European Journal of Public Health最新文献

While alcohol's health effects are well documented, less is known about how health influences alcohol use and whether this varies by socioeconomic position (SEP). This study investigated the association between health-related quality of life (HRQoL), mental health, and alcohol use, and whether SEP moderates these associations. Baseline data from 7097 participants in the 2010 Stockholm Public Health Cohort were used. The exposures were HRQoL and mental health (good, moderate, poor); Outcomes (2014) were heavy episodic drinking (HED: ≥5 units/≥2 times/month) and heavy drinking (men: ≥21 units/week; women: ≥14 units/week). Logistic regression estimated odds ratios (OR), with interaction assessed using relative excess risk of interaction (RERI) and attributable proportion (AP). Joint exposure analyses used good health and high SEP as the reference group. Compared with good HRQoL, moderate (OR: 1.26, 95% CI: 1.02-1.56) and poor HRQoL (OR: 1.39, 95% CI: 1.08-1.78) were associated with higher odds of heavy drinking. Moderate HRQoL and low SEP had increased odds of HED (OR: 1.48, 95% CI: 1.02-2.15) and heavy drinking (OR: 1.62, 95% CI: 1.01-2.60), with evidence of additive interaction (RERI: 0.79; AP: 0.49). Mental health findings were less consistent: good mental health and low SEP was associated with increased HED (OR: 1.35), while moderate mental health and intermediate SEP was associated with decreased HED (OR: 0.66). Findings suggest a dose-response relationship between HRQoL and self-reported heavy drinking and an interaction between moderate HRQoL and low SEP. Associations with mental health were weaker and inconsistent.

Mental health issues are highly prevalent among precarious workers, often leading to prolonged sickness absence and unemployment. A worker's perceptions and attitudes about return-to-work are important determinants of work resumption and can be categorized into three modes: an expectant, an ambivalent-uncertain, and an active return-to-work mode. To support professionals in identifying these modes, we developed the REturn-to-work MODe Evaluation (REMODE) tool. This study evaluated REMODE's inter-rater agreement, inter-item consistency, content validity, and usability. In a vignette study, 71 occupational health professionals from a Dutch social security institute viewed six videos of consultations between insurance physicians and precarious workers. They then used REMODE to assess the worker's return-to-work mode and need for occupational support. Participants also rated REMODE's validity and usability with 5-point Likert scale questions based on the Content Validity Index and System Usability Scale. We used a generalized linear mixed model to analyse inter-rater agreement and inter-item consistency. The professionals highly agreed on the REMODE-score [ICC 0.87 (95% CI 0.63-0.97)] and corresponding return-to-work mode [ICC 0.83 (0.54-0.95), Κω 0.75 (0.74-0.75)]. Their agreement on need for occupational support was moderate [ICC 0.65 (0.30-0.89), Κω 0.57 (0.56-0.57)]. REMODE's internal consistency demonstrated excellence (Cronbach's alpha 0.92), and the content validity index (0.83) and system usability scale (76) were acceptable. REMODE is a promising tool for occupational health professionals as it supports identification of the return-to-work mode of precarious workers with mental health issues. We propose a refined version of RE-MODE for use in occupational healthcare and research.

Background: Ensuring equitable healthcare provision is key in ageing societies, yet it may be hindered by financial barriers. We assessed trends and socioeconomic disparities in cost-related forgone medical care among Swiss adults aged 65 years and older between 2017 and 2024.

Methods: We used data from the 2017, 2021, and 2024 waves of the 'International Health Policy Survey', a population-based study of randomly sampled adults aged 65 or older (n = 2570, 1888, and 1948, respectively). Participants reported whether they had forgone medical prescriptions, consultations, medical tests, treatments or follow-up consultations, and dental visits due to cost. Weighted prevalence estimates were computed for services covered by the basic insurance and for dental care. Disparities by education and income were assessed using stratified analyses and the index of disparity.

Results: Participants' characteristics were stable across all waves (mean age 75; 54% women). In 2024, 20% reported forgoing at least one service due to cost (13% forgoing dental care, 13% insurance-covered services). Forgone care was similar in 2017 (21%) and lower in 2021 (16%). Forgone care was more frequent among men and participants aged 65-79 years. The index of disparity showed widening income-related disparities over time, while disparities by education remained stable. Dental care consistently showed the largest disparities.

Conclusion: Despite Switzerland's compulsory health insurance, one in five older adults still forgo care for financial reasons. Rates of forgone care remained stable, but income disparities have widened since 2017.

Commercial products such as tobacco, alcohol, ultra-processed food and fossil fuels drive the global burden of non-communicable diseases (NCDs) and the escalating climate crisis. The concept 'commercial determinants of health' (CDOH) offers a framework for understanding the ways in which commercial actors, processes, and products influence health. With most CDOH research originating from Anglo-Saxon countries, we sought to map Germany's CDOH research landscape and related scientific discourse. We conducted a scoping review according to a pre-registered protocol. Records were identified through systematic searches in Medline, Embase, Web of Science, and Google Scholar, last updated 6 December 2024, and by searching seminal CDOH literature. We included peer-reviewed articles (co-)authored by researchers affiliated with German institutions, which examined the public health effects of corporate sector practices; results were presented in an evidence map. We included 136 articles, comprising 64 original research articles (47.1%), 36 overview type articles (26.5%), and 17 opinion pieces (12.5%). Fifteen mentioned the 'commercial determinants of health' (11.0%). Research activities focused on the tobacco, alcohol, food, and pharmaceutical industries; articles were primarily concerned with political, scientific, marketing, and reputational management practices. A supplementary social network analysis showed fragmented authorship networks. CDOH are key upstream determinants to consider in the prevention of NCDs. Germany faces a substantial and growing burden of disease from NCDs but the country's research on the CDOH is limited. We suggest that researchers embrace the scholarship on CDOH, and that practitioners harness relevant insights in addressing the commercially driven NCD burden.

Multimorbidity places increasing pressure on healthcare systems, requiring effective tools to assess clinical complexity. Existing comorbidity indices are often setting-specific and lack generalizability. The Multisource Comorbidity Score (MCS), developed in Italy, has shown strong predictive value. This study aimed to externally validate MCS and to test recalibrated and context-adapted versions to enhance its performance in a different healthcare system. A longitudinal observational study included 198 753 residents aged ≥50 in the Barcelona-Esquerra health district, followed between 2016 and 2019. The original MCS was validated, and two adapted versions were tested: a recalibrated MCS with locally derived weights and an enhanced MCS incorporating primary care data. Predictive validity for 1-year mortality (primary outcome) and secondary outcomes (4-year mortality, hospitalizations, and healthcare use) was assessed using the Area Under the Receiver Operating Characteristic (AUROC) curve, survival analysis, and net reclassification improvement (NRI). All MCS versions showed good discrimination. AUROCs for 1-year mortality were 0.742 (original), 0.756 (recalibrated), and 0.771 (enhanced). Adapted versions achieved better risk reclassification and higher discrimination for long-term mortality. Higher MCS scores were associated with progressively lower survival probabilities and increased healthcare resource utilization. The MCS demonstrated satisfactory external validity in the validation context, with adapted versions offering modest improvements.

Wastewater-based surveillance (WBS) is increasingly recognized as a valuable tool for monitoring public health at the population level. However, its integration into national public health frameworks across Europe remains uneven. In mid-2024, the EU-WISH Joint Action conducted a system mapping survey across 27 European countries to assess the governance, development, and integration of WBS systems. The survey combined quantitative and qualitative data to evaluate national strategies, legal and financial frameworks, and system capacities. By May 2024, most participating countries had operational WBS systems, primarily targeting SARS-CoV-2. Other monitored targets included influenza and other respiratory viruses, poliovirus, antimicrobial resistance (AMR), emerging pathogens, illicit drugs, and health-related biomarkers. Prioritization in system design was largely based on operational feasibility and perceived public health value. Challenges identified included fragmented governance, lack of sustainable financing, and limited workforce capacity. Integration into public health decision-making varied, and dissemination practices differed significantly across countries and surveillance targets. The EU-WISH survey provides a baseline assessment of WBS implementation across Europe and highlights key enablers and barriers to its institutionalization. The findings support ongoing efforts at national and EU levels to enhance coordination, sustainability, and integration of WBS into routine public health frameworks.

Prior research has shown that high composite biological health scores (BHS, based on the allostatic load theory of multisystem physiological dysregulation) are associated with mortality. However, most of this work remains cross-sectional and does not explore the implications of long-term biological health changes, although this is an essential perspective for a better understanding of ageing and health span. To explore the relationship between BHS-at two time points and longitudinally-and mortality, we analysed waves six (2007-08) and seven (2015-16) of the Tromsø Study linked with all-cause mortality data from the Norwegian Population Registry up to 2022. Using 10 biomarkers from 8117 individuals, we created 2-category (low/high) Tromsø6-BHS, Tromsø7-BHS, and longitudinal BHS measures. Cox proportional hazard regression analysis adjusted for confounders revealed that both higher Tromsø6-BHS and Tromsø7-BHS were significant predictors of mortality 15 and 7 years later, respectively (Tromsø6-BHS: HR = 1.20 [0.99-1.45]; Tromsø7-BHS: HR = 1.26 [1.05-1.52]), and that the 7-year mortality risk was more pronounced for the longitudinal BHS (1.30 [1.09-1.56]). Corresponding sex- and age-adjusted median survival was lowered by 0.71, 1.69, and 1.84 years in participants with a high versus low Tromsø6-BHS, Tromsø7-BHS and longitudinal-BHS, respectively. These results indicate that both historical elevations of BHS and their cumulation over time play a role in determining mortality risk. Our findings underline the importance of monitoring biological health over the life course as a preventive measure and suggest that individuals with high BHS levels may benefit from dynamic monitoring from mid-adulthood to mitigate the risk of premature mortality.

Biopsychosocial frailty, integrating physical, psychological, and social dimensions, significantly affects health outcomes in older adults. Hospitalization, a major contributor to healthcare burden, is strongly associated with frailty. However, the role of socioeconomic determinants within frailty trajectories remains insufficiently explored. This study aimed to evaluate the association between biopsychosocial frailty trajectories and hospitalization rates, with a focus on social determinants. We conducted a retrospective cohort study involving 6086 individuals (mean age 83.6 ± 4.9 years; 65.9% women). They underwent serial frailty assessments between 2016 and 2024 using the Short Functional Geriatric Evaluation (SFGE). Frailty trajectories were categorized as improved, stable, or worsened. Hospitalization rates were analyzed through parametric/non-parametric tests and negative binomial regression models adjusted for age, baseline frailty, and psycho-physical status. Hospitalization rates increased with frailty severity: 84‰ in robust, 97‰ in pre-frail, 149‰ in frail, and 136‰ in very frail individuals (P < 0.001). Improved or stable financial conditions significantly reduced hospitalization risk (rate ratio [RR] 0.24 and 0.41, respectively), as did stable or restored informal support networks (RR 0.45 and 0.79, respectively). Improved living arrangements were also associated with reduced hospital admissions. Robust and pre-frail individuals accounted for ∼50% of all admissions. Social and economic stability are key protective factors against hospitalization in older adults, independent of physical frailty. Community-based interventions addressing social isolation and financial vulnerability could substantially reduce hospital admissions, particularly among robust and pre-frail individuals. A holistic approach integrating social, economic, and physical frailty dimensions is recommended to optimize public health strategies for aging populations.