BMJ Public Health最新文献

{"title":"Development of indicators to measure health system capacity for quality abortion care in 10 countries: a rapid assessment of a measurement framework and indicators","authors":"Heidi Bart Johnston, Ulrika Rehnstrom Loi, Mohamed Ali, Katy Footman, Ghislaine Glitho Alinsato, Eman Aly, Asmani Chilanga, Shikha Bansal, Laurence Codjia, Fahdi Dkhimi, Sithembile Dlamini-Nqeketo, H. Elamin, Dina Gbenou, K. Gholbzouri, Lisa Hedman, N. Hemachandra, Yelmali Hien, Md Khurshid Alam Hyder, Theopista John, Amrita Kansal, Priya Karna, Laurence Läser, Antonella F. Lavelanet, Belete Mihretu, P. Onyiah, L. Ouedraogo, Sikander Qais, E. Thom, M. Upadhyay, Qudsia Uzma, S. Zan, B. Ganatra","doi":"10.1136/bmjph-2023-000401","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000401","url":null,"abstract":"A significant gap exists in the availability of indicators and tools to monitor health system capacity for quality abortion care at input and process levels. In this paper, we describe the process and results of developing and assessing indicators to monitor health system capacity strengthening for quality abortion care.As part of a 4-year (2019–2022) multicountry project focused on preventing unsafe abortion using a health system strengthening approach in 10 countries, we developed a monitoring framework with indicators and metadata. Through an internal consultative process, we identified a structured list of operational health system capacity indicators for abortion. After implementing the indicators for baseline and annual project monitoring, project staff from 10 teams assessed each indicator using 4 criteria: validity, feasibility, usefulness and importance.We identified 30 indicators aligning with 5 of the 6 WHO health system building blocks (excluding service delivery): 6 indicators in leadership and governance, 5 in health workforce, 6 in health information, 8 in access to medicines and health products and 5 in health financing. In our assessment of indicators, average scores against the predetermined criteria were lowest for feasibility (7.7 out of 10) compared with importance (8.5), usefulness (8.9) and validity (9.3). Assessors highlighted the need for fewer and less complex indicators, simplified language, clearer benchmarks, for indicators to be abortion-specific, less subjective and for future frameworks to also include service delivery and research and innovation.We used 30 indicators to monitor health system capacity for quality abortion care in 10 countries and gathered critical feedback that can be used to further strengthen the set of indicators in future work. Establishing core input and process indicators will be critical to inform and support evidence-based policy and programme improvements for quality abortion care.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141028043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability of digital vending machines to improve access to sexual and reproductive health in Brighton, UK: a qualitative analysis","authors":"Syra Dhillon, R. Wenlock, G. Dean, John Mear, Richard Cooper, Jaime H. Vera","doi":"10.1136/bmjph-2023-000598","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000598","url":null,"abstract":"Sexual health remains a public health priority and relies on widely available testing to enable prompt diagnosis and treatment. Technology-based approaches to distribute tests have potential to increase access and enable prompt diagnosis and treatment. We evaluated the acceptability of vending machines (VMs) to distribute HIV self-test (HIVST) and sexually transmitted infection (STI) self-sample kits, from the service user and stakeholder perspective.Six VMs were placed across Brighton and Hove (UK) in publicly accessible locations. After use, individuals received a text with an online questionnaire link. Participants completing the questionnaire were invited to a semistructured interview. Stakeholders were staff on sites where the VM was placed. Data analysis took place on NVivo, using a thematic approach.12 users completed the interview. 42% within the age 18–25 years with equal male and female identifying distributions. 33% were heterosexual, 25% homosexual and 33% bisexual. VM acceptability was high with anonymity and instant access as main benefits. Some participants expressed concern that the public location of the VM may deter others from using it. Participants found the HIVST mouth swabs were acceptable, although there was concern over accuracy. Participants welcomed being able to access comprehensive sexual health screening through a VM. Five stakeholders completed the interview. There was recognition that a publicly visible VM led to positive sexual health conversations between service users and staff. There were initial issues with restocking and machine hardwiring.VMs to distribute HIV and STI testing kits is acceptable to service users and stakeholders. The main reported benefits are increased confidentiality, privacy and immediate access. Further education referencing the accuracy of the HIVST mouth swab may alleviate concerns. From a stakeholder perspective, the pathway is beneficial and the role of community champions to reduce stigma is favourable.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141048319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of perinatal post-traumatic stress disorder (PTSD) in low-income and middle-income countries: a systematic review and meta-analysis","authors":"Holly Jenkins, Zoe Daskalopoulou, C. Opondo, F. Alderdice, G. Fellmeth","doi":"10.1136/bmjph-2023-000215","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000215","url":null,"abstract":"To systematically synthesise the evidence on prevalence of perinatal post-traumatic stress disorder (PTSD) in low-income and middle-income countries (LMICs).Systematic review and meta-analysis.MEDLINE, Embase, PsycINFO, Scopus, Web of Science, Global Health, Global Index Medicus and the grey literature were searched with no language or date restrictions. The final search was carried out on 3 May 2022.Cross-sectional, cohort or case–control studies that assessed the prevalence of PTSD in pregnant or postpartum women in LMICs were included.Screening, data extraction and quality assessment were conducted independently by two reviewers. Pooled prevalence estimates were calculated with 95% CIs and prediction intervals (PI) using random-effects meta-analyses. Subgroup analyses and meta-regression were conducted to explore possible sources of statistical heterogeneity.39 studies were included in the systematic review of which 38 were included in meta-analysis. The pooled prevalence of clinically diagnosed perinatal PTSD was 4.2% (95% CI 2.2% to 6.8%; 95% PI 0–18%; 15 studies). The pooled prevalence of self-reported perinatal PTSD symptoms was 11.0% (95% CI 7.6% to 15.0%; 95% PI 0–36%; 23 studies). There was no evidence of differences in prevalence according to perinatal stage (antenatal versus postnatal), geographical region, type of setting or study quality.Findings of this review suggest 1 in 10 perinatal women experiences symptoms of PTSD and 1 in 20 experiences clinically diagnosed PTSD. Statistical heterogeneity between studies persisted in subgroup analyses and results should be interpreted with caution. More research from low-income countries is needed to improve understanding of the burden of perinatal PTSD in these settings.CRD42022325072.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141054736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary factors associated with anaemia among pregnant women attending antenatal care clinics in Sekota town, Northern Ethiopia: a facility-based cross-sectional study","authors":"Kassahun Ayele, Meron Demisew","doi":"10.1136/bmjph-2023-000368","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000368","url":null,"abstract":"Anaemia is a major public health problem during pregnancy, especially in developing countries such as Ethiopia. Poor diet patterns are common contributors to anaemia. This study assessed the dietary factors associated with anaemia among pregnant women attending antenatal care clinics in Sekota town, Northern Ethiopia.A facility-based cross-sectional study was conducted from June to August 2021 among 367 pregnant women who were selected using systematic random sampling techniques. A structured questionnaire was used to collect sociodemographic, obstetric and dietary data. The nutritional status of pregnant women was assessed using a mid-upper arm circumference measuring tape, and haemoglobin levels were tested using the haematocrit centrifugation technique. The data were analysed using SPSS V.21. Bivariate and multivariate logistic regression analyses were performed to assess dietary factors associated with anaemia and p<0.05 was used to declare statistical significance.Dietary pattern predictors such as meal frequency (adjusted OR (AOR)=0.27, 95% CI: 0.12, 0.59), meat consumption frequency (AOR=4.05, 95% CI: 2.46, 33.65), fruit and vegetable consumption frequency (AOR=2.88, 95% CI: 2.08, 26.81), Dietary Diversity Score (AOR=12.81, 95% CI: 3.93, 41.75), food aversion (AOR=0.12, 95% CI: 0.03, 0.47) and undernutrition (AOR=0.22, 95% CI: 0.07, 0.64) were significantly associated with anaemia.Predictors of dietary pattern, such as meal frequency, Dietary Diversity Score, food aversion, meat consumption frequency, fruit and vegetable consumption frequency, and undernutrition were significantly associated with anaemia among pregnant women in the study area. Therefore, healthcare providers, policymakers, researchers and other stakeholders should pay special attention to maternal dietary patterns to address the identified factors. Programmes should be developed and implemented to improve optimal dietary patterns and proper nutrition during pregnancy to overcome anaemia and other pregnancy complications.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141056217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting implementation of interventions for oral health, substance use, smoking and diet for people with severe and multiple disadvantage: a community-based qualitative study in England","authors":"N. Jain, E. Adams, E. C. Joyes, Gillian McLellan, M. Burrows, M. Paisi, L. McGowan, Lorenzo Iafrate, David Landes, R. Watt, F. Sniehotta, Eileen Kaner, S. Ramsay","doi":"10.1136/bmjph-2023-000626","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000626","url":null,"abstract":"Populations facing severe and multiple disadvantage (SMD), co-occurring homelessness, substance use and repeat offending have high levels of physical and mental ill-health. Poor oral health is one of the most common health problems in this population and is closely linked with substance use, smoking and poor diet. Issues related to the implementation of interventions among SMD populations to address oral health and related health behaviours are poorly understood. This study aimed to understand the factors that affect implementation (relevance of setting, acceptability and adverse effects of interventions) and the sustainability of interventions targeting oral health, substance use, smoking and diet for people experiencing SMD.Between August 2021 and April 2023, interviews and focus group discussions were conducted with two groups of participants: (1) people experiencing SMD in Newcastle Upon Tyne/Gateshead and (2) frontline staff, volunteers, policymakers and commissioners from London, Plymouth and Newcastle Upon Tyne/Gateshead. Information was gathered on factors related to the implementation and acceptability of interventions related to oral health and related behaviours. The data were analysed iteratively using thematic analysis.Twenty-eight people experiencing SMD (age range: 27–65 years; 21% females) and 78 service providers, commissioners and policymakers (age range: 28–72 years; 63% females) were interviewed or included in focus groups. The data were organised into three overarching themes: environmental, organisational and interpersonal factors. Environmental factors included funding and integrated services; organisational factors included inclusive services, health promotion, prevention and training healthcare providers; interpersonal factors included the presence of support workers and motivation among service providers.The implementation and sustainability of health interventions for people experiencing SMD are influenced by factors across environmental, organisational and interpersonal levels that interact with the inherent challenges of disadvantaged groups. The findings highlight the need for tailoring healthcare interventions according to the needs of people experiencing SMD. Further research on the implementation of diet interventions and co-producing interventions is needed.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141030529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the feasibility of using publicly available data sources to identify healthcare data discrepancies and enhance service delivery: a retrospective cross-sectional study of four low human index scoring countries","authors":"Alix Boisson-Walsh, Jack Lewis, M. Neilson, Sheila Leatherman","doi":"10.1136/bmjph-2023-000145","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000145","url":null,"abstract":"Quality of care (QoC) remains a persistent challenge in countries with low Human Development Index scores (LHDIS) despite global efforts to promote universal health coverage. Addressing root causes and systematically implementing improvement interventions in LHDIS countries require a better understanding and use of QoC data. We aim to describe the data gaps and illustrate the state of quality in health services across a small set of countries. We demonstrate how we can leverage currently available, although imperfect, public data sources to compile quality metrics across multiple LHDIS countries.Using public data sources, the Demographic Health Survey (DHS) and Service Provision Assessment (SPA), we selected relevant quality metrics and categorised them within a QoC matrix. We based the selection of metrics on the quality of care in fragile, conflict-affected and vulnerable settings framework domains and the Donabedian model. Criteria for our retrospective cross-sectional study included a LHDIS and recent availability of both DHS and SPA data for data relevance.The approach was feasible, with relevant indicators distributed across various QoC categories. However, some cells in the indicator matrix lacked suitable indicators from SPA and DHS data. We selected the Democratic Republic of the Congo, Haiti, Afghanistan and Senegal for a snapshot of QoC in LHDIS countries. Comparisons highlighted areas of positive performance and shared challenges across these countries, with notable variability in certain categories. Senegal ranked highest overall, while Afghanistan ranked lowest across all matrix categories. Senegal had the most comprehensive data, with 94.7% of metrics available. Missing data existed for two specific metrics in all four countries, particularly within the improving clinical care domain.The results are a clarion call for advancing efforts to develop standardised, publicly available, routinely collected and validated data sets to measure and publicly report LHDIS countries’ state of quality to marshal global attention and action in pursuit of more significant health equity.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141053951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of scaling up of kangaroo mother care on neonatal mortality among babies born with birth weight <2000 g in a district in southern India: a prospective cohort analysis","authors":"Tinku Thomas, Arin Kar, Suman P N Rao, Swaroop Narayana, Maryann Washington, Shashidhar Rao, K. Jayanna, Prabhu Deva Gowda, M. Lakkappa, P. Mony","doi":"10.1136/bmjph-2023-000349","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000349","url":null,"abstract":"To assess the impact of scaling up of kangaroo mother care (KMC) on neonatal mortality among babies born with birth weight <2000 g across an entire district in southern India.Within an implementation research setting, analysis of a prospective birth cohort of babies with birth weight <2000 g born during March–December 2018 in Koppal district of Karnataka state, India, to estimate the incidence, risk and HRs of neonatal mortality associated with KMC.Initiation and maintenance of KMC.Neonatal mortality.Among 23 667 live births, 1152 (4.9%) had birth weight <2000 g; the birth weight was <1500 g in 24% and <1000 g in 4%. Among them, 213 (18%, 95% CI 16% to 21%) babies died during the neonatal period, with 56% of the mortality occurring in the first 3 days of life and risk of mortality decreasing with higher birth weight. Overall, KMC was initiated in 816 (71%) babies; KMC-initiated babies had a substantially lower risk of neonatal mortality (risk ratio 0.07 (95% CI 0.05 to 0.09)). In a subset of 705 babies ‘eligible-for-KMC’ after exclusion of deaths, referrals or ‘terminal discharges’ (leaving against medical advice) in the first 3 days of life, and whose mother was a resident of the study area, 88% (95% CI 85% to 90%) were initiated on KMC. The RR of mortality among KMC-initiated babies remained low at 0.05 (95% CI 0.03 to 0.08) after adjusting for covariates and propensity-score adjusted analysis to address selection bias. Among 874 babies with follow-up data till 29 days of life, neonatal mortality rate was 24.4% (95% CI 21.6% to 27.3%); it was 6.4% (95% CI 4.7% to 8.6%) among KMC-initiated babies and 74.8% (95% CI 67.8% to 79.1%) among non-initiated babies (n=233).KMC implementation across a district was associated with substantial reduction in neonatal mortality. Scaling up KMC coverage across large geographies could facilitate achieving global child survival targets.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141058112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rehabilitation needs screening to identify potential beneficiaries: a scoping review","authors":"Wouter De Groote, Melissa Corso, Kent Murnaghan, Antony Duttine, Carla Sabariego","doi":"10.1136/bmjph-2023-000523","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000523","url":null,"abstract":"The aim is to identify and compare the content of screening tools and needs assessments used to select rehabilitation beneficiaries and to describe the context of their use.Scoping review.We systematically searched five indexed databases for studies published from 1 January 2010 to 3 February 2023.We searched for papers published in English only. Papers describe a screening tool or needs assessment aiming to prospectively select potential beneficiaries of rehabilitation services based on a cut-off score or classification system.We charted the evidence according to the characteristics of the paper, rehabilitation needs screening context, screening tool and content of the screening tool. A descriptive synthesis is provided for screening methodology, settings, target populations, rehabilitation need types and phases of care. The WHO International Classification of Functioning, Disability and Health is used to categorise screening items.We identified 24 tools that use a range of screening methodologies, but mostly questionnaires that are used by health workers. Most tools have been proposed for the identification of a rehabilitation beneficiary among people with selected health conditions assessing the need to access a specific rehabilitation intervention, programme or occupational group. The majority of tools screen for current functioning limitations, and this is often the only screening component. When mapping screening items with the WHO International Classification of Functioning, Disability and Health (ICF), almost all ICF chapters for body functions and activities and participation have been included across screening tools, with the following most frequently included ICF categories: emotional functions (b152), acquiring, keeping and terminating a job (d845), sensation of pain (b280) and carrying out daily routine (d230).Rehabilitation need screening tools commonly include the screening for current functioning limitations among people with selected health conditions. A screening tool that is applicable across health conditions and settings is not available.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140788241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between lifestyle factors and COVID-19 infection rates: a cross-sectional analysis in the USA","authors":"Razaz Shaheen, W. L. Beeson, Michael Paalani, Hildemar Dos Santos, A. Alismail, Rhonda K Spencer-Hwang","doi":"10.1136/bmjph-2024-000906","DOIUrl":"https://doi.org/10.1136/bmjph-2024-000906","url":null,"abstract":"The COVID-19 pandemic has underscored the vital connection between lifestyle factors and health outcomes, highlighting the need to understand how lifestyle choices influence both chronic and infectious diseases. Despite known links between lifestyle factors and chronic diseases, the relationship between these factors and infectious diseases like COVID-19 warrants further investigation.This cross-sectional study used an anonymous survey collected from a diverse sample of US residents aged 18 or older. Excluding individuals under 18 or residing outside the USA, the survey captured data on diet, body mass index, smoking status, alcohol consumption, physical activity, sleep duration, COVID-19 infection status, socio-demographics and other potential confounders. Statistical analysis was performed using χ2tests and logistic regression to explore the associations between lifestyle factors and COVID-19 infection, with a particular focus on gender differences.Among 1032 participants, the prevalence of COVID-19 was higher in women (42.8%) compared with men (32.0%). Significant associations were found between inadequate sleep (less than 4 hours per day) and increased risk of COVID-19 in both genders (OR=2.89, 95% CI: 1.13 to 7.35, p=0.02 for men; OR=5.69, 95% CI: 3.14 to 10.29, p<0.00 for women). Additionally, a significant association was observed between a lifestyle index, incorporating multiple lifestyle factors and COVID-19 infection in women (OR=1.79, 95% CI: 1.05 to 3.025, p=0.03).The findings indicate a potential link between lifestyle factors and susceptibility to COVID-19, with inadequate sleep identified as a significant risk factor. These results suggest that promoting a healthy lifestyle could be an effective strategy for controlling the pandemic and mitigating the impact of infectious diseases. Further research is recommended to explore the role of restful sleep in preventing COVID-19 for men and women (including multiple lifestyle factors among women).","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140761081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Area deprivation and premature cardiovascular mortality: a nationwide population-based study in South Korea","authors":"Eunji Kim, Hokyou Lee, D. Lloyd-Jones, Young Gyu Ko, Byoung Gwon Kim, Hyeon Chang Kim","doi":"10.1136/bmjph-2023-000877","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000877","url":null,"abstract":"Regional disparities in cardiovascular disease (CVD) burden exist. The effect of area deprivation, one of the possible explanations, still needs to be fully understood. This population-based study investigated the association between Area Deprivation Index (ADI) and CVD-related premature death.ADI was derived from 10 socioeconomic indicators in 250 South Korean municipalities using the 2020 Population and Housing Census data. Mortality rates for CVD and its subtypes, namely ischaemic heart diseases, other heart diseases and cerebrovascular diseases, in adults under 65 years were directly standardised by sex and age, referencing the total population structure. Municipalities were categorised by urbanicity, and adjustments for the number of hospitals and geographical area size were made using log-linear regression models.The most deprived municipalities showed 41.6% excess mortality for CVD, 30.3% for ischaemic heart diseases, 60.7% for other heart diseases and 36.9% for cerebrovascular diseases compared with the least deprived municipalities. Even after adjusting for the number of hospitals per unit area, the association between ADI and premature CVD death was more significant in metropolitan areas than in other provinces. For each incremental increase in the continuous ADI, the adjusted mortality rate ratios were observed as 1.031 (95% CI, 1.020 to 1.043) in metropolitan areas and 1.009 (95% CI, 1.000 to 1.019) in other provinces. Additional multilevel analyses showed consistent findings of a higher risk in deprived areas.This study highlights a higher risk of premature cardiovascular death in socioeconomically disadvantaged areas. CVD prevention strategies should reflect regional characteristics and focus on reducing the burden in deprived metropolitan areas.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140774901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}