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Fianu A, Doussiet É, Naty N, Porcherat S, Mussard C, Boussaïd K, Cogne M, Gérardin P, Favier F. Usefulness of Home Screening for Promoting Awareness of Impaired Glycemic Status and Utilization of Primary Care in a Low Socio-Economic Setting: A Follow-Up Study in Reunion Island. Int J Health Policy Manag 2022; 11:2208-2218. [PMID: 34634871 PMCID: PMC9808280 DOI: 10.34172/ijhpm.2021.114] [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: 07/02/2020] [Accepted: 08/21/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Low socio-economic settings are characterized by high prevalence of diabetes and difficulty in accessing healthcare. In these contexts, proximity health services could improve healthcare access for diabetes prevention. Our primary objective was to evaluate the usefulness of home screening for promoting awareness of impaired glycemic status and utilization of primary care among adults aged 18-79 in a low socio-economic setting. METHODS This follow-up study was conducted in 2015-2016 in Reunion Island, a French overseas department in the Indian Ocean. Enrollment and screening occurred on the same day at the home of participants (N=907). Impaired glycemic status was defined as [glycated hemoglobin (HbA1c) ≥5.7%] OR [fasting capillary blood glucose (FCBG) ≥1.10 g/L] OR [HbA1c=5.5-5.6% and FCBG=1.00-1.09 g/L]. Medical, socio-cultural, and socio-economic characteristics were collected via a face-to-face questionnaire. A one-month telephone follow-up survey was conducted to determine whether participants had consulted a general practitioner (GP) for confirmation of screening results. A multinomial polytomous logistic regression model was used to identify factors independently associated with non-use of GP consultation for confirmation of screening results and nonresponse to the telephone follow-up survey. RESULTS Prevalence of glycemic abnormalities was 46.0% (95% CI = 42.7-49.2%). Among participants with impaired glycemic status (N=417), 77.7% (95% CI=73.7-81.7%) consulted a GP for confirmation of screening results, 12.5% (95% CI=9.3-15.6%) did not, and 9.8% failed to respond to the follow-up survey. Factors independently associated with non-use of GP consultation for confirmation of screening results were self-reported unwillingness to consult a GP (adjusted odds ratio [OR]: 4.86, 95% CI=1.70-13.84), usual GP consultation frequency of less than once a year (adjusted OR: 4.13, 95% CI=1.56-10.97), and age 18-39 years (adjusted OR: 3.09, 95% CI=1.46-6.57). CONCLUSION Home screening for glycemic abnormalities is a useful proximity health service for diabetes prevention in low socio-economic settings. Further efforts, including health literacy interventions, are needed to increase utilization of primary care.
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Affiliation(s)
- Adrian Fianu
- INSERM CIC1410, CHU Réunion, Saint-Pierre, France
- CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
| | | | - Nadège Naty
- INSERM CIC1410, CHU Réunion, Saint-Pierre, France
| | | | | | | | - Muriel Cogne
- Service de Diabétologie - Site Sud, CHU de la Réunion, Saint-Pierre, France
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Bramajo ON. An Age-Period-Cohort Approach to Analyse Late-Life Depression Prevalence in Six European Countries, 2004-2016. Eur J Popul 2022; 38:223-245. [PMID: 35228766 PMCID: PMC8865500 DOI: 10.1007/s10680-022-09610-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/24/2022] [Indexed: 12/20/2022]
Abstract
Late-life depression is a condition that affects an ever-growing share of the population in ageing societies. While depression prevalence varies across countries for a myriad of reasons, generational factors, expressed in the shared experience of birth cohorts, may also play a part in such differentials. This paper describes the presence of age, period, and cohort (APC) effects in late-life depression prevalence trends (for adults aged 50 and above) for selected countries in Europe, using the Survey of Health and Ageing and Retirement of Europe (SHARE). We analysed six countries during the 2004-2016 period: Denmark, Sweden, and Germany, with a lower baseline prevalence, and Italy, Spain, and France, with a higher baseline prevalence. By applying a set of APC statistical models to visualise linear and nonlinear effects, we found that all countries followed a J-shaped curve when describing the transversal and longitudinal age trajectories of late-life depression. We also found a combination of nonlinear effects present in Germany, France and Sweden in males, indicating that younger male cohorts had a higher relative risk of depression. In females, we found nonlinear cohort effects, indicating that younger and older cohorts presented a higher risk of depression in Sweden and Germany and a lower risk in Spain. The presence of an increased risk for younger male cohorts may be indicative of a new trend in some countries, which may reduce the sex gap in prevalence. Future analysis should focus on the causes and mechanisms that lead to differential risks across cohorts.
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Yoon J, Kim JH, Chung Y, Park J, Sorensen G, Kim SS. Gender difference in under-reporting hiring discrimination in South Korea: a machine learning approach. Epidemiol Health 2021; 43:e2021099. [PMID: 34809416 PMCID: PMC8920741 DOI: 10.4178/epih.e2021099] [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: 07/06/2021] [Accepted: 11/17/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study was conducted to examine gender differences in under-reporting hiring discrimination by building a prediction model for workers who responded “not applicable (NA)” to a question about hiring discrimination despite being eligible to answer. METHODS Using data from 3,576 wage workers in the seventh wave (2004) of the Korea Labor and Income Panel Study, we trained and tested 9 machine learning algorithms using “yes” or “no” responses regarding the lifetime experience of hiring discrimination. We then applied the best-performing model to estimate the prevalence of experiencing hiring discrimination among those who answered “NA.” Under-reporting of hiring discrimination was calculated by comparing the prevalence of hiring discrimination between the “yes” or “no” group and the “NA” group. RESULTS Based on the predictions from the random forest model, we found that 58.8% of the “NA” group were predicted to have experienced hiring discrimination, while 19.7% of the “yes” or “no” group reported hiring discrimination. Among the “NA” group, the predicted prevalence of hiring discrimination for men and women was 45.3% and 84.8%, respectively. CONCLUSIONS This study introduces a methodological strategy for epidemiologic studies to address the under-reporting of discrimination by applying machine learning algorithms.
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Affiliation(s)
- Jaehong Yoon
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea, Seoul, Korea
| | - Ji-Hwan Kim
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea, Seoul, Korea
| | - Yeonseung Chung
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea, Daejeon, Korea
| | - Jinsu Park
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea, Daejeon, Korea
| | - Glorian Sorensen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA, Boston, United States
| | - Seung-Sup Kim
- Hana Science Hall B 368, Associate Professor of Epidemiology, Korea University., Seoul, Korea.,Interdisciplinary Program in Precision Public Health, Korea University, Seoul, South Korea, Seoul, Korea
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Keralis JM. Pain and Poverty: Disparities by Poverty Level in the Experience of Pain-Related Interference. Pain Med 2021; 22:1532-1538. [PMID: 33527133 DOI: 10.1093/pm/pnab030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess the relationship between poverty and pain-related interference. SUBJECTS Data on a sample of 108,259 adults aged 18 and older from the Household Component of the Medical Expenditure Panel Survey (MEPS) from 2013 to 2017 were analyzed. METHODS I assess the odds of reporting any pain-related interference, as well as increasing levels of pain-related interference, using binary and ordinal logistic regression, respectively. RESULTS After controlling for covariates, the analysis showed a significant association between poverty and pain-related interference, with more severe levels of poverty associated with increased odds of reporting any pain-related interference as well as increased levels of pain-related interference. However, Hispanics were less likely to report any pain-related interference overall, and more severe levels of poverty were associated with decreased odds of reporting pain among Hispanics. CONCLUSIONS Policy makers should regard poverty as a social determinant of health, taking poverty and socioeconomic status into consideration when designing health policies.
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Affiliation(s)
- Jessica M Keralis
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
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Abstract
Objectives Health studies of structural racism/discrimination have been animated through the deployment of neighborhood effects frameworks that engage institutionalist concerns about sociopolitical resources and mobility structures. This study highlights the acute illness risks of place-based inequalities and neighborhood-varying race-based inequalities by focusing on access to and the regulation of mortgage markets. Design By merging neighborhood data on lending processes from the Home Mortgage Disclosure Act with individual health from the Project on Human Development in Chicago Neighborhoods, this article evaluates the acute childhood illness risks of four mutually inclusive, political economies using multilevel generalized linear models. Setting Chicago, IL, USA. Participants Youth aged 0 to 17 years. Main Outcome Measures The prevalence of 11 acute illnesses (cold/flu, sinus trouble, sore throat/tonsils, headache, upset stomach, bronchitis, skin infection, pneumonia, urinary tract infections, fungal disease, mononucleosis) and the past-year frequencies of 6 acute illnesses (cold/flu, sinus trouble, sore throat/tonsils, headache, upset stomach, bronchitis) are evaluated. Methods Multilevel logistic regression. Results The most theoretically consistent predictor of illness is a measure identifying neighborhoods with above-city-median levels of racial disparities in the regulation of loans - a mesolevel measure of structural racism. In areas with high levels of minority-White differences in less-regulated credit, youth are more likely to have a range of acute illnesses and experience them at more frequent intervals in the past year. Conclusions This article highlights the substantive and methodological importance of focusing on multidimensional representations of institutionalized political economic inequalities circumscribed and traversed by the power relations established by institutions and the state.
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Ford CL, Takahashi LM, Chandanabhumma PP, Ruiz ME, Cunningham WE. Anti-Racism Methods for Big Data Research: Lessons Learned from the HIV Testing, Linkage, & Retention in Care (HIV TLR) Study. Ethn Dis 2018; 28:261-266. [PMID: 30116096 DOI: 10.18865/ed.28.s1.261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Public Health Critical Race Praxis (PHCRP) contributes three functional elements to health equity studies: a race conscious orientation; an antiracism lexicon based on Critical Race Theory (CRT); and an integrated, reflexive approach. Few big data studies employ all three functional elements. Therefore, this article describes the application of PHCRP to the Human Immunodeficiency Virus Testing, Linkage and Retention in care (HIV TLR) study (N=3,476,741), which connects multiple large datasets to electronic medical records to examine contextual determinants of racial/ethnic disparities in HIV care continuum outcomes in southern California. As HIV TLR demonstrates, PHCRP's innovative tools and strategies help big data research maintain fidelity to CRT.
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Affiliation(s)
- Chandra L Ford
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health at UCLA, Los Angeles, CA.,Department of Community Health Sciences, Fielding School of Public Health at UCLA, Los Angeles, CA
| | - Lois M Takahashi
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health at UCLA, Los Angeles, CA.,Price School of Public Policy, University of Southern California, Los Angeles, CA
| | - P Paul Chandanabhumma
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health at UCLA, Los Angeles, CA.,Department of Community Health Sciences, Fielding School of Public Health at UCLA, Los Angeles, CA
| | - Maria Elena Ruiz
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health at UCLA, Los Angeles, CA.,School of Nursing, University of California at Los Angeles (UCLA), Los Angeles, CA
| | - William E Cunningham
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health at UCLA, Los Angeles, CA.,Department of Health Services Research & General Internal Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA
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Niedzwiedz CL, Katikireddi SV, Reeves A, McKee M, Stuckler D. Economic insecurity during the Great Recession and metabolic, inflammatory and liver function biomarkers: analysis of the UK Household Longitudinal Study. J Epidemiol Community Health 2017; 71:1005-1013. [PMID: 28855264 PMCID: PMC5754862 DOI: 10.1136/jech-2017-209105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 02/21/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 12/11/2022]
Abstract
Background Economic insecurity correlates with adverse health outcomes, but the biological pathways involved are not well understood. We examine how changes in economic insecurity relate to metabolic, inflammatory and liver function biomarkers. Methods Blood analyte data were taken from 6520 individuals (aged 25–59 years) participating in Understanding Society. Economic insecurity was measured using an indicator of subjective financial strain and by asking participants whether they had missed any bill, council tax, rent or mortgage payments in the past year. We investigated longitudinal changes in economic insecurity (remained secure, increase in economic insecurity, decrease in economic insecurity, remained insecure) and the accumulation of economic insecurity. Linear regression models were calculated for nine (logged) biomarker outcomes related to metabolic, inflammatory, liver and kidney function (as falsification tests), adjusting for potential confounders. Results Compared with those who remained economically stable, people who experienced consistent economic insecurity (using both measures) had worsened levels of high-density lipoprotein (HDL)-cholesterol, triglycerides, C reactive protein (CRP), fibrinogen and glycated haemoglobin. Increased economic insecurity was associated with adverse levels of HDL-cholesterol (0.955, 95% CI 0.929 to 0.982), triglycerides (1.077, 95% CI 1.018 to 1.139) and CRP (1.114, 95% CI 1.012 to 1.227), using the measure of financial strain. Results for the other measure were generally consistent, apart from the higher levels of gamma-glutamyl transferase observed among those experiencing persistent insecurity (1.200, 95% CI 1.110 to 1.297). Conclusion Economic insecurity is associated with adverse metabolic and inflammatory biomarkers (particularly HDL-cholesterol, triglycerides and CRP), heightening risk for a range of health conditions.
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Affiliation(s)
| | | | - Aaron Reeves
- International Inequalities Institute, London School of Economics and Political Science, London, UK
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Stuckler
- Department of Policy Analysis and Public Management, University of Bocconi, Milan, Italy
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Niedzwiedz CL, Katikireddi SV, Reeves A, McKee M, Stuckler D. Economic insecurity during the Great Recession and metabolic, inflammatory and liver function biomarkers: analysis of the UK Household Longitudinal Study. J Epidemiol Community Health 2017; 71:jech-2017-209105. [PMID: 28847843 DOI: 10.1136/jech-2017-209105-] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Economic insecurity correlates with adverse health outcomes, but the biological pathways involved are not well understood. We examine how changes in economic insecurity relate to metabolic, inflammatory and liver function biomarkers. METHODS Blood analyte data were taken from 6520 individuals (aged 25-59 years) participating in Understanding Society. Economic insecurity was measured using an indicator of subjective financial strain and by asking participants whether they had missed any bill, council tax, rent or mortgage payments in the past year. We investigated longitudinal changes in economic insecurity (remained secure, increase in economic insecurity, decrease in economic insecurity, remained insecure) and the accumulation of economic insecurity. Linear regression models were calculated for nine (logged) biomarker outcomes related to metabolic, inflammatory, liver and kidney function (as falsification tests), adjusting for potential confounders. RESULTS Compared with those who remained economically stable, people who experienced consistent economic insecurity (using both measures) had worsened levels of high-density lipoprotein (HDL)-cholesterol, triglycerides, C reactive protein (CRP), fibrinogen and glycated haemoglobin. Increased economic insecurity was associated with adverse levels of HDL-cholesterol (0.955, 95% CI 0.929 to 0.982), triglycerides (1.077, 95% CI 1.018 to 1.139) and CRP (1.114, 95% CI 1.012 to 1.227), using the measure of financial strain. Results for the other measure were generally consistent, apart from the higher levels of gamma-glutamyl transferase observed among those experiencing persistent insecurity (1.200, 95% CI 1.110 to 1.297). CONCLUSION Economic insecurity is associated with adverse metabolic and inflammatory biomarkers (particularly HDL-cholesterol, triglycerides and CRP), heightening risk for a range of health conditions.
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Affiliation(s)
| | | | - Aaron Reeves
- International Inequalities Institute, London School of Economics and Political Science, London, UK
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Stuckler
- Department of Policy Analysis and Public Management, University of Bocconi, Milan, Italy
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Abstract
The impending implementation of pre-exposure prophylaxis (PrEP) has prompted complicated bioethical and public health ethics concerns regarding the moral distribution of antiretroviral medications (ARVs) to ostensibly healthy populations as a form of HIV prevention when millions of HIV-positive people still lack access to ARVs globally. This manuscript argues that these questions are, in part, concerns over the ethics of the knowledge production practices of epidemiology. Questions of distribution, and their attendant cost-benefit calculations, will rely on a number of presupposed, and therefore, normatively cultural assumptions within the science of epidemiology specifically regarding the ability of epidemiologic surveillance to produce accurate maps of HIV throughout national populations. Specifically, ethical questions around PrEP will focus on who should receive ARVs given the fact that global demand will far exceed supply. Given that sexual transmission is one of the main modes of HIV transmission, these questions of 'who' are inextricably linked to knowledge about sexual personhood. As a result, the ethics of epidemiology, and how the epidemiology of HIV in particular conceives, classifies and constructs sexual populations will become a critical point of reflection and contestation for bioethicists, health activists, physicians, nurses, and researchers in the multi-disciplinary field of global health. This paper examines how cultural conundrums within the fields of bioethics and public health ethics are directly implicated within the ethics of PrEP, by analyzing the problems of population inaugurated by the construction of the men who have sex with men (MSM) epidemiologic category in the specific national context of South Africa.
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Affiliation(s)
- Kirk J. Fiereck
- Department of Sociomedical Sciences, Columbia University, New York City, New York, 10032, United States, Phone: 212-305-5656
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Chapman B, Fiscella K, Duberstein P, Kawachi I, Muennig P. Measurement confounding affects the extent to which verbal IQ explains social gradients in mortality. J Epidemiol Community Health 2014; 68:728-33. [PMID: 24729404 PMCID: PMC4846277 DOI: 10.1136/jech-2013-203741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND IQ is thought to explain social gradients in mortality. IQ scores are based roughly equally on Verbal IQ (VIQ) and Performance IQ tests. VIQ tests, however, are suspected to confound true verbal ability with socioeconomic status (SES), raising the possibility that associations between SES and IQ scores might be overestimated. We examined, first, whether two of the most common types of VIQ tests exhibited differential item functioning (DIF) favouring persons of higher SES and/or majority race/ethnicity. Second, we assessed what impact, if any, this had on estimates of the extent to which VIQ explains social gradients in mortality. METHODS Data from the General Social Survey-National Death Index cohort, a US population representative dataset, was used. Item response theory models queried social-factor DIF on the Thorndike Verbal Intelligence Scale and Wechsler Adult Intelligence Scales, Revised Similarities test. Cox models examined mortality associations among SES and VIQ scores corrected and uncorrected for DIF. RESULTS When uncorrected for DIF, VIQ was correlated with income, education, occupational prestige and race, with correlation coefficients ranging between |0.12| and |0.43|. After correcting for DIF, correlations ranged from |0.06| to |0.16|. Uncorrected VIQ scores explained 11-40% of the Relative Index of Inequalities in mortality for social factors, while DIF-corrected scores explained 2-29%. CONCLUSIONS Two of the common forms of VIQ tests appear confound verbal intelligence with SES. Since these tests appear in most IQ batteries, circumspection may be warranted in estimating the amount of social inequalities in mortality attributable to IQ.
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Affiliation(s)
- Benjamin Chapman
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Center for Communication and Disparities Research, Rochester, New York, USA
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Paul Duberstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
- Department of Family Medicine, University of Rochester Medical Center, Center for Communication and Disparities Research, Rochester, New York, USA
| | - Ichiro Kawachi
- Department of Society, Human Development, and Health, Harvard University School of Public Health, Boston, Massachusetts, USA
| | - Peter Muennig
- Department of Health Management and Policy, Columbia University, Mailman School of Public Health, New York, New York, USA
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Villalonga-Olives E, Kawachi I. The changing health status of economic migrants to the European Union in the aftermath of the economic crisis. J Epidemiol Community Health 2014; 68:801-3. [PMID: 24860182 DOI: 10.1136/jech-2014-203869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ester Villalonga-Olives
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA Institute for Medical Psychology and Medical Sociology, Georg-August-University Göttingen, Germany
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
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Briggs FBS, Acuña BS, Shen L, Bellesis KH, Ramsay PP, Quach H, Bernstein A, Schaefer C, Barcellos LF. Adverse socioeconomic position during the life course is associated with multiple sclerosis. J Epidemiol Community Health 2014; 68:622-9. [PMID: 24577137 DOI: 10.1136/jech-2013-203184] [Citation(s) in RCA: 38] [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] [Indexed: 01/02/2023]
Abstract
BACKGROUND Adverse socioeconomic position (SEP) in childhood and adulthood is associated with a proinflammatory phenotype, and therefore an important exposure to consider for multiple sclerosis (MS), a complex neuroinflammatory autoimmune disease. The objective was to determine whether SEP over the life course confers increased susceptibility to MS. METHODS 1643 white, non-Hispanic MS case and control members recruited from the Kaiser Permanente Medical Care Plan, Northern California Region, for which comprehensive genetic, clinical and environmental exposure data have been collected were studied. Logistic regression models investigated measures of childhood and adulthood SEP, and accounted for effects due to established MS risk factors, including HLA-DRB1*15:01 allele carrier status, smoking history, history of infectious mononucleosis, family history of MS and body size. RESULTS Multiple measures of childhood and adulthood SEP were significantly associated with risk of MS, including parents renting versus owning a home at age 10: OR=1.48, 95% CI 1.09 to 2.02, p=0.013; less than a college education versus at least a college education based on parental household: OR=1.28, 95% CI 1.01 to 1.63, p=0.041; low versus high life course SEP: OR=1.50, 95% CI 1.09 to 2.05, p=0.012; and low versus high social mobility: OR=1.74, 95% CI 1.27 to 2.39, p=5.7×10(-4). CONCLUSIONS Results derived from a population-representative case-control study provide support for the role of adverse SEP in MS susceptibility and add to the growing evidence linking lower SEP to poorer health outcomes. Both genetic and environmental contributions to chronic conditions are important and must be characterised to fully understand MS aetiology.
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Affiliation(s)
- Farren B S Briggs
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, California, USA
| | - Brigid S Acuña
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Ling Shen
- Kaiser Permanente Division of Research, Oakland, California, USA
| | | | - Patricia P Ramsay
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, California, USA
| | - Hong Quach
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, California, USA
| | | | | | - Lisa F Barcellos
- Division of Epidemiology, Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California, Berkeley, California, USA Kaiser Permanente Division of Research, Oakland, California, USA
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Astell-Burt T, Feng X, Kolt GS. Neighbourhood green space and the odds of having skin cancer: multilevel evidence of survey data from 267072 Australians. J Epidemiol Community Health 2013; 68:370-4. [PMID: 24376218 DOI: 10.1136/jech-2013-203043] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND If green spaces encourage people to spend more time outdoors in physical, recreational and social activities, this could have unintended but important consequences for health in countries where levels of ultraviolet (UV) radiation are non-trivial. We investigated whether people who lived in neighbourhoods containing lots of green space were likely to spend more time outdoors and, subsequently, were more likely to report a case of skin cancer. METHODS Multilevel logit regression was used to fit associations between self-reported medically diagnosed skin cancer (melanoma and non-melanoma) and an objective measure of green space. These models were adjusted for measures of susceptibility (skin colour and tanning), socioeconomic variables, demographic and cultural characteristics (eg, ancestry and country of birth). Mediation analyses were conducted using self-reported measures of time spent outdoors and participation in moderate-to-vigorous physical activity (MVPA). RESULTS Descriptive analyses reported a positive association between green space and skin cancer (p<0.001). Time outdoors and in MVPA was also higher among people living in greener areas. The association between green space and skin cancer was robust after adjustment. In comparison to people with 0-20% green space, for example, the adjusted odds of having skin cancer were 9% higher among those with >80% green space. Only 1.6% and less than 1% of the association was mediated by MVPA and time spent outdoors. CONCLUSIONS Neighbourhood green space is associated with higher odds of having skin cancer in Australia. The relationship between green space and health, in its broadest terms, is likely to vary by geographical context.
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Affiliation(s)
- Thomas Astell-Burt
- School of Science and Health, University of Western Sydney, , Sydney, Australia
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Gauffin K, Hemmingsson T, Hjern A. The effect of childhood socioeconomic position on alcohol-related disorders later in life: a Swedish national cohort study. J Epidemiol Community Health 2013; 67:932-8. [PMID: 23814272 DOI: 10.1136/jech-2013-202624] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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: 02/06/2023]
Abstract
BACKGROUND Alcohol use is the third most important global-health risk factor and a main contributor to health inequalities. Previous research on social determinants of alcohol-related disorders has delivered inconsistent results. We aimed to investigate whether socioeconomic position (SEP) in childhood predicts alcohol-related disorders in young adulthood in a Swedish national cohort. METHODS We studied a register-based national cohort of Swedish citizens born during 1973-1984 (N=948 518) and followed them up to 2009 from age 15. Childhood SEP was defined by a six-category socioeconomic index from the Censuses of 1985 and 1990. HRs of alcohol-related disorders, as indicated by register entries on alcohol-related death and alcohol-related medical care, were analysed in Cox regression models with adjustment for sociodemographic variables and indicators of parental morbidity and criminality. RESULTS Low childhood SEP was associated with alcohol-related disorders later in life among both men and women in a stepwise manner. Growing up in a household with the lowest SEP was associated with risk for alcohol-related disorders of HR: 2.24 (95% CI 2.08 to 2.42) after adjustment for sociodemographic variables, compared with the highest SEP group. Adjusting the analysis for parental psychosocial problems attenuated the association to HR 1.87 (95% CI 1.73 to 2.01). CONCLUSIONS The study demonstrates that low SEP in childhood predicts alcohol-related disorders in young adulthood. Alcohol abuse needs to be addressed in policies to bridge the gap of health inequalities.
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Affiliation(s)
- Karl Gauffin
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, , Stockholm, Sweden
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Haukenes I, Riise T, Haug K, Farbu E, Maeland JG. Smokers' increased risk for disability pension: social confounding or health-mediated effects? Gender-specific analyses of the Hordaland Health Study cohort. J Epidemiol Community Health 2013; 67:758-64. [PMID: 23709663 DOI: 10.1136/jech-2012-202182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 11/03/2022]
Abstract
BACKGROUND Studies indicate that cigarette smokers have an increased risk for disability pension, presumably mediated by adverse health effects. However, smoking is also related to socioeconomic status. The current study examined the association between smoking and subsequent disability pension, and whether the association is explained by social confounding and/or health-related mediation. METHODS A subsample of 7934 men and 8488 women, aged 40-46, from the Hordaland Health Study, Norway (1997-1999), provided baseline information on smoking status, self-reported health measures and socioeconomic status. Outcome was register-based disability pension from 12 months after baseline to end of 2004. Gender stratified Cox regression analyses were used adjusted for socioeconomic status, physical activity, self-reported health and musculoskeletal pain sites. RESULTS A total of 155 (2%) men and 333 (3.9%) women were granted disability pension during follow-up. The unadjusted disability risk associated with heavy smoking versus non-smoking was 1.88 (95% CI 1.23 to 2.89) among men and 3.06 (95% CI 2.23 to 4.20) among women. In multivariate analyses, adjusting for socioeconomic status, HRs were 1.33 (95% CI 0.84 to 2.11) among men and 2.22 (95% CI 1.58 to 3.13) among women. Final adjustment for physical activity, self-reported health and musculoskeletal pain further reduced the effect of heavy smoking in women (HR=1.53, 95% CI 1.09 to 2.16). CONCLUSIONS Socioeconomic status confounded the smoking-related risk for disability pension; for female heavy smokers, however, a significant increased risk persisted after adjustment. Women may be particularly vulnerable to heavy smoking and to its sociomedical consequences, such as disability pension.
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Affiliation(s)
- Inger Haukenes
- Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
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Westerlund H, Gustafsson PE, Theorell T, Janlert U, Hammarström A. Parental academic involvement in adolescence, academic achievement over the life course and allostatic load in middle age: a prospective population-based cohort study. J Epidemiol Community Health 2013; 67:508-13. [PMID: 23493586 DOI: 10.1136/jech-2012-202052] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Parental involvement in their children's studies, particularly in terms of academic socialisation, has been shown to predict academic achievement, and is thus a candidate modifiable factor influencing life course socioeconomic circumstances. Socioeconomic disadvantage is thought to impact on health over the life course partly by allostatic load, that is, cumulative biological risk. We sought to elucidate the role of parental involvement at age 16 on the life course development of allostatic load. METHODS In a population-based cohort (365 women and 352 men, 67% of the eligible participants), we examined the association between parental involvement in their offspring's studies, measured by teacher and pupil ratings at age 16 and an allostatic load index summarising 12 physiological risk markers at age 43. Mediation through life course academic and occupational achievement was assessed by entering school grades, adult educational achievement and socioeconomic position at age 43 in a linear regression analysis in a stepwise manner and testing for mediation. RESULTS Parental interest in their offspring's studies during the last year of compulsory school-rather than the parent's social class or availability of practical academic support-was found to predict adult allostatic load (β=-0.12, 95% CI -0.20 to -0.05). Further adjustments indicated that academic achievement over the life course mediated a large part of the effect of parental interest on allostatic load. CONCLUSIONS Parental interest in their offspring's studies may have protective effects by decreasing the likelihood of a chain of risk involving low academic achievement, low socioeconomic position and high accumulated physiological stress.
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Affiliation(s)
- Hugo Westerlund
- Stress Research Institute, Stockholm University, Stockholm SE-106 91, Sweden.
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Hargreaves JR, Davey C, White RG. Does the 'inverse equity hypothesis' explain how both poverty and wealth can be associated with HIV prevalence in sub-Saharan Africa? J Epidemiol Community Health 2012; 67:526-9. [PMID: 23235546 DOI: 10.1136/jech-2012-201876] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- James R Hargreaves
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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