European Journal of Public Health最新文献

Cross-country comparisons of socioeconomic inequalities in mortality/life expectancy (LE) face limitations regarding the comparability of population subgroup data. One potential alternative which can overcome this limitation is lifespan variation (LV). Our aims were to: (i) compare long-term trends in LV across Western European countries, focussing on Scotland as a country with known wide LE inequalities; and (ii) explore the validity of LV through comparisons with ranked measures of socioeconomic inequalities in mortality/LE within Scotland. We calculated e† (one measure of LV) using Human Mortality Database data from 1855 to 2021 for European nations, by sex. We then compared e† with absolute inequalities in mortality and LE by ranked area-level socioeconomic deprivation for all 32 local government areas in Scotland. Male and female LV in Scotland is the highest in Western Europe. For males especially, this resulted from increases in the 1980s-1990s, and was made worse by further increases in the early 2010s. All UK nations have relatively high LV, especially among females. Comparisons of sub-national, area-based, data show a moderate level of correlation between ranked LV and absolute socioeconomic inequalities in mortality (0.57), and male (0.48) and female (0.51) LE. For cross-country comparisons, LV may be a useful proxy for absolute socioeconomic inequalities in mortality/LE where comparable socioeconomic measures are not available; however, it requires cautious interpretation. Given the high level of, and recent increases in, LV in Scotland and the UK, the need for socioeconomic policies to narrow health inequalities has never been more urgent.

Adverse childhood experiences (ACEs) increase the risk of various health issues, including oral problems. ACEs also heighten the risk of revictimization, though the impact of adulthood revictimization on oral health is less understood. Conversely, positive influences, such as a trusted adult in childhood, may buffer these effects. This study examines how different dimensions of adversity relate to oral health. This cross-sectional study included 37 559 adults from the HUNT4 Survey, a general population study in Norway. We examined distinct ACE exposures: (i) specific ACEs (i.e. sexual, physical and psychological abuse, bully victimization, parental divorce, and death of a parent), (ii) cumulative ACE, (iii) combined exposure of ACE and adult support, and (iv) adversity trajectories identified by group-based trajectory modelling of ACE and adulthood sexual, physical and psychological abuse. Associations with oral health were assessed by logistic regression, estimating odds ratios with 95% confidence intervals. Most ACE types were associated with poorer adult oral health outcomes, exhibiting a dose-response gradient, where one-unit ACE increase indicated a higher likelihood of self-reported poor dental health (28%), dental fear (31%), and no dental visit in the last 2 years (10%). Combined exposure of ACE and adult support showed that those with high support had lower odds of reporting poor oral health. The revictimized trajectory exhibited the strongest association with impaired oral health outcomes. Our findings support that ACEs are linked to poor oral health later in life, especially among those revictimized as adults, whilst supportive childhood relations may buffer this effect.

The invasion of Ukraine by the Russian Federation on 24 February 2022 displaced millions. While the European Union's Temporary Protection Directive aims to facilitate the right to healthcare for Ukrainian citizens staying in European Union Member States, health systems were already heavily burdened. Ensuring efficient and accessible care for refugees requires insights into individual and context-specific barriers to and facilitators of uptake of health services. In depth interviews were conducted between May 2022 and September 2023 in five countries receiving refugees from Ukraine. Interview guides and rapid analysis procedures followed a modified capability, opportunity, motivation-behaviour (COM-B) framework. Language was a cross-cutting issue touching all COM-B factors. Mental health services use was characterized by specific barriers and drivers across COM-B factors. Additional barriers include health literacy, long wait times for appointments, and lack of sufficient focus on the most vulnerable groups. Drivers include peer and community support, perceived high quality of care and trust in health workers. Successful navigation of new health systems depends on strong health literacy, availability of actionable information, additional support for the most vulnerable and support for health workers. Study insights can inform revisions to health services being offered to refugees from Ukraine and provide considerations for future refugee health crises in any location.

Prior research on the relationship between health risk behaviours (HRBs), obesity, and gambling has primarily focused on problem gambling, while studies focusing on lower severity levels are scarce. Moreover, this relationship has rarely been analysed separately for women and men. This study aimed to investigate the association between HRBs, obesity, and the full spectrum of gambling severity in women and men. Cross-sectional population-based data from Healthy Finland Survey 2022-23 was exploited, including adults aged 20+ years (n = 28 154, response rate 46%, mean age 52 years). The Problem Gambling Severity Index (PGSI) was used as the dependent variable, both in continuous (score 0-27) and categorical (non-problem, low-risk, moderate-risk, and problem gambling) form. Independent variables included HRBs (daily smoking, excessive drinking, low fruit and vegetable (F & V) consumption, low physical activity, and insufficient sleep) and obesity. Sociodemographic factors, suboptimal self-rated health, and psychological distress were adjusted for. Daily smoking, excessive drinking, low F & V consumption, and insufficient sleep were less prevalent in the non-problem gambling category (PGSI score = 0) compared to the low-risk (score 1-2), moderate-risk (score 3-7), and problem gambling (score ≥8) categories. After adjusting for potential confounding variables, all HRBs and obesity, except for physical inactivity, were significantly associated with higher PGSI scores. These findings highlight the need for public health strategies that address gambling across the entire risk spectrum. Moreover, a holistic approach that considers the individual's broader life context could strengthen both research and prevention efforts.

Socioeconomic inequalities in healthcare costs are large, but the underlying behavioral mechanisms remain unclear. We examined how neighborhood socioeconomic status (NSES) and lifestyle behaviors-physical activity (PA), sport participation, smoking, and alcohol use-jointly relate to healthcare costs in the Netherlands. Using a population-wide ecological dataset of 6213 neighborhoods, we linked relative (i.e. age- and sex-standardized) healthcare costs with survey-based estimates of lifestyle behaviors. Linear regression models estimated the associations between lifestyle factors and relative healthcare costs, adjusting for demographic and urbanization characteristics. Additional models stratified by NSES decile assessed socioeconomic modification of lifestyle-cost associations. A strong socioeconomic gradient in relative healthcare costs was observed; the most deprived NSES decile having €1096 higher average costs than the most affluent decile. NSES alone explained over €300 of this inter-decile cost gap. Across all neighborhoods, each 1-percentage-point higher sport participation, PA adherence, and smoking prevalence were associated with cost changes of -€14.27 (95% CI -16.96 to -11.59), -€6.96 (95% CI -9.59 to -4.32), and +€22.06 (95% CI 17.96 to 26.16), respectively; alcohol use showed no association. Within-decile analyses revealed strong protective effects of sport in the most deprived neighborhoods (-€37.26, 95% CI -47.54 to -26.97) and consistent cost increases associated with smoking across all deciles. Lifestyle-cost associations differ markedly by socioeconomic context. Structured sport participation shows the greatest cost-saving potential in disadvantaged neighborhoods, while smoking remains the dominant cost driver nationwide. Addressing behavioral inequalities is key to narrowing socioeconomic disparities in healthcare expenditures.

Problematic alcohol use has been suggested to be associated with higher prevalence of musculoskeletal pain (MSP) among manual workers; however, such relationship remains understudied among non-manual workers. This cross-sectional study investigated the association between alcohol consumption and MSP patterns among non-manual workers. We analysed 6847 non-manual civil servants and retirees aged 50-75 years from the phase 7 of the British Whitehall II Cohort study. Self-reported alcohol consumption was measured as average weekly intake and an alcohol dependency score. MSP was assessed through self-reported anatomical pain sites in the upper body and their frequency. We used multiple-group latent class analysis to identify MSP patterns by age, sex, and employment status. Multinomial logistic regression was used to assess the association between alcohol and pain patterns, adjusting for covariates. There were 3651 (53.3%) reported MSP, with four patterns identified: all upper-body pain sites (6.9%), low back pain (LBP) alone (10.3%), combined LBP and cervical pain (24.8%), and upper-extremity pain (11.3%). We did not observe any significant association between alcohol consumption/dependency and any pain patterns (Ps > .05). Above-moderate alcohol consumption was associated with combined LBP/cervical pain (OR: 1.31, 95% CI: 1.05-1.31) among retirees. Potential alcohol dependency was associated with upper-extremity pain among women (OR: 2.04, 95% CI: 1.15-3.60) and early retirees (OR: 1.81, 95% CI: 1.15-2.84). No overall association between alcohol consumption and MSP was found. Increased spinal pain was found in retirees who exceeded recommended limits, and increased extremity pain was found in women and early retirees with potential alcohol dependency.

WHO's Immunization Agenda 2030 has placed renewed focus on life-course vaccination, including among migrants. Despite the availability of a seasonal vaccine, influenza remains a key contributor to winter excess mortality in Northern Europe, yet limited data on influenza vaccination uptake in migrants has been published. We analyzed Danish national registry data to determine influenza vaccine uptake across six flu seasons (2015/16-2020/21) among migrants (asylum-pathway and quota refugees, family reunified migrants) ≥65 years matched 1:6 on age and gender to Danish-born individuals. We used multivariate logistic regression models controlling for migrant status (immigration status, time in Denmark) and other sociodemographic variables (age, gender, nationality, urban/rural residence) to identify factors associated with influenza vaccination uptake. All analyses were done in R v4.2.1. Across all six seasons, overall flu vaccination uptake was 49.3% (Danish-born: 50.9%; migrant cohort: 39.4%). Migrants were less likely [odds ratio (OR): 0.66; 95% confidence interval (CI): 0.64-0.67] to receive an influenza vaccine across all seasons, with this gap widening from 2015/16 (OR: 0.78; 95% CI: 0.74-0.84) to the 2020/21 season (OR: 0.44; 95% CI: 0.42-0.46). Family-reunified migrants were less likely to receive an influenza vaccine across the study period than asylum-pathway and quota refugees and those from the Sub-Saharan Africa region had the lowest uptake in terms of area of origin. This large and unique dataset shows that migrant groups have lower uptake rates for influenza vaccination compared with Danish-born individuals, with the gap widening over time. Going forward, developing tailored interventions, co-developed in collaboration with communities themselves, will be key.

Adolescence is a life stage characterized by physical, social, and emotional changes including a shift towards peer orientation and an explorative approach to substance use. Previously, we identified distinct adolescent substance use patterns. Here we characterized adolescents with distinct patterns of substance use and tested whether patterns were associated with acute outcomes. Data from the Danish National Youth Cohort 2014, comprising 68 301 participants aged 15-19 years attending upper secondary education, were used. Previously identified substance use patterns were Alcohol Only (48.8%), Frequent Binge Drinking (23.3%), Experimental Use (16.3%), and Early Multiple Use (11.6%). Adolescents with distinct substance use patterns were characterized by adverse childhood experiences, social networks, parental support, and mental health. Associations between patterns and the risk of unintentional injury, violence, and mortality were assessed over an 8.2-year follow-up period. An accumulation of adverse childhood experiences, lack of parental support and poor mental health were observed in adolescents with most substance use. Substance use patterns were associated with the risk of unintentional injury, violence, and mortality in a dose-dependent manner. For instance, compared to Alcohol Only, hazard ratios (95% CI) for severe unintentional injury were 1.25 (1.08-1.44), 1.40 (1.17-1.66), 1.50 (1.25-1.79) for adolescents with Frequent Binge Drinking, Experimental Use, and Early Multiple Use. Adolescent substance use patterns were associated with short- and long-term risks of acute health outcomes. Additionally, disadvantages cluster in adolescents with more substance use, highlighting the aggregation and potential interaction of challenges faced by vulnerable subgroups that extend into adulthood.

Injuries lead to heath loss, disability, and significant costs. The aim of this study was to evaluate self-reported home and leisure injuries outside school by the 8th and 9th graders in Finnish secondary schools, and potential explanatory factors associated with their injuries. Data were gathered on 383 550 pupils in cross-sectional surveys (every second school year) done between years 2013 and 2021. Associations between injuries and the explanatory variables were assessed using logistic regression analysis. Bronfenbrenner's bioecological model and the KINDL-R health-related quality of life measurement were used as the framework for this study. Nearly a third of the respondents (n = 120 494, 31.4%) had been injured one or more times during leisure time or at home. The most common injuries among all respondents were sport-related injuries (19.8%), other injuries sustained during leisure time (13.8%) and at home or nearby (9.4%). The use of safety equipment was quite low. The potential risk for injuries was highest among those who were severely anxious, those who often consumed enough alcohol to become heavily drunk, those who had tried or used drugs before, and adolescents of foreign background who had been born abroad. Adolescents with no close friends had a lower association with injury. Boys were more likely to sustain injuries than girls. Injuries suffered in leisure time and at home were linked to risky behaviour, emotional well-being, social and family relationships, and housing. Professionals in preventive work need to take the complex factors behind injuries into account.