European Journal of Public Health最新文献

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.

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.

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.

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.

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.

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.

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.

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.