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A new era of inequality: profound changes to mortality in England, Scotland, and 10 major British cities.
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-19 DOI: 10.1093/eurpub/ckaf008
Maria Teresa de Haro Moro, Lauren Schofield, Rosalia Munoz-Arroyo, Gerry McCartney, David Walsh

Deeply concerning changes to UK health trends have been noted since the early 2010s, including a widening of mortality inequalities. Given the importance of urban areas to national health outcomes, we sought to address gaps in the evidence by examining trends in intra-city mortality inequalities across Britain, including assessing the impact of the peak COVID-19 pandemic period. Age-standardized mortality rates were calculated (for England, Scotland, and 10 major UK cities) by age (all ages, 0-64 years), sex, year (1981-2020), and country-specific and city-specific area-based quintiles of socio-economic deprivation. Trends in absolute and relative inequalities in mortality by country and city were analysed by means of the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII), respectively. Profound changes to mortality trends and inequalities were observed across both nations and all cities in the decade up to 2020, including increases in death rates among the 20% most deprived populations of almost every city. For deaths at all ages, this was particularly evident in Leeds, Liverpool, Edinburgh, Dundee, and Glasgow. For 0-64 years, Scottish cities stood out. With few exceptions, both absolute and relative inequalities increased in the same time period. COVID-19 further increased death rates and inequalities. The analyses provide a hugely concerning picture of worsening mortality and widening inequalities across England and Scotland. When viewed in the context of the evidence for the impact of UK government austerity policies on population health, they represent a wake-up call for both current and future UK governments.

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引用次数: 0
Effects of changes to income tax and devolved benefits in Scotland on health inequalities: a modelling study.
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-11 DOI: 10.1093/eurpub/ckaf009
Elizabeth Richardson, David Walsh, Gerry McCartney, Andrew Pulford, Mark Robinson

There is a well-understood relationship between inequalities in income and health. We assessed how changes to income tax and social security-options recently devolved to the Scottish Government-could affect income and life expectancy inequalities. We used the microsimulation model UKMOD to estimate policies' effects on household income distribution by socioeconomic deprivation, compared to baseline (Scottish income tax schedule for 2022/23). We then used the 'Triple I' (Informing Interventions to reduce health Inequalities) scenario modelling approach to estimate mortality effects for the income changes and calculated inequalities in life expectancy at birth. Scenario health impacts were determined largely by how much money they gave or took from households in the most deprived areas. Policies that increased incomes for households in deprived areas tended to reduce inequalities in life expectancy. Although we found this also applied to tax-cutting policies that increased income inequality, our estimates did not account for the public spending cuts that these costly policies would necessitate and their likely widening effect on health inequalities. Combining the best-performing (i.e. greatest positive impact) revenue-generating and revenue-spending policies we modelled-tax increases targeted at high earners and a doubling the value of social security benefits-would generate net revenue while reducing income inequality by approximately 10% and inequalities in life expectancy by 8% to 9%, but sizeable inequalities would remain. A multifaceted approach based on combinations of policies-including, but not limited to, bolder income tax measures-is required to achieve meaningful reductions in inequalities.

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引用次数: 0
Excess healthcare utilization and costs linked to chronic conditions: a comparative study of nine European countries. 与慢性病相关的过度医疗使用和成本:九个欧洲国家的比较研究。
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-11 DOI: 10.1093/eurpub/ckaf012
Boris Polanco, Ana Oña, Armin Gemperli, Diana Pacheco Barzallo

The increasing prevalence of chronic conditions is a significant challenge for healthcare systems worldwide, not only from a public health perspective but also for the aggregate cost that these represent. This paper estimates the additional use of healthcare services due to chronic health conditions and their associated costs in nine European countries. We analyzed inpatient and outpatient healthcare utilization using longitudinal data (Survey of Health, Ageing and Retirement in Europe [SHARE]). We implemented a difference-in-differences approach across multiple time periods. Monetary estimates were derived using WHO-CHOICE healthcare service costs. To compare countries, we calculated the healthcare cost burden of chronic conditions as a percentage of total health expenditure. People with chronic conditions require significantly more healthcare services than those without such conditions, averaging three additional outpatient visits and one extra overnight inpatient stay annually. These patterns vary across countries. In Germany, outpatient care usage is particularly high, with an average of four additional visits, while Switzerland leads in inpatient care with two extra overnight stays. The associated costs also differ widely, influenced by variations in healthcare demand, service pricing, and the prevalence of chronic conditions in each country. Chronic conditions significantly increase healthcare utilization, and demographic trends suggest this demand will continue to grow steadily. This rising pressure poses serious challenges for healthcare systems, necessitating a shift toward more efficient service delivery models.

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引用次数: 0
Women's physical health around live births and pregnancy losses: a longitudinal study.
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-11 DOI: 10.1093/eurpub/ckaf013
Alessandro Di Nallo

This study examines the long-term physical health impacts of pregnancy outcomes, comparing women who experienced live births to those who had pregnancy losses (miscarriages or stillbirths). While previous research has documented short-term links between pregnancy outcomes and physical health, fewer studies have explored these associations over the long term, particularly considering women's preconception health. Data were drawn from the Understanding Society Survey [UK Household Longitudinal Study (UKHLS)] from 2009 to 2023. The sample included 2386 women who reported their first pregnancy and were observed over multiple time points, both before and after pregnancy. Physical health was assessed using the Physical Component Summary (PCS) from the 12-item Short Form Survey (SF-12) questionnaire. Linear fixed-effects models were used to analyze changes in physical health relative to pregnancy outcomes, adjusting for socioeconomic, demographic, and mental health covariates. The analysis revealed a sharp decline in physical health (PCS score) at the end of pregnancy for both groups, with a more pronounced decline among women experiencing pregnancy losses. Post-pregnancy, these women continued to report lower PCS scores compared to those with live births, particularly in the 2 years following pregnancy. The confounders did not fully explain the observed differences. Pregnancy losses are associated with a significant and lasting decline in women's physical health, even after controlling for socio-demographic factors. Women who experience losses often report worse health than those transitioning to motherhood, with symptoms potentially including fatigue, pain, and cardiovascular diseases. These findings underscore the importance of long-term health monitoring and support for women following miscarriage or stillbirth.

{"title":"Women's physical health around live births and pregnancy losses: a longitudinal study.","authors":"Alessandro Di Nallo","doi":"10.1093/eurpub/ckaf013","DOIUrl":"https://doi.org/10.1093/eurpub/ckaf013","url":null,"abstract":"<p><p>This study examines the long-term physical health impacts of pregnancy outcomes, comparing women who experienced live births to those who had pregnancy losses (miscarriages or stillbirths). While previous research has documented short-term links between pregnancy outcomes and physical health, fewer studies have explored these associations over the long term, particularly considering women's preconception health. Data were drawn from the Understanding Society Survey [UK Household Longitudinal Study (UKHLS)] from 2009 to 2023. The sample included 2386 women who reported their first pregnancy and were observed over multiple time points, both before and after pregnancy. Physical health was assessed using the Physical Component Summary (PCS) from the 12-item Short Form Survey (SF-12) questionnaire. Linear fixed-effects models were used to analyze changes in physical health relative to pregnancy outcomes, adjusting for socioeconomic, demographic, and mental health covariates. The analysis revealed a sharp decline in physical health (PCS score) at the end of pregnancy for both groups, with a more pronounced decline among women experiencing pregnancy losses. Post-pregnancy, these women continued to report lower PCS scores compared to those with live births, particularly in the 2 years following pregnancy. The confounders did not fully explain the observed differences. Pregnancy losses are associated with a significant and lasting decline in women's physical health, even after controlling for socio-demographic factors. Women who experience losses often report worse health than those transitioning to motherhood, with symptoms potentially including fatigue, pain, and cardiovascular diseases. These findings underscore the importance of long-term health monitoring and support for women following miscarriage or stillbirth.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long-term health effects of a third-generation waste-to-energy plant: the experience of Turin (Italy).
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-08 DOI: 10.1093/eurpub/ckaf014
Martina Gandini, Elena Farina, Antonella Bena, Cristiana Ivaldi, Laura Crosetto

The long-term study on adverse health effects of the third-generation waste-to-energy (WTE) plant located in Turin, Italy, is part of a broader health surveillance system. We considered 369 236 subjects living in areas with different levels of emission fallout, as well as a control group, from 1 January 2014, until the end of the follow-up period. Hospital admissions for cardiac diseases (ICD-IX: 390-429), ischaemic heart diseases (ICD IX: 410-414), chronic heart failure (ICD IX: 428.0, 428.2, 428.9), cerebrovascular diseases (ICD IX: 430-438), acute respiratory diseases (ICD IX: 460-466, 480-487), and COPD (ICD IX: 490-492, 494, 496) were evaluated for the population considered. Cox models were used, considering individual characteristics and overall environmental exposure. We also considered all births (n = 8296) of women residing in the area at the time of delivery during the study period. Log-binomial models were run separately for each outcome (sex ratio, multiple births, preterm births, on term low birthweight and small for gestational age births), adjusting for exposure to other pollution sources and maternal characteristics. Miscarriages were evaluated using hospital admissions registries. No relationship was found for the outcomes considered in the wider area, neither with hospital admissions nor with adverse reproductive outcomes. There is an association with chronic heart failure and ischaemic heart diseases in the maximum exposure area, but the small number of events suggests caution in interpreting this result. This study confirm results of other health surveillance lines, showing no evident harmful effects of the WTE plant.

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引用次数: 0
Inequalities in health and resources between siblings of individuals with and without mental health disorder: an observational study using the French national health data system.
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-06 DOI: 10.1093/eurpub/ckae223
Thibaut Heyer, Philippe Tuppin

The aim of the present study was to describe the effect of an individual's mental health disorder on the resources of his or her adult siblings. A subject rarely analyzed on a large scale. The French National Health Data System (SNDS) collects data on individuals, including their characteristics and the types of healthcare used. A national observational sectional case-control study included individuals covered as of 1 January 2019 and receiving yearly at least one healthcare reimbursement in 2019 including their SNDS data collected from 2013 to 2018. The main variables of interest were a Complementary Universal Health Coverage (CUHC) granted to people who had limited resources. There is also a long-term disease (LTD) status qualifying also for 100% for a specific disease and an ecological index of social deprivation of the place of residence. Conditions were also collected using a specific tool including LTD and hospital diagnosis. Analyzed siblings included 280 709 cases with at least one member suffering from a mental health disorder and 561 418 randomly selected control individuals were addressed using a multilevel model. Siblings of people with mental health problems were more likely to benefit from CUHC or to live in the most deprived area. In addition, the study also highlighted the importance of parental background, which appears to be poorer than in the control population. Social inequalities are particularly marked among the siblings of a person suffering from mental health disorder. Further studies are needed to better understand and enlarge these observational results.

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引用次数: 0
What are the health priorities of the new European Commission? 新欧盟委员会的卫生优先事项是什么?
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-01 DOI: 10.1093/eurpub/ckae205
Hanna Tolonen
{"title":"What are the health priorities of the new European Commission?","authors":"Hanna Tolonen","doi":"10.1093/eurpub/ckae205","DOIUrl":"10.1093/eurpub/ckae205","url":null,"abstract":"","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":" ","pages":"1-2"},"PeriodicalIF":3.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Physical activity partially mediates the association between health literacy and mild cognitive impairment in older adults: cross-sectional evidence from Switzerland. 身体活动部分介导老年人健康素养与轻度认知障碍之间的关联:来自瑞士的横断面证据。
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-01 DOI: 10.1093/eurpub/ckae209
Clément Meier, Maud Wieczorek, Damaris Aschwanden, Andreas Ihle, Matthias Kliegel, Jürgen Maurer

Individuals' health literacy (HL) is positively associated with healthy behaviors and global cognitive functioning. Current evidence also suggests that physical activity may prevent or delay cognitive decline and dementia. This study examines the potential mediating role of physical activity in the association between HL and cognition in a population-based sample of adults aged 58+ in Switzerland. We used data from 1645 respondents to Wave 8 (2019/2020) of the Survey on Health, Ageing, and Retirement in Europe in Switzerland. HL was assessed using the HLS-EU-Q16 questionnaire. Mild cognitive impairment (MCI) was defined as a 1.5 SD below the mean of age- and education-specific global cognition score. The frequency of moderate and vigorous physical activity was self-reported. The associations were assessed using probit regression models, controlling for social, health, and regional characteristics. Structural equation modeling was used to test the mediation hypothesis. Higher HL was associated with a higher likelihood of being engaged in moderate (P < .001) and vigorous (P < .01) physical activity and with a lower likelihood of having MCI (P < .05). In addition, both moderate (P < .05) and vigorous (P < .01) physical activity were associated with a lower probability of having MCI. Mediation analysis indicated that the association between HL and MCI was partially mediated by both moderate (12.9%) and vigorous (6.7%) physical activity. Given that physical activity may partially mediate the association between HL and MCI, improving HL in older adults could potentially foster engagement in physical activity, which could, in turn, act as a protective factor against MCI.

个体健康素养与健康行为和整体认知功能呈正相关。目前的证据还表明,体育活动可以预防或延缓认知能力下降和痴呆。本研究以瑞士58岁以上的成年人为样本,探讨了体育活动在HL和认知之间的关联中的潜在中介作用。我们使用了瑞士欧洲健康、老龄化和退休调查第8轮(2019/2020)的1645名受访者的数据。采用HLS-EU-Q16问卷评估HL。轻度认知障碍(MCI)被定义为低于年龄和教育水平的整体认知得分平均值1.5 SD。中度和剧烈体育活动的频率是自我报告的。在控制社会、健康和区域特征的情况下,使用概率回归模型评估这些关联。采用结构方程模型对中介假设进行检验。HL越高,参与中度疼痛的可能性越高(P
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引用次数: 0
Public Health, One Health, and Planetary Health: what is next? 公共卫生、"一体健康 "和 "行星健康":下一步是什么?
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-01 DOI: 10.1093/eurpub/ckae149
Francisco Olea-Popelka, Nicole Redvers, Saverio Stranges
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引用次数: 0
The association between tobacco use and COVID-19 diagnoses in three Nordic countries: a pooled analysis. 北欧三国烟草使用与 COVID-19 诊断之间的关系:汇总分析。
IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-01 DOI: 10.1093/eurpub/ckae156
Ahmed Nabil Shaaban, Filip Andersson, Robert Thiesmeier, Nicola Orsini, Sebastian Peña, Ida Henriette Caspersen, Cecilia Magnusson, Sakari Karvonen, Per Minor Magnus, Maria Pia Hergens, Basra Qazi, Maria Rosaria Galanti

Previous research has suggested an unexpected negative association between smoking and susceptibility to COVID-19. This study, drawing on population-based data from three Nordic countries-Sweden, Norway, and Finland-aims to investigate this association further, capitalizing on diversity introduced by different containment measures. The objective of this research was to examine the association between cigarette smoking and snus (smokeless tobacco) use and the risk of confirmed COVID-19 infection. A pooled analysis integrating original data from 547,685 participants across three countries. We used a multiple imputation approach based on conditional probabilities to impute the systematically missing covariates. The associations between tobacco use and COVID-19 infection were assessed, controlling for potential confounding factors. Current cigarette smokers had a lower risk of a confirmed COVID-19 case, whereas there was an increased risk among snus users. Our sensitivity analysis confirmed that the associations between tobacco use and COVID-19 infection risk are robust, remaining consistent regardless of whether covariate imputation was applied. Findings support a negative association between smoking and SARS-CoV-2 infection, but not the hypothesis that nicotine may be protective against the risk of contracting SARS-CoV-2 infection.

以前的研究表明,吸烟与 COVID-19 易感性之间存在意想不到的负相关。本研究利用瑞典、挪威和芬兰这三个北欧国家的人口数据,旨在利用不同遏制措施带来的多样性,进一步研究这种关联。本研究的目的是探讨吸烟和吸食鼻烟(无烟烟草)与确诊 COVID-19 感染风险之间的关系。我们对三个国家 547,685 名参与者的原始数据进行了汇总分析。我们采用了基于条件概率的多重估算方法来估算系统缺失的协变量。在控制潜在混杂因素的情况下,我们评估了吸烟与 COVID-19 感染之间的关系。目前吸烟的人感染 COVID-19 确诊病例的风险较低,而吸食鼻烟的人感染 COVID-19 的风险较高。我们的敏感性分析证实,烟草使用与COVID-19感染风险之间的关系是稳健的,无论是否应用协变量估算,两者之间的关系都是一致的。研究结果支持吸烟与SARS-CoV-2感染之间的负相关,但不支持尼古丁可降低感染SARS-CoV-2风险的假设。
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引用次数: 0
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European Journal of Public Health
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