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Dierckens M, Deforche B, De Clercq B, Weinberg D, Stevens GWJM, Chatelan A, Rouche M, Clays E, Delaruelle K. Country-level sociocultural context and socioeconomic inequalities in adolescent dietary behaviours: A multilevel analysis in 21 European countries. Appetite 2024; 198:107339. [PMID: 38604381 DOI: 10.1016/j.appet.2024.107339] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
Studies to date have predominantly focused on countries' socioeconomic conditions (e.g., income inequality) to explain cross-national differences in socioeconomic inequalities in adolescent health (behaviours). However, the potential explanatory role of sociocultural contexts at country-level remains underexamined. This study examined whether the country-level sociocultural context and changes thereof were associated with adolescent socioeconomic inequalities in dietary behaviours. International comparative data of 344,352 adolescents living in 21 countries participating in 2002, 2006, 2010 and 2014 waves of the Health Behaviour in School-aged Children (HBSC) survey were combined with aggregated levels of openness-to-change from the European Social Survey (ESS). Four dietary behaviours (i.e., fruit, vegetable, sweets and soft drink consumption) and two measures of socioeconomic status (SES) on the individual level (i.e., family affluence scale [FAS] and occupational social class [OSC]) were studied. Multilevel logistic regression analyses returned contrasting results for the two SES measures used. In countries with higher levels of openness-to-change, smaller FAS inequalities in daily fruit, sweets and soft drink consumption were observed, but no such inequalities were found for vegetable consumption. Conversely, in these countries, larger OSC inequalities in soft drink consumption were found. Country-specific changes in openness-to-change over time were not associated with the magnitude of adolescent dietary inequalities. Findings underscore the importance of including country-level sociocultural contexts to improve the understanding of cross-national differences in socioeconomic inequalities in adolescents' diets. Future studies, spanning a longer timeframe, are required to examine whether such associations exist within countries over time since our timeframe might have been too small to capture these long-term trends.
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Affiliation(s)
- Maxim Dierckens
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Benedicte Deforche
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Movement and Nutrition for Health and Performance Research Group, Department of Movement and Sports Sciences, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Bart De Clercq
- Mensura R&D Department, Mensura EDPB, Italiëlei 2, 2000, Antwerpen, Belgium
| | - Dominic Weinberg
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Sciences, Utrecht University, Padualaan 14, 3584 CH, Utrecht, the Netherlands
| | - Gonneke W J M Stevens
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Sciences, Utrecht University, Padualaan 14, 3584 CH, Utrecht, the Netherlands
| | - Angeline Chatelan
- Research Centre in Epidemiology, Biostatistics and Clinical Trials, School of Public Health, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Manon Rouche
- Research Centre in Epidemiology, Biostatistics and Clinical Trials, School of Public Health, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Katrijn Delaruelle
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of Sociology, Ghent University, Sint-Pietersnieuwstraat 41, 9000, Ghent, Belgium
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Panico L, Goisis A, Martinson M. Gradients in low birthweight by maternal education: A comparative perspective. SSM Popul Health 2024; 26:101674. [PMID: 38711567 PMCID: PMC11070621 DOI: 10.1016/j.ssmph.2024.101674] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024] Open
Abstract
Background Longstanding research has shown strong inequalities in low birthweight by household income. However, most such research has focused on Anglophone countries, while evidence emerging from other developed countries suggest a stronger role of education rather than incomes in creating inequalities at birth. This paper compares gradients in low birthweight by maternal education, as well as explores underlying mechanisms contributing to these gradients, in France, the United States, and the United Kingdom. Methods Analyses are based on harmonized data from large, nationally-representative samples from France, UK and US. We use regression models and decomposition methods to explore the relative role of several possible mechanisms in producing birthweight inequalities. Results Inequalities in low birth weight across maternal education groups were relatively similar in the United States, the United Kingdom and France. However, the individual-level mechanisms producing such inequalities varied substantially across the three countries, with income being most important in the US, pregnancy smoking being most evident in France, and the UK occupying an intermediate position. Differences in the mechanisms producing birth health inequalities mirror differences in the policy environment in the three countries. Conclusion While inequalities in health appear from the earliest moments in many countries, our results suggest research on birth health inequalities, and therefore policies, is not easily generalizable across national contexts, and call for more scholarship in uncovering the "whys" of health inequalities in a variety of contexts.
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Affiliation(s)
- Lidia Panico
- Center for Research on Social Inequalities (CRIS), Sciences Po, CNRS, 27, rue Saint-Guillaume, 75337, Paris, Cedex 07, France
- Institut National d’Etudes Démographiques (INED), 9 cours des Humanités, CS 50004, 93322, Aubervilliers, Cedex, France
| | - Alice Goisis
- Centre for Longitudinal Studies, Department of Social Science, University College London, 55-59 Gordon Square, London, WC1H 0NU, UK
| | - Melissa Martinson
- School of Social Work, University of Washington, 4101 15th Ave NE, Seattle, WA, 98105-6299, USA
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Khalid S, Kearney M, McReynolds DE. Can social adversity alter the epigenome, trigger oral disease, and affect future generations? Ir J Med Sci 2024:10.1007/s11845-024-03697-3. [PMID: 38740675 DOI: 10.1007/s11845-024-03697-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024]
Abstract
The nature versus nurture debate has intrigued scientific circles for decades. Although extensive research has established a clear relationship between genetics and disease development, recent evidence has highlighted the insufficiency of attributing adverse health outcomes to genetic factors alone. In fact, it has been suggested that environmental influences, such as socioeconomic position (SEP), may play a much larger role in the development of disease than previously thought, with extensive research suggesting that low SEP is associated with adverse health conditions. In relation to oral health, a higher prevalence of caries (tooth decay) exists among those of low SEP. Although little is known about the biological mechanisms underlying this relationship, epigenetic modifications resulting from environmental influences have been suggested to play an important role. This review explores the intersection of health inequalities and epigenetics, the role of early-life social adversity and its long-term epigenetic impacts, and how those living within the lower hierarchies of the socioeconomic pyramid are indeed at higher risk of developing diseases, particularly in relation to oral health. A deeper understanding of these mechanisms could lead to the development of targeted interventions for individuals of low SEP to improve oral health or identify those who are at higher risk of developing oral disease.
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Affiliation(s)
- Sakr Khalid
- Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Michaela Kearney
- Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - David E McReynolds
- Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland.
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Nusselder WJ, Long D, Waterlander WE, Stronks K, Boshuizen HC. Estimating the contribution of overweight and obesity to ethnic inequalities in cardio-metabolic diseases in the Netherlands: a simulation study. Public Health 2024; 232:45-51. [PMID: 38733960 DOI: 10.1016/j.puhe.2024.04.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES Overweight and obesity (OWOB) starts in childhood, influences adult cardiovascular risk, and is not equally distributed across ethnic groups. It is unclear which effects can be expected from reductions in OWOB across the life course on inequalities in cardio-metabolic diseases in a multi-ethnic population. This study aims to estimate the effects of three scenarios of changes in OWOB (the Normal-Weight-for-All scenario, the No-Ethnic-Difference-over-the-Life-Course scenario, the and No-Ethnic-Differences-in-Childhood scenario). STUDY DESIGN A simulation study. METHODS We combine data from multiple data sources and use the Dynamic Modeling for Health Impact Assessment (DYNAMO-HIA) model to estimate the effects of three scenarios on the cumulative incidence of diabetes mellitus, ischaemic heart disease (IHD) and stroke between 18 and 70 years in the five largest ethnic groups in the Netherlands. RESULTS In the scenario where all individuals have normal weight, the cumulative incidence decreased in all ethnic minority groups for all diseases, with largest decreases among South-Asian Surinamese, where the reduction of diabetes incidence exceeded 50%. In the scenario where the prevalence of OWOB in each ethnic-minority group was reduced to the current level among the Dutch-origin population, ethnic inequalities in cardio-metabolic diseases were substantially reduced, particularly when lowered prevalence of OWOB persisted across the lifespan. Reductions were the largest for diabetes and for the Asian Surinamese population. CONCLUSIONS A substantial part of the well-known ethnic inequalities in incidence of diabetes, IHD, and stroke can be attributed to OWOB. Interventions aimed at reducing OWOB have clear potential to reduce the health inequalities in these outcomes, especially for diabetes, in particular when they have an impact across the lifespan.
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Affiliation(s)
- W J Nusselder
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - D Long
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - W E Waterlander
- Department of Public and Occupational Health, Academic Medical Centers Amsterdam/Universiteit of Amsterdam, Amsterdam, the Netherlands
| | - K Stronks
- Department of Public and Occupational Health, Academic Medical Centers Amsterdam/Universiteit of Amsterdam, Amsterdam, the Netherlands
| | - H C Boshuizen
- Department Statistics, Data Science and Mathematical Modelling, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
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Rodriguez-Mireles S, Lopez-Valcarcel BG, Galdos-Arias P, Perez-Diaz E, Serra-Majem L. Socioeconomic disparities in diet and physical activity in children: evidence from well-child visit electronic health records in the Canary Islands, Spain. J Epidemiol Community Health 2024; 78:354-359. [PMID: 38458631 DOI: 10.1136/jech-2023-220335] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/10/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Diet and physical activity (PA) in childhood are heavily influenced by the living environment. While diet quality follows a socioeconomic pattern, limited evidence is available in relation to PA in children. We assessed the effect of socioeconomic status at the individual (SES) and neighbourhood (NSES) levels on diet and PA among children from the general population of the Canary Islands, Spain. METHODS In this cross-sectional study, patients aged 6-14 years from the Canary Health Service in 2018 were included (n=89 953). Diet and PA surveys from the electronic health records of the well-child visit programme were used. A healthy habits (HH) score was defined to assess the level of adherence to the dietary and leisure time PA guidelines. We modelled the association between the HH score, SES and NSES using a stepwise multilevel linear regression analysis, differentiating between specific and general contextual observational effects. RESULTS A strong positive association between SES and the HH score was found, as children living in more affluent families were more likely to follow a healthy diet and being physically active. Differences in the HH score between geographical areas were of minor relevance (variance partition coefficient=1.8%) and the general contextual effects were not substantially mediated by NSES (proportional change in variance=3.5%). However, the HH score was significantly lower in children from areas with a higher percentage of annual incomes below the €18 000 threshold. CONCLUSION HH followed a socioeconomic gradient at the individual and the neighbourhood level. In the study population, the geographical component of the inequalities found were low.
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Affiliation(s)
- Silvia Rodriguez-Mireles
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Department of Admissions and Clinical Documentation, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
- Department of Health Care Quality Assessment and Information System, Healthcare Programmes General Directorate, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain
| | - Beatriz G Lopez-Valcarcel
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Patricia Galdos-Arias
- Department of Primary Care, Healthcare Programmes General Directorate, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain
| | - Enrique Perez-Diaz
- Department of Primary Care, Healthcare Programmes General Directorate, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain
| | - Lluis Serra-Majem
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Department of Preventive Medicine, Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain
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Bell S. Nucleus of fairness: epigenetic ageing, social determinants of health and the imperative for proactive preventive measures. J Epidemiol Community Health 2024; 78:341-342. [PMID: 37827811 DOI: 10.1136/jech-2023-221341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Steven Bell
- Precision Breast Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
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Crawshaw AF, Goldsmith LP, Deal A, Carter J, Knights F, Seedat F, Lau K, Hayward SE, Yong J, Fyle D, Aspray N, Iwami M, Ciftci Y, Wurie F, Majeed A, Forster AS, Hargreaves S. Driving delivery and uptake of catch-up vaccination among adolescent and adult migrants in UK general practice: a mixed methods pilot study. BMC Med 2024; 22:186. [PMID: 38702767 PMCID: PMC11068568 DOI: 10.1186/s12916-024-03378-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/02/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Migrants in the UK and Europe face vulnerability to vaccine-preventable diseases (VPDs) due to missed childhood vaccines and doses and marginalisation from health systems. Ensuring migrants receive catch-up vaccinations, including MMR, Td/IPV, MenACWY, and HPV, is essential to align them with UK and European vaccination schedules and ultimately reduce morbidity and mortality. However, recent evidence highlights poor awareness and implementation of catch-up vaccination guidelines by UK primary care staff, requiring novel approaches to strengthen the primary care pathway. METHODS The 'Vacc on Track' study (May 2021-September 2022) aimed to measure under-vaccination rates among migrants in UK primary care and establish new referral pathways for catch-up vaccination. Participants included migrants aged 16 or older, born outside of Western Europe, North America, Australia, or New Zealand, in two London boroughs. Quantitative data on vaccination history, referral, uptake, and sociodemographic factors were collected, with practice nurses prompted to deliver catch-up vaccinations following UK guidelines. Focus group discussions and in-depth interviews with staff and migrants explored views on delivering catch-up vaccination, including barriers, facilitators, and opportunities. Data were analysed using STATA12 and NVivo 12. RESULTS Results from 57 migrants presenting to study sites from 18 countries (mean age 41 [SD 7.2] years; 62% female; mean 11.3 [SD 9.1] years in UK) over a minimum of 6 months of follow-up revealed significant catch-up vaccination needs, particularly for MMR (49 [86%] required catch-up vaccination) and Td/IPV (50 [88%]). Fifty-three (93%) participants were referred for any catch-up vaccination, but completion of courses was low (6 [12%] for Td/IPV and 33 [64%] for MMR), suggesting individual and systemic barriers. Qualitative in-depth interviews (n = 39) with adult migrants highlighted the lack of systems currently in place in the UK to offer catch-up vaccination to migrants on arrival and the need for health-care provider skills and knowledge of catch-up vaccination to be improved. Focus group discussions and interviews with practice staff (n = 32) identified limited appointment/follow-up time, staff knowledge gaps, inadequate engagement routes, and low incentivisation as challenges that will need to be addressed. However, they underscored the potential of staff champions, trust-building mechanisms, and community-based approaches to strengthen catch-up vaccination uptake among migrants. CONCLUSIONS Given the significant catch-up vaccination needs of migrants in our sample, and the current barriers to driving uptake identified, our findings suggest it will be important to explore this public health issue further, potentially through a larger study or trial. Strengthening existing pathways, staff capacity and knowledge in primary care, alongside implementing new strategies centred on cultural competence and building trust with migrant communities will be important focus areas.
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Affiliation(s)
- Alison F Crawshaw
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Lucy P Goldsmith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Anna Deal
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jessica Carter
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Felicity Knights
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Farah Seedat
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Karen Lau
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sally E Hayward
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Joanna Yong
- NHS North Central London Research Network (NoCLoR) and Clinical Research Network (CRN) North Thames, London, UK
| | - Desiree Fyle
- NHS North Central London Research Network (NoCLoR) and Clinical Research Network (CRN) North Thames, London, UK
| | - Nathaniel Aspray
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Michiyo Iwami
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Yusuf Ciftci
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Fatima Wurie
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.
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Newton D, Stephenson J, Azevedo L, Sah RK, Poudel AN, Richardson O. The impact of social determinants on health outcomes in a region in the North of England: a structural equation modelling analysis. Public Health 2024; 231:198-203. [PMID: 38703494 DOI: 10.1016/j.puhe.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES The aim of this study was to identify the impact of social determinants of health on physical and mental health outcomes in a UK population. STUDY DESIGN Structural equation modelling was used to hypothesise a model of relationships between health determinants and outcomes within a region in the North of England using large-scale population survey data (6208 responses). METHODS We analysed responses from a population survey to assess the influence of a deprivation-based index at the environmental level, education and income on a behaviour index (smoking, alcohol consumption, physical activity, and dietary habits) and the influence of all these factors on self-reported physical health and the influence of the behaviour index and income on mental wellbeing. RESULTS The proposed model was well supported by the data. Goodness-of-fit statistics, most notably a low value of the root mean square error of approximation (RMSEA), supported the validity of the proposed relationships (RMSEA = 0.054). The model revealed all examined paths to be statistically significant. Income and education were influential in determining an individual's behaviour index score, which, with income was the most important predictor of both the correlated outcomes of physical health and mental wellbeing (P < 0.001 in all cases). CONCLUSIONS Findings challenge the traditional view of singular causal pathways, emphasising that interventions should consider the underlying influencing socio-economic conditions, which would influence behaviour and therefore physical and mental wellbeing. The extent to which the model is supported by the data, and the statistical significance of individual relationships accentuates the imperative for comprehensive public health strategies that integrate multiple socio-economic factors.
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Affiliation(s)
- D Newton
- University of Huddersfield, Huddersfield, United Kingdom.
| | - J Stephenson
- University of Huddersfield, Huddersfield, United Kingdom
| | - L Azevedo
- University of Huddersfield, Huddersfield, United Kingdom; Sheffield Hallam University, Sheffield, United Kingdom
| | - R K Sah
- University of Huddersfield, Huddersfield, United Kingdom
| | - A N Poudel
- University of Huddersfield, Huddersfield, United Kingdom
| | - O Richardson
- University of Huddersfield, Huddersfield, United Kingdom
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Dias LR, Tomasi YT, Boing AF. The newborn screening tests in Brazil: regional and socioeconomic prevalence and inequalities in 2013 and 2019. J Pediatr (Rio J) 2024; 100:296-304. [PMID: 38169234 PMCID: PMC11065651 DOI: 10.1016/j.jped.2023.11.008] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To analyze the prevalence evolution of Guthrie, hearing, and eye screening testing among newborns in Brazil, between 2013 and 2019, according to demographic and socioeconomic characteristics. METHODS This is a cross-sectional study with data from 5231 infants from the Pesquisa Nacional de Saúde (PNS), in 2013, and 6637 infants, in 2019, for the Guthrie test, hearing, and red reflex tests. The authors analyzed the outcomes according to the region of residence, self-reported color/race, having health insurance, and per capita household income. By using bivariate and multivariate Poisson regression models, the prevalence ratios and their respective 95 % Confidence Intervals (CI95%) were calculated for each year. RESULTS In 2013, Guthrie test, hearing, and red reflex tests were performed in 96.5 % (95%CI 95,8;97,0), 65.8 % (95%CI 63,9;67,7), and 60.4 % (95%CI 58,5;62,3) of infants, respectively. In 2019, the prevalence was 97.8 % (95%CI 97,3;98,2) in the Guthrie test, 81.6 % (95%CI 80,3;82,9) in the hearing test, and 78.6 % (95%CI 77,1;79,9) in the red reflex test. The testing frequency was higher among residents of the Southeast and South regions of Brazil, among infants whose mother or guardian was white, had health insurance, and was in the higher income strata; and the most evident differences were in the eye and hearing testing. CONCLUSIONS The coverage inequalities according to the region of residence, income, and having health insurance highlight the need to use strategies that enable exams to be carried out, with more information about their importance, encompassing actions from primary care, prenatal care to the puerperium, aiming at universal access and equity.
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Affiliation(s)
- Letícia R Dias
- Universidade Federal de Santa Catarina (UFSC), Programa de Pós-Graduação em Saúde Coletiva (PPGSC), Florianópolis, SC, Brazil.
| | - Yaná T Tomasi
- Universidade do Estado de Santa Catarina (UDESC), Departamento de Enfermagem, Florianópolis, SC, Brazil
| | - Antonio F Boing
- Universidade Federal de Santa Catarina (UFSC), Departamento de Saúde Pública, Florianópolis, SC, Brazil.
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Zahra SA, Choudhury RY, Naqvi R, Boulton AJ, Chahal CAA, Munir S, Carrington M, Ricci F, Khanji MY. Health inequalities in cardiopulmonary resuscitation and use of automated electrical defibrillators in out-of-hospital cardiac arrest. Curr Probl Cardiol 2024; 49:102484. [PMID: 38401825 DOI: 10.1016/j.cpcardiol.2024.102484] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024]
Abstract
Out of hospital cardiac arrest (OHCA) outcomes can be improved by strengthening the chain of survival, namely prompt cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED). However, provision of bystander CPR and AED use remains low due to individual patient factors ranging from lack of education to socioeconomic barriers and due to lack of resources such as limited availability of AEDs in the community. Although the impact of health inequalities on survival from OHCA is documented, it is imperative that we identify and implement strategies to improve public health and outcomes from OHCA overall but with a simultaneous emphasis on making care more equitable. Disparities in CPR delivery and AED use in OHCA exist based on factors including sex, education level, socioeconomic status, race and ethnicity, all of which we discuss in this review. Most importantly, we discuss the barriers to AED use, and strategies on how these may be overcome.
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Affiliation(s)
- Syeda Anum Zahra
- St Marys Hospital, Imperial College NHS Trust, Praed Street, Paddington, London W2 1NY, UK; Imperial College London, Exhibition Rd, South Kensington, London SW7 2BX, UK
| | - Rozina Yasmin Choudhury
- Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust, Romsey Rd, Winchester SO22 5DG, UK
| | - Rameez Naqvi
- Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust, Turner Rd, Colchester CO4 5JL, UK
| | - Adam J Boulton
- Warwick Clinical Trails Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - C Anwar A Chahal
- Centre for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA, USA; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sabrina Munir
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, Plaistow, London E13 8SL, UK
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti 66100, Italy; Heart Department, SS. Annunziata Hospital, ASL 2 Abruzzo, Chieti 66100, Italy; Department of Clinical Sciences, Lund University, Malmö 21428, Sweden
| | - Mohammed Y Khanji
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, Plaistow, London E13 8SL, UK; Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University, London EC1A 7BE, UK.
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Hoebel J, Nowossadeck E, Michalski N, Baumert J, Wachtler B, Tetzlaff F. [Socioeconomic deprivation and premature mortality in Germany, 1998-2021 : An ecological study with what-if scenarios of inequality reduction]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:528-537. [PMID: 38587641 DOI: 10.1007/s00103-024-03862-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Earlier mortality in socioeconomically disadvantaged population groups represents an extreme manifestation of health inequity. This study examines the extent, time trends, and mitigation potentials of area-level socioeconomic inequalities in premature mortality in Germany. METHODS Nationwide data from official cause-of-death statistics were linked at the district level with official population data and the German Index of Socioeconomic Deprivation (GISD). Age-standardized mortality rates before the age of 75 were calculated stratified by sex and deprivation quintile. A what-if analysis with counterfactual scenarios was applied to calculate how much lower premature mortality would be overall if socioeconomic mortality inequalities were reduced. RESULTS Men and women in the highest deprivation quintile had a 43% and 33% higher risk of premature death, respectively, than those in the lowest deprivation quintile of the same age. Higher mortality rates with increasing deprivation were found for cardiovascular and cancer mortality, but also for other causes of death. Socioeconomic mortality inequalities had started to increase before the COVID-19 pandemic and further exacerbated in the first years of the pandemic. If all regions had the same mortality rate as those in the lowest deprivation quintile, premature mortality would be 13% lower overall. DISCUSSION The widening gap in premature mortality between deprived and affluent regions emphasizes that creating equivalent living conditions across Germany is also an important field of action for reducing health inequity.
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Affiliation(s)
- Jens Hoebel
- Fachgebiet Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland.
| | - Enno Nowossadeck
- Fachgebiet Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Niels Michalski
- Fachgebiet Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Jens Baumert
- Fachgebiet Körperliche Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Benjamin Wachtler
- Fachgebiet Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Fabian Tetzlaff
- Fachgebiet Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
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Mead R, Rinaldi C, McGill E, Egan M, Popay J, Hartwell G, Daras K, Edwards A, Lhussier M. Does better than expected life expectancy in areas of disadvantage indicate health resilience? Stakeholder perspectives and possible explanations. Health Place 2024; 87:103242. [PMID: 38692227 DOI: 10.1016/j.healthplace.2024.103242] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/08/2024] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Abstract
Some places have better than expected health trends despite being disadvantaged in other ways. Thematic analysis of qualitative data from stakeholders (N = 25) in two case studies of disadvantaged local authorities the North West and South East of England assessed explanations for the localities' apparent health resilience. Participants identified ways of working that might contribute to improved life expectancy, such as partnering with third sector, targeting and outcome driven action. Stakeholders were reluctant to assume credit for better-than-expected health outcomes. External factors such as population change, national politics and finances were considered crucial. Local public health stakeholders regard their work as important but unlikely to cause place-centred health resilience.
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Affiliation(s)
- Rebecca Mead
- Division of Health Research, Lancaster University, Lancaster, UK.
| | - Chiara Rinaldi
- Department Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
| | - Elizabeth McGill
- Department Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Matt Egan
- Department Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Jennie Popay
- Division of Health Research, Lancaster University, Lancaster, LA1 4YW, UK.
| | - Greg Hartwell
- Department Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
| | - Konstantinos Daras
- Institute of Population Health, Department of Public Health, Policy, and Systems, University of Liverpool, Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 3GL, UK.
| | | | - Monique Lhussier
- Department: Social Work, Education and Community, Wellbeing, Northumbria University, Coach Lane Campus, Benton, Newcastle Upon Tyne, NE7 7XA, UK.
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Dantas AAG, de Oliveira NPD, Costa GAB, Martins LFL, Dos Santos JEM, Migowski A, de Camargo Cancela M, de Souza DLB. Multilevel analysis of social determinants of advanced stage colorectal cancer diagnosis. Sci Rep 2024; 14:9667. [PMID: 38671078 PMCID: PMC11053035 DOI: 10.1038/s41598-024-60449-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
The advanced stage at diagnosis of colorectal cancer (CRC) may be related to individual factors, socioeconomic conditions, and healthcare service availability. The objective of the study was to analyze the prevalence of advanced stage CRC at the time of diagnosis and its association with individual, contextual, socioeconomic, and healthcare service indicators. An observational, cross-sectional study was conducted, analyzing cases of malignant neoplasms of the colon and rectum in individuals of both sexes, aged between 18 and 99 years, diagnosed between 2010 and 2019 in Brazil (n = 69,047). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A Multilevel Poisson Regression model with random intercept was used. The prevalence of advanced stage CRC at diagnosis was 65.6%. Advanced stage was associated with older age groups prevalence ratio (PR) 4.40 and younger age groups (PR 1.84), low Human Development Index (HDI) (PR 1.22), and low density of family health strategy teams (PR 1.10). The study highlights the unequal distribution of social determinants of health in the diagnosis CRC in Brazil, revealing the need to evaluate and redirect public policies aimed at improving early detection and prevention of CRC in the country.
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Affiliation(s)
| | | | - Guilherme Augusto Barcello Costa
- Graduate Program in Oncology, Research and Innovation Coordination, National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Luís Felipe Leite Martins
- Surveillance and Situation Analysis Division, Prevention and Surveillance Coordination (CONPREV), National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Jonas Eduardo Monteiro Dos Santos
- Surveillance and Situation Analysis Division, Prevention and Surveillance Coordination (CONPREV), National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Arn Migowski
- Epidemiology Unit. Education and Research Coordination, National Institute of Cardiology (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
- Prevention and Surveillance Coordination (CONPREV), National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Marianna de Camargo Cancela
- Graduate Program in Oncology, Research and Innovation Coordination, National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Dyego Leandro Bezerra de Souza
- Graduate Program in Public Health, Federal University of Rio Grande do Norte - UFRN, Natal, RN, Brazil.
- Methodology, Methods, Models and Results in Health and Social Sciences Research Group (M3O), Faculty of Health Sciences and Well-Being. Health and Social Care Research Center (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain.
- Public Health Department, Graduate Program in Public Health, Federal University of Rio Grande do Norte, 1787 Senador Salgado Filho Ave., Lagoa Nova, Natal, RN, 59010-000, Brazil.
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Schelleman-Offermans K, Dito BB, Gudeta KH, Fourie E, Kebede SW, Mazzucato V, Jonas KJ. Socio-economic inequities in mental health problems and wellbeing among women working in the apparel and floriculture sectors: testing the mediating role of psychological capital, social support and tangible assets. BMC Public Health 2024; 24:1157. [PMID: 38658920 PMCID: PMC11044536 DOI: 10.1186/s12889-024-18678-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 04/22/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND It is still unknown whether the mechanisms proposed by the Reserve Capacity Model (RCM) explaining socio-economic health and wellbeing inequities in high income countries can be applied to low-income countries. This study investigates whether different reserve capacities (intra-, inter-personal, and tangible) can explain the association between relative socio-economic position (SEP) and wellbeing outcome measures among Ethiopian women working in Foreign Direct Investment (FDI). METHOD Using a cross-sectional design, we collected quantitative survey data among 2,515 women working in the apparel and floriculture sectors in Ethiopia, measuring GHQ-12 mental health problems, multi-dimensional wellbeing, relative SEP, psychological capital (PsyCap), social support (emotional and financial social support network), and tangible assets (e.g., owning mobile phone, having access to toilet facilities). We used cluster-adjusted structural equation modelling to test whether PsyCap, social support, and/or tangible assets mediate the association between relative SEP (IV) and GHQ-12 mental health problems and multi-dimensional wellbeing (DVs). RESULTS PsyCap and the size of the financial support network significantly mediate the socio-economic gradient in both wellbeing outcomes. The size of the emotional social support network shows no association with multi-dimensional wellbeing and shows an unexpected negative association with GHQ-12 mental health problems scores, including a significant mediation effect. Tangible assets show no association with the wellbeing outcome measures and do not mediate socio-economic mental health problems and wellbeing inequities. CONCLUSIONS The RCM can be applied in low-income countries, although in unexpected ways. Similar to findings from high-income countries, PsyCap and size of the financial social support network show significant mediation effects in explaining mental health problems and wellbeing inequities in Ethiopia. These reserves could therefore serve as a buffer for socio-economic inequities in mental health and wellbeing and can therefore assist in decreasing these inequities for women working in FDI sectors in Ethiopia.
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Affiliation(s)
- Karen Schelleman-Offermans
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Postbus 616, Maastricht, 6200MD, the Netherlands.
| | - Bilisuma B Dito
- Department of Society Studies, Faculty of Arts and Social Sciences, Maastricht University, Maastricht, the Netherlands
| | - Konjit H Gudeta
- Department of Society Studies, Faculty of Arts and Social Sciences, Maastricht University, Maastricht, the Netherlands
- School of Commerce, Addis Ababa University, Addis Ababa, Ethiopia
| | - Elsje Fourie
- Department of Society Studies, Faculty of Arts and Social Sciences, Maastricht University, Maastricht, the Netherlands
| | | | - Valentina Mazzucato
- Department of Society Studies, Faculty of Arts and Social Sciences, Maastricht University, Maastricht, the Netherlands
| | - Kai J Jonas
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Postbus 616, Maastricht, 6200MD, the Netherlands
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Owusu BA, Doku DT. Living with type 1 diabetes and schooling among young people in Ghana: a truism of health selection, inadequate support, or artefactual explanation of educational inequalities? BMC Public Health 2024; 24:1137. [PMID: 38654212 DOI: 10.1186/s12889-024-18590-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/14/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) is mostly diagnosed among young people. Despite the evidence that T1DM is disruptive, and affects individuals' health and cognitive ability, there is dearth of knowledge on the impact of T1DM on schooling in LMICs including Ghana. In this research, we explored the impact of T1DM on the schooling of young people living with the disease, and discussed the results within health selection, social support, and artefactual perspectives of inequality. METHODS Data were extracted from a qualitative project on T1DM lived experiences in southern Ghana. The study participants were young persons living with T1DM (n = 28) and their caregivers (n = 12). They were purposively recruited to participate in the study using maximum variation and snowball sampling techniques and interviewed in their support group centres, homes, or healthcare facilities using semi-structured interview guides. A computer-assisted qualitative data analysis was performed using QSR NVivo 14 software, and the results were categorised into themes. RESULTS Three themes were identified from the transcripts. These themes were school and classroom attendance, choice of school, and school/academic performance. T1DM was a major reason for patients' limited contact hours with teachers, school drop-out, preference for day schools rather than boarding, opting for vocational training instead of continuation of formal education, limited concentration at school, and delayed educational progression. CONCLUSION T1DM impacted the schooling of young people living with the disease. The mechanisms of these impacts, and young peoples lived experiences are not artefactual, but rather support discourses on health selection and inadequate social support for young people living with the disease. The results call for the need to develop educational and social interventions to address these barriers. The full implementation of the Inclusive Education Policy (IEP) may contribute to reducing educational and social inequalities caused by ill-health.
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Affiliation(s)
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Calderón-Villarreal A, Avelar Portillo LJ, Abramovitz D, Goldenberg S, Flanigan S, Quintana PJE, Harvey-Vera A, Vera CF, Rangel G, Strathdee SA, Kayser GL. Water, sanitation, and hygiene access among people who inject drugs in Tijuana and San Diego in 2020-2021: a cross-sectional study. Int J Equity Health 2024; 23:79. [PMID: 38644494 PMCID: PMC11034064 DOI: 10.1186/s12939-024-02163-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/27/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Water, sanitation, and hygiene (WASH) access is critical to public health and human dignity. People who inject drugs (PWID) experience stigma and structural violence that may limit WASH access. Few studies have assessed WASH access, insecurity, and inequities among PWID. We describe WASH access, social and geographic inequalities, and factors associated with WASH insecurity among PWID in the Tijuana-San Diego metropolitan area. METHODS In this cross-sectional binational study, we interviewed PWID (age 18+) in 2020-2021 about WASH access and insecurity. City of residence (Tijuana/San Diego) and housing status were considered as independent variables to describe key WASH access outcomes and to assess as factors associated with WASH insecurity outcomes. Measures of association between outcomes and independent variables were assessed using log modified-Poisson regression models adjusting for covariates. RESULTS Of 586 PWID (202 Tijuana; 384 San Diego), 89% reported basic access to drinking water, 38% had basic hand hygiene, 28% basic sanitation, and 46% access to bathing, and 38% reported recent open defecation. Participants residing in Tijuana reported significantly higher insecurity in accessing basic drinking water (aRR: 1.68, 95%CI: 1.02-2.76), basic hygiene (aRR: 1.45, 95%CI: 1.28-1.64), and bathing (aRR: 1.21, 95%CI: 1.06-1.39) than those living in San Diego. Participants experiencing unsheltered homelessness experienced significantly higher insecurity in accessing basic drinking water (aRR: 2.03, 95%CI: 1.07-3.86), basic sanitation (aRR: 1.68, 95%CI: 1.48, 1.92), bathing (aRR: 1.84, 95%CI: 1.52-2.22), and improved water sources for cleaning wounds (aRR: 3.12, 95%CI: 1.55-6.29) and for preparing drugs (aRR: 2.58, 95%CI: 1.36-4.89) than participants living in permanent housing. CONCLUSION WASH access among PWID in the Tijuana-San Diego metropolitan area was low by international standards and lower than the national averages in both countries. Homelessness was significantly associated with WASH insecurity in this population. Concentrated efforts are needed to guarantee continuously available WASH services for PWID-especially those who are unsheltered.
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Affiliation(s)
- Alhelí Calderón-Villarreal
- Department of Family and Preventive Medicine, University of California San Diego (UCSD), San Diego, California, USA.
- School of Public Health, San Diego State University (SDSU), San Diego, California, USA.
| | - Lourdes Johanna Avelar Portillo
- Benioff Homelessness and Housing Initiative, School of Medicine, University of California, San Francisco, California, USA
- Division of Global Health, Herbert Wertheim School of Public Health and Human Longevity Science, UCSD, San Diego, California, USA
| | - Daniela Abramovitz
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, California, USA
| | - Shira Goldenberg
- School of Public Health, San Diego State University (SDSU), San Diego, California, USA
| | - Shawn Flanigan
- School of Public Affairs, SDSU, San Diego, California, USA
| | - Penelope J E Quintana
- School of Public Health, San Diego State University (SDSU), San Diego, California, USA
| | - Alicia Harvey-Vera
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, California, USA
- Universidad de Xochicalco, Tijuana, Baja California, Mexico
| | - Carlos F Vera
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, California, USA
| | - Gudelia Rangel
- El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico
- Border Health Commission, Tijuana, Baja California, Mexico
| | - Steffanie A Strathdee
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, California, USA
| | - Georgia L Kayser
- Benioff Homelessness and Housing Initiative, School of Medicine, University of California, San Francisco, California, USA
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de Abreu MM, Monticielo OA, Fernandes V, Rodrigues DLAS, da Silva CAL, Maiorano AC, Beserra FDS, Lamarão FRM, de Veras BMG, David N, Araújo M, Alves MCR, Stocco MA, Lima FM, Borret E, Gasparin AA, Chapacais GF, Bulbol GA, da Silva Lima D, da Silva NJM, Freitas MMC, Bica BERG, de Lima DSN, das Chagas Medeiros MM. Characterization of the patterns of care, access, and direct cost of systemic lupus erythematosus in Brazil: findings from the Macunaíma study. Adv Rheumatol 2024; 64:30. [PMID: 38641825 DOI: 10.1186/s42358-024-00369-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/30/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND A cost of illness (COI) study aims to evaluate the socioeconomic burden that an illness imposes on society as a whole. This study aimed to describe the resources used, patterns of care, direct cost, and loss of productivity due to systemic lupus erythematosus (SLE) in Brazil. METHODS This 12-month, cross-sectional, COI study of patients with SLE (ACR 1997 Classification Criteria) collected data using patient interviews (questionnaires) and medical records, covering: SLE profile, resources used, morbidities, quality of life (12-Item Short Form Survey, SF-12), and loss of productivity. Patients were excluded if they were retired or on sick leave for another illness. Direct resources included health-related (consultations, tests, medications, hospitalization) or non-health-related (transportation, home adaptation, expenditure on caregivers) hospital resources.Costs were calculated using the unit value of each resource and the quantity consumed. A gamma regression model explored cost predictors for patients with SLE. RESULTS Overall, 300 patients with SLE were included (92.3% female,mean [standard deviation (SD)] disease duration 11.8 [7.9] years), of which 100 patients (33.3%) were on SLE-related sick leave and 46 patients (15.3%) had stopped schooling. Mean (SD) travel time from home to a care facility was 4.4 (12.6) hours. Antimalarials were the most commonly used drugs (222 [74.0%]). A negative correlation was observed between SF-12 physical component and SLE Disease Activity Index (- 0.117, p = 0.042), Systemic Lupus International CollaboratingClinics/AmericanCollegeofRheumatology Damage Index (- 0.115, p = 0.046), medications/day for multiple co-morbidities (- 0.272, p < 0.001), SLE-specific drugs/day (- 0.113, p = 0.051), and lost productivity (- 0.570, p < 0.001). For the mental component, a negative correlation was observed with medications/day for multiple co-morbidities (- 0.272, p < 0.001), SLE-specific medications/day (- 0.113, p = 0.051), and missed appointments (- 0.232, p < 0.001). Mean total SLE cost was US$3,123.53/patient/year (median [interquartile range (IQR)] US$1,618.51 [$678.66, $4,601.29]). Main expenditure was medication, with a median (IQR) cost of US$910.62 ($460, $4,033.51). Mycophenolate increased costs by 3.664 times (p < 0.001), and inflammatory monitoring (erythrocyte sedimentation rate or C-reactive protein) reduced expenditure by 0.381 times (p < 0.001). CONCLUSION These results allowed access to care patterns, the median cost for patients with SLE in Brazil, and the differences across regions driven by biological, social, and behavioral factors. The cost of SLE provides an updated setting to support the decision-making process across the country.
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Affiliation(s)
- Mirhelen Mendes de Abreu
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil.
- MAPEAR Laboratory, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Odirlei Andre Monticielo
- Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | | | | | | | | | | | - Marcelly Cristinny Ribeiro Alves
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
| | - Matheus Amaral Stocco
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
| | - Fernando Mello Lima
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
| | - Emilly Borret
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
| | - Andrese Aline Gasparin
- Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gustavo Flores Chapacais
- Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | - Blanca Elena Rios Gomes Bica
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
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Dooley J, Jardine J, Ibrahim B, Mongru R, Pradhan F, Wolstenholme D, Lenguerrand E, Draycott T, Bruce F, Iliodromiti S. A positive deviant approach to examining the impact of Covid-19 on ethnic inequalities in maternal and neonatal outcomes. Sex Reprod Healthc 2024; 40:100971. [PMID: 38692137 DOI: 10.1016/j.srhc.2024.100971] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES During the COVID-19 pandemic, rapid and heterogeneous changes were made to maternity care. Identification of changes that may reduce maternal health inequalities is a national priority. The aim of this project was to use data collected about care and outcomes to identify NHS Trusts in the UK where inequalities in outcomes reduced during the pandemic and explore through interviews how the changes that occurred may have led to a reduction in inequalities. METHODS A Women's Reference Group of public advisors guided the project. Analysis of Hospital Episode Statistics Admitted Patient Care data of 128 organisations in England identified "positive deviant" organisations that reduced inequalities, using maternal and perinatal composite adverse outcome indicators. Positive deviant organisations were identified for investigation, alongside comparators. Senior clinicians, heads of midwifery and representatives of women giving birth were interviewed. Reflexive thematic analysis was employed. RESULTS The change in the inequality gap for the maternal indicator ranged from a reduction of -0.24 to an increase of 0.30 per 1000 births between the pre-pandemic and pandemic period. For the perinatal composite indicator, the change in inequality gap ranged from -0.47 to 0.67 per 1000 births. Nine Trusts were identified as positive deviants and 10 as comparators. We conducted 20 interviews from six positive deviant and four comparator organisations. Positive deviants reported that necessary shifts in roles led to productive and novel use of expert staff; comparators reported senior staff 'stepping in' where needed and no benefits of this. They reported proactivity and quick reactions, increased team working, and rapid implementation of new ideas. Comparators found constant changes overwhelming, and no increase in team working. No specific differences in care processes were identified. CONCLUSIONS Harnessing proactivity, flexibility, staffing resource, and increased team working proves vital in reducing health inequalities.
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Affiliation(s)
- Jemima Dooley
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK.
| | - Jen Jardine
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Buthaina Ibrahim
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Rohan Mongru
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Farrah Pradhan
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Daniel Wolstenholme
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, BS10 5NB, UK
| | - Tim Draycott
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Faye Bruce
- Caribbean and African Health Network, Transformation Community Resource Centre, 1st Floor, Richmond House, 11 Richmond Grove, Manchester, M13 0LN, UK
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Carrilero N, García-Altés A. Health inequalities in childhood diseases: temporal trends in the inter-crisis period. Int J Equity Health 2024; 23:76. [PMID: 38632575 PMCID: PMC11025183 DOI: 10.1186/s12939-024-02169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Since 2008, children in Catalonia (Spain) have suffered a period of great economic deprivation. This situation has generated broad-ranging health inequalities in a variety of diseases. It is not known how these inequalities have changed over time. The aim of the present study is to determine trends in inequalities over this period in ten relevant diseases in children according to sex and age. METHODS A retrospective cross-sectional population-based study of all children under 15 years old resident in Catalonia during the 2014-2021 period (over 1.2 million children/year) and of their diagnoses registered by the Catalan Health System. Health inequalities were estimated by calculating the relative index of inequality and time trends using logistic regression models. Interaction terms were added to test for the effects of sex on time trends. RESULTS Increasing significant temporal trends in inequalities were shown for both sexes in almost all the diseases or adverse events studied (asthma, injuries, poisoning, congenital anomalies, overweight and obesity), in mood disorders in boys, and in adverse birth outcomes in girls. Adjustment and anxiety and mood disorders in girls showed a decreasing temporal trend in inequalities. More than half of the diseases and adverse events studied experienced significant annual increases in inequality. Poisoning stood out with an average annual increase of 8.65% [4.30, 13.00], p ≤ 0.001 in boys and 8.64% [5.76, 11.52], p ≤ 0.001) in girls, followed by obesity with increases of 5.52% [4.15, 6.90], p = < 0.001 in boys and 4.89% [4.26, 5.51], p ≤ 0.001) in girls. CONCLUSIONS Our results suggest that inequalities persist and have increased since 2014. Policy makers should turn their attention to how interventions to reduce Health inequalities are designed, and who benefits from them.
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Affiliation(s)
- Neus Carrilero
- Agència de Qualitat I Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain.
- Department of Medicine and Life Sciences (MELIS-UPF), Pompeu Fabra University, Barcelona, Spain.
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) , Barcelona, Spain.
- Research Group on Primary and Community Care in Barcelona (APICBA), Hospital del Mar Research Institute, Barcelona, Spain.
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain.
| | - Anna García-Altés
- Agència de Qualitat I Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
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20
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Bridson L, Robinson E, Putra IGNE. Financial-related discrimination and socioeconomic inequalities in psychological well-being related measures: a longitudinal study. BMC Public Health 2024; 24:1008. [PMID: 38605335 PMCID: PMC11010292 DOI: 10.1186/s12889-024-18417-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND This study examined the prospective association between financial-related discrimination and psychological well-being related measures and assessed the role of financial-related discrimination in explaining socioeconomic inequalities in psychological well-being related measures. METHODS Data of UK older adults (≥ 50 years) from the English Longitudinal Study of Ageing were used (baseline: Wave 5, 2010/2011; n = 8,988). The baseline total non-pension wealth (in tertiles: poorest, middle, richest) was used as a socioeconomic status (SES) measure. Financial-related discrimination at baseline was defined as participants who reported they had been discriminated against due to their financial status. Five psychological well-being related measures (depressive symptoms, enjoyment of life, eudemonic well-being, life satisfaction and loneliness) were examined prospectively across different follow-up periods (Waves 6, 2012/2013, 2-year follow-up; and 7, 2014/2015, 4-year follow-up). Regression models assessed associations between wealth, financial-related discrimination, and follow-up psychological measures, controlling for sociodemographic covariates and baseline psychological measures (for longitudinal associations). Mediation analysis informed how much (%) the association between wealth and psychological well-being related measures was explained by financial-related discrimination. RESULTS Participants from the poorest, but not middle, (vs. richest) wealth groups were more likely to experience financial-related discrimination (OR = 1.97; 95%CI = 1.49, 2.59). The poorest (vs. richest) wealth was also longitudinally associated with increased depressive symptoms and decreased enjoyment of life, eudemonic well-being and life satisfaction in both 2-year and 4-year follow-ups, and increased loneliness at 4-year follow-up. Experiencing financial-related discrimination was longitudinally associated with greater depressive symptoms and loneliness, and lower enjoyment of life across follow-up periods. Findings from mediation analysis indicated that financial-related discrimination explained 3-8% of the longitudinal associations between wealth (poorest vs. richest) and psychological well-being related measures. CONCLUSIONS Financial-related discrimination is associated with worse psychological well-being and explains a small proportion of socioeconomic inequalities in psychological well-being.
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Affiliation(s)
- Lucy Bridson
- Department of Psychology, Institute of Population Health, University of Liverpool, Bedford Street South, L69 7ZA, Liverpool, UK
| | - Eric Robinson
- Department of Psychology, Institute of Population Health, University of Liverpool, Bedford Street South, L69 7ZA, Liverpool, UK
| | - I Gusti Ngurah Edi Putra
- Department of Psychology, Institute of Population Health, University of Liverpool, Bedford Street South, L69 7ZA, Liverpool, UK.
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21
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McCann ZH, Chang HH, D'Souza R, Scovronick N, Ebelt S. Assessment of census-tract level socioeconomic position as a modifier of the relationship between short-term PM 2.5 exposure and cardiovascular emergency department visits in Missouri. J Epidemiol Community Health 2024; 78:296-302. [PMID: 38302278 PMCID: PMC11006568 DOI: 10.1136/jech-2023-221438] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Ambient particulate matter ≤ 2.5 µm in aerodynamic diameter (PM2.5) exposure elevates the risk for cardiovascular disease morbidity (CVDM). The aim of this study is to characterise which area-level measures of socioeconomic position (SEP) modify the relationship between PM2.5 exposure and CVDM in Missouri at the census-tract (CT) level. METHODS We use individual level Missouri emergency department (ED) admissions data (n=3 284 956), modelled PM2.5 data, and yearly CT data from 2012 to 2016 to conduct a two-stage analysis. Stage one uses a case-crossover approach with conditional logistic regression to establish the baseline risk of ED visits associated with IQR changes in PM2.5. In the second stage, we use multivariate metaregression to examine how CT-level SEP modifies the relationship between ambient PM2.5 exposure and CVDM. RESULTS We find that overall, ambient PM2.5 exposure is associated with increased risk for CVDM. We test effect modification in statewide and urban CTs, and in the warm season only. Effect modification results suggest that among SEP measures, poverty is most consistently associated with increased risk for CVDM. For example, across Missouri, the highest poverty CTs are at an elevated risk for CVDM (OR=1.010 (95% CI 1.007 to 1.014)) compared with the lowest poverty CTs (OR=1.004 (95% CI 1.000 to 1.008)). Other SEP modifiers generally display an inconsistent or null effect. CONCLUSION Overall, we find some evidence that area-level SEP modifies the relationship between ambient PM2.5 exposure and CVDM, and suggest that the relationship between air-pollution, area-level SEP and CVDM may be sensitive to spatial scale.
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Affiliation(s)
- Zachary H McCann
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Howard H Chang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory Univeristy, Atlanta, Georgia, USA
| | - Rohan D'Souza
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory Univeristy, Atlanta, Georgia, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Stefanie Ebelt
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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22
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Ghassabian A, Titus AR, Conderino S, Azan A, Weinberger R, Thorpe LE. Beyond traffic jam alleviation: evaluating the health and health equity impacts of New York City's congestion pricing plan. J Epidemiol Community Health 2024; 78:273-276. [PMID: 38195634 DOI: 10.1136/jech-2023-221639] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/31/2023] [Indexed: 01/11/2024]
Abstract
New York City (NYC) is slated to be the first jurisdiction in the USA to implement a cordon-based congestion tax, which will be levied on vehicles entering its Central Business District. Several cities around the world, for example, London and Stockholm, have had similar cordon-based pricing programmes, defined as road pricing that charges drivers a fee for entering a specified area (typically a congested urban centre). In addition to reducing congestion and creating revenue, projections suggest the NYC congestion pricing plan may yield meaningful traffic-related air quality improvements that could result in health benefits. NYC is a large city with high air pollution and substantial racial/ethnic and socioeconomic health inequities. The distinct geography and meteorological conditions of the city also suggest that the policy's impact on air quality may extend beyond the NYC metropolitan area. As such, the potential breadth, directionality and magnitude of health impacts on communities who might be heavily affected by the nation's first congestion pricing plan should be empirically investigated. We briefly review evaluation studies of other cordon-based congestion pricing policies and argue that implementation of this policy provides an excellent opportunity to employ a quasi-experimental study design to evaluate the policy's impacts on air quality and health outcomes across population subgroups using a health equity lens. We discuss why real-time evaluations of the NYC congestion pricing plan can potentially help optimise benefits for communities historically negatively affected by traffic-related air pollution. Assessing intended and unintended impacts on health equity is key to achieving these goals.
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Affiliation(s)
| | - Andrea R Titus
- Population Health, NYU Langone Health, New York, New York, USA
| | - Sarah Conderino
- Department of Population Health, NYU Langone Health, New York, New York, USA
| | - Alexander Azan
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | | | - Lorna E Thorpe
- Department of Population Health, New York University School of Medicine, New York, New York, USA
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Zhou Y, Lu Y, Wei D, He S. Impacts of social deprivation on mortality and protective effects of greenness exposure in Hong Kong, 1999-2018: A spatiotemporal perspective. Health Place 2024; 87:103241. [PMID: 38599046 DOI: 10.1016/j.healthplace.2024.103241] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/27/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024]
Abstract
Addressing health inequality is crucial for fostering healthy city development. However, there is a dearth of literature simultaneously investigating the effects of social deprivation and greenness exposure on mortality risks, as well as how greenness exposure may mitigate the adverse effect of social deprivation on mortality risks from a spatiotemporal perspective. Drawing on socioeconomic, remote sensing, and mortality record data, this study presents spatiotemporal patterns of social deprivation, population weighted greenness exposure, and all-cause and cause-specific mortality in Hong Kong. A Bayesian regression model was applied to investigate the impacts of social deprivation and greenness exposure on mortality and examine how socioeconomic inequalities in mortality may vary across areas with different greenness levels in Hong Kong from 1999 to 2018. We observed a decline in social deprivation (0.67-0.56), and an increase in greenness exposure (0.34-0.41) in Hong Kong during 1999-2018. Areas with high mortality gradually clustered in the Kowloon Peninsula and the northern regions of Hong Kong Island. Adverse impacts of social deprivation on all-cause mortality weakened in recent years (RR from 2009 to 2013: 1.103, 95%CI: 1.051-1.159, RR from 2014 to 2018: 1.041 95%CI: 0.950-1.139), while the protective impacts of greenness exposure consistently strengthened (RR from 1999 to 2003: 0.903, 95%CI: 0.827-0.984, RR from 2014 to 2018: 0.859, 95%CI: 0.763-0.965). Moreover, the adverse effects of social deprivation on mortality risks were found to be higher in areas with lower greenness exposure. These findings provide evidence of associations between social deprivation, greenness exposure, and mortality risks in Hong Kong over the past decades, and highlight the potential of greenness exposure to mitigate health inequalities. Our study provides valuable implications for policymakers to develop a healthy city.
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Affiliation(s)
- Yuxuan Zhou
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Yi Lu
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Di Wei
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong Special Administrative Region, China; School of Architecture and Urban Planning, Huazhong University of Science and Technology, Wuhan, China; Hubei Engineering and Technology Research Center of Urbanization, Wuhan, China.
| | - Shenjing He
- Department of Urban Planning and Design, Urban Systems Institute, And the Social Infrastructure for Equity and Wellbeing Lab, The University of Hong Kong, Hong Kong Special Administrative Region of China, China.
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24
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Videholm S, Silfverdal SA, Gustafsson PE. Intersectional inequalities in paediatric infectious diseases: a national cohort study in Sweden. J Epidemiol Community Health 2024:jech-2023-220593. [PMID: 38589219 DOI: 10.1136/jech-2023-220593] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND It is well known that socially deprived children are more likely to be hospitalised for infections. Less is known about how different social disadvantages interact. Therefore, we examine intersectional inequalities in overall, upper respiratory, lower respiratory, enteric and genitourinary infections in the first 5 years of life. METHODS We conducted a population-based retrospective cohort study of Swedish children born between 1998 and 2015. Inequalities were examined using analysis of individual heterogeneity and discriminatory accuracy as the analytical framework. A variable with 60 intersectional strata was created by combining information on maternal education, household income, sex/gender and maternal migration status. We estimated the incidence rates of infectious disease hospitalisation for each intersectional strata and the associations between intersectional strata and infectious disease hospitalisations using logistic regression models. We furthermore quantified the discriminatory ability of the intersectional strata with respect to infectious disease hospitalisation. RESULTS The study included 1785 588 children and 318 080 hospital admissions. The highest overall incidence of hospitalisations for infections was found in boys born to low-educated mothers who lived in families with the lowest household income. The overall incidence of infections was unrelated to household income in children born to highly educated mothers. The ability of the intersectional strata to discriminate between children with and without infections was poor. CONCLUSION We found that inequalities in paediatric infectious diseases were shaped by the intersections of different social disadvantages. These inequalities should be addressed by public health policies that reach all children.
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Affiliation(s)
- Samuel Videholm
- Department of Clinical Sciences, Pediatrics, Umea Universitet, Umea, Sweden
| | | | - Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå Universitet Medicinska fakulteten, Umea, Sweden
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25
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King TL, Vitaliano PP, Maheen H, Taouk Y. Impact of informal caregiving on depressive symptoms among a national cohort of men. J Epidemiol Community Health 2024:jech-2023-221814. [PMID: 38583877 DOI: 10.1136/jech-2023-221814] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/13/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND There is evidence that unpaid caregiving can have negative effects on the mental health of female caregivers; however, evidence of impacts on male caregivers is limited. This study addressed this gap by examining associations between becoming a caregiver and depressive symptoms among men. METHODS We used data from waves 1-2 (2013, 2016) of the Longitudinal Study of Australian Male Health (Ten to Men). Effects of incident caregiving on depressive symptoms were estimated using augmented inverse probability treatment weighting, with adjustment for potential confounders. Incident caregiving was assessed as a binary variable (became a caregiver vs not), and depressive symptoms were measured using the Patient Health Questionnaire (moderate to severe depressive symptoms; yes, no). Main analysis was prospective, drawing on wave 1 (caregiving) and wave 2 (depressive symptoms), and sensitivity analyses modelled cross-sectional associations. RESULTS In the main analysis, incident caregiving in wave 1 was associated with depressive symptoms in the subsequent wave, with an average treatment effect of 0.11 (95% CI 0.06, 0.17) and equating to a risk ratio of 2.03 (95% CI 1.55, 2.51). Associations were robust to several sensitivity analyses, with cross-sectional associations supporting the main prospective analyses. CONCLUSION These results provide evidence of the association between caregiving and depressive symptoms among male caregivers. This has important implications for policy and support programmes. As we seek to shift caregiving responsibilities toward a more gender-equal distribution of care, policy must recognise that, like female caregivers, male caregivers also experience mental health impacts related to their caregiving role.
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Affiliation(s)
- Tania L King
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter P Vitaliano
- Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Humaira Maheen
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yamna Taouk
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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26
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Trias-Llimós S. [DDHealth Protocol: Justification, design and implementation of a cross-sectional survey of sociodemographic health, health literacy and digital divide in 2,000 adults aged fifty to seventy-nine residing in Spain in 2022]. Rev Esp Salud Publica 2024; 98:e202404029. [PMID: 38597242] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/14/2024] [Indexed: 04/11/2024] Open
Abstract
Socioeconomic inequalities in health persist in Spain. The DDHealth project aims to address two timely innovative aspects that have been postulated to contribute to socioeconomic inequalities in health. DDHealth aims to address two innovative and timely aspects that have been proposed to contribute to socioeconomic health inequalities. The first one is the socioeconomic digital divide, which refers to the greater capabilities and opportunities to access technology and use the internet among higher social classes compared to lower ones. The second aspect is health literacy, which refers to individuals' capacity to meet and understand the complex demands of health promotion and maintenance in modern society. The study conducted over 2,000 interviews among residents in Spain aged between fifty and seventy-nine years old from March to April 2022, using a computer-assisted telephone interviewing (CATI) approach. The questionnaire comprises four different modules: sociodemographic; digital divide; health; health literacy. The anonymized data are available through the following link: https://dataverse.csuc.cat/dataset.xhtml?persistentId=doi:10.34810/data765. DDHealth enables addressing innovative dimensions concerning the social determinants of health in Spain. The data are available to external researchers for scientific purposes upon request of a reasonable research proposal.
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Affiliation(s)
- Sergi Trias-Llimós
- Centre d'Estudis Demogràfics; Centres de Recerca de Catalunya (CERCA); Universitat Autònoma de Barcelona. Bellaterra (Barcelona). España
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Bell L, Whelan M, Lycett D, Fernandez E, Khera-Butler T, Kehal I, Patel R. Healthcare and housing provision for a UK homeless community: a qualitative service evaluation. Public Health 2024; 229:1-6. [PMID: 38368810 DOI: 10.1016/j.puhe.2024.01.017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/04/2024] [Accepted: 01/19/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Homelessness is both a significant determinant and consequence of health and social inequalities. To better meet healthcare needs, dedicated mental health and general nurses were implemented to deliver outreach healthcare to people experiencing homelessness in one United Kingdom (UK) county. During COVID-19, the UK Government also instructed local authorities to accommodate individuals sleeping rough and have a national target to end rough sleeping. This qualitative study explored experiences of this nurse-let outreach service and housing journeys during and beyond COVID-19 among people experiencing homelessness. STUDY DESIGN Face-to-face, narrative storytelling interviews were conducted via opportunistic sampling in community settings. Individuals with recent or current experiences of homelessness were eligible. METHODS Participants were informed about the study via known professionals and introduced to the researcher. Eighteen narrative interviews were conducted, transcribed, and analysed using reflective thematic analysis. RESULTS Individuals described complex journeys in becoming and being homeless. The nurse-led outreach service provided integral support, with reported benefits to person-centred and accessible care and improved outcomes in health and well-being. After being housed, individuals valued housing necessities and described new responsibilities. However, some participants did not accept or stay in housing provisions where they perceived risks. CONCLUSIONS Interviewed participants perceived that the dedicated nurse-led outreach service improved their access to care and health outcomes. In the absence of dedicated provisions, mainstream healthcare should ensure flexible processes and collaborative professional working. Local authorities must also be afforded increased resources for housing, as well as integrated support, to reduce social and health inequalities.
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Affiliation(s)
- L Bell
- Research Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - M Whelan
- Research Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - D Lycett
- Research Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - E Fernandez
- Warwickshire County Council, Warwickshire, UK
| | | | - I Kehal
- Warwickshire County Council, Warwickshire, UK
| | - R Patel
- Research Institute for Health and Wellbeing, Coventry University, Coventry, UK; NIHR Applied Research Collaboration-East Midlands (ARC-EM), Leicester, UK.
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Chen J, Zhu Y, Li L, Lv J, Li Z, Chen X, Chen X, Huang S, Xie R, Zhang Y, Ye G, Luo R, Shen X, Fu M, Zhuo Y. Visual impairment burden in retinopathy of prematurity: trends, inequalities, and improvement gaps. Eur J Pediatr 2024; 183:1891-1900. [PMID: 38319404 DOI: 10.1007/s00431-024-05450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
Retinopathy of prematurity (ROP) is an important cause of avoidable childhood visual impairment, and the increase in number and survival of premature infants may inflate its burden globally. We aimed to comprehensively assess the trends and inequalities in the burden of ROP-related visual impairment and to identify improvement gaps to facilitate appropriate actions in neonatal care systems. We obtained ROP data from the Global Burden of Disease 2019 study. We employed joinpoint regression analysis to assess the trends of the burden of ROP-related visual impairment, measured by age-standardised prevalence rates, health equity analysis methods to evaluate cross-country burden inequalities, and data envelopment and stochastic frontier analyses to identify improvement gaps based on the development status, i.e., sociodemographic index (SDI). Between 1990 and 2019, the age-standardised prevalence rates of ROP-related visual impairment significantly increased worldwide (average annual percentage change: 0.23 [95% confidence interval, 0.21-0.26] among males and 0.26 [0.25-0.27] among females), primarily in developed regions. Although significant SDI-related cross-country inequalities were identified, these reduced over time (slope index of inequality: -57.74 [-66.22 to -49.25] in 1990 to -29.68 [-38.39 to -20.97] in 2019; health concentration index: -0.11 [-0.13 to -0.09] in 1990 to -0.07 [-0.09 to -0.06] in 2019). Notably, some less-developed countries exhibited superior performance despite limited resources, whereas others with a higher SDI delivered lagging performance. Conclusion: The global burden of ROP-related visual impairment has steadily increased between 1990 and 2019, with disproportionate burden concentration among less-developed countries, requiring appropriate preventive and intervention measures. What is Known: • Retinopathy of prematurity (ROP) is an important cause of avoidable childhood visual impairment. • The prevalence of ROP is anticipated to increase due to the growing number of extremely premature infants. What is New: • The prevalence of ROP-related visual impairment has increased worldwide, primarily in developed regions, with declining but persisting cross-country inequalities. • The increasing burden of ROP-related visual impairment should be considered as part of global and national health agendas, requiring interventions with proven efficacy.
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Affiliation(s)
- Jianqi Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Linling Li
- Shenzhen Maternal and Child Health Care Hospital, Shenzhen, 518000, China
| | - Juan Lv
- Shenzhen Maternal and Child Health Care Hospital, Shenzhen, 518000, China
| | - Zhidong Li
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Xuhao Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Xiaohong Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Shaofen Huang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Rui Xie
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Yuan Zhang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Guitong Ye
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Ruiyu Luo
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Xinyue Shen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Min Fu
- Shenzhen Maternal and Child Health Care Hospital, Shenzhen, 518000, China.
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China.
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Fotakis EA, Mateo-Urdiales A, Fabiani M, Sacco C, Petrone D, Riccardo F, Bella A, Pezzotti P. Socioeconomic Inequalities in SARS-CoV-2 Infection and COVID-19 Health Outcomes in Urban Italy During the COVID-19 Vaccine Rollout, January-November 2021. J Urban Health 2024; 101:289-299. [PMID: 38498248 PMCID: PMC11052739 DOI: 10.1007/s11524-024-00844-0] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
This study analysed the evolution of the association of socioeconomic deprivation (SED) with SARS-CoV-2 infection and COVID-19 outcomes in urban Italy during the vaccine rollout in 2021. We conducted a retrospective cohort analysis between January and November 2021, comprising of 16,044,530 individuals aged ≥ 20 years, by linking national COVID-19 surveillance system data to the Italian SED index calculated at census block level. We estimated incidence rate ratios (IRRs) of infection and severe COVID-19 outcomes by SED tercile relative to the least deprived tercile, over three periods defined as low (0-10%); intermediate (> 10-60%) and high (> 60-74%) vaccination coverage. We found patterns of increasing relative socioeconomic inequalities in infection, hospitalisation and death as COVID-19 vaccination coverage increased. Between the low and high coverage periods, IRRs for the most deprived areas increased from 1.09 (95%CI 1.03-1.15) to 1.28 (95%CI 1.21-1.37) for infection; 1.48 (95%CI 1.36-1.61) to 2.02 (95%CI 1.82-2.25) for hospitalisation and 1.57 (95%CI 1.36-1.80) to 1.89 (95%CI 1.53-2.34) for death. Deprived populations in urban Italy should be considered as vulnerable groups in future pandemic preparedness plans to respond to COVID-19 in particular during mass vaccination roll out phases with gradual lifting of social distancing measures.
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Affiliation(s)
- Emmanouil Alexandros Fotakis
- European Programme On Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | | | - Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Chiara Sacco
- European Programme On Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Daniele Petrone
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Flavia Riccardo
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy.
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Naidoo M, Shephard W, Kambewe I, Mtshali N, Cope S, Rubio FA, Rasella D. Incorporating social vulnerability in infectious disease mathematical modelling: a scoping review. BMC Med 2024; 22:125. [PMID: 38500147 PMCID: PMC10949739 DOI: 10.1186/s12916-024-03333-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Highlighted by the rise of COVID-19, climate change, and conflict, socially vulnerable populations are least resilient to disaster. In infectious disease management, mathematical models are a commonly used tool. Researchers should include social vulnerability in models to strengthen their utility in reflecting real-world dynamics. We conducted a scoping review to evaluate how researchers have incorporated social vulnerability into infectious disease mathematical models. METHODS The methodology followed the Joanna Briggs Institute and updated Arksey and O'Malley frameworks, verified by the PRISMA-ScR checklist. PubMed, Clarivate Web of Science, Scopus, EBSCO Africa Wide Information, and Cochrane Library were systematically searched for peer-reviewed published articles. Screening and extracting data were done by two independent researchers. RESULTS Of 4075 results, 89 articles were identified. Two-thirds of articles used a compartmental model (n = 58, 65.2%), with a quarter using agent-based models (n = 24, 27.0%). Overall, routine indicators, namely age and sex, were among the most frequently used measures (n = 42, 12.3%; n = 22, 6.4%, respectively). Only one measure related to culture and social behaviour (0.3%). For compartmental models, researchers commonly constructed distinct models for each level of a social vulnerability measure and included new parameters or influenced standard parameters in model equations (n = 30, 51.7%). For all agent-based models, characteristics were assigned to hosts (n = 24, 100.0%), with most models including age, contact behaviour, and/or sex (n = 18, 75.0%; n = 14, 53.3%; n = 10, 41.7%, respectively). CONCLUSIONS Given the importance of equitable and effective infectious disease management, there is potential to further the field. Our findings demonstrate that social vulnerability is not considered holistically. There is a focus on incorporating routine demographic indicators but important cultural and social behaviours that impact health outcomes are excluded. It is crucial to develop models that foreground social vulnerability to not only design more equitable interventions, but also to develop more effective infectious disease control and elimination strategies. Furthermore, this study revealed the lack of transparency around data sources, inconsistent reporting, lack of collaboration with local experts, and limited studies focused on modelling cultural indicators. These challenges are priorities for future research.
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Affiliation(s)
- Megan Naidoo
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain.
| | - Whitney Shephard
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Innocensia Kambewe
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Nokuthula Mtshali
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Sky Cope
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Felipe Alves Rubio
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Davide Rasella
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
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Salinas-Rodríguez A, Fernández-Niño JA, Rivera-Almaraz A, Manrique-Espinoza B. Intrinsic capacity trajectories and socioeconomic inequalities in health: the contributions of wealth, education, gender, and ethnicity. Int J Equity Health 2024; 23:48. [PMID: 38462637 PMCID: PMC10926672 DOI: 10.1186/s12939-024-02136-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/25/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Life-long health inequalities exert enduring impacts and are governed by social determinants crucial for achieving healthy aging. A fundamental aspect of healthy aging, intrinsic capacity, is the primary focus of this study. Our objective is to evaluate the social inequalities connected with the trajectories of intrinsic capacity, shedding light on the impacts of socioeconomic position, gender, and ethnicity. METHODS Our dynamic cohort study was rooted in three waves (2009, 2014, 2017) of the World Health Organization's Study on Global AGEing and Adult Health in Mexico. We incorporated a nationally representative sample comprising 2722 older Mexican adults aged 50 years and over. Baseline measurements of socioeconomic position, gender, and ethnicity acted as the exposure variables. We evaluated intrinsic capacity across five domains: cognition, psychological, sensory, vitality, and locomotion. The Relative Index of Inequality and Slope Index of Inequality were used to quantify socioeconomic disparities. RESULTS We discerned three distinct intrinsic capacity trajectories: steep decline, moderate decline, and slight increase. Significant disparities based on wealth, educational level, gender, and ethnicity were observed. Older adults with higher wealth and education typically exhibited a trajectory of moderate decrease or slight increase in intrinsic capacity. In stark contrast, women and indigenous individuals were more likely to experience a steeply declining trajectory. CONCLUSIONS These findings underscore the pressing need to address social determinants, minimize gender and ethnic discrimination to ensure equal access to resources and opportunities across the lifespan. It is imperative for policies and interventions to prioritize these social determinants in order to promote healthy aging and alleviate health disparities. This approach will ensure that specific demographic groups receive customized support to sustain their intrinsic capacity during their elder years.
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Affiliation(s)
- Aaron Salinas-Rodríguez
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Julián Alfredo Fernández-Niño
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E8532, Baltimore, MD, 21205, USA.
- Department of Public Health, Universidad del Norte, Barranquilla, Atlántico, Colombia.
| | - Ana Rivera-Almaraz
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Betty Manrique-Espinoza
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Avallone F, Hickson F. Sexual Health Needs Among Men Who Engage in Transactional Sex with Men in the UK. Arch Sex Behav 2024:10.1007/s10508-024-02838-0. [PMID: 38467959 DOI: 10.1007/s10508-024-02838-0] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 12/30/2023] [Accepted: 02/18/2024] [Indexed: 03/13/2024]
Abstract
Men who engage in transactional sex with men (MTSM) are a high-risk population for HIV and other sexually transmitted infections. Epidemiological data have so far included them in the broad category of men who have sex with men (MSM), while research on transactional sex typically focused on female sex workers. The internet has substantially changed sex work practices and earlier findings concerning the sexual health needs of MTSM may no longer be applicable. We analyzed quantitative data from MSM based in the UK (n = 11629) taking part in the European MSM Internet Survey (EMIS-2017). Compared to non-MTSM, MTSM (n = 230; 2%) were younger, more likely to self-identify as an ethnic minority, be single, have lower education levels, struggle financially, and-controlling for age-more likely to be living with diagnosed HIV. Commonly unmet needs among all MSM were a lack of confidence in accessing HIV post-exposure prophylaxis, uncertainty about HIV status, and ignorance of where to access hepatitis vaccinations. Compared with other MSM, MTSM were notably less satisfied with the safety of their sexual practices, less confident in their ability to maintain sexual boundaries, and more likely to engage in risk because of absent precautionary resources. Given their greater opportunity for sexual risk, as well as fewer resources for negotiating safety, our findings suggest that services should prioritize MTSM in HIV prevention and sexual health promotion, including assertiveness and social skills training, in addition to knowledge-based education.
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Affiliation(s)
- Francesco Avallone
- Department of Family Medicine, McGill University, Montreal, QC, H3S 1Z1, Canada.
- Center for Outcomes Research and Evaluation Research Institute, McGill University Health Centre, Montreal, QC, Canada.
| | - Ford Hickson
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Jacobs C, Musukuma M, Hamoonga R, Sikapande B, Chooye O, Wehrmeister FC, Michelo C, Blanchard AK. Trends and Inequalities in Maternal and Newborn Health Services for Unplanned Settlements of Lusaka City, Zambia. J Urban Health 2024:10.1007/s11524-024-00837-z. [PMID: 38459401 DOI: 10.1007/s11524-024-00837-z] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/10/2024]
Abstract
Living conditions and other factors in urban unplanned settlements present unique challenges for improving maternal and newborn health (MNH), yet MNH inequalities associated with such challenges are not well understood. This study examined trends and inequalities in coverage of MNH services in the last 20 years in unplanned and planned settlements of Lusaka City, Zambia. Geospatial information was used to map Lusaka's settlements and health facilities. Zambia Demographic Health Surveys (ZDHS 2001, 2007, 2013/2014, and 2018) were used to compare antenatal care (ANC), institutional delivery, and Cesarean section (C-section) coverage, and neonatal mortality rates between the poorer 60% and richer 40% households. Health Management Information System (HMIS) data from 2018 to 2021 were used to compute service volumes and coverage rates for ANC1 and ANC4, and institutional delivery and C-sections by facility level and type in planned and unplanned settlements. Although the correlation is not exact, our data analysis showed close alignment; and thus, we opted to use the 60% poorer and 40% richer groups as a proxy for households in unplanned versus planned settlements. Unplanned settlements were serviced by primary centers or first-level hospitals. ZDHS findings show that by 2018, at least one ANC visit and institutional delivery became nearly universal throughout Lusaka, but early and four or more ANC visits, C-sections, and neonatal mortality rates remained worse among poorer than richer women in ZDHS. In HMIS, ANC and institutional delivery volumes were highest in public facilities, especially in unplanned settlements. The volume of C-sections was much greater within facilities in planned than unplanned settlements. Our study exposed persistent gaps in timing and use of ANC and emergency obstetric care between unplanned and planned communities. Closing such gaps requires strengthening outreach early and consistently in pregnancy and increasing emergency obstetric care capacities and referrals to improve access to important MNH services for women and newborns in Lusaka's unplanned settlements.
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Affiliation(s)
- Choolwe Jacobs
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.
| | - Mwiche Musukuma
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | | | | | | | - Fernando C Wehrmeister
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | | | - Andrea K Blanchard
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Serrano-Gallardo P, Mas-Giralt R, Castellani S, Juarez SP. Advancing migration and health research by examining return migration. J Epidemiol Community Health 2024; 78:263-268. [PMID: 38182410 PMCID: PMC10958324 DOI: 10.1136/jech-2023-220670] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024]
Abstract
This essay offers an analysis of research on return migration and health by adopting the social determinants of health (SDH) framework proposed by the WHO. Specifically, we argue that the SDH are implicated in the decision to migrate, stay or return, which in itself also contributes to social health inequities. Most theoretical frameworks developed to study migration have predominantly considered primary migration movements. The lack of a fluid consideration of the migration phenomenon has a direct impact on our understanding of the relationship between migration and health. In this essay, we, first, address the challenges of defining and studying return and its implications for health research. Second, we propose to use the WHO's SDH framework to understand how social factors shape migrants' health, influence the decision to return and can contribute to health inequalities. The conceptual approach developed in this paper can help design future studies on the health of return migrants, fostering interdisciplinary collaborations to investigate how social factors are embodied, giving rise to health inequities in society that are intricately linked to the migration experience.
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Affiliation(s)
- Pilar Serrano-Gallardo
- Nursing Department, Universidad Autonoma de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), Madrid, Spain
- Research Institute for Higher Education and Science (INAECU), Madrid, Spain
| | - Rosa Mas-Giralt
- Lifelong Learning Centre, School of Geography, University of Leeds, Leeds, UK
| | - Simone Castellani
- Department of General Economics, Faculty of Social and Communication Sciences, Universidad de Cadiz, Cadiz, Spain
| | - Sol P Juarez
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies, Stockholm, Sweden
- Karolinska Institute, Stockholm, Sweden
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35
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Reece S, Dickerson J, Pickett KE. Exploring attitudes and variation by sociodemographic factors in consent provided for financial data linkage in an experimental birth cohort study. BMC Public Health 2024; 24:712. [PMID: 38443847 PMCID: PMC10916313 DOI: 10.1186/s12889-024-18226-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/28/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Improving our understanding of household incomes and what constitutes financial insecurity can help us to better understand how financial insecurity is experienced and how this can change over time within and between individuals and populations. However, financial circumstances are often perceived as sensitive and stigmatising, particularly within some ethnic minority groups. This research aims to explore attitudes and variation by sociodemographic factors in consent provided for financial data linkage in an experimental birth cohort study, in order to obtain validated income and benefits data and to better understand the impact of community interventions on the financial security of its participants and their families. METHODS This research utilises an observational study design to explore consent rates, attitudes and variation in sociodemographic factors between participants of an experimental birth cohort in a deprived and ethnically diverse setting who consent and do not consent to financial data linkage. RESULTS Overall, participants were equally likely to consent and decline consent for financial data linkage. Measures of socioeconomic insecurity were associated with being more likely to provide consent for financial data linkage. Participants who were not employed (OR 1.49 95% CI 0.93, 2.40) and were more financially insecure (OR 1.85 95% CI 1.14, 3.93) were more likely to provide consent for financial data linkage. Where the participant's first language was a language other than English, participants were also less likely to provide consent for data linkage (OR 0.65 95% CI 0.39, 0.98). The choice of consent for financial data linkage was not associated with: ethnicity; relationship factors; employment status of the participant's partner; person present at time of recruitment; and measures of health, such as general health, mental health, wellbeing and health-related quality of life. CONCLUSIONS This research sets out an approach to obtaining validated income and benefits data, as a proxy measure for financial security, within an experimental birth cohort study in a deprived and ethnically diverse setting. It achieves good consent rates and demonstrates greater input from those who report greater potential need for financial support. Further research should be conducted to further understand the interplay of language spoken in this context.
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Affiliation(s)
- Sian Reece
- Hull York Medical School, York, North Yorkshire, UK.
| | - Josie Dickerson
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, West Yorkshire, UK
| | - Kate E Pickett
- Department of Health Sciences, University of York, Heslington Road, York, North Yorkshire, UK
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Morris K, Lampropoulos D. The progressive place paradox: Status-based health inequalities are magnified in more economically progressive Swiss localities. Health Place 2024; 86:103215. [PMID: 38402812 DOI: 10.1016/j.healthplace.2024.103215] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/17/2024] [Accepted: 02/16/2024] [Indexed: 02/27/2024]
Abstract
Low socioeconomic status (measured both objectively and subjectively) is systematically associated with worse health. Amid renewed interest in contextual influences on health inequalities, we ask whether variation in the prevailing ideological climate moderates the size of the health gap between low and high status individuals. Based on the minority stress hypothesis, we expect that living in an economically progressive place within Switzerland - places where more residents endorse the need for change to the economic status quo - will reduce the magnitude of the health gap. Multilevel modelling of MOSAiCH 2015-2020 data shows the opposite: low status individuals in progressive places report markedly lower subjective health and life satisfaction than similarly low status individuals in conservative places, such that status-based health inequalities are maximised in progressive places. We interpret this apparent progressive place paradox in terms of collective inefficacy and system frustration, which we argue is the corollary of system justification.
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Affiliation(s)
- Katy Morris
- Swiss National Centre of Competence in Research (LIVES), University of Lausanne, Lausanne, Switzerland.
| | - Dimitrios Lampropoulos
- Swiss National Centre of Competence in Research (LIVES), University of Lausanne, Lausanne, Switzerland; Laboratoire Parisien de Psychologie Sociale (LAPPS), University of Paris 8, Vincennes, Saint-Denis, France
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Jia F, Liu X, Wang Y. Social integration as a mediator of the association between housing tenure and health inequalities among China's migrants: A housing discrimination perspective. SSM Popul Health 2024; 25:101614. [PMID: 38317772 PMCID: PMC10839530 DOI: 10.1016/j.ssmph.2024.101614] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
Due to the housing affordability crisis and institutional discrimination embedded in China's housing system, which refers to the unequal rights between homeowners and renters, migrant renters face greater social exclusion and health inequalities compared to migrant homeowners. Although housing tenure is considered an important determinant of health, along with other socioeconomic factors, the pathways underlying the association between housing tenure and health remain overlooked. Using data from the 2017 China Migrants Dynamic Survey of 62,268 participants, this study examined the mediating effects of social integration between housing tenure and self-rated health, and whether housing affordability moderated the mediating effects. Simple mediation models showed that social integration partly mediated the association between housing tenure and self-rated health. Moderated mediation models revealed that housing affordability moderated the association between housing tenure and social integration, and did not moderate the association between social integration and self-rated health. Compared with migrants living in affordable housing, the mediating effect of social integration was significantly smaller among migrants living in unaffordable housing. The results add knowledge to previous literature by uncovering the underlying mechanisms between housing tenure and health and linking housing studies to social inequalities in health. Our study suggested that diminishing housing discrimination and improving housing affordability could not only be beneficial for migrants' health but also be helpful to narrowing the health inequalities among migrants.
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Affiliation(s)
- Fulin Jia
- Business School of Zhengzhou University, No.100, Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China
| | - Xiaonan Liu
- Business School of Zhengzhou University, No.100, Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China
| | - Yuxiang Wang
- School of Management, Zhengzhou University, No.100, Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China
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Zhang X, Veenstra G. Intergenerational reproduction and self-assessed mental health in adulthood in China. SSM Popul Health 2024; 25:101645. [PMID: 38444402 PMCID: PMC10914578 DOI: 10.1016/j.ssmph.2024.101645] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 03/07/2024] Open
Abstract
Physical and mental health disparities by socioeconomic status in China are well documented but the effects of the intergenerational reproduction in socioeconomic status on adult mental health have received little attention to date. We utilized cross-sectional data from the 2017 Chinese General Social Survey to examine the significance of intergenerational socioeconomic reproduction for differences in self-assessed mental health in a national sample of Chinese adults between the ages of 23 and 65. We documented substantial elasticities between the socioeconomic status of the survey respondents and their parents: father's education, mother's education and childhood social class were all associated with both respondent education and respondent household income. We also found that associations between parental socioeconomic status and their adult children's self-assessed mental health were partly explained by the children's own socioeconomic status. However, these pathways were noticeably moderated by age cohort. Among younger people, associations between parental socioeconomic status and mental health were mostly explained by educational attainment whereas among older people associations between parental socioeconomic status and mental health were mostly explained by household income. In general, parental socioeconomic status appear to have a greater influence on the mental health of people who grew up after the Chinese economic reform of the 1970s.
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Affiliation(s)
- Xueqing Zhang
- Department of Sociology, The University of British Columbia, Canada
| | - Gerry Veenstra
- Department of Sociology, The University of British Columbia, Canada
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Iqbal H, West J, McEachan RRC, Haith-Cooper M. Identifying the Health Concerns of Pregnant British Pakistani Women Living in Deprived Areas: A Qualitative Study. Matern Child Health J 2024; 28:489-495. [PMID: 37902920 PMCID: PMC10914889 DOI: 10.1007/s10995-023-03797-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION Pregnant British Pakistani women have disproportionately poorer health than the wider population. Bradford has a strong Pakistani presence and a wide range of public health problems including high levels of gestational diabetes, high obesity rates and a high infant mortality rate, which is highest for babies of Pakistani origin. For women to be healthy, we need to know what concerns they have about their health so they can be addressed appropriately. The aim of this study, therefore, was to explore the health concerns of pregnant British Pakistani women living in deprived areas. METHODS Semi-structured qualitative interviews were conducted with 21 pregnant Pakistani women in a hospital setting. Data were analysed using thematic analysis. RESULTS Pakistani women identified safety issues, barriers to undertaking physical activity in the areas where they live, concerns surrounding exercising during pregnancy and cultural and religious constraints that prevented them from engaging in physical activity. They reported issues around food, concerns around a lack of culturally appropriate diet information, the cost of unhealthy food locally, and the lack of healthy food options in their residences. Women were unsure on where to obtain health promotion information and reported a lack of access in obtaining that information. Language barriers in accessing health promotion information were further reported as a concern. DISCUSSION Researchers, midwives, health providers, local authority and policy makers interested in improving the health of pregnant Pakistani women may use these findings to develop further research and interventions to improve the poor health of this population.
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Affiliation(s)
- Halima Iqbal
- Faculty of Health Studies, University of Bradford, Bradford, UK.
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, UK.
| | - Jane West
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, UK
| | - Rosemary R C McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, UK
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Reuter M, Diehl K, Richter M, Sundmacher L, Hövener C, Spallek J, Dragano N. A longitudinal analysis of health inequalities from adolescence to young adulthood and their underlying causes. Adv Life Course Res 2024; 59:100593. [PMID: 38340523 DOI: 10.1016/j.alcr.2024.100593] [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] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 12/04/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024]
Abstract
Research suggests that children of low-educated parents face greater health burdens during the passage from adolescence to young adulthood, as they are more likely to become low-educated themselves, establish behavioural and psychosocial disadvantages, or being exposed to unhealthy working conditions. However, studies examining the development and drivers of health inequalities during this particular life stage are limited in number and have produced varied results. This study investigates trajectories of self-rated health and overweight from 14 to 25 years of age, stratified by parental education, and explores the role of potential mediators (educational achievement, health behaviours, psychosocial factors, working conditions). We rely on prospective cohort data from the National Educational Panel Study (NEPS), a representative sample of 14,981 German ninth graders interviewed yearly from 2011 to 2021 (n = 90,096 person-years). First, we estimated random-effects growth curves for self-rated health and overweight over participants' age and calculated the average marginal effect of high versus low parental education. Second, a series of simulation-based mediation analyses were performed to test how much of health inequalities were explained by children's educational attainment (years of school education, years in university), health behaviours (smoking, alcohol, physical inactivity), psychosocial factors (number of grade repetitions, years in unemployment, chronic stress, self-esteem) and working conditions (physical and psychosocial job demands). We accounted for potential confounding by controlling for age, sex, migration background, residential area, household composition, and interview mode. Results show that higher parental education was related to higher self-rated health and lower probabilities of being overweight. Interaction between parental education and age indicated that, after some equalisation in late adolescence, health inequalities increased in young adulthood. Furthermore, educational attainment, health behaviours, psychosocial factors, and early-career working conditions played a significant role in mediating health inequalities. Of the variables examined, the level of school education and years spent in university were particular strong mediating factors. School education accounted for around one-third of the inequalities in self-rated health and one-fifth of the differences in overweight among individuals. Results support the idea that the transition to adulthood is a sensitive period in life and that early socio-economic adversity increases the likelihood to accumulate health disadvantages in multiple dimensions. In Germany, a country with comparatively low educational mobility, intergenerational continuities in class location seem to play a key role in the explanation of health inequalities in youth.
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Affiliation(s)
- Marvin Reuter
- Junior Professorship for Sociology, esp. Work and Health, Department of Sociology, University of Bamberg, Bamberg, Germany.
| | - Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Richter
- Chair for Social Determinants of Health, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Claudia Hövener
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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Nelson D, Selby P, Kane R, Harding-Bell A, Kenny A, McPeake K, Cooke S, Hogue T, Oliver K, Gussy M, Lawler M. Implementing the European code of cancer practice in rural settings. J Cancer Policy 2024; 39:100465. [PMID: 38184144 DOI: 10.1016/j.jcpo.2023.100465] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/08/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
Existing evidence often indicates higher cancer incidence and mortality rates, later diagnosis, lower screening uptake and poorer long-term survival for people living in rural compared to more urbanised areas. Despite wide inequities and variation in cancer care and outcomes across Europe, much of the scientific literature explicitly exploring the impact of rurality on cancer continues to come from Australia and North America. The European Code of Cancer Practice or "The Code" is a citizen and patient-centred statement of the most salient requirements for good clinical cancer practice and has been extensively co-produced by cancer patients, cancer professionals and patient advocates. It contains 10 key overarching Rights that a cancer patient should expect from their healthcare system, regardless of where they live and has been strongly endorsed by professional and patient cancer organisations as well as the European Commission. In this article, we use these 10 fundamental Rights as a framework to argue that (i) the issues and needs identified in The Code are generally more profound for rural people with cancer; (ii) addressing these issues is also more challenging in rural contexts; (iii) interventions and support must explicitly account for the unique needs of rural residents living with and affected by cancer and (iv) new innovative approaches are urgently required to successfully overcome the challenges faced by rural people with cancer and their caregivers. Despite equitable healthcare being a key European policy focus, the needs of rural people living with cancer have largely been neglected.
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Affiliation(s)
- David Nelson
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; Macmillan Cancer Support, London, UK.
| | - Peter Selby
- Faculty of Medicine and Health, University of Leeds, Leeds, UK; Lincoln Medical School, Universities of Nottingham and Lincoln, Lincoln, UK
| | - Ros Kane
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | | | - Amanda Kenny
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Kathie McPeake
- Macmillan Cancer Support, London, UK; NHS Lincolnshire Integrated Care Board, Sleaford, UK
| | - Samuel Cooke
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Todd Hogue
- School of Psychology, University of Lincoln, Lincoln, UK
| | | | - Mark Gussy
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Faculty of Medicine, Health and Life Sciences, Queens University Belfast, Belfast, UK
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Pettican A, Southall-Edwards R, Reinhardt GY, Gladwell V, Freeman P, Low W, Copeland R, Mansfield L. Tackling physical inactivity and inequalities: implementing a whole systems approach to transform community provision for disabled people and people with long-term health conditions. BMC Public Health 2024; 24:636. [PMID: 38418996 PMCID: PMC10903012 DOI: 10.1186/s12889-024-18051-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Physical inactivity is a global public health priority. There are known health and well-being consequences of being inactive, and the benefits of being physically active are well established. However, there are persistent inequalities when it comes to how physically active people are, with disabled people, people living with long-term health conditions, and people residing in areas of socio-economic deprivation being particularly affected. Methods such as whole system approaches (WSAs), which are dynamic, multifaceted, and engage all relevant stakeholders, have gained momentum as an approach to address such complex public health problems. However, evidence relating to the implementation of WSAs to address physical inactivity is lacking. The aim of the Prevention and Enablement Model (PEM) was to take a whole system approach in Essex to encourage and support disabled people and/or individuals living with long-term health conditions to be more active, happier, and to live more independently. METHODS The aim of this study was to explore the enablers, challenges, and reflections associated with the process of designing and implementing the PEM. Semi-structured interviews (n = 12) were used to collect data from people involved in the PEM's design, implementation and/or delivery. Data was analysed using Braun and Clarke's reflexive thematic analysis. RESULTS Four themes were identified: (1) Working collaboratively: Specific enablers of time and space were identified as important in the planning and implementation of a WSA (2) Leadership and planning: Distributed and flexible leadership was identified as central to successful implementation (3) Re-orientating practice: Highlighted the transformative potential of a whole system approach and how it contrasts with conventional work practices, and (4) Reflection and learning: Informing ongoing refinements and further implementation of successful system change. CONCLUSIONS These findings highlight the challenge and complexity of implementing a WSA that involves diverse stakeholders from across adult social care, the NHS, and the third sector. Several important enablers are identified, such as leadership and planning, and the challenges and discomfort that can arise whilst changing systems. Ongoing efforts are required to ensure that different elements of the system collaborate effectively to address inequalities in physical activity participation, through the implementation of a WSA.
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Affiliation(s)
- Anna Pettican
- School of Health and Social Care, University of Essex, Wivenhoe Park, CO4 3SQ, Colchester, UK.
| | - Robert Southall-Edwards
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, UK
- Institute of Health and Well-being, University of Suffolk, Waterfront Building, Ipswich, UK
| | | | - Valerie Gladwell
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, UK
- Institute of Health and Well-being, University of Suffolk, Waterfront Building, Ipswich, UK
| | - Paul Freeman
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, UK
| | - William Low
- School of Social Sciences, Heriot-Watt University, Edinburgh, Scotland, UK
| | - Robert Copeland
- Advanced Well-being Research Centre, Sheffield Hallam University, Olympic Legacy Park, Sheffield, UK
| | - Louise Mansfield
- Division of Sport, Health and Exercise Sciences, Heinz Wolff Building, Brunel University London, Uxbridge, UK
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Bladon S, Ashiru-Oredope D, Cunningham N, Pate A, Martin GP, Zhong X, Gilham EL, Brown CS, Mirfenderesky M, Palin V, van Staa TP. Rapid systematic review on risks and outcomes of sepsis: the influence of risk factors associated with health inequalities. Int J Equity Health 2024; 23:34. [PMID: 38383380 PMCID: PMC10882893 DOI: 10.1186/s12939-024-02114-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND AND AIMS Sepsis is a serious and life-threatening condition caused by a dysregulated immune response to an infection. Recent guidance issued in the UK gave recommendations around recognition and antibiotic treatment of sepsis, but did not consider factors relating to health inequalities. The aim of this study was to summarise the literature investigating associations between health inequalities and sepsis. METHODS Searches were conducted in Embase for peer-reviewed articles published since 2010 that included sepsis in combination with one of the following five areas: socioeconomic status, race/ethnicity, community factors, medical needs and pregnancy/maternity. RESULTS Five searches identified 1,402 studies, with 50 unique studies included in the review after screening (13 sociodemographic, 14 race/ethnicity, 3 community, 3 care/medical needs and 20 pregnancy/maternity; 3 papers examined multiple health inequalities). Most of the studies were conducted in the USA (31/50), with only four studies using UK data (all pregnancy related). Socioeconomic factors associated with increased sepsis incidence included lower socioeconomic status, unemployment and lower education level, although findings were not consistent across studies. For ethnicity, mixed results were reported. Living in a medically underserved area or being resident in a nursing home increased risk of sepsis. Mortality rates after sepsis were found to be higher in people living in rural areas or in those discharged to skilled nursing facilities while associations with ethnicity were mixed. Complications during delivery, caesarean-section delivery, increased deprivation and black and other ethnic minority race were associated with post-partum sepsis. CONCLUSION There are clear correlations between sepsis morbidity and mortality and the presence of factors associated with health inequalities. To inform local guidance and drive public health measures, there is a need for studies conducted across more diverse setting and countries.
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Affiliation(s)
- Siân Bladon
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
| | - Diane Ashiru-Oredope
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
- School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Neil Cunningham
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
| | - Alexander Pate
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Glen P Martin
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Xiaomin Zhong
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Ellie L Gilham
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
| | - Colin S Brown
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
- NIHR Health Protection Unit in Healthcare-Associated Infection & Antimicrobial Resistance, Imperial College London, London, UK
| | - Mariyam Mirfenderesky
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
| | - Victoria Palin
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, The University of Manchester, Manchester, M13 9WL, UK
| | - Tjeerd P van Staa
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
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Sabatini S, Martyr A, Hunt A, Gamble LD, Matthews FE, Thom JM, Jones RW, Allan L, Knapp M, Quinn C, Victor C, Pentecost C, Rusted JM, Morris RG, Clare L. Health conditions in spousal caregivers of people with dementia and their relationships with stress, caregiving experiences, and social networks: longitudinal findings from the IDEAL programme. BMC Geriatr 2024; 24:171. [PMID: 38373905 PMCID: PMC10875834 DOI: 10.1186/s12877-024-04707-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/13/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Longitudinal evidence documenting health conditions in spousal caregivers of people with dementia and whether these influence caregivers' outcomes is scarce. This study explores type and number of health conditions over two years in caregivers of people with dementia and subgroups based on age, sex, education, hours of care, informant-rated functional ability, neuropsychiatric symptoms, cognition of the person with dementia, and length of diagnosis in the person with dementia. It also explores whether over time the number of health conditions is associated with caregivers' stress, positive experiences of caregiving, and social networks METHODS: Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised spousal caregivers (n = 977) of people with dementia. Self-reported health conditions using the Charlson Comorbidity Index, stress, positive experiences of caregiving, and social network were assessed over two years. Mixed effect models were used RESULTS: On average participants had 1.5 health conditions at baseline; increasing to 2.1 conditions over two years. More health conditions were reported by caregivers who were older, had no formal education, provided 10 + hours of care per day, and/or cared for a person with more neuropsychiatric symptoms at baseline. More baseline health conditions were associated with greater stress at baseline but not with stress over time. Over two years, when caregivers' health conditions increased, their stress increased whereas their social network diminished DISCUSSION: Findings highlight that most caregivers have their own health problems which require management to avoid increased stress and shrinking of social networks.
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Affiliation(s)
- Serena Sabatini
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Anthony Martyr
- University of Exeter Medical School, University of Exeter, Exeter, UK.
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK.
| | - Anna Hunt
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona E Matthews
- Institute for Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Jeanette M Thom
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Louise Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
| | - Claire Pentecost
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Linda Clare
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Metsä-Simola N, Heggebø K, Kjaer Urhoj S, Martikainen P, Einiö E, Östergren O. Neurological conditions and subsequent divorce risk in the Nordic countries: the importance of gender and both spouses' education. J Epidemiol Community Health 2024:jech-2023-221328. [PMID: 38355292 DOI: 10.1136/jech-2023-221328] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Prior studies suggest that poor physical health, accompanied by functional disability, is associated with increased divorce risk. However, this association may depend on gender, the socioeconomic resources of the couple, as well as the social policy and social (in)equality context in which the illness is experienced. This study focuses on neurological conditions, which often have substantial functional consequences. METHODS We used longitudinal population-wide register data from the years 2007-2016 (Denmark, Sweden) or 2008-2017 (Finland, Norway) to follow 2 809 209 married couples aged 30-64 for neurological conditions, identified using information on specialised healthcare for diseases of the nervous system and subsequent divorce. Cox regression models were estimated in each country, and meta-analysis used to calculate across-country estimates. RESULTS During the 10-year follow-up period, 22.2% of couples experienced neurological conditions and 12.0% of marriages ended in divorce. In all countries, divorce risk was elevated among couples where at least one spouse had a neurological condition, and especially so if both spouses were ill. The divorce risk was either larger or similar for husband's illness, compared with wife's illness, in all educational categories. For the countries pooled, the weighted average HR was 1.21 (95% CI 1.20 to 1.23) for wives' illness, 1.27 (95% CI 1.25 to 1.29) for husbands' illness and 1.38 (95% CI 1.34 to 1.42) for couples where both spouses were ill. CONCLUSIONS Despite some variation by educational resources and country context, the results suggest that the social consequences of illness are noticeable even in Nordic welfare states, with the husband's illness being at least as important as the wife's.
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Affiliation(s)
- Niina Metsä-Simola
- Helsinki Instute for Demography and Population Health, University of Helsinki, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | | | - Stine Kjaer Urhoj
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Pekka Martikainen
- Helsinki Instute for Demography and Population Health, University of Helsinki, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
- Max-Planck-Institute for Demographic Research, Rostock, Germany
| | - Elina Einiö
- Helsinki Instute for Demography and Population Health, University of Helsinki, Helsinki, Finland
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Olof Östergren
- Department of Public Health Sciences, Stockholm University & Aging Research Center (ARC), Karolinska Institutet, Stockholm, Sweden
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Dalecka A, Bartoskova Polcrova A, Pikhart H, Bobak M, Ksinan AJ. Living in poverty and accelerated biological aging: evidence from population-representative sample of U.S. adults. BMC Public Health 2024; 24:458. [PMID: 38350911 PMCID: PMC10865704 DOI: 10.1186/s12889-024-17960-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Biological aging reflects a decline in the functions and integrity of the human body that is closely related to chronological aging. A variety of biomarkers have been found to predict biological age. Biological age higher than chronological age (biological age acceleration) indicates an accelerated state of biological aging and a higher risk of premature morbidity and mortality. This study investigated how socioeconomic disadvantages influence biological aging. METHODS The data from the National Health and Nutrition Examination Survey (NHANES) IV, including 10 nationally representative cross-sectional surveys between 1999-2018, were utilized. The analytic sample consisted of N = 48,348 individuals (20-84 years). We used a total of 11 biomarkers for estimating the biological age. Our main outcome was biological age acceleration, indexed by PhenoAge acceleration (PAA) and Klemera-Doubal biological age acceleration (KDM-A). Poverty was measured as a ratio of family income to the poverty thresholds defined by the U.S. Census Bureau, adjusted annually for inflation and family size (5 categories). The PAA and KDM-A were regressed on poverty levels, age, their interaction, education, sex, race, and a data collection wave. Sample weights were used to make the estimates representative of the U.S. adult population. RESULTS The results showed that higher poverty was associated with accelerated biological aging (PAA: unstandardized coefficient B = 1.38 p <.001, KDM: B = 0.96, p = .026 when comparing the highest and the lowest poverty level categories), above and beyond other covariates. The association between PAA and KDM-A and age was U-shaped. Importantly, there was an interaction between poverty levels and age (p <.001), as the effect of poverty was most pronounced in middle-aged categories while it was modest in younger and elderly groups. CONCLUSION In a nationally representative US adult population, we found that higher poverty was positively associated with the acceleration of biological age, particularly among middle-aged persons.
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Affiliation(s)
- Andrea Dalecka
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | | | - Hynek Pikhart
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Martin Bobak
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Albert J Ksinan
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic.
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Samuel M, Park RY, Eastwood SV, Eto F, Morton CE, Stow D, Bacon SC, Goldacre B, Mehrkar A, Morley J, Dillingham I, Inglesby P, Hulme WJ, Khunti K, Mathur R, Valabhji J, MacKenna B, Finer S. Weight trends amongst adults with diabetes or hypertension during the COVID-19 pandemic: an observational study using OpenSAFELY. Br J Gen Pract 2024:BJGP.2023.0492. [PMID: 38296356 DOI: 10.3399/bjgp.2023.0492] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND COVID-19 pandemic restrictions may have influenced behaviours related to weight. AIMS To describe patterns of weight change amongst adults living in England with Type 2 Diabetes (T2D) and/or hypertension during the COVID-19 pandemic. Design and Setting With the approval of NHS England, we conducted an observational cohort study using the routinely collected health data of approximately 40% of adults living in England, accessed through the OpenSAFELY service inside TPP. METHOD We investigated clinical and sociodemographic characteristics associated with rapid weight gain (>0·5kg/m2/year) using multivariable logistic regression. RESULTS We extracted data on adults with T2D (n=1,231,455, 44% female, 76% white British) or hypertension (n=3,558,405, 50% female, 84% white British). Adults with T2D lost weight overall (median δ = -0.1kg/m2/year [IQR: -0.7, 0.4]), however, rapid weight gain was common (20.7%) and associated with sex (male vs female: aOR 0.78[95%CI 0.77, 0.79]); age, older age reduced odds (e.g. 60-69-year-olds vs 18-29-year-olds: aOR 0.66[0.61, 0.71]); deprivation, (least-deprived-IMD vs most-deprived-IMD: aOR 0.87[0.85, 0.89]); white ethnicity (Black vs White: aOR 0.95[0.92, 0.98]); mental health conditions (e.g. depression: aOR 1.13 [1.12, 1.15]); and diabetes treatment (non-insulin treatment vs no pharmacological treatment: aOR 0.68[0.67, 0.69]). Adults with hypertension maintained stable weight overall (median δ = 0.0kg/m2/year [ -0.6, 0.5]), however, rapid weight gain was common (24.7%) and associated with similar characteristics as in T2D. CONCLUSION Amongst adults living in England with T2D and/or hypertension, rapid pandemic weight gain was more common amongst females, younger adults, those living in more deprived areas, and those with mental health condition.
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Affiliation(s)
- Miriam Samuel
- Queen Mary University of London, Wolfson Institute of Population Health, London, United Kingdom
| | - Robin Y Park
- Oxford University, Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | | | - Fabiola Eto
- Queen Mary University of London, Wolfson Institute of Population Health, London, United Kingdom
| | - Caroline E Morton
- Queen Mary University of London, Wolfson Institute of Population Health, London, United Kingdom
| | - Daniel Stow
- Queen Mary University of London, Wolfson Institute of Population Health, London, United Kingdom
| | - Sebastian Cj Bacon
- Oxford University, Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Ben Goldacre
- Oxford University, Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Amir Mehrkar
- Oxford University, Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Jessica Morley
- Oxford University, Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Iain Dillingham
- Oxford University, Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Peter Inglesby
- Oxford University, Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - William J Hulme
- Oxford University, Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Kamlesh Khunti
- University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Rohini Mathur
- Queen Mary University of London, Wolfson Institute of Population Health, London, United Kingdom
| | - Jonathan Valabhji
- Imperial College London, Division of Metabolism, Digestion and Reproduction, London, United Kingdom
| | - Brian MacKenna
- Oxford University, Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Sarah Finer
- Queen Mary University of London, Wolfson Institute of Population Health, London, United Kingdom
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Lima Figueiredo ER, do Socorro Carvalho Miranda C, Viana Campos AC, de Campos Gomes F, Câmara Rodrigues CN, de Melo-Neto JS. Influence of sociodemographic and obstetric factors on maternal mortality in Brazil from 2011 to 2021. BMC Womens Health 2024; 24:84. [PMID: 38302949 PMCID: PMC10835861 DOI: 10.1186/s12905-024-02925-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Obstetric causes are classified as direct (complications of pregnancy, childbirth or the puerperium) or indirect (caused by pregnancy but not directly caused by it). This study aimed to analyze maternal mortality from obstetric causes in Brazil from 2011 to 2021. METHODS This was an ecological study on mortality and live births. The outcomes were the specific risk of mortality from direct and indirect cause adjustment and death during pregnancy and the puerperium. Binary and multiple linear logistic regressions were used to assess the influence of sociodemographic factors and maternal and child health indicators on maternal mortality and time of death (pregnancy and puerperium). RESULTS Regarding mortality during pregnancy and during the puerperium, increased (p = 0.003) and decreased (p = 0.004) mortality over the years, respectively; residing in the northern region was associated with lower (p < 0.05) and greater (p = 0.035) odds; and the Maternal Mortality Committee was the primary and least active source of investigation, respectively (p < 0.0001). The number of deaths from indirect causes increased with age (p < 0.001) and in the northern region (p = 0.011) and decreased in the white (< 0.05) and stable union (0.002) regions. Specifically, for mortality risk, the age group [women aged 15-19 years presented an increase in cesarean section (p < 0.001) was greater than that of women who had < 4 antenatal visits (p < 0.001)], education [women who completed high school (8 to 11 years) was greater when they had < 4 prenatal visits (p = 0.018)], and marital status [unmarried women had more than 4 antenatal visits (p < 0.001); cesarean birth (p = 0.010) and < 4 antenatal visits (p = 0.009) were predictors of marriage; and women in a stable union who had < 4 prenatal visits and live births to teenage mothers (p < 0.001) were predictors]. Women who had no education (p = 0.003), were divorced (p = 0.036), had cesarean deliveries (p < 0.012), or lived in the north or northeast (p < 0.008) had higher indirect specific mortality risk. CONCLUSIONS Sociodemographic factors and maternal and child health indicators were related to different patterns of obstetric mortality. Obstetric mortality varied by region, marital status, race, delivery, prenatal care, and cause of death.
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Affiliation(s)
- Eric Renato Lima Figueiredo
- Urogenital System Clinical and Experimental Research Unit, Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, 66075-110, Brazil
| | | | - Ana Cristina Viana Campos
- Laboratory and Observatory in Surveillance and Social Epidemiology, Federal University of the South and Southeast of Pará (Unifesspa), Marabá, PA, 68500-000, Brazil
| | | | - Cibele Nazaré Câmara Rodrigues
- Urogenital System Clinical and Experimental Research Unit, Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, 66075-110, Brazil
| | - João Simão de Melo-Neto
- Urogenital System Clinical and Experimental Research Unit, Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, 66075-110, Brazil.
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Neufcourt L, Castagné R, Wilsgaard T, Grimsgaard S, Chadeau-Hyam M, Vuckovic D, Ugarteche-Perez A, Farbu EH, Sandanger TM, Delpierre C, Kelly-Irving M. Educational patterning in biological health seven years apart: Findings from the Tromsø Study. Psychoneuroendocrinology 2024; 160:106670. [PMID: 37992555 DOI: 10.1016/j.psyneuen.2023.106670] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Social-to-biological processes is one set of mechanisms underlying the relationship between social position and health. However, very few studies have focused on the relationship between social factors and biology at multiple time points. This work investigates the relationship between education and the dynamic changes in a composite Biological Health Score (BHS) using two time points seven years apart in a Norwegian adult population. METHODS We used data from individuals aged 30 years and above who participated in Tromsø6 (2007-2008) and Tromsø7 (2015-2016) (n = 8117). BHS was defined using ten biomarkers measured from blood samples and representing three physiological systems (cardiovascular, metabolic, inflammatory). The higher the BHS, the poorer the health status. FINDINGS Linear regression models carried out on BHS revealed a strong educational gradient at two distinct time points but also over time. People with lower educational attainment were at higher risk of poor biological health at a given time point (βlow education Tromsø6=0.30 [95 %-CI=0.18-0.43] and βlow education Tromsø7=0.30 [95 %-CI=0.17-0.42]). They also presented higher longitudinal BHS compared to people with higher education (βlow education = 0.89 [95 %-CI=0.56-1.23]). Certain biomarkers related to the cardiovascular system and the metabolic system were strongly socially distributed, even after adjustment for sex, age, health behaviours and body mass index. CONCLUSION This longitudinal analysis highlights that participants with lower education had their biological health deteriorated to a greater extent over time compared to people with higher education. Our findings provide added evidence of the biological embodiment of social position, particularly with respect to dynamic aspects for which little evidence exists.
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Affiliation(s)
- Lola Neufcourt
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France.
| | - Raphaële Castagné
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Dragana Vuckovic
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Ainhoa Ugarteche-Perez
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Erlend Hoftun Farbu
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Torkjel M Sandanger
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Cyrille Delpierre
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Michelle Kelly-Irving
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
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50
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Cross-Sudworth F, Taylor B, Kenyon S. Community postnatal care delivery in England since Covid-19: A qualitative study of midwifery leaders' perspectives and strategies. Women Birth 2024; 37:240-247. [PMID: 37903683 DOI: 10.1016/j.wombi.2023.10.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/01/2023]
Abstract
PROBLEM COVID-19 impacted negatively on maternity care experiences of women and staff. Understanding the emergency response is key to inform future plans. BACKGROUND Before the COVID-19 pandemic, experts highlighted concerns about UK community postnatal care, and its impact on long-term health, wellbeing, and inequalities. These appear to have been exacerbated by the pandemic. AIM To explore community postnatal care provision during and since the pandemic across a large diverse UK region. METHODS A descriptive qualitative approach. Virtual semi-structured interviews conducted November 2022-February 2023. All regional midwifery community postnatal care leaders were invited to participate. FINDINGS 11/13 midwifery leaders participated. Three main themes were identified: Changes to postnatal care (strategic response, care on the ground); Impact of postnatal care changes (staff and women's experiences); and Drivers of postnatal care changes (COVID-19, workforce issues). DISCUSSION Changes to postnatal care during the pandemic included introduction of virtual care, increased role of Maternity Support Workers, and moving away from home visits to clinic appointments. This has largely continued without evaluation. The number of care episodes provided for low and high-risk families appears to have changed little. Those requiring additional support but not deemed highest risk appear to have been most impacted. Staffing levels influenced amount and type of care provided. There was little inter-organisation collaboration in the postnatal pandemic response. CONCLUSION Changes to postnatal care provision introduced more efficient working practices. However, evaluation is needed to ensure ongoing safe, equitable and individualised care provision post pandemic within limited resources.
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Affiliation(s)
- Fiona Cross-Sudworth
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Beck Taylor
- Warwick Medical School, University of Warwick, University Road, Coventry CV4 7AL, UK
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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