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Mercogliano M, Valdecantos RL, Fevola G, Sorrentino M, Buonocore G, Triassi M, Palladino R. An ecological analysis of socio-economic determinants associated with paediatric vaccination coverage in the Campania Region: A population-based study, years 2003-2017. Vaccine X 2024; 18:100482. [PMID: 38585381 PMCID: PMC10997839 DOI: 10.1016/j.jvacx.2024.100482] [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: 01/21/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Vaccines are the most cost-effective and straightforward intervention against severe infectious diseases. However, in Europe and in Italy, paediatric vaccination coverage for certain vaccines remains suboptimal, with considerable regional differences in Italy. Vaccine coverage varies significantly due to socio-economic and organisational factors. Aim of this study was to assess the influence of the Deprivation Index, the density of General Practitioners and General Paediatricians per inhabitants on the coverage of both mandatory and non-mandatory paediatric vaccinations across local health authorities and health districts in the Campania Region for birth cohorts from 2001 to 2015. Materials and methods Population-based, ecological time series analysis focusing on the Campania Region, most populous region in the south of Italy. Vaccination coverage data were extracted from the regional immunization database, whilst information on the Deprivation Index and number of primary care doctors and primary care paediatricians per local health district were extracted from public health records. Univariate descriptive statistics were employed to describe study characteristics, as appropriate, whilst and mixed-effect linear regression models were employed to assess the associations between variables of interest and vaccination coverage. Results Overall vaccination coverage has generally increased, except for the MMR vaccine, which showed coverage fluctuations. An increase in the Deprivation Index, indicative of less favourable socio-economic conditions, was associated with decreased vaccination coverage in the 24-month age group for some mandatory vaccines (DTaP: Coef -0.97, 95% CI -1.77 | -0.17; Poliomyelitis: Coef -0.98, 95% CI -1.78 | -0.17; Hepatitis B: Coef -0.90, 95% CI -1.71 | -0.10). Moreover, areas with a greater density of General Paediatricians per inhabitants saw increased coverage for Haemophilus influenzae type b in the 6-year age group (Coef 9.78, 95% CI 1.00 | 18.56). Conclusions It is necessary to target public health policies to address vaccination inequalities. These efforts should include expanding vaccination campaigns, enhancing catch-up programs, and increase resource allocation in primary care settings to facilitate the role of General Practitioners and Paediatricians in fostering awareness and adherence.
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Affiliation(s)
| | | | - Gianluca Fevola
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
| | - Michele Sorrentino
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
| | - Gaetano Buonocore
- Clinical Directorate, University Hospital “Federico II” of Naples, Naples, Italy
| | - Maria Triassi
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
- Interdepartmental Research Center in Healthcare Management and Innovation in Healthcare (CIRMIS), 80131 Naples, Italy
| | - Raffaele Palladino
- Department of Public Health, University “Federico II” of Naples, Naples, Italy
- Interdepartmental Research Center in Healthcare Management and Innovation in Healthcare (CIRMIS), 80131 Naples, Italy
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
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Byun G, Kim S, Choi Y, Kim A, Team AC, Lee JT, Bell ML. Long-term exposure to PM 2.5 and mortality in a national cohort in South Korea: effect modification by community deprivation, medical infrastructure, and greenness. BMC Public Health 2024; 24:1266. [PMID: 38720292 PMCID: PMC11080206 DOI: 10.1186/s12889-024-18752-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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Long-term exposure to PM2.5 has been linked to increased mortality risk. However, limited studies have examined the potential modifying effect of community-level characteristics on this association, particularly in Asian contexts. This study aimed to estimate the effects of long-term exposure to PM2.5 on mortality in South Korea and to examine whether community-level deprivation, medical infrastructure, and greenness modify these associations. METHODS We conducted a nationwide cohort study using the National Health Insurance Service-National Sample Cohort. A total of 394,701 participants aged 30 years or older in 2006 were followed until 2019. Based on modelled PM2.5 concentrations, 1 to 3-year and 5-year moving averages of PM2.5 concentrations were assigned to each participant at the district level. Time-varying Cox proportional-hazards models were used to estimate the association between PM2.5 and non-accidental, circulatory, and respiratory mortality. We further conducted stratified analysis by community-level deprivation index, medical index, and normalized difference vegetation index to represent greenness. RESULTS PM2.5 exposure, based on 5-year moving averages, was positively associated with non-accidental (Hazard ratio, HR: 1.10, 95% Confidence Interval, CI: 1.01, 1.20, per 10 µg/m3 increase) and circulatory mortality (HR: 1.22, 95% CI: 1.01, 1.47). The 1-year moving average of PM2.5 was associated with respiratory mortality (HR: 1.33, 95% CI: 1.05, 1.67). We observed higher associations between PM2.5 and mortality in communities with higher deprivation and limited medical infrastructure. Communities with higher greenness showed lower risk for circulatory mortality but higher risk for respiratory mortality in association with PM2.5. CONCLUSIONS Our study found mortality effects of long-term PM2.5 exposure and underlined the role of community-level factors in modifying these association. These findings highlight the importance of considering socio-environmental contexts in the design of air quality policies to reduce health disparities and enhance overall public health outcomes.
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Affiliation(s)
- Garam Byun
- School of the Environment, Yale University, New Haven, CT, 06511, USA
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, 02841, Republic of Korea
| | - Sera Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, 02841, Republic of Korea
| | - Yongsoo Choi
- School of the Environment, Yale University, New Haven, CT, 06511, USA
| | - Ayoung Kim
- Department of Public Health Sciences, Graduate School of Public health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - AiMS-Create Team
- Ai-Machine learning Statistics Collaborative Research Ensemble for Air pollution, Temperature, and all types of Environmental exposures, Seoul National University and Pusan National University, Seoul, Republic of Korea
| | - Jong-Tae Lee
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, 02841, Republic of Korea.
- School of Health Policy and Management, College of Health Sciences, Korea University, Hana Science Hall, 145, Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT, 06511, USA
- School of Health Policy and Management, College of Health Sciences, Korea University, Hana Science Hall, 145, Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
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Mazzilli S, Paparatto G, Chieti A, Nannavecchia AM, Bisceglia L, Lopalco PL, Martinelli D, Tavoschi L. Comparison of geographical and individual deprivation index to assess the risk of Sars-CoV-2 infection and disease severity: a retrospective cohort study. Int J Health Geogr 2024; 23:8. [PMID: 38575967 PMCID: PMC10993505 DOI: 10.1186/s12942-024-00367-6] [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: 09/28/2023] [Accepted: 03/13/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND It has been shown that COVID-19 affects people at socioeconomic disadvantage more strongly. Previous studies investigating the association between geographical deprivation and COVID-19 outcomes in Italy reported no differences in case-hospitalisation and case-fatality. The objective of this research was to compare the usefulness of the geographic and individual deprivation index (DI) in assessing the associations between individuals' deprivation and risk of Sars-CoV-2 infection and disease severity in the Apulia region from February to December 2020. METHODS This was a retrospective cohort study. Participants included individuals tested for SARS-CoV-2 infection during the study period. The individual DI was calculated employing polychoric principal component analysis on four census variables. Multilevel logistic models were used to test associations between COVID-19 outcomes and individual DI, geographical DI, and their interaction. RESULTS In the study period, 139,807 individuals were tested for COVID-19 and 56,475 (43.5%) tested positive. Among those positive, 7902 (14.0%) have been hospitalised and 2215 (4.2%) died. During the first epidemic wave, according the analysis done with the individual DI, there was a significant inversely proportional trend between the DI and the risk of testing positive. No associations were found between COVID-19 outcomes and geographic DI. During the second wave, associations were found between COVID-19 outcomes and individual DI. No associations were found between the geographic DI and the risk of hospitalisation and death. During both waves, there were no association between COVID-19 outcomes and the interaction between individual and geographical DI. CONCLUSIONS Evidence from this study shows that COVID-19 pandemic has been experienced unequally with a greater burden among the most disadvantaged communities. The results of this study remind us to be cautious about using geographical DI as a proxy of individual social disadvantage because may lead to inaccurate assessments. The geographical DI is often used due to a lack of individual data. However, on the determinants of health and health inequalities, monitoring has to have a central focus. Health inequalities monitoring provides evidence on who is being left behind and informs equity-oriented policies, programmes and practices. Future research and data collection should focus on improving surveillance systems by integrating individual measures of inequalities into national health information systems.
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Affiliation(s)
- Sara Mazzilli
- Scuola Normale Superiore, Pisa, Italy.
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | - Gianluca Paparatto
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Health Science Interdisciplinary Research Centre, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Antonio Chieti
- Strategic Regional Health and Social Agency of Puglia (AReSS Puglia), Bari, Italy
| | | | - Lucia Bisceglia
- Strategic Regional Health and Social Agency of Puglia (AReSS Puglia), Bari, Italy
| | - Pier Luigi Lopalco
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
| | - Domenico Martinelli
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Fortunato F, Lillini R, Martinelli D, Iannelli G, Ascatigno L, Casanova G, Lopalco PL, Prato R. Association of socio-economic deprivation with COVID-19 incidence and fatality during the first wave of the pandemic in Italy: lessons learned from a local register-based study. Int J Health Geogr 2023; 22:10. [PMID: 37143110 PMCID: PMC10157567 DOI: 10.1186/s12942-023-00332-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND COVID-19 has been characterised by its global and rapid spread, with high infection, hospitalisation, and mortality rates worldwide. However, the course of the pandemic showed differences in chronology and intensity in different geographical areas and countries, probably due to a multitude of factors. Among these, socio-economic deprivation has been supposed to play a substantial role, although available evidence is not fully in agreement. Our study aimed to assess incidence and fatality rates of COVID-19 across the levels of socio-economic deprivation during the first epidemic wave (March-May 2020) in the Italian Province of Foggia, Apulia Region. METHODS Based on the data of the regional active surveillance platform, we performed a retrospective epidemiological study among all COVID-19 confirmed cases that occurred in the Apulian District of Foggia, Italy, from March 1st to May 5th, 2020. Geocoded addresses were linked to the individual Census Tract (CT) of residence. Effects of socio-economic condition were calculated by means of the Socio-Economic and Health-related Deprivation Index (SEHDI) on COVID-19 incidence and fatality. RESULTS Of the 1054 confirmed COVID-19 cases, 537 (50.9%) were men, 682 (64.7%) were 0-64 years old, and 338 (32.1%) had pre-existing comorbidities. COVID-19 incidence was higher in the less deprived areas (p < 0.05), independently on age. The level of socio-economic deprivation did not show a significant impact on the vital status, while a higher fatality was observed in male cases (p < 0.001), cases > 65 years (p < 0.001), cases having a connection with a nursing home (p < 0.05) or having at least 1 comorbidity (p < 0.001). On the other hand, a significant protection for healthcare workers was apparent (p < 0.001). CONCLUSIONS Our findings show that deprivation alone does not affect COVID-19 incidence and fatality burden, suggesting that the burden of disease is driven by a complexity of factors not yet fully understood. Better knowledge is needed to identify subgroups at higher risk and implement effective preventive strategies.
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Affiliation(s)
- Francesca Fortunato
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
| | - Roberto Lillini
- Analytical Epidemiology & Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Domenico Martinelli
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giuseppina Iannelli
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Leonardo Ascatigno
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Georgia Casanova
- IRCCS-INRCA National Institute of Health & Science on Ageing, Centre for Socio-Economic Research on Ageing, Ancona, Italy
| | - Pier Luigi Lopalco
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
| | - Rosa Prato
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Mulliri A, Gardy J, Dejardin O, Bouvier V, Pocard M, Alves A. Social inequalities in health: How do they influence the natural history of colorectal cancer? J Visc Surg 2023:S1878-7886(23)00031-0. [PMID: 37062638 DOI: 10.1016/j.jviscsurg.2023.02.002] [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] [Indexed: 04/18/2023]
Abstract
As regards colorectal cancer (CRC) in France, social inequalities in health (SIH) exist. Underprivileged patients are characterized by reduced incidence of CRC and, conversely, by excess mortality. The explanatory mechanisms of the SIHs influencing survival are complex, multidimensional and variable according to healthcare system. Among the most deprived compared to the least deprived patients, SIHs are reflected by lower participation in screening campaigns, and CRC diagnosis is more frequently given at a later stage in an emergency context. During treatment, disadvantaged patients are more at risk of having to undergo open surgery and of enduring severe postoperative complications and belated chemotherapy (when recommended). Study of SIHs poses unusual challenges, as it is necessary not only to pinpoint social deprivation, but also to locate the different treatment facilities existing in a given territorial expanse. In the absence of individualized socioeconomic information, research in France on the social determinants of health is based on duly constituted cancer registries, in which an ecological index of social deprivation, the European Deprivation Index (EDI), provides an aggregate measure of the socioeconomic environment of a given individual in a given geographical setting at a given point in time. All in all, studies on SIHs are justified as means of identification and comprehension of the mechanisms underlying social deprivation, the objective being to more precisely orient programs and practices aimed at combating SIH.
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Affiliation(s)
- A Mulliri
- Inserm-UCN, ANTICIPE U1086, 14000 Caen, France; Department of visceral and digestive surgery, Caen University Hospital Center, 14000 Caen, France.
| | - J Gardy
- Inserm-UCN, ANTICIPE U1086, 14000 Caen, France; Registry of Digestive Tumors of Calvados, Caen University Hospital Center Center, 14000 Caen, France; François-Baclesse Cancer Center, 14000 Caen, France
| | - O Dejardin
- Inserm-UCN, ANTICIPE U1086, 14000 Caen, France; Research unit, Caen University Hospital Center, 14000 Caen, France
| | - V Bouvier
- Inserm-UCN, ANTICIPE U1086, 14000 Caen, France; Registry of Digestive Tumors of Calvados, Caen University Hospital Center Center, 14000 Caen, France
| | - M Pocard
- Inserm, U1275 CAP Paris-Tech, Paris Cité University, 75010 Paris, France; Digestive and Hepato-Bilio-Pancreatic Surgery, Liver Transplantation, Pitié Salpêtrière Hospital, AP-HP, 75013 Paris, France
| | - A Alves
- Inserm-UCN, ANTICIPE U1086, 14000 Caen, France; Department of visceral and digestive surgery, Caen University Hospital Center, 14000 Caen, France; Registry of Digestive Tumors of Calvados, Caen University Hospital Center Center, 14000 Caen, France
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Kim YY, Park HJ. Factors Influencing Suicidal Ideation According to the Deprivation Indices of Different Regions in Korea. J Prev Med Public Health 2023; 56:88-94. [PMID: 36746426 PMCID: PMC9925278 DOI: 10.3961/jpmph.22.356] [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: 08/12/2022] [Accepted: 12/15/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES This study examined how deprivation differed by region and the effect those differences had on suicidal ideation among the local population. METHODS Data collected over 10 years (2012-2021) in the Korea Welfare Panel Study were organized into 3 categories: metropolitan, city, and rural. A panel analysis was conducted on the impact of deprivation indices, socio-demographic characteristics, and life satisfaction on suicidal ideation in each category. RESULTS Income, divorce status, family relationship satisfaction, and medical deprivation had a significant impact on suicidal ideation in metropolitan areas, whereas these variables did not have significant effects in rural areas. In other words, income, family, and medical support were more impactful in city areas. CONCLUSIONS Although the deprivation index was higher in rural areas than in city areas due to an aging population and reduced income levels, the mental health of rural residents was found to be generally better than that of city residents. The possibility that this is related to the strength of relationships within the respective communities should be considered in light of recent discussions on relational welfare.
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Affiliation(s)
- Yun-Young Kim
- Department of Social Welfare, Jeonbuk National University, Jeonju, Korea
| | - Hyung-Joo Park
- Department of Social Welfare, Jeonbuk National University, Jeonju, Korea,Corresponding author: Hyung-Joo Park, Department of Social Welfare, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju 54896, Korea E-mail:
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Luque-Fernández MÁ, Redondo-Sánchez D, Fernández P, Salamanca-Fernández E, Marcos-Gragera R, Guevara M, Carulla Aresté M, Jiménez R, Núñez O, Sabater C, López de Munain Marqués A, Chirlaque MD, Mateos A, Rodríguez-Barranco M, Espín Balbino J, Pollán M, Sánchez MJ. [Study protocol on Socioeconomic and Geographic Inequalities in Cancer Incidence, Mortality and Survival in Spain: Multilevel Population-Base Study: DESOCANES study]. Gac Sanit 2021; 35:199-203. [PMID: 32674866 DOI: 10.1016/j.gaceta.2020.02.015] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 11/30/2022]
Abstract
Incidence and mortality provide information on the burden of cancer morbidity and the potential years of life lost due to cancer. The Spanish Deprivation Index (SDI) has been developed as a standardized measure to study socioeconomic deprivation in Spain at the census tract level. In addition, SDI information can be combined with ecological variables at the population level and data from the High-Resolution European Studies in Cancer. The aim of this study is to characterize socioeconomic inequalities in incidence, excess mortality, premature mortality and net survival for three of the most incident cancers (lung, colon-rectum and breast) in Spain using the SDI. This national population-based study will assess the impact of socioeconomic inequalities using a multilevel modelling approach. Spatial analysis, multilevel modeling, net survival and economic impact assessment will be used. The results will be useful for supporting decision-making, planning, and management of public health interventions aimed at reducing the impact of socioeconomic inequalities in the diagnosis and prognosis of cancer patients in Spain.
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Affiliation(s)
- Miguel Ángel Luque-Fernández
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Daniel Redondo-Sánchez
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Andaluza de Salud Pública, Granada, España.
| | - Pablo Fernández
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
| | - Elena Salamanca-Fernández
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, España; Escuela Andaluza de Salud Pública, Granada, España
| | - Rafael Marcos-Gragera
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Unitat d'Epidemiologia i Registre de Cáncer de Girona, Pla Director d'Oncologia, Departament de Salut, Generalitat de Catalunya, Institut Català de Oncologia, Girona, España; Instituto de Investigación Biomédica de Girona (IDIBGI), Grupo de Epidemiología. Descriptiva, Genética y Prevención del Cáncer, Girona, España
| | - Marcela Guevara
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Salud Pública de Navarra, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España
| | | | | | - Olivier Núñez
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
| | | | | | | | | | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Andaluza de Salud Pública, Granada, España
| | - Jaime Espín Balbino
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Andaluza de Salud Pública, Granada, España
| | - Marina Pollán
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
| | - María-José Sánchez
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Andaluza de Salud Pública, Granada, España; Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España
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Feuillet T, Valette JF, Charreire H, Kesse-Guyot E, Julia C, Vernez-Moudon A, Hercberg S, Touvier M, Oppert JM. Influence of the urban context on the relationship between neighbourhood deprivation and obesity. Soc Sci Med 2020; 265:113537. [PMID: 33250318 DOI: 10.1016/j.socscimed.2020.113537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/22/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In middle- and high-income countries, obesity is positively associated with neighbourhood deprivation. However, the moderating effect of the broader urban residential context on this relationship remains poorly understood. METHODS In this study, we have examined the nonlinear and geographically varying relationship between neighbourhood deprivation and the likelihood of being a person with overweight among participants of the French NutriNet-Santé adult cohort study (n = 68,698), adjusted for age, gender and educational level. Ten urban residential contexts (e.g., suburbs, peri-urban or rural areas) were defined. We used a multilevel generalised additive modelling framework for analyses. RESULTS We found that the relationship between neighbourhood deprivation and overweight differed according to urban context, in terms of both linearity and intensity. Overall, the deprivation-overweight relationship was strongly positive (with a higher prevalence of overweight in deprived neighbourhoods) in suburban areas of Paris and of other large French cities, while weak or null in small towns and rural areas, and intermediate in inner cities. In addition, we observed in suburbs of Paris and in peri-urban belts of large cities that beyond a certain level of neighbourhood deprivation, the relationship with overweight plateaued. DISCUSSION In a French population from a high-income country, suburbs, as well as moderately deprived neighbourhoods of peri-urban areas of large cities, are potential targets for public health and urban planning policies aiming at preventing obesity. Our results emphasize the value of local analyses to better capture the complexity and contextual variations of socioeconomic determinants of non-communicable diseases such as obesity.
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Affiliation(s)
- T Feuillet
- University Paris 8, LADYSS, UMR 7533 CNRS, Saint-Denis, France; Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France.
| | - J F Valette
- University Paris 8, LADYSS, UMR 7533 CNRS, Saint-Denis, France
| | - H Charreire
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France; University Paris Est, Lab Urba, Créteil, France
| | - E Kesse-Guyot
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - C Julia
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France; Public Health Department, Avicenne Hospital (AP-HP), Bobigny, France
| | - A Vernez-Moudon
- Architecture, Landscape Architecture, and Urban Design and Planning, University of Washington, 1107 NE 45th St, Suite 535, Box 354802, Seattle, WA, 98195, USA
| | - S Hercberg
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France; Public Health Department, Avicenne Hospital (AP-HP), Bobigny, France
| | - M Touvier
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France
| | - J M Oppert
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Bobigny, France; Sorbonne University, Department of Nutrition, Pitié-Salpêtrière Hospital (AP-HP), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
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Lauriot Dit Prevost A, Genin M, Occelli F, Priso RH, Besson R, Lanier C, Sharma D. Spatial analysis of hypospadias cases in northern France: taking clinical data into account. BMC Pediatr 2020; 20:442. [PMID: 32957953 PMCID: PMC7504625 DOI: 10.1186/s12887-020-02332-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/07/2020] [Indexed: 01/16/2023] Open
Abstract
Background Strong evidence for a causal role of environmental factors in a congenital anomaly is still difficult to produce. The collection of statistical data is crucial for gaining a better understanding of the epidemiology and pathophysiology of these anomalies. We aimed to evaluate spatial variations in hypospadias within our region and it’s association to socioeconomic and ecological factors, taking clinical data into account. Methods All boys with hypospadias born in northern France and seen in Lille University Medical Center (Lille, France) between 1999 and 2012 were included in the analysis. We retrospectively collected geographic data, clinical data (especially known confounding factors associated with an elevated risk of hypospadias), and demographic, socio-economic and ecological data. We analyzed the entire study population and subsequently the subset of boys lacking confounding factors. Results The study sample of 975 cases of hypospadias over the 13-year period resulted in an incidence of 25.4/10,000 male births, and was characterized by significant spatial heterogeneity (p < 0.005) and autocorrelation (p < 0.001). We detected two high-incidence clusters that differed with regard to their land use. After the exclusion of 221 patients with confounding factors, two high-incidence clusters with significant disease risks (1.65 and 1.75, respectively; p < 0.001) and a significant difference in land use (p < 0.001) again appeared. The first cluster contained a higher median [interquartile range] proportion of artificialized land (0.40 [0.22;0.47]) than the remaining “neutral areas” (0.19 [0.08;0.53]) did (p < 0.001). Conversely, the second cluster contained a higher median proportion of rural land (0.90 [0.78;0.96]) than the “neutral areas” (0.81 [0.47;0.92]) did (p < 0.001). The median deprivation index was significantly lower in the urban cluster (0.47 [0.42;0.55]) and significantly higher in the rural cluster (0.69 [0.56;0.73]) (p < 0.001). Conclusions Our results evidenced the heterogeneous spatial distribution of cases of hypospadias in northern France. We identified two clusters with different environmental and social patterns – even after the exclusion of known confounding factors.
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Affiliation(s)
- Arthur Lauriot Dit Prevost
- CHU Lille, Clinique de Chirurgie et Orthopédie de l'Enfant, F-59000, Lille, France. .,CHU Lille, Centre de référence du développement génital DEV-GEN, F-59000, Lille, France. .,Univ. Lille, CHU Lille, ULR 2694 METRICS - Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France.
| | - Michael Genin
- Univ. Lille, CHU Lille, ULR 2694 METRICS - Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
| | - Florent Occelli
- Univ. Lille, Laboratoire de Génie Civil et géo-Environnement, F-59000, Lille, France.,Faculté ILIS/Faculté de pharmacie de Lille - LSVF, Lille, F-59000, France
| | - René-Hilaire Priso
- CHU Lille, Clinique de Chirurgie et Orthopédie de l'Enfant, F-59000, Lille, France.,CHU Lille, Centre de référence du développement génital DEV-GEN, F-59000, Lille, France
| | - Remi Besson
- CHU Lille, Clinique de Chirurgie et Orthopédie de l'Enfant, F-59000, Lille, France.,CHU Lille, Centre de référence du développement génital DEV-GEN, F-59000, Lille, France
| | - Caroline Lanier
- Univ. Lille, Laboratoire de Génie Civil et géo-Environnement, F-59000, Lille, France.,Faculté ILIS/Faculté de pharmacie de Lille - LSVF, Lille, F-59000, France
| | - Dyuti Sharma
- CHU Lille, Clinique de Chirurgie et Orthopédie de l'Enfant, F-59000, Lille, France.,CHU Lille, Centre de référence du développement génital DEV-GEN, F-59000, Lille, France
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Duque I, Domínguez-Berjón MF, Cebrecos A, Prieto-Salceda MD, Esnaola S, Calvo Sánchez M, Marí-Dell'Olmo M. [ Deprivation index by enumeration district in Spain, 2011]. Gac Sanit 2020; 35:113-122. [PMID: 32014314 DOI: 10.1016/j.gaceta.2019.10.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/30/2019] [Accepted: 10/23/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To present the methodology used in the design and implementation of a deprivation index by enumeration district, and to describe the socioeconomic situation of Spain in 2011. METHOD The unit of analysis was the enumeration district (N=35,960). Data came from the 2011 Population and Housing Census of Spain. Given both the sampling nature of the Census and the regulatory limitations of data confidentiality, variables were calculated indirectly by using the complement of the available variables. Checks were made to ensure reliability. The selection of the indicators took into account comparability with the MEDEA index. The inclusion of additional information was explored. A deprivation index was built using Principal Component Analysis. Sensitivity analysis of the index was performed for urban areas and the rest of the regions. RESULTS Using the census information, 22 indicators were calculated for 35,917 enumeration districts. The deprivation index was based on six indicators: manual and temporary workers, unemployment, insufficient education overall and in young people (aged 16 to 29 years), and dwellings without access to the internet. The map of Spain shows a gradient of decreasing deprivation from south-west to north-east. CONCLUSIONS The socioeconomic information of the 2011 census by enumeration district was used systematically. The drafted index, similar to the MEDEA, will facilitate the updated study of health inequalities for Spain overall following the economic recession that began in 2008.
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Affiliation(s)
- Ignacio Duque
- Subdirección General de Tecnologías de la Información y las Comunicaciones, Instituto Nacional de Estadística, Madrid, España.
| | | | - Alba Cebrecos
- Grupo de Investigación Social y Cardiovascular, Universidad de Alcalá de Henares, Alcalá de Henares (Madrid), España; Departamento de Geología, Geografía y Ciencias Ambientales, Alcalá de Henares (Madrid), España
| | - María Dolores Prieto-Salceda
- Observatorio de Salud Pública de Cantabria, Fundación Marqués de Valdecilla, Consejería de Sanidad, Santander, España
| | - Santiago Esnaola
- Estudios e Investigación Sanitaria, Dirección de Planificación, Ordenación y Evaluación, Departamento de Salud, Gobierno Vasco, Vitoria (Álava), España
| | - Montserrat Calvo Sánchez
- Estudios e Investigación Sanitaria, Dirección de Planificación, Ordenación y Evaluación, Departamento de Salud, Gobierno Vasco, Vitoria (Álava), España
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau, Barcelona, España
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STEFANATI A, LUPI S, LILLINI R, MATTEO G, PERRONE P, MASETTI G, BROSIO F, FERRETTI S, GABUTTI G. Identifying Ferrara's elderly people with low influenza immunization rates: the contribution of a local socio-economic deprivation index. J Prev Med Hyg 2019; 59:E38-E44. [PMID: 31016266 PMCID: PMC6419304 DOI: 10.15167/2421-4248/jpmh2018.59.4s2.1033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/21/2018] [Indexed: 12/02/2022]
Abstract
Influenza immunization coverage rates remain far below the optimal value recommended by the World Health Organization, even in groups considered at high risk, such as the elderly. A possible explanation for this suboptimal vaccination uptake may be deprivation. A specifically developed local deprivation index was proposed for the classification of residents in the municipality of Ferrara in order to evaluate the characteristics of subjects over 65 years of age who accepted/refused influenza immunization (2010-2015). The variables building this deprivation index were primarily related to demographic aspects, such as age, widow/widower status, education, family composition and housing characteristics. Influenza immunization coverage rates were unsatisfactory in all categories of deprivation. A statistically significant decreasing trend in coverage rates was observed with decreasing deprivation in the general population and in males, but not in females. In addition to factors composing the local deprivation index, being separated, living in a family of three members and independent contractor were features that hindered immunization among very deprived elderly.
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Affiliation(s)
- A. STEFANATI
- University of Ferrara, Department of Medical Sciences, Italy
| | - S. LUPI
- University of Ferrara, Department of Medical Sciences, Italy
| | - R. LILLINI
- University of Genova, Dissal, Italy
- Analytical Epidemiology & Health Impact, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy
| | - G. MATTEO
- University of Ferrara, Department of Medical Sciences, Italy
| | - P. PERRONE
- University of Ferrara, Department of Medical Sciences, Italy
| | - G. MASETTI
- University of Ferrara, Department of Medical Sciences, Italy
| | - F. BROSIO
- University of Ferrara, Department of Medical Sciences, Italy
| | - S. FERRETTI
- University of Ferrara, Department of Department of Morphology, Surgery and Experimental Medicine, Ferrara, Italy
| | - G. GABUTTI
- University of Ferrara, Department of Medical Sciences, Italy
- Giovanni Gabutti, University of Ferrara, Department of Medical Sciences, via Fossato di Mortara 64b, 44121 Ferrara, Italy - Tel. +39 0532 455568 - Fax +39 0532 205066 - E-mail:
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Ho HC, Wong MS, Man HY, Shi Y, Abbas S. Neighborhood-based subjective environmental vulnerability index for community health assessment: Development, validation and evaluation. Sci Total Environ 2019; 654:1082-1090. [PMID: 30841383 DOI: 10.1016/j.scitotenv.2018.11.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 07/31/2018] [Revised: 10/29/2018] [Accepted: 11/09/2018] [Indexed: 06/09/2023]
Abstract
Neighborhood-based environmental vulnerability is significantly associated with long-term community health impacts. Previous studies have quantified environmental vulnerability using objective environmental datasets. However, environmental cognition among a population may influence subjective feelings of environmental vulnerability, and this can be associated with community health risk. In this study, a mixed-methods approach was applied to estimate neighborhood-based environmental vulnerability based on objective environmental measures and subjective environmental understanding from a local population. The synergistic use of both qualitative and quantitative data resulted in a "subjective environmental vulnerability" index which can demonstrate environmental deprivation across Hong Kong. The resultant maps were compared with a mortality dataset between 2007 and 2014, based on a case-series analysis. The case-series analysis indicated that using a subjective environmental vulnerability index as an approach for neighborhood mapping is able to estimate the community health risk across Hong Kong. In particular, the following types of cause-specific mortality have significant association with the subjective environmental vulnerability index: 1) mortality associated with mental and behavioral disorders, 2) cardiovascular mortality, 3) respiratory mortality, and 4) mortality associated with diseases of the digestive system. In conclusion, the use of a subjective environmental vulnerability index can be implemented within a community health planning program, especially to reduce long-term adverse impacts on population with mental impairment.
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Affiliation(s)
- Hung Chak Ho
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong; Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - Man Sing Wong
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong; Research Institute for Sustainable Urban Development, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - Ho Yin Man
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Yuan Shi
- School of Architecture, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Sawaid Abbas
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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BECHINI A, PIERALLI F, CHELLINI E, MARTINI A, DUGHERI G, CRESCIOLI F, SCATENA T, BAGGIANI L, LILLINI R, FIASCHI P, BONANNI P, BOCCALINI S. Application of socio-economic-health deprivation index, analysis of mortality and influenza vaccination coverage in the elderly population of Tuscany. J Prev Med Hyg 2019; 59:E18-E25. [PMID: 31016263 PMCID: PMC6419307 DOI: 10.15167/2421-4248/jpmh2018.59.4s2.1116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/20/2018] [Indexed: 02/03/2023]
Abstract
Objective The aim of this paper is to describe the results obtained from the application of a specific local deprivation index, to general and cause-specific mortality and influenza vaccination coverage among elderly people in the municipality of Florence. Methods General and cause-specific mortality data (2009-2013) and influenza vaccination coverage data (2015/16 and 2016/17) were collected for subjects aged ≥ 65 years residing in the municipality of Florence (Tuscany), at the 2011 Census section level. A Socio-Economic and Health Deprivation Index (SEHDI) was constructed and validated by means of socio-economic indicators and mortality ratios. Results Half of the population of Florence belonged to the medium deprivation group; about 25% fell into the two most deprived groups, and the remaining 25% were deemed to be wealthy. Elderly people mostly belonged to the high deprivation group. All-cause mortality and cause-specific mortality (cancer and respiratory diseases) reached their highest values in the high deprivation group. Influenza vaccination coverage (VC) was 54.7% in the 2015/16 and 2016/17 seasons, combined. VC showed a linear rising trend as deprivation increased and appeared to be correlated with different factors in the different deprivation groups. Conclusions As socio-economic deprivation plays an important role in health choices, application of the SEHDI enables us to identify the characteristics of the main sub-groups of the population with low adherence to influenza vaccination. The results of the present study should be communicated to General Practitioners, in order to help them to promote influenza vaccination among their patients.
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Affiliation(s)
- A. BECHINI
- Department of Health Sciences, University of Florence, Italy
- Angela Bechini, Department of Health Sciences, University of Florence, viale G.B. Morgagni 48, 50134 Florence, Italy - E-mail:
| | - F. PIERALLI
- Department of Health Sciences, University of Florence, Italy
| | - E. CHELLINI
- Regional Mortality Register of Tuscany, Florence, Italy
| | - A. MARTINI
- Regional Mortality Register of Tuscany, Florence, Italy
| | - G. DUGHERI
- Municipal Statistical Office of Florence, Statistics and Toponomy Service, Florence, Italy
| | - F. CRESCIOLI
- Municipal Statistical Office of Florence, Statistics and Toponomy Service, Florence, Italy
| | - T. SCATENA
- Municipal Statistical Office of Florence, Statistics and Toponomy Service, Florence, Italy
| | | | - R. LILLINI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- Analytical Epidemiology & Health Impact, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy
| | - P. FIASCHI
- Department of Health Sciences, University of Florence, Italy
| | - P. BONANNI
- Department of Health Sciences, University of Florence, Italy
| | - S. BOCCALINI
- Department of Health Sciences, University of Florence, Italy
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Colls C, Mias M, García-Altés A. [A deprivation index to reform the financing model of primary care in Catalonia (Spain)]. Gac Sanit 2018; 34:44-50. [PMID: 30595339 DOI: 10.1016/j.gaceta.2018.07.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To build a deprivation index for the assignation of the budgets of the primary healthcare teams in Catalonia (Spain) valid for both urban and rural environments and updatable with greater frequency than indices built from census variables. METHOD Starting from a review of the most common deprivation indices, variables were selected from sources that allow frequent updating and are representative at the territorial level of primary care. The correlations were calculated between the chosen variables and variables of need for healthcare and morbidity. principal components analysis was applied. Finally, the correlations of the index built with the MEDEA index and with variables of use of healthcare resources and morbidity was calculated stratifying by geographical dispersion. RESULTS The variables of income, occupation and education are the ones with the highest correlation with the need for healthcare and morbidity. The composed socioeconomic index (CSI) ranges from -.01 to 5.68, with an average value of 2.60 and a standard deviation of .91. The correlation between the CSI and the MEDEA index is .89. The CSI correlates with use for healthcare in both urban and rural environments, although in rural environments the association is lower. CONCLUSIONS The CSI was built with data that allow frequent updating and was integrated in the model for allocating resources to primary healthcare starting in 2017.
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Affiliation(s)
- Cristina Colls
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, Departament de Salut de Catalunya, Barcelona, España
| | - Montse Mias
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, Departament de Salut de Catalunya, Barcelona, España
| | - Anna García-Altés
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, Departament de Salut de Catalunya, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, España.
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FORTUNATO F, IANNELLI G, COZZA A, DEL PRETE M, POLLIDORO F, COCCIARDI S, DI TRANI M, MARTINELLI D, PRATO R. Local deprivation status and seasonal influenza vaccination coverage in adults ≥ 65 years residing in the Foggia municipality, Italy, 2009-2016. J Prev Med Hyg 2018; 59:E51-E64. [PMID: 31016268 PMCID: PMC6419308 DOI: 10.15167/2421-4248/jpmh2018.59.4s2.1167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 12/20/2018] [Indexed: 11/16/2022]
Abstract
Introduction In Italy, vaccination against seasonal influenza has been recommended for the elderly since 1980, but coverage is still far below the WHO minimum target level of 75%. Effective interventions to improve influenza vaccination should take into account socioeconomic determinants of inequalities in vaccine uptake. This study aimed to assess differences in vaccination coverage, by socioeconomic status, among people ≥ 65 years of age residing in the Foggia municipality, Italy. Methods A Socio-Economic-Health Deprivation Index (SEHDI) was constructed by using a multivariate analysis model. The resident population, for census block, was classified in 5 deprivation groups. Differences in demographic and socioeconomic indicators, the standardized mortality ratios (SMRs), and the average vaccination coverage among deprivation groups were evaluated with the linear F-test. The association between census variables and influenza vaccination coverage, in each deprivation group, was assessed using the Pearson bivariate correlation. Results The SEHDI allowed to identify factors related to ageing, housing, household size and composition, and education. Forty percent of people residing in the Foggia municipality lived in conditions of socioeconomic and health deprivation. Belonging to families with 3 or 4 members was associated with increased coverage rates. In the most deprived group, vaccination uptake was positively associated with the dependency ratio. Conclusions The results of this study have shown that there is still large room for improving influenza vaccination coverage among subjects belonging to the most deprived areas. Surveillance of trends in influenza vaccine uptake by socioeconomic groups is a feasible contribution to implementing effective, tailored to the frail older persons, vaccine utilization programs.
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Affiliation(s)
| | | | | | | | | | | | | | | | - R. PRATO
- Rosa Prato, Department of Medical and Surgical Sciences, University of Foggia, viale Luigi Pinto, 71122 Foggia, Italy - Tel. +39 0881 588036 - Fax +39 0881 588047 - E-mail:
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Abstract
INTRODUCTION A socio-economic (SE) deprivation index is a measure that aims to provide an indication of SE hardship and disadvantage in the population. Our aim was constructing 10 Socio-Economonic and Health Deprivation Indexes (SEHDI) by means of the same method. This particular method enables these indexes to be used to investigate the relationships between SE inequalities and aspects of health and prevention in the population. MATERIALS AND METHODS Data on the demographic and SE situation of the populations were taken from the 2011 Census at the Census Tract (CT) level (2001 for Rome municipality). To construct the SEHDIs, variables displaying a statistically significant correlation with the SMRs of overall mortality were subjected to a tolerance test of linearity, in order to eliminate collinear variables. The variables selected underwent PCA factor analysis, in order to obtain the factors to be linearly combined into the SEHDI. The final values were scaled from minimum to maximum deprivation, and the quantitative scale was converted into five ordinal normalized population groups. The SEHDIs were validated at the SE level by comparing them with the trends of the main SE indexes used in the 2011 Census (2001 for Rome municipality), and at the health level by comparing them with the trends of some causes of death. Both comparisons were made by means of ANOVA. RESULTS The 10 areas considered were: the municipalities of Cagliari, Ferrara, Florence, Foggia, Genoa, Rome, Palermo, Sassari, Siena, and the ULSS 7 Veneto area. For each one, a specific SEHDI was computed and the different variables comprising each index focused on particular aspects of SE and health deprivation at the area level. The SEHDIs showed good percentages of explained variance (from 72.2% to 49.1%) and a linear distribution of the main statistical SE indices and of overall mortality in each area; these findings were in line with the literature on the relationship between the SE condition and health status of the population. The distribution of cause-specific mortality across the SEHDIs deprivation clusters is analyzed in other articles, which deal with the findings of the study in each area. CONCLUSIONS The SEHDIs showed good ability to identify the elements of SE inequalities that impact on the health conditions of populations; to depict the distribution of causes of death that are sensitive to SE differences concerning aspects of the social and family support structure. From a public health perspective, these results are relevant because they enable interventions of health promotion and prevention to be implemented on the basis of the characteristics that define deprivation groups.
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Affiliation(s)
- R. LILLINI
- Department of Health Sciences (DISSAL), University of Genova, Italy
- Analytical Epidemiology & Health Impact, Fondazione IRCCS “Istituto Nazionale Tumori”Milan, Italy
| | - M. VERCELLI
- Department of Health Sciences (DISSAL), University of Genova, Italy
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Deborde T, Chatignoux E, Quintin C, Beltzer N, Hamers FF, Rogel A. Breast cancer screening programme participation and socioeconomic deprivation in France. Prev Med 2018; 115:53-60. [PMID: 30099047 DOI: 10.1016/j.ypmed.2018.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 02/06/2018] [Revised: 06/18/2018] [Accepted: 08/04/2018] [Indexed: 11/17/2022]
Abstract
The objective was to quantify the relationship between deprivation and national breast cancer screening programme (NBCSP) participation at an ecological level in mainland France. Data from 4,805,390 women-living in 36,209 municipalities within 95 departments-participating in the 2013-2014 NBCSP were analysed using the French Deprivation Index (FDep). FDep population quintiles by municipality were computed to describe NBCSP participation according to deprivation. To better examine the relationship between continuous value of deprivation index and participation rates at the municipality level, we built a generalized linear mixed model. Geographical variations in participation rates were marked. The national standardized participation rate was higher in the intermediate quintiles (55%), 45% for the least deprived one and 52% for the most deprived one. Using our model, we also obtained an inverted U-curve for the relationship between NBCSP participation and municipality deprivation: participation was lower for both the least and most deprived municipalities. This relationship was also observed for each of the two subpopulations-urban municipalities and rural ones-considered separately. Introducing the FDep in the model reduced slightly the unexplained variations in participation rates between departments and between municipalities (with a proportional change in variance of 14% and 12% respectively). We highlight major disparities in departmental participation rates and FDep/participation profiles. However, deprivation appears to have only little influence on geographical variation in participation rates. There is a need to further understand the factors affecting geographical variation in participation rates, in particular the use of opportunistic screening.
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Affiliation(s)
- Thérèse Deborde
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Edouard Chatignoux
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Cécile Quintin
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Nathalie Beltzer
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Françoise F Hamers
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Agnès Rogel
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France.
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Anderson SG, Shoo H, Saluja S, Anderson CD, Khan A, Livingston M, Jude EB, Lunt M, Dunn G, Heald AH. Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort. Diabetologia 2018; 61:959-967. [PMID: 29264632 PMCID: PMC6448990 DOI: 10.1007/s00125-017-4522-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/25/2017] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to determine whether social deprivation in the presence of diabetes is an independent predictor of developing a foot ulcer and separately of mortality. METHODS This was a primary-care-based retrospective analysis of 13,955 adults with type 1 (n = 1370) or type 2 (n = 12,585) diabetes after a median follow-up of 10.5 years. Demographic characteristics, indices of social deprivation and clinical variables were assessed at baseline. The primary outcomes were new foot ulceration (in those without a previous history of foot ulcers) and all-cause mortality. Cox proportional hazard models were used to describe the associations among foot ulceration, social deprivation and mortality. RESULTS The mean age of the population was 69.4 (range: 16-89) years. The incidence of foot ulceration was greater in individuals with type 2 (8.6%) compared with type 1 diabetes (4.8%). Occurrence was similar by sex, but increased with age and deprivation index. Individuals in the highest quintile of deprivation were 77% more likely to develop a foot ulcer compared with those in the lowest quintile (OR 1.77 [95% CI 1.45, 2.14], p < 0.0001). Overall, 2946 (21.1%) deaths were recorded. Compared with individuals without a foot ulcer, the development of a foot ulcer was associated with a higher age- and sex-adjusted mortality rate (25.9% vs 14.0%), and a 72% (HR 1.72 [95% CI 1.56, 1.90], p < 0.001) increased risk of mortality in those with type 2 diabetes. Risk of death increased by 14% per quintile of deprivation in a univariable analysis (HR 1.14 [95% CI 1.10, 1.17]). In multivariable Cox regression analyses, there was a 48% increased risk of mortality in individuals with a foot ulcer (HR 1.48 [95% CI 1.33, 1.66]) independent of the Townsend index score (HR 1.13 [95% CI 1.10, 1.17], per quintile), baseline age, sex, diabetes type, smoking status, hypertension, statin use, β-blocker use, metformin use, HbA1c levels and insulin use. CONCLUSIONS/INTERPRETATION This study confirms the high mortality rate in individuals with diabetes-related foot ulcers. In addition, socioeconomic disadvantage was found to be an independent effect modifier, contributing to an increased burden of mortality in people with diabetes who develop foot ulceration. In light of this, and as diabetes service configurations are orientated for the next 5-10 years, modelling of foot ulceration risk needs to take socioeconomic disadvantage into account.
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Affiliation(s)
- Simon G Anderson
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, Core Technology Facility, The University of Manchester, Manchester, UK
| | - Haika Shoo
- Diabetes and Endocrine Department, East Cheshire NHS Trust, Macclesfield, UK
| | - Sushant Saluja
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, Core Technology Facility, The University of Manchester, Manchester, UK
| | | | - Adnan Khan
- Department of Endocrinology and Diabetes, Leighton Hospital, Crewe, UK
| | - Mark Livingston
- Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK
| | - Edward B Jude
- Department of Diabetes and Endocrinology, Tameside Hospital NHS Foundation Trust, Ashton-under-Lyme, UK
| | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - George Dunn
- Department of Podiatry, East Cheshire NHS Trust, Macclesfield, UK
| | - Adrian H Heald
- Salford Royal NHS Foundation Trust, Diabetes and Endocrinology, Stott Lane, Salford, UK.
- School of Medical Sciences, Faculty of Biology, Medicine, and Health, and Manchester Academic Health Science Centre (MAHSC), The University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK.
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Landi S, Ivaldi E, Testi A. Socioeconomic status and waiting times for health services: An international literature review and evidence from the Italian National Health System. Health Policy 2018; 122:334-351. [PMID: 29373188 DOI: 10.1016/j.healthpol.2018.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 02/15/2017] [Revised: 12/01/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
Abstract
In the absence of priority criteria, waiting times are an implicit rationing instrument where the absence or limited use of prices creates an excess of demand. Even in the presence of priority criteria, waiting times may be unfair because they reduce health care demand of patients in lower socio-economic conditions due to high opportunity costs of time or a decay in their health level. Significant evidence has shown a relationship between socioeconomic status and the length of waiting time. The first phase of the study involved an extensive review of the existent literature for the period of 2002-2016 in the main databases (Scopus, PubMed and Science Direct). Twenty-eight met the eligibility criteria. The 27 papers were described and classified. The e mpirical objective of this study was to determine whether socioeconomic characteristics affect waiting time for different health services in the Italian national health system. The services studied were specialist visits, diagnostics tests and elective surgeries. A classification tree and logistic regression models were implemented. Data from the 2013 Italian Health National Survey were used. The analysis found heterogeneous results for different types of service. Individuals with lower education and economic resources have a higher risk of experiencing excessive waiting times for diagnostic and specialist visits. For elective surgery, socioeconomic inequalities are present but appear to be lower.
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Affiliation(s)
- Stefano Landi
- Department of Economics and Business Studies, University of Genoa, Genoa, Italy; Department of Political Science, University of Genoa, Genoa, Italy; Department of Management, University "Ca' Foscari" Venice, Venice, Italy.
| | - Enrico Ivaldi
- Department of Political Science, University of Genoa, Genoa, Italy
| | - Angela Testi
- Department of Economics and Business Studies, University of Genoa, Genoa, Italy
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20
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Temam S, Varraso R, Pornet C, Sanchez M, Affret A, Jacquemin B, Clavel-Chapelon F, Rey G, Rican S, Le Moual N. Ability of ecological deprivation indices to measure social inequalities in a French cohort. BMC Public Health 2017; 17:956. [PMID: 29246202 PMCID: PMC5732455 DOI: 10.1186/s12889-017-4967-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 12/11/2015] [Accepted: 11/29/2017] [Indexed: 11/18/2022] Open
Abstract
Background Despite the increasing interest in place effect to explain health inequalities, there is currently no consensus on which kind of area-based socioeconomic measures researchers should use to assess neighborhood socioeconomic position (SEP). The study aimed to evaluate the reliability of different area-based deprivation indices (DIs) in capturing socioeconomic residential conditions of French elderly women cohort. Methods We assessed area-based SEP using 3 DIs: Townsend Index, French European Deprivation Index (FEDI) and French Deprivation index (FDep), among women from E3N (Etude épidémiologique auprès des femmes de la Mutuelle Générale de l’Education Nationale). DIs were derived from the 2009 French census at IRIS level (smallest geographical units in France). Educational level was used to evaluate individual-SEP. To evaluate external validity of the 3 DIs, associations between two well-established socially patterned outcomes among French elderly women (smoking and overweight) and SEP, were compared. Odd ratios were computed with generalized estimating equations to control for clustering effects from participants within the same IRIS. Results The analysis was performed among 63,888 women (aged 64, 47% ever smokers and 30% overweight). Substantial agreement was observed between the two French DIs (Kappa coefficient = 0.61) and between Townsend and FEDI (0.74) and fair agreement between Townsend and FDep (0.21). As expected among French elderly women, those with lower educational level were significantly less prone to be ever smoker (Low vs. High; OR [95% CI] = 0.43 [0.40–0.46]) and more prone to being overweight (1.89 [1.77–2.01]) than women higher educated. FDep showed expected associations at area-level for both smoking (most deprived vs. least deprived quintile; 0.77 [0.73–0.81]) and overweight (1.52 [1.44–1.62]). For FEDI opposite associations with smoking (1.13 [1.07–1.19]) and expected association with overweight (1.20 [1.13–1.28]) were observed. Townsend showed opposite associations to those expected for both smoking and overweight (1.51 [1.43–1.59]; 0.93 [0.88–0.99], respectively). Conclusion FDep seemed reliable to capture socioeconomic residential conditions of the E3N women, more educated in average than general French population. Results varied strongly according to the DI with unexpected results for some of them, which suggested the importance to test external validity before studying social disparities in health in specific populations. Electronic supplementary material The online version of this article (10.1186/s12889-017-4967-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sofia Temam
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France. .,Univ Paris Sud, Le Kremlin-Bicêtre, France. .,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France.
| | - Raphaëlle Varraso
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - Carole Pornet
- Agence Régionale de Santé (ARS) Basse-Normandie, Caen, France
| | - Margaux Sanchez
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France.,Univ Paris Sud, Le Kremlin-Bicêtre, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - Aurélie Affret
- Univ Paris Sud, Le Kremlin-Bicêtre, France.,Centre for Research in Epidemiology and Population Health (CESP), Mode de vie, gènes et santé: épidémiologie intégrée trans-générationnelle, INSERM, U1018, Villejuif, France
| | - Bénédicte Jacquemin
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France.,Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Françoise Clavel-Chapelon
- Univ Paris Sud, Le Kremlin-Bicêtre, France.,Centre for Research in Epidemiology and Population Health (CESP), Mode de vie, gènes et santé: épidémiologie intégrée trans-générationnelle, INSERM, U1018, Villejuif, France
| | | | - Stéphane Rican
- LADYSS, Laboratoire dynamiques sociales et recompositions des espaces, Université Paris Ouest Nanterre La Défense, Nanterre, France
| | - Nicole Le Moual
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
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Kim EJ, Kim H. Effect modification of individual- and regional-scale characteristics on heat wave-related mortality rates between 2009 and 2012 in Seoul, South Korea. Sci Total Environ 2017; 595:141-148. [PMID: 28384570 DOI: 10.1016/j.scitotenv.2017.03.248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 08/24/2016] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 05/24/2023]
Abstract
Many studies have investigated the associations between heat waves, ambient temperature, cold spells, and mortality or morbidity. Some studies have utilized effect modification to reveal the factors that increase an individual's susceptibility to temperature extremes, which can then be used to reshape public policy. In this study, we used a time-stratified case-crossover technique to examine how individual- and regional-scale characteristics modified heat wave-related impacts on mortality rates in Seoul, South Korea, between 2009 and 2012. We defined a heat wave as having at least two consecutive days with a daily mean temperature greater than or equal to the 95th percentile recorded in each of Seoul's twenty-five districts. At the individual scale, citizens classified as belonging to a lower education group had a higher vulnerability to heat wave-related morbidity or mortality [odds ratio (OR) 1.261; 95% confidence interval (CI): 1.034-1.538]. At a regional scale, death during heat waves was more likely to occur in districts with a high deprivation index (OR=1.194; 95% CI: 1.028-1.388). And a low proportion of green space around buildings (OR=1.178; 95% CI: 1.016-1.366), a low proportion of rooftop green space (OR=1.207; 95% CI: 1.042-1.399), or those that had fewer hospitals (OR=1.186; 95% CI: 1.019-1.379). Our data show that mortality during heat waves is more likely where these individual and regional-scale vulnerabilities overlap. Our findings support evidence of mortality impacts from heat waves and provide a basis for selection to policy makers choose on the target groups to reduce the public health burden of heat waves.
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Affiliation(s)
- E-Jin Kim
- Department of Biostatistics, Graduate School of Public Heath, Seoul National University, Republic of Korea
| | - Ho Kim
- Department of Biostatistics, Graduate School of Public Heath, Seoul National University, Republic of Korea.
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Conway R, Cournane S, Byrne D, O'Riordan D, Coveney S, Silke B. Broadband access, housing and car ownership as deprivation predictors of the emergency medical admission. Eur J Intern Med 2016; 35:e25-e26. [PMID: 27449118 DOI: 10.1016/j.ejim.2016.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 07/07/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Richard Conway
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Sean Cournane
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin 8, Ireland
| | - Declan Byrne
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Deirdre O'Riordan
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | | | - Bernard Silke
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
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23
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Abstract
Ambulatory care sensitive conditions (ACSCs) are a group of conditions judged to be suitable for healthcare efficiency initiatives to reduce the rate of hospital admissions. All emergency medical admissions to an Irish hospital between 2002 and 2013 were assessed for ACSCs. They were categorised by quintile of deprivation index and evaluated against hospital admission rate. Univariable and multivariable risk estimates were calculated, using logistic regression or zero-truncated Poisson regression. There were 66,861 admissions in 36,214 patients. ACSCs represented 66.4% of admissions. The rate of ACSC admissions increased with deprivation index, Q1 10.4 (95% confidence interval (CI) 10.2-10.5), Q2 17.3 (95% CI 17.2-17.5), Q3 34.0 (95% CI 33.7-34.2), Q4 30.2 (95% CI 30.0-30.4) and Q5 44.5 (95% CI 43.8- 45.1) (p<0.001), corresponding incidence rate ratios compared with Q1 were: Q2 1.67 (95% CI 1.64-1.70), Q3 3.28 (95% CI 3.22-3.33), Q4 2.92 (95% CI 2.87-2.97) and Q5 4.29 (95% CI 4.20-4.39) (p<0.001). ACSCs are common in acute medical admissions and are strongly influenced by the underlying social demographics of the population.
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Affiliation(s)
- Richard Conway
- Department of Internal Medicine, St James's Hospital, Dublin, Ireland, and CARD Newman Research Fellow, University College Dublin, Dublin, Ireland
| | - Deirdre O'Riordan
- Department of Internal Medicine, St James's Hospital, Dublin, Ireland
| | - Declan Byrne
- Department of Internal Medicine, St James's Hospital, Dublin, Ireland
| | - Sean Cournane
- Department of Internal Medicine, St James's Hospital, Dublin, Ireland
| | - Seamus Coveney
- School of Geographical and Earth Sciences, University of Glasgow, Glasgow, UK
| | - Bernard Silke
- Department of Internal Medicine, St James's Hospital, Dublin, Ireland
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24
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Cournane S, Byrne D, Conway R, O'Riordan D, Coveney S, Silke B. Social deprivation and hospital admission rates, length of stay and readmissions in emergency medical admissions. Eur J Intern Med 2015; 26:766-71. [PMID: 26477015 DOI: 10.1016/j.ejim.2015.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 08/05/2015] [Revised: 09/25/2015] [Accepted: 09/29/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Patients from deprived backgrounds have a higher in-patient mortality following an emergency medical admission. How deprivation relates to the admission or readmission incidence rates, episode length of stay (LOS) and ancillary resource utilization is less clear. METHODS All emergency medical admissions (66,861 episodes in 36,214 patients) between 2002 and 2013, categorized by quintile of Irish National Deprivation Index were assessed against admission or readmission incidence rates (/1000 local population by electoral division), LOS and utilization of five ancillary services. Univariate and multi-variable risk estimates (odds ratios (OR) or incidence rate ratios (IRR)) were calculated, using truncated Poisson regression. RESULTS The deprivation index quintile was strongly correlated with the emergency medical admission rate with IRR (as compared with quintile 1) as follows: Q2 1.99 (95% CI: 1.96, 2.01), Q3 3.45 (95% CI: 3.41, 3.49), Q4 3.27 (95% CI: 3.23, 3.31) and Q5 4.29 (95% CI: 4.23, 4.35). LOS was not influenced by deprivation status; although increasing deprivation resulted in increased utilization of social services (OR 1.04: 95% CI: 1.03, 1.06), with a lower requirement for occupational therapy (OR 0.94: 95% CI: 0.93, 0.96) and speech/language services (OR 0.83: 95% CI: 0.80, 0.86). There was a rather decreased use of ancillary services with increasing deprivation; however, the readmission rate was strongly predicted by deprivation status. CONCLUSION Deprivation status strongly influenced the admission and readmission rates for medical patients admitted as emergencies; however, ancillary resource utilization was not increased. Deprivation index will increase demand on hospital resources due to the aggregate effect on both admission and readmission incidence rates.
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Affiliation(s)
- Seán Cournane
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin 8, Ireland
| | - Declan Byrne
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Richard Conway
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Deirdre O'Riordan
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Seamus Coveney
- School of Geographical and Earth Sciences, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Bernard Silke
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
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25
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Sabel CE, Kihal W, Bard D, Weber C. Creation of synthetic homogeneous neighbourhoods using zone design algorithms to explore relationships between asthma and deprivation in Strasbourg, France. Soc Sci Med 2012; 91:110-21. [PMID: 23332654 DOI: 10.1016/j.socscimed.2012.11.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 07/11/2012] [Accepted: 11/15/2012] [Indexed: 11/19/2022]
Abstract
The concept of 'neighbourhood' as a unit of analysis has received considerable research attention over the last decade. Many of these studies raise the question of the influence of local characteristics on variations in health and more recently, researchers have sought to understand how the neighbourhood can influence individual health through individual behaviour. Relatively few studies discuss the question of the borders and definition of a neighbourhood but we know that the results from health or population datasets are very sensitive to how zones are constructed - part of the Modifiable Areal Unit Problem (MAUP). In reality, we know that neighbourhoods are not constrained by artificial statistical boundaries, but rather exist as complex multi-dimensional living communities. This paper tries to better represent the reality on the ground of these communities to better inform studies of health. In this work, we have developed an experimental approach for the automated design of neighbourhoods using a small tessellated cell as a basic building block. Using the software AZTool, we considered population, shape and homogeneity constraints to develop a highly innovative approach to zone construction. The paper reports the challenges and compromises involved in building these new synthetic neighbourhoods. We provide a fully worked example of how our new synthetic homogeneous zones perform using data from Strasbourg, France. We examine data on Asthma reported through calls to the emergency services, and compare these rates with an index of multiple deprivation (NDI) which we have constructed and reported elsewhere. Higher correlations between Asthma and NDI were found using our newly constructed synthetic zones than using the existing French census areas of similar size. The significance of our work is that we show that careful construction of neighbourhoods - which we claim are more realistic than census areas - can greatly aid unpacking our understanding of neighbourhood relationships between health and the social and physical environments.
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Affiliation(s)
- C E Sabel
- Geography, College of Life & Environmental Sciences, and European Centre for Environment and Human Health, Exeter Medical School, University of Exeter, Amory Building, Rennes Drive, Exeter EX4 4RJ, UK.
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