covering 1.3 million individuals in Sweden. SSM Popul Health 2024; 25:101589. [PMID: 38229658 PMCID: PMC10790084 DOI: 10.1016/j.ssmph.2023.101589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 01/18/2024] Open
Abstract
•Studies on how increased formal educational level in mid-life affects mortality is lacking.•We found that women who increased their educational level in mid-life had a reduced risk of mortality.•In men, mortality was reduced only for those who increased their education from a low level.
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Affiliation(s)
- M. Balaj
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - H. Sjöqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - L. van der Velde
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - PA. Allebeck
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - AN. Shaaban
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - TA. Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - EE. Agardh
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Kopasker D, Katikireddi SV, Santos JV, Richiardi M, Bronka P, Rostila M, Cecchini M, Ali S, Emmert-Fees K, Bambra C, Hoven H, Backhaus I, Balaj M, Eikemo TA. Microsimulation as a flexible tool to evaluate policies and their impact on socioeconomic inequalities in health. Lancet Reg Health Eur 2023; 34:100758. [PMID: 37876527 PMCID: PMC10590730 DOI: 10.1016/j.lanepe.2023.100758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Daniel Kopasker
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK
| | | | - João Vasco Santos
- Public Health Unit, ACES Grande Porto V – Porto Ocidental, ARS Norte, Portugal
- MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Portugal
- CINTESIS - Centre for Health Technology and Services Research, Portugal
| | - Matteo Richiardi
- Centre for Microsimulation and Policy Analysis, University of Essex, UK
| | - Patryk Bronka
- Centre for Microsimulation and Policy Analysis, University of Essex, UK
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Sweden
- Aging Research Center (ARC), Karolinska Institutet, Sweden
| | - Michele Cecchini
- Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Shehzad Ali
- Department of Epidemiology and Biostatistics, Western University, Canada
- Department of Health Sciences, University of York, UK
- WHO Collaborating Centre for Knowledge Translation and HTA in Health Equity, Canada
| | - Karl Emmert-Fees
- School of Medicine and Health, Technical University of Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Germany
| | - Clare Bambra
- Population Health Sciences Institute, University of Newcastle, UK
| | - Hanno Hoven
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Germany
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | - Insa Backhaus
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | - Mirza Balaj
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
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Andrade CAS, Mahrouseh N, Gabrani J, Charalampous P, Cuschieri S, Grad DA, Unim B, Mechili EA, Chen-Xu J, Devleesschauwer B, Isola G, von der Lippe E, Baravelli CM, Fischer F, Weye N, Balaj M, Haneef R, Economou M, Haagsma JA, Varga O. Inequalities in the burden of non-communicable diseases across European countries: a systematic analysis of the Global Burden of Disease 2019 study. Int J Equity Health 2023; 22:140. [PMID: 37507733 PMCID: PMC10375608 DOI: 10.1186/s12939-023-01958-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Although overall health status in the last decades improved, health inequalities due to non-communicable diseases (NCDs) persist between and within European countries. There is a lack of studies giving insights into health inequalities related to NCDs in the European Economic Area (EEA) countries. Therefore, the aim of the present study was to quantify health inequalities in age-standardized disability adjusted life years (DALY) rates for NCDs overall and 12 specific NCDs across 30 EEA countries between 1990 and 2019. Also, this study aimed to determine trends in health inequalities and to identify those NCDs where the inequalities were the highest. METHODS DALY rate ratios were calculated to determine and compare inequalities between the 30 EEA countries, by sex, and across time. Annual rate of change was used to determine the differences in DALY rate between 1990 and 2019 for males and females. The Gini Coefficient (GC) was used to measure the DALY rate inequalities across countries, and the Slope Index of Inequality (SII) to estimate the average absolute difference in DALY rate across countries. RESULTS Between 1990 and 2019, there was an overall declining trend in DALY rate, with larger declines among females compared to males. Among EEA countries, in 2019 the highest NCD DALY rate for both sexes were observed for Bulgaria. For the whole period, the highest DALY rate ratios were identified for digestive diseases, diabetes and kidney diseases, substance use disorders, cardiovascular diseases (CVD), and chronic respiratory diseases - representing the highest inequality between countries. In 2019, the highest DALY rate ratio was found between Bulgaria and Iceland for males. GC and SII indicated that the highest inequalities were due to CVD for most of the study period - however, overall levels of inequality were low. CONCLUSIONS The inequality in level 1 NCDs DALYs rate is relatively low among all the countries. CVDs, digestive diseases, diabetes and kidney diseases, substance use disorders, and chronic respiratory diseases are the NCDs that exhibit higher levels of inequality across countries in the EEA. This might be mitigated by applying tailored preventive measures and enabling healthcare access.
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Affiliation(s)
- Carlos Alexandre Soares Andrade
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary
| | - Nour Mahrouseh
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary
| | - Jonila Gabrani
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Periklis Charalampous
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sarah Cuschieri
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Diana Alecsandra Grad
- Department of Public Health, Babes-Bolyai University, Cluj-Napoca-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca-Napoca, Romania
| | - Brigid Unim
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore Di Sanità, Rome, Italy
| | - Enkeleint A Mechili
- Department of Healthcare, Faculty of Health, University of Vlora, Vlora, Albania
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece
| | - José Chen-Xu
- Public Health Unit, Primary Healthcare Cluster Baixo Mondego, Coimbra, Portugal
- National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Gaetano Isola
- Department of General Surgery and Surgical Medical Specialties, University of Catania, Catania, Italy
| | - Elena von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nanna Weye
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Mirza Balaj
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Romana Haneef
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France
| | - Mary Economou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary.
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Huijts T, Gage Witvliet M, Balaj M, Andreas Eikemo T. Assessing the long-term health impact of COVID-19: The importance of using self-reported health measures. Scand J Public Health 2023; 51:645-647. [PMID: 37382292 DOI: 10.1177/14034948221143421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
It is estimated that at least one out of 10 people who contracted COVID-19 continue to experience health problems long after the clearance of the acute infection. These belong to the growing group of people who have post-acute sequelae of SARS CoV-2 infection or long COVID, a multifaceted condition involving multiple organ systems. Given the lack of clear definition and diagnosis, this marked increase in the number of people who have long COVID might not be fully reflected in data on population health in the years to come. In this editorial, we argue that the use of self-reported health measures is vital for fully assessing the long-term impact of the COVID-19 pandemic on health and health inequalities. After briefly introducing self-reported health measures, we discuss strengths and limitations of specific measures that capture direct self-reports of long COVID. We then outline how the impact of long COVID may also be reflected in response patterns to more general self-reported health measures and give suggestions on how these can be used to examine the long-term health impact of the COVID-19 pandemic.
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Affiliation(s)
- Tim Huijts
- Research Centre for Education and the Labour Market (ROA), Maastricht University, The Netherlands
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology, Norway
| | | | - Mirza Balaj
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology, Norway
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology, Norway
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7
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Mosquera I, Todd A, Balaj M, Zhang L, Benitez Majano S, Mensah K, Eikemo TA, Basu P, Carvalho AL. Components and effectiveness of patient navigation programmes to increase participation to breast, cervical and colorectal cancer screening: A systematic review. Cancer Med 2023; 12:14584-14611. [PMID: 37245225 PMCID: PMC10358261 DOI: 10.1002/cam4.6050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Inequalities in cancer incidence and mortality can be partly explained by unequal access to high-quality health services, including cancer screening. Several interventions have been described to increase access to cancer screening, among them patient navigation (PN), a barrier-focused intervention. This systematic review aimed to identify the reported components of PN and to assess the effectiveness of PN to promote breast, cervical and colorectal cancer screening. METHODS We searched Embase, PubMed and Web of Science Core Collection databases. The components of PN programmes were identified, including the types of barriers addressed by navigators. The percentage change in screening participation was calculated. RESULTS The 44 studies included were mainly on colorectal cancer and were conducted in the USA. All described their goals and community characteristics, and the majority reported the setting (97.7%), monitoring and evaluation (97.7%), navigator background and qualifications (81.4%) and training (79.1%). Supervision was only referred to in 16 studies (36.4%). Programmes addressed mainly barriers at the educational (63.6%) and health system level (61.4%), while only 25.0% reported providing social and emotional support. PN increased cancer screening participation when compared with usual care (0.4% to 250.6% higher) and educational interventions (3.3% to 3558.0% higher). CONCLUSION Patient navigation programmes are effective at increasing participation to breast, cervical and colorectal cancer screening. A standardized reporting of the components of PN programmes would allow their replication and a better measure of their impact. Understanding the local context and needs is essential to design a successful PN programme.
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Affiliation(s)
- Isabel Mosquera
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
| | - Adam Todd
- School of PharmacyNewcastle University, Newcastle upon TyneUK
| | - Mirza Balaj
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Li Zhang
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
| | - Sara Benitez Majano
- Noncommunicable Diseases, Violence and Injuries Prevention Unit, Pan American Health OrganizationWashingtonDCUSA
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical MedicineLondonUK
| | - Keitly Mensah
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
| | - Andre L. Carvalho
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
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Baravelli CM, Eikemo TA, Klitkou ST, Kinge JM, Clarsen BM, Bølling AK, Balaj M, Knudsen AKS. Using individual-level stratification as an approach to integrating social inequalities into the burden of disease. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Substantial social inequalities in almost all non-fatal and fatal health outcomes are one of the most consistent and universal epidemiological findings. Therefore, monitoring social inequalities in health is considered a key priority for researchers and policy makers. The Global Burden of Disease Injuries, and Risk Factors Study (GBD) is the most comprehensive worldwide observational epidemiological synthesis of data to date. However, currently, the GBD Study does not include the potential to stratify associated metrics, such as the disability-adjusted life years metric, by different socioeconomic factors, such as education or income level. Although The GBD Study does include the Socio-Demographic Index, this measure is only useful when comparing between, and not within, countries or regions. We conducted a Cox regression analysis using a national longitudinal prospective cohort study design and registry-based data linked at the individual-level. We stratified on educational groups and investigated cause-specific mortality rates over a 30-year period, adjusting for age, sex and 5-year age cohorts. We also calculate years of life lost (YLLs) stratified by educational groups, standardised by age, and presented for specific years - to investigate trends over time. We discuss the benefits and limitations of this “individual-level” stratification approach as one possible solution to the integration of social inequalities into the GBD study or when using a burden of disease framework approach more generally.
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Affiliation(s)
- CM Baravelli
- Department of Disease Burden, Norwegian Institute of Public Health , Bergen, Norway
- Centre for Global Health Inequalities Research, Norwegian University of Science and Technology , Trondheim, Norway
| | - TA Eikemo
- Centre for Global Health Inequalities Research, Norwegian University of Science and Technology , Trondheim, Norway
| | - ST Klitkou
- Department of Disease Burden, Norwegian Institute of Public Health , Bergen, Norway
| | - JM Kinge
- Department of Disease Burden, Norwegian Institute of Public Health , Bergen, Norway
| | - BM Clarsen
- Department of Disease Burden, Norwegian Institute of Public Health , Bergen, Norway
| | - AK Bølling
- Department of Disease Burden, Norwegian Institute of Public Health , Bergen, Norway
| | - M Balaj
- Centre for Global Health Inequalities Research, Norwegian University of Science and Technology , Trondheim, Norway
| | - AKS Knudsen
- Department of Disease Burden, Norwegian Institute of Public Health , Bergen, Norway
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Abstract
Abstract
The general aims and evaluation blocks concerned the extent to which JAHEE achieved its objectives, and the identification of lessons learned for future health inequalities programmes. More specific aims included: • Producing knowledge: to understand the outcomes of JAHEE and build knowledge on health inequalities. • Influencing decision-making: to produce results that can guide the development of policies and initiatives tackling health inequalities. • Accountability: to clarify responsibilities and outcomes of JAHEE. • Lessons learned: to provide recommendations for future initiatives.
The evaluation was grounded in five evaluation blocks: relevance, effectiveness and impact, sustainability, dissemination, and added value. The main results will be presented.
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Affiliation(s)
- M Balaj
- Center for Global Health Inequality Research, Norwegian University of Science and Technology , Oslo, Norway
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Friedman J, Balaj M, Islam N, Gu Y, Nahmia P, Santamaría-Ulloa C, Gutierrez Rojas A, Rasanathan K, Hosseinpoor AR, Emina JBO, Eikemo TA, Castillo-Salgado C. Inequalities in COVID-19 mortality: defining a global research agenda. Bull World Health Organ 2022; 100:648-650. [PMID: 36188017 PMCID: PMC9511668 DOI: 10.2471/blt.22.288211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Joseph Friedman
- Center for Social Medicine and Humanities, University of California, B7-435, UCLA Semel Institute, Los Angeles, CA 90095-1759United States of America (USA)
| | - Mirza Balaj
- Centre for Global Health Inequalities Research, Norwegian University for Science and Technology, Trondheim, Norway
| | - Nazrul Islam
- Nuffield Department of Population Health, University of Oxford, Oxford, England
| | | | - Petra Nahmia
- Statistics Division, United Nations Economic and Social Commission for Asia and the Pacific, Bangkok, Thailand
| | | | - Andres Gutierrez Rojas
- Statistics Division, United Nations Economic Commission for Latin America and the Caribbean, Santiago, Chile
| | - Kumanan Rasanathan
- Department of Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | | | - Jacques BO Emina
- Department of Population and Development Studies, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research, Norwegian University for Science and Technology, Trondheim, Norway
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Balaj M, Eikemo TA. Sick of social status: A Bourdieusian perspective on morbidity and health inequalities. Sociol Health Illn 2022; 44:1214-1250. [PMID: 35779001 PMCID: PMC9540620 DOI: 10.1111/1467-9566.13512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
Self-reported health (SRH) is one of the most frequently used measures for examining socioeconomic inequalities in health. Studies find that when faced with 'identical objective health', individuals in lower socioeconomic groups consistently report worse SRH than those in higher socioeconomic groups. Such findings are often dismissed as being the result of reporting bias, and existing literature dominated by the biomedical conception of SRH has not investigated the underlying social mechanisms at work. To address this limitation, drawing on the work of Bourdieu we employ a relational thinking between health and social position. By way of multiple correspondence analysis, we construct social space of health determinants for three European countries from different welfare states and map the trajectories of educational groups experiencing similar levels of morbidity and their relation to SRH. Differences in SRH observed among social groups for the same level of morbidity are understood in relation to the position and the relative power of individuals in different educational groups to maintain or improve their social conditions, especially with increasing levels of health loss. Our analysis indicates that reporting differences in SRH among educational groups emerges from objectively healthy individuals and follows differences in accumulation of social advantages and disadvantages.
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Affiliation(s)
- Mirza Balaj
- Centre for Global Health Inequalities Research (CHAIN)Department of Sociology and Political ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Terje A. Eikemo
- Centre for Global Health Inequalities Research (CHAIN)Department of Sociology and Political ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
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12
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Beck KC, Balaj M, Donadello L, Mohammad T, Vonen HD, Degail C, Eikemo K, Giouleka A, Gradeci I, Westby C, Sripada K, Jensen MR, Solhaug S, Gakidou E, Eikemo TA. Educational inequalities in adult mortality: a systematic review and meta-analysis of the Asia Pacific region. BMJ Open 2022; 12:e059042. [PMID: 35940840 PMCID: PMC9364406 DOI: 10.1136/bmjopen-2021-059042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES In this study, we aim to analyse the relationship between educational attainment and all-cause mortality of adults in the high-income Asia Pacific region. DESIGN This study is a comprehensive systematic review and meta-analysis with no language restrictions on searches. Included articles were assessed for study quality and risk of bias using the Joanna Briggs Institute critical appraisal checklists. A random-effects meta-analysis was conducted to evaluate the overall effect of individual level educational attainment on all-cause mortality. SETTING The high-income Asia Pacific Region consisting of Japan, South Korea, Singapore and Brunei Darussalam. PARTICIPANTS Articles reporting adult all-cause mortality by individual-level education were obtained through searches conducted from 25 November 2019 to 6 December 2019 of the following databases: PubMed, Web of Science, Scopus, EMBASE, Global Health (CAB), EconLit and Sociology Source Ultimate. PRIMARY AND SECONDARY OUTCOME MEASURES Adult all-cause mortality was the primary outcome of interest. RESULTS Literature searches resulted in 15 345 sources screened for inclusion. A total of 30 articles meeting inclusion criteria with data from the region were included for this review. Individual-level data from 7 studies covering 222 241 individuals were included in the meta-analyses. Results from the meta-analyses showed an overall risk ratio of 2.40 (95% CI 1.74 to 3.31) for primary education and an estimate of 1.29 (95% CI 1.08 to 1.54) for secondary education compared with tertiary education. CONCLUSION The results indicate that lower educational attainment is associated with an increase in the risk of all-cause mortality for adults in the high-income Asia Pacific region. This study offers empirical support for the development of policies to reduce health disparities across the educational gradient and universal access to all levels of education. PROSPERO REGISTRATION NUMBER CRD42020183923.
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Affiliation(s)
- Kathryn Christine Beck
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mirza Balaj
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lorena Donadello
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Talal Mohammad
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hanne Dahl Vonen
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Claire Degail
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristoffer Eikemo
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Giouleka
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Indrit Gradeci
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Celine Westby
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kam Sripada
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
- Centre for Digital Life Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Magnus Rom Jensen
- Library Section for Humanities, Education and Social Sciences, University Library, Norwegian University of Science and Technology, Trondheim, Norway
| | - Solvor Solhaug
- Library Section for Humanities, Education and Social Sciences, University Library, Norwegian University of Science and Technology, Trondheim, Norway
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington Seattle Campus, Seattle, Washington, USA
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
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York HW, Balaj M, Sripada K, Gakidou E, Eikemo TA. Understanding the social determinants of health - Authors' reply. Lancet 2022; 399:1467-1468. [PMID: 35430016 DOI: 10.1016/s0140-6736(21)02661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Hunter Wade York
- Department of Sociology and Office of Population Research, Princeton University, Princeton, NJ, USA
| | - Mirza Balaj
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, 7491, Norway
| | - Kam Sripada
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, 7491, Norway
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, 7491, Norway.
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14
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Peñalvo JL, Mertens E, Devleeschauwer B, Grad DA, Hrzic R, Bikbov B, Abbafati C, Balaj M, Cuschieri S, Eikemo TA, Fischer F, Ghith N, Haagsma JA, Ngwa CH, Noguer-Zambrano I, O’Caoimh R, Paalanen L, Padron-Monedero A, Pallari E, Sarmiento Suárez R, Sulo G, Tecirli G, Vasco Santos J. Inequalities in non-communicable diseases across the European Union: current state and trends from 2000 to 2019. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Non-communicable diseases (NCDs) remain the leading cause of disease burden in the European Union (EU). However, this burden varies across Member States, driven by the socioeconomic and demographic structure of the populations, as well as health care and social support systems in each country. This geographical gradient in the burden of NCDs represents health inequalities that may have expanded as a result of population ageing, migration, and economic crisis, and historic backgrounds.
Methods
Using data from the GBD 2019 study, we quantify the inequality gap between EU countries, characterize the geographical gradient of total and individual NCDs, and analyze the trends over the last 20 years.
Results
A considerable gap exists in the rates of NCD-related DALYs between the country with the lowest burden (Slovenia in 2019) and the highest (Bulgaria in 2019), with a constant (p-trend > 0.05) ratio of 1.6 (95%CI, 1.57; 1.64) since the year 2000. The largest inequality was observed for the burden of stroke between the lowest (France in 2019) and the highest (Bulgaria in 2019) with a ratio of 7.47 (6.78; 8.24) Increasing steadily (p-trend < 0.001) since 2000. Using the relative index of inequality to characterize the gradient of inequalities across the EU, a decreasing trend (p < 0.001) can be observed for NCD-related DALYs rates from 1.56 (1.44; 1.7) in 2000 to in 1.42 (1.33; 1.52) 2019.
Conclusions
Despite overall improvements in health, spatial disparities related to NCDs in the EU persist. Our estimates provide a baseline to inform future equitable health policies.
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Affiliation(s)
- JL Peñalvo
- European Burden of Disease Network (COST Action CA18218)
| | - E Mertens
- European Burden of Disease Network (COST Action CA18218)
| | | | - DA Grad
- European Burden of Disease Network (COST Action CA18218)
| | - R Hrzic
- European Burden of Disease Network (COST Action CA18218)
| | - B Bikbov
- European Burden of Disease Network (COST Action CA18218)
| | - C Abbafati
- European Burden of Disease Network (COST Action CA18218)
| | - M Balaj
- European Burden of Disease Network (COST Action CA18218)
| | - S Cuschieri
- European Burden of Disease Network (COST Action CA18218)
| | - TA Eikemo
- European Burden of Disease Network (COST Action CA18218)
| | - F Fischer
- European Burden of Disease Network (COST Action CA18218)
| | - N Ghith
- European Burden of Disease Network (COST Action CA18218)
| | - JA Haagsma
- European Burden of Disease Network (COST Action CA18218)
| | - CH Ngwa
- European Burden of Disease Network (COST Action CA18218)
| | | | - R O’Caoimh
- European Burden of Disease Network (COST Action CA18218)
| | - L Paalanen
- European Burden of Disease Network (COST Action CA18218)
| | | | - E Pallari
- European Burden of Disease Network (COST Action CA18218)
| | | | - G Sulo
- European Burden of Disease Network (COST Action CA18218)
| | - G Tecirli
- European Burden of Disease Network (COST Action CA18218)
| | - J Vasco Santos
- European Burden of Disease Network (COST Action CA18218)
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Balaj M, York HW, Sripada K, Besnier E, Vonen HD, Aravkin A, Friedman J, Griswold M, Jensen MR, Mohammad T, Mullany EC, Solhaug S, Sorensen R, Stonkute D, Tallaksen A, Whisnant J, Zheng P, Gakidou E, Eikemo TA. Parental education and inequalities in child mortality: a global systematic review and meta-analysis. Lancet 2021; 398:608-620. [PMID: 34119000 PMCID: PMC8363948 DOI: 10.1016/s0140-6736(21)00534-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/31/2021] [Accepted: 02/25/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The educational attainment of parents, particularly mothers, has been associated with lower levels of child mortality, yet there is no consensus on the magnitude of this relationship globally. We aimed to estimate the total reductions in under-5 mortality that are associated with increased maternal and paternal education, during distinct age intervals. METHODS This study is a comprehensive global systematic review and meta-analysis of all existing studies of the effects of parental education on neonatal, infant, and under-5 child mortality, combined with primary analyses of Demographic and Health Survey (DHS) data. The literature search of seven databases (CINAHL, Embase, MEDLINE, PsycINFO, PubMed, Scopus, and Web of Science) was done between Jan 23 and Feb 8, 2019, and updated on Jan 7, 2021, with no language or publication date restrictions. Teams of independent reviewers assessed each record for its inclusion of individual-level data on parental education and child mortality and excluded articles on the basis of study design and availability of relevant statistics. Full-text screening was done in 15 languages. Data extracted from these studies were combined with primary microdata from the DHS for meta-analyses relating maternal or paternal education with mortality at six age intervals: 0-27 days, 1-11 months, 1-4 years, 0-4 years, 0-11 months, and 1 month to 4 years. Novel mixed-effects meta-regression models were implemented to address heterogeneity in referent and exposure measures among the studies and to adjust for study-level covariates (wealth or income, partner's years of schooling, and sex of the child). This study was registered with PROSPERO (CRD42020141731). FINDINGS The systematic review returned 5339 unique records, yielding 186 included studies after exclusions. DHS data were compiled from 114 unique surveys, capturing 3 112 474 livebirths. Data extracted from the systematic review were synthesized together with primary DHS data, for meta-analysis on a total of 300 studies from 92 countries. Both increased maternal and paternal education showed a dose-response relationship linked to reduced under-5 mortality, with maternal education emerging as a stronger predictor. We observed a reduction in under-5 mortality of 31·0% (95% CI 29·0-32·6) for children born to mothers with 12 years of education (ie, completed secondary education) and 17·3% (15·0-18·8) for children born to fathers with 12 years of education, compared with those born to a parent with no education. We also showed that a single additional year of schooling was, on average, associated with a reduction in under-5 mortality of 3·04% (2·82-3·23) for maternal education and 1·57% (1·35-1·72) for paternal education. The association between higher parental education and lower child mortality was significant for both parents at all ages studied and was largest after the first month of life. The meta-analysis framework incorporated uncertainty associated with each individual effect size into the model fitting process, in an effort to decrease the risk of bias introduced by study design and quality. INTERPRETATION To our knowledge, this study is the first effort to systematically quantify the transgenerational importance of education for child survival at the global level. The results showed that lower maternal and paternal education are both risk factors for child mortality, even after controlling for other markers of family socioeconomic status. This study provides robust evidence for universal quality education as a mechanism to achieve the Sustainable Development Goal target 3.2 of reducing neonatal and child mortality. FUNDING Research Council of Norway, Bill & Melinda Gates Foundation, and Rockefeller Foundation-Boston University Commission on Social Determinants, Data, and Decision Making (3-D Commission).
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Affiliation(s)
- Mirza Balaj
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hunter Wade York
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Sociology and Office of Population Research, Princeton University, Princeton, NJ, USA
| | - Kam Sripada
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elodie Besnier
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hanne Dahl Vonen
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Aleksandr Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Applied Mathematics, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Joseph Friedman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Magnus Rom Jensen
- Library Section for Humanities, Education and Social Sciences, University Library, Norwegian University of Science & Technology, Trondheim, Norway
| | - Talal Mohammad
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Solvor Solhaug
- Library Section for Humanities, Education and Social Sciences, University Library, Norwegian University of Science & Technology, Trondheim, Norway
| | - Reed Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Donata Stonkute
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas Tallaksen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Joanna Whisnant
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway.
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Bimpong K, Thomson K, Mcnamara CL, Balaj M, Akhter N, Bambra C, Todd A. The Gender Pain Gap: gender inequalities in pain across 19 European countries. Scand J Public Health 2021; 50:287-294. [PMID: 33568013 PMCID: PMC8873965 DOI: 10.1177/1403494820987466] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: Chronic pain is increasingly considered to be an international public health issue, yet gender differences in chronic pain in Europe are under-examined. This work aimed to examine gender inequalities in pain across Europe. Methods: Data for 27,552 men and women aged 25–74 years in 19 European countries were taken from the social determinants of health module of the European Social Survey (2014). Inequalities in reporting pain were measured by means of adjusted rate differences (ARD) and relative adjusted rate risks (ARR). Results: At the pooled pan-European level, a greater proportion of women (62.3%) reported pain than men (55.5%) (ARD 5.5% (95% confidence intervals (CI) 4.1, 6.9), ARR 1.10 (95% CI 1.08, 1.13)). These inequalities were greatest for back/neck pain (ARD 5.8% (95% CI 4.4, 7.1), ARR 1.15 (95% CI 1.12, 1.19)), but were also significant for hand/arm pain (ARD 4.6% (95% CI 3.5, 5.7), ARR 1.24 (95% CI 1.17, 1.30)) and foot/leg pain (ARD 2.6% (95% CI 1.5, 3.8), ARR 1.12 (95% CI 1.07, 1.18)). There was considerable cross-national variation in gender pain inequalities across European countries. Conclusions: Significant gender pain inequalities exist across Europe whereby women experience more pain than men. The extent of the gender pain gap varies by country. The gender pain gap is a public health concern and should be considered in future prevention and management strategies.
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Affiliation(s)
| | - Katie Thomson
- Population Health Sciences Institute, Newcastle University, UK
| | - Courtney L Mcnamara
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | - Mirza Balaj
- Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | | | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, UK.,Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
| | - Adam Todd
- School of Pharmacy, Newcastle University, UK.,Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Norway
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Abstract
AbstractSince the strong predictive power of self-reported health (SRH) for prospective health and social outcomes has been established, researchers have been in a quest to build a theoretical understanding of this widely used health measure. Current literature based predominantly in a biomedical perspective asserts a linear relationship between physical conditions and perception of health. Discrepancies from this expected relationship are considered an important weakness of SRH. Systematic discrepancies between physical conditions and reporting of SRH have been documented across different socio-economic groups. Evidence identified for educational groups shows that for the same level of health status, lower-educated groups report poorer levels of perceived health. This raised doubts whether it is useful to use SRH to measure social inequalities in health within and between countries. To date, sociologists of health have not engaged in the discussion of reporting heterogeneity in SRH. After reviewing existing evidence, we contend that the discrepancy in SRH reporting across social groups argued to be a weakness of SRH as a health measure is a strength from a sociological perspective. SRH as a social measure of health is a better predictor than objective measures of health precisely because it captures the lived experience of the embodied agent.
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Todd A, McNamara CL, Balaj M, Huijts T, Akhter N, Thomson K, Kasim A, Eikemo TA, Bambra C. The European epidemic: Pain prevalence and socioeconomic inequalities in pain across 19 European countries. Eur J Pain 2019; 23:1425-1436. [DOI: 10.1002/ejp.1409] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 04/02/2019] [Accepted: 04/21/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Adam Todd
- School of Pharmacy, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
- Institute of Health and Society, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
| | - Courtney L. McNamara
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science Norwegian University of Science and Technology (NTNU) Trondheim Norway
| | - Mirza Balaj
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science Norwegian University of Science and Technology (NTNU) Trondheim Norway
| | - Tim Huijts
- Department of Sociology Wentworth College, University of York York UK
| | - Nasima Akhter
- Wolfson Research Institute for Health and Wellbeing Durham University, Queen's Campus Stockton‐on‐Tees UK
| | - Katie Thomson
- Institute of Health and Society, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
| | - Adetayo Kasim
- Wolfson Research Institute for Health and Wellbeing Durham University, Queen's Campus Stockton‐on‐Tees UK
| | - 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
| | - Clare Bambra
- Institute of Health and Society, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
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Balaj M, McNamara CL, Eikemo TA, Bambra C. The social determinants of inequalities in self-reported health in Europe: findings from the European social survey (2014) special module on the social determinants of health. Eur J Public Health 2018; 27:107-114. [PMID: 28355634 DOI: 10.1093/eurpub/ckw217] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Health inequalities persist between and within European countries. Such inequalities are usually explained by health behaviours and according to the conditions in which people work and live. However, little is known about the relative contribution of these factors to health inequalities in European countries. This paper aims to investigate the independent and joint contribution of a comprehensive set of behavioural, occupational and living conditions factors in explaining social inequalities in self-rated health (SRH). Method Data from 21 countries was obtained from the 2014 European Social Survey and examined for respondents aged 25-75. Adjusted rate differences (ARD) and adjusted rate risks (ARR), generated from binary logistic regression models, were used to measure health inequalities in SRH and the contribution of behavioural, occupational and living conditions factors. Result Absolute and relative inequalities in SRH were found in all countries and the magnitude of socio-economic inequalities varied considerably between countries. While factors were found to differentially contribute to the explanation of educational inequalities in different European countries, occupational and living conditions factors emerged as the leading causes of inequalities across most of the countries, contributing both independently and jointly with behavioural factors. Conclusion The observed shared effects of different factors to health inequalities points to the interdependent nature of occupational, behavioural and living conditions factors. Tackling health inequalities should be a concentred effort that goes beyond interventions focused on single factors.
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Affiliation(s)
- Mirza Balaj
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Courtney L McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Terje A Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Clare Bambra
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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McNamara CL, Balaj M, Thomson KH, Eikemo TA, Bambra C. The contribution of housing and neighbourhood conditions to educational inequalities in non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health. Eur J Public Health 2018; 27:102-106. [PMID: 28355640 DOI: 10.1093/eurpub/ckw224] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Social gradients have been found across European populations, where less affluent groups are more often affected by poor housing and neighbourhood conditions. While poor housing and neighbourhood quality have been associated with a range of non-communicable diseases (NCDs), these conditions have rarely been applied to the examination of socioeconomic differences in NCDs. This study therefore asks ‘to what extent does adjusting for poor housing and neighbourhood conditions reduce inequalities in NCDs among men and women in Europe’? Methods Our analysis used pooled-data from 20 European countries for women (n= 12 794) and men (n= 11 974), aged 25–75, from round 7 of the European Social Survey. Fourteen NCDs were investigated: heart/circulatory problems, high blood pressure, back pain, arm/hand pain, foot/leg pain, allergies, breathing problems, stomach/digestion problems, skin conditions, diabetes, severe headaches, cancer, obesity and depression. We used binary logistic regression models, stratified by gender, and adjusted rate ratios to examine whether educational inequalities in NCDs were reduced after controlling for poor housing and neighbourhood quality. Results Overall, we find that adjusting for poor housing and neighbourhood quality reduces inequalities in NCDs. While reductions were relatively small for some NCDs–for high blood pressure, reductions were found in the range of 0–4.27% among women—for other conditions reductions were more considerable. Controlling for both housing and neighbourhood conditions for example, reduced inequalities by 16–24% for severe headaches and 14–30% for breathing problems. Conclusions Social gradients in poor housing and neighbourhood quality could be an important contributor to educational inequalities in some NCDs.
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Affiliation(s)
- Courtney L McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mirza Balaj
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Katie H Thomson
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, UK
| | - Terje A Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Clare Bambra
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, UK
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McNamara CL, Toch-Marquardt M, Balaj M, Reibling N, Eikemo TA, Bambra C. Occupational inequalities in self-rated health and non-communicable diseases in different regions of Europe: findings from the European Social Survey (2014) special module on the social determinants of health. Eur J Public Health 2018; 27:27-33. [PMID: 28355639 DOI: 10.1093/eurpub/ckw223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Socioeconomic inequalities in the prevalence of non-communicable diseases (NCDs) are evident across European populations. Several previous studies have addressed the question of whether occupational inequalities in health differ across European regions. It is uncertain however, the degree to which occupational inequalities in NCDs are similar or dissimilar across different European regions. Methods Using 2014 European Social Survey data from 20 countries, this article examines occupational inequalities in poor self-rated health (SRH) and 14 self-reported NCDs separately for women and men, by European region: heart/circulatory problems, high blood pressure, back pain, arm/hand pain, foot/leg pain, allergies, breathing problems, stomach/digestion problems, skin conditions, diabetes, severe headaches, cancer, obesity and depression. Age-controlled adjusted risk ratios were calculated and separately compared a working class and intermediate occupational group with a salariat group. Results Working class Europeans appear to have the highest risk of reporting poor SRH and a number of NCDs. We find inequalities in some NCDS to be the largest in the Northern region, suggesting further evidence of a Nordic paradox. Like some previous work, we did not find larger inequalities in poor SRH in the Central/East region. However, we did find the largest inequalities in this region for some NCDs. Our results do not align completely with previous work which finds smaller health inequalities in Southern Europe. Conclusions This work provides a first look at occupational inequalities across a range of NCDs for European men and women by region. Future work is needed to identify the underlying determinants behind regional differences.
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Affiliation(s)
- Courtney L McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marlen Toch-Marquardt
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mirza Balaj
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nadine Reibling
- University of Siegen, Adolf-Reichwein-Str. 2, Siegen, Germany
| | - Terje A Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Clare Bambra
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, UK
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Fjær EL, Balaj M, Stornes P, Todd A, McNamara CL, Eikemo TA. Exploring the differences in general practitioner and health care specialist utilization according to education, occupation, income and social networks across Europe: findings from the European social survey (2014) special module on the social determinants of health. Eur J Public Health 2018; 27:73-81. [PMID: 28355650 DOI: 10.1093/eurpub/ckw255] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Low socioeconomic position (SEP) tends to be linked to higher use of general practitioners (GPs), while the use of health care specialists is more common in higher SEPs. Despite extensive literature in this area, previous studies have, however, only studied health care use by income or education. The aim of this study is, therefore, to examine inequalities in GP and health care specialist use by four social markers that may be linked to health care utilization (educational level, occupational status, level of financial strain and size and frequency of social networks) across 20 European countries and Israel. Methods Logistic regression models were employed using data from the seventh round of the European Social Survey; this study focused upon people aged 25–75 years, across 21 countries. Health care utilization was measured according to self-reported use of GP or specialist care within 12 months. Analyses tested four social markers: income (financial strain), occupational status, education and social networks. Results We observed a cross-national tendency that countries with higher or equal probability of GP utilization by lower SEP groups had a more consistent probability of specialist use among high SEP groups. Moreover, countries with inequalities in GP use in favour of high SEP groups had comparable levels of inequalities in specialist care utilization. This was the case for three social markers (education, occupational class and social networks), while the pattern was less pronounced for income (financial strain). Conclusion There are significant inequalities associated with GP and specialist health care use across Europe—with higher SEP groups more likely to use health care specialists, compared with lower SEP groups. In the context of health care specialist use, education and occupation appear to be particularly important factors.
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Affiliation(s)
- Erlend L Fjær
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mirza Balaj
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Per Stornes
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Adam Todd
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, Stockton-on-Tees, UK
| | - Courtney L McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Terje A Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
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McNamara CL, Balaj M, Thomson KH, Eikemo TA, Solheim EF, Bambra C. The socioeconomic distribution of non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health. Eur J Public Health 2018; 27:22-26. [PMID: 28355638 DOI: 10.1093/eurpub/ckw222] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background A range of non-communicable diseases (NCDs) has been found to follow a social pattern whereby socioeconomic status predicts either a higher or lower risk of disease. Comprehensive evidence on the socioeconomic distribution of NCDs across Europe, however, has been limited. Methods Using cross-sectional 2014 European Social Survey data from 20 countries, this paper examines socioeconomic inequalities in 14 self-reported NCDs separately for women and men: heart/circulatory problems, high blood pressure, back pain, arm/hand pain, foot/leg pain, allergies, breathing problems, stomach/digestion problems, skin conditions, diabetes, severe headaches, cancer, obesity and depression. Using education to measure socioeconomic status, age-controlled adjusted risk ratios were calculated and separately compared a lower and medium education group with a high education group. Results At the pooled European level, a social gradient in health was observed for 10 NCDs: depression, diabetes, obesity, heart/circulation problems, hand/arm pain, high blood pressure, breathing problems, severe headaches, foot/leg pain and cancer. An inverse social gradient was observed for allergies. Social gradients were observed among both genders, but a greater number of inequalities were observed among women. Country-specific analyses show that inequalities in NCDs are present everywhere across Europe and that inequalities exist to different extents for each of the conditions. Conclusion This study provides the most up-to-date overview of socioeconomic inequalities for a large number of NCDs across 20 European countries for both women and men. Future investigations should further consider the diseases, and their associated determinants, for which socioeconomic differences are the greatest.
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Affiliation(s)
- Courtney L McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mirza Balaj
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Katie H Thomson
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, UK
| | - Terje A Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erling F Solheim
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Clare Bambra
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, UK
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Todd A, Hillier-Brown F, Thomson K, Balaj M, Walton N, Bambra C. The effects of community pharmacy public health interventions on health and health inequalities. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Todd
- Newcastle University, Newcastle upon Tyne, UK
| | | | - K Thomson
- Newcastle University, Newcastle upon Tyne, UK
| | - M Balaj
- Norwegian University of Science and Technology, Trondheim, Norway
| | - N Walton
- Newcastle University, Newcastle upon Tyne, UK
| | - C Bambra
- Newcastle University, Newcastle upon tyne, United Arab Emirates
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Hillier-Brown F, Bambra C, Thomson K, Balaj M, Walton N, Todd A. The effects of community pharmacy public health interventions on population health and health inequalities: a systematic review of reviews protocol. Syst Rev 2017; 6:176. [PMID: 28854958 PMCID: PMC5577831 DOI: 10.1186/s13643-017-0573-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/22/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Community pharmacies have great potential to deliver services aimed at promoting health and preventing disease, and are embedded within communities. In the light of a rapid increase in community pharmacy-delivered public health services and an accompanying increase in the evidence base, this systematic review of reviews will synthesise systematic reviews of public health community pharmacy interventions and assess their effects on public health and health inequalities. METHODS/DESIGN Systematic review methodology will be used to identify all systematic reviews that describe the health and health equity effects of community pharmacy public health interventions. Twenty databases will be searched using a pre-determined search strategy to evaluate community pharmacy-delivered public health interventions. Findings from the included reviews will be pooled, and a narrative synthesis executed to identify overarching patterns and results. DISCUSSION Findings will support future decision-making around how community pharmacy public health services can be used alongside other strategies to promote health, prevent disease and reduce health inequalities. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42017056264 .
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Affiliation(s)
- Frances Hillier-Brown
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Clare Bambra
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Katie Thomson
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Mirza Balaj
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Dragvoll, Building 9, Level 5, 7491, Trondheim, Norway
| | - Nick Walton
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Adam Todd
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK. .,School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 7RU, UK.
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Bøe T, Balaj M, Eikemo TA, McNamara CL, Solheim EF. Financial difficulties in childhood and adult depression in Europe. Eur J Public Health 2017; 27:96-101. [DOI: 10.1093/eurpub/ckw253] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tormod Bøe
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Mirza Balaj
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Terje A. Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Courtney L. McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erling F. Solheim
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
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Beckfield J, Balaj M, McNamara CL, Huijts T, Bambra C, Eikemo TA. The health of European populations: introduction to the special supplement on the 2014 European Social Survey (ESS) rotating module on the social determinants of health. Eur J Public Health 2017; 27:3-7. [PMID: 28355648 DOI: 10.1093/eurpub/ckw250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
This introduction summarizes the main findings of the Supplement 'Social inequalities in health and their determinants' to the European Journal of Public Health. The 16 articles that constitute this supplement use the new ESS (2014) health module data to analyze the distribution of health across European populations. Three main themes run across these articles: documentation of cross-national variation in the magnitude and patterning of health inequalities; assessment of health determinants variation across populations and in their contribution to health inequalities; and the examination of the effects of health outcomes across social groups. Social inequalities in health are investigated from an intersectional stance providing ample evidence of inequalities based on socioeconomic status (occupation, education, income), gender, age, geographical location, migrant status and their interactions. Comparison of results across these articles, which employ a wide range of health outcomes, social determinants and social stratification measures, is facilitated by a shared theoretical and analytical approach developed by the authors in this supplement.
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Affiliation(s)
- Jason Beckfield
- Department of Sociology, Harvard University, Cambridge, MA, USA
| | - Mirza Balaj
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Courtney L McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tim Huijts
- Department of Sociology, Wentworth College, University of York, York, UK
| | - Clare Bambra
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Terje A Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
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Balaj M, Huijts T, McNamara CL, Stornes P, Bambra C, Eikemo TA. Non-communicable diseases and the social determinants of health in the Nordic countries: Findings from the European Social Survey (2014) special module on the social determinants of health. Scand J Public Health 2017; 45:90-102. [PMID: 28128015 DOI: 10.1177/1403494816686026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Comparative studies examining non-communicable diseases (NCDs) and determinants of health in the Nordic countries are scarce, outdated and focus only on a limited range of NCDs and health determinants. This study is the first to present a comprehensive overview of the distribution of social and behavioural determinants of health and of physical and mental NCDs in the Nordic population. We examined regional, country and gender differences for 17 health outcomes and 20 determinants of health. We use data from the 7th wave of the European Social Survey. All results were age-standardised by weighting up or down the unstandardized (crude) prevalence rates for five year age groups in each country to a common standard. We present pooled estimates for the combined regional samples as well as country-specific results for the Nordic region. Overall, the population of the Nordic region reported among the highest prevalence for one or both genders in 10 out of 17 health outcomes. Despite being the region with the highest prevalence for most health outcomes, overall self-rated health levels tend to be better in the Nordic region. Similarly, we found that the Nordic countries adhere to a healthier lifestyle and have better access to health care. Future studies should consider investigating further the association between health outcomes and determinants of health and how they are distributed in the Nordic societies.
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Affiliation(s)
- Mirza Balaj
- 1 Department of Sociology and Political Science, Norwegian University of Science and Technology, Norway
| | - Tim Huijts
- 2 Department of Sociology, Wentworth College, University of York, UK
| | - Courtney L McNamara
- 1 Department of Sociology and Political Science, Norwegian University of Science and Technology, Norway
| | - Per Stornes
- 1 Department of Sociology and Political Science, Norwegian University of Science and Technology, Norway
| | - Clare Bambra
- 3 Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, UK
| | - Terje A Eikemo
- 1 Department of Sociology and Political Science, Norwegian University of Science and Technology, Norway
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