Pub Date : 2024-09-18DOI: 10.1136/jech-2024-222472
Yinhua Tao, Jane Maddock, Laura Howe, Eleanor M Winpenny
Background Diet is an important risk factor for cardiovascular disease and shows well-established socioeconomic patterning among adults. However, less clear is how socioeconomic inequalities in diet develop across the life course. This study assessed the associations of early adulthood socioeconomic trajectories (SETs) with adult diet quality, adjusting for childhood socioeconomic position (SEP) and testing for mediation by adulthood SEP. Methods Participants from the 1970 British Cohort Study with socioeconomic data in early adulthood were included (n=12 434). Diet quality at age 46 years, evaluated using the Mediterranean diet pyramid, was regressed on six previously identified classes of early adulthood SETs between ages 16 and 24 years including a continued education class, four occupation-defined classes and an economically inactive class. Causal mediation analyses tested the mediation of the association via household income and neighbourhood deprivation at age 46 years separately. Models were adjusted for sex, childhood SEP, adolescent diet quality and adolescent health. Results The continued education class showed the best diet quality at age 46 years while little difference in diet quality was found among the remaining SET classes. The association between the continued education class and adult diet quality was independent of parental SEP in childhood and was largely not mediated by household income or neighbourhood deprivation (0.7% and 3.7% of the total effect mediated, respectively) in mid-adulthood. Conclusions Early adulthood SETs independently contribute to adult diet quality with continuing education associated with better adherence to the Mediterranean diet. Early adulthood therefore represents a sensitive period for intervention to alleviate dietary inequalities in later life. Data are available in a public, open access repository. Data are available in a public, open access repository. The data underlying this article are freely available to bona fide researchers via the UK Data Service ().
{"title":"Early adulthood socioeconomic trajectories contribute to inequalities in adult diet quality, independent of childhood and adulthood socioeconomic position","authors":"Yinhua Tao, Jane Maddock, Laura Howe, Eleanor M Winpenny","doi":"10.1136/jech-2024-222472","DOIUrl":"https://doi.org/10.1136/jech-2024-222472","url":null,"abstract":"Background Diet is an important risk factor for cardiovascular disease and shows well-established socioeconomic patterning among adults. However, less clear is how socioeconomic inequalities in diet develop across the life course. This study assessed the associations of early adulthood socioeconomic trajectories (SETs) with adult diet quality, adjusting for childhood socioeconomic position (SEP) and testing for mediation by adulthood SEP. Methods Participants from the 1970 British Cohort Study with socioeconomic data in early adulthood were included (n=12 434). Diet quality at age 46 years, evaluated using the Mediterranean diet pyramid, was regressed on six previously identified classes of early adulthood SETs between ages 16 and 24 years including a continued education class, four occupation-defined classes and an economically inactive class. Causal mediation analyses tested the mediation of the association via household income and neighbourhood deprivation at age 46 years separately. Models were adjusted for sex, childhood SEP, adolescent diet quality and adolescent health. Results The continued education class showed the best diet quality at age 46 years while little difference in diet quality was found among the remaining SET classes. The association between the continued education class and adult diet quality was independent of parental SEP in childhood and was largely not mediated by household income or neighbourhood deprivation (0.7% and 3.7% of the total effect mediated, respectively) in mid-adulthood. Conclusions Early adulthood SETs independently contribute to adult diet quality with continuing education associated with better adherence to the Mediterranean diet. Early adulthood therefore represents a sensitive period for intervention to alleviate dietary inequalities in later life. Data are available in a public, open access repository. Data are available in a public, open access repository. The data underlying this article are freely available to bona fide researchers via the UK Data Service (<http://ukdataservice.ac.uk>).","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258772","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}
Pub Date : 2024-09-11DOI: 10.1136/jech-2024-222669
Erwin Stolz, Moritz Oberndorfer, Wolfgang Freidl
Background Little is known about education-related inequalities in late-life disability. Here, we use individual-level register data on the receipt of the Austrian long-term care allowance (ALTCA) to assess education-related inequalities in the duration of late-life disability. Methods In this retrospective mortality follow-back study, we analyse receipt of ALTCA, a universal cash benefit based on physician-assessed disability in activities of daily living, during the last 5 years of life among all decedents aged 65 years and over from 2020 in Austria (n=76 772). Results The higher the level of education, the shorter the period for which ALTCA was received. Over the last 5 years of life, those with the primary/lower secondary education received ALTCA for 47% or 10 months (men), respectively, 38% or 12 months (women) longer than those with tertiary education. Education-related inequalities decreased with time to death and age at death. Conclusion We found education-related inequalities in the duration of late-life disability, that is, higher education was associated with a prolonged ability to live independently during the last years of life. Inequalities in disability decreased with time to death and age at death, pointing to a gradual levelling due to mortality-related declines as well as selective mortality.
{"title":"Education-related inequalities in disability during the last years of life: a full population register-based study","authors":"Erwin Stolz, Moritz Oberndorfer, Wolfgang Freidl","doi":"10.1136/jech-2024-222669","DOIUrl":"https://doi.org/10.1136/jech-2024-222669","url":null,"abstract":"Background Little is known about education-related inequalities in late-life disability. Here, we use individual-level register data on the receipt of the Austrian long-term care allowance (ALTCA) to assess education-related inequalities in the duration of late-life disability. Methods In this retrospective mortality follow-back study, we analyse receipt of ALTCA, a universal cash benefit based on physician-assessed disability in activities of daily living, during the last 5 years of life among all decedents aged 65 years and over from 2020 in Austria (n=76 772). Results The higher the level of education, the shorter the period for which ALTCA was received. Over the last 5 years of life, those with the primary/lower secondary education received ALTCA for 47% or 10 months (men), respectively, 38% or 12 months (women) longer than those with tertiary education. Education-related inequalities decreased with time to death and age at death. Conclusion We found education-related inequalities in the duration of late-life disability, that is, higher education was associated with a prolonged ability to live independently during the last years of life. Inequalities in disability decreased with time to death and age at death, pointing to a gradual levelling due to mortality-related declines as well as selective mortality.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142194692","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}
Pub Date : 2024-09-09DOI: 10.1136/jech-2024-222094
Hilary L Colbeth, Corinne A Riddell, Marilyn Thomas, Mahasin Mujahid, Ellen A Eisen
Background Structural racism’s influence on workforce policies and practices presents possible upstream targets for assessing and reducing racial health disparities. This study is the first to examine workforce racial diversity in association with racial disparities in cardiovascular disease (CVD) outcomes. Methods This retrospective cohort study of 39 693 hourly autoworkers from three Michigan automobile plants, includes 75 years of follow-up (1941–2015). Workforce racial diversity (per cent black autoworkers) was a plant and year level variable. Annual exposure was cumulated over each individual’s working life and divided by time since hire. This time-varying measure was categorised into low, moderate and high. We estimated age-standardised rates of CVD and Cox proportional HRs by race. Results CVD mortality per 100 000 person-years decreased among autoworkers over the study period; however, black workers’ rates remained higher than white workers. Among black workers, we observed a strong protective association between greater workforce racial diversity and CVD mortality. For example, at the Detroit plant, the HR for moderate exposure to racial diversity was 0.94 (0.83, 1.08) and dropped to 0.78 (0.67, 0.90) at the highest level. Among white workers, results were mixed by plant, with protective effects in plants where less than 20% of workers were black and null results where black workers became the majority. Conclusion Our findings provide evidence that workplace racial diversity may reduce CVD mortality risk among black workers. Workplace practices encouraging diverse hiring and retention have potential to improve all workers’ health; particularly the socially racialised groups in that workforce. Data are available upon reasonable request. Data are available upon reasonable request, with limitations to preserve the autonomy and the rights of the individual participants.
{"title":"Impact of increasing workforce racial diversity on black-white disparities in cardiovascular disease mortality","authors":"Hilary L Colbeth, Corinne A Riddell, Marilyn Thomas, Mahasin Mujahid, Ellen A Eisen","doi":"10.1136/jech-2024-222094","DOIUrl":"https://doi.org/10.1136/jech-2024-222094","url":null,"abstract":"Background Structural racism’s influence on workforce policies and practices presents possible upstream targets for assessing and reducing racial health disparities. This study is the first to examine workforce racial diversity in association with racial disparities in cardiovascular disease (CVD) outcomes. Methods This retrospective cohort study of 39 693 hourly autoworkers from three Michigan automobile plants, includes 75 years of follow-up (1941–2015). Workforce racial diversity (per cent black autoworkers) was a plant and year level variable. Annual exposure was cumulated over each individual’s working life and divided by time since hire. This time-varying measure was categorised into low, moderate and high. We estimated age-standardised rates of CVD and Cox proportional HRs by race. Results CVD mortality per 100 000 person-years decreased among autoworkers over the study period; however, black workers’ rates remained higher than white workers. Among black workers, we observed a strong protective association between greater workforce racial diversity and CVD mortality. For example, at the Detroit plant, the HR for moderate exposure to racial diversity was 0.94 (0.83, 1.08) and dropped to 0.78 (0.67, 0.90) at the highest level. Among white workers, results were mixed by plant, with protective effects in plants where less than 20% of workers were black and null results where black workers became the majority. Conclusion Our findings provide evidence that workplace racial diversity may reduce CVD mortality risk among black workers. Workplace practices encouraging diverse hiring and retention have potential to improve all workers’ health; particularly the socially racialised groups in that workforce. Data are available upon reasonable request. Data are available upon reasonable request, with limitations to preserve the autonomy and the rights of the individual participants.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142194704","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}
Pub Date : 2024-06-05DOI: 10.1136/jech-2023-221860
Achamyeleh Birhanu Teshale, Htet Lin Htun, Alice J. Owen, Joanne Ryan, JR Baker, Mor Vered, Christopher M Reid, Robyn L. Woods, Michael Berk, Andrew Tonkin, Johannes T Neumann, Monique F Kilkenny, Aung Zaw Zaw Phyo, Mark R Nelson, Nigel Stocks, Carlene Britt, Rosanne Freak-Poli
Background Gender influences cardiovascular disease (CVD) through norms, social relations, roles and behaviours. This study identified gender-specific aspects of socialisation associated with CVD. Methods A longitudinal study was conducted, involving 9936 (5,231 women and 4705 men) initially healthy, community-dwelling Australians aged 70 years or more from the ASPirin in Reducing Events in the Elderly (ASPREE) study and ASPREE Longitudinal Study of Older Persons, with a median follow-up time of 6.4 years. Variable categorisation, variable selection (using machine learning (ML) models; Elastic Net and extreme gradient boosting) and Cox-regression were employed separately by binary gender to identity socialisation factors (n=25 considered) associated with CVD. Results Different socialisation factors were identified using the ML models. In the Cox model, for both genders, being married/partnered was associated with a reduced risk of CVD (men: HR 0.76, 95% CI 0.60 to 0.96; women: HR 0.67, 95% CI 0.58 to 0.95). For men, having 3–8 relatives they felt close to and could call on for help (HR 0.76, 95% CI 0.58 to 0.99; reference <3 relatives), having 3–8 relatives they felt at ease talking with about private matters (HR 0.70, 95% CI 0.55 to 0.90; reference <3 relatives) or playing games such as chess or cards (HR 0.82, 95% CI 0.67 to 1.00) was associated with reduced risk of CVD. For women, living with others (HR 0.71, 95% CI 0.55 to 0.91) or having ≥3 friends they felt at ease talking with about private matters (HR 0.74, 95% CI 0.58 to 0.95; reference <3 friends) was associated with a lower risk of CVD. Conclusions This study demonstrates the need to prioritise gender-specific social factors to improve cardiovascular health in older adults. Data may be obtained from a third party and are not publicly available. The ASPREE and ALSOP are not publicly available since they are ongoing. However, they are available to partnering and external researchers for projects of appropriate scientific merit and expressions of interest to analyse data from these datasets are co-ordinated through the ASPREE Access Management Site (AMS) ().
背景 性别通过规范、社会关系、角色和行为影响心血管疾病（CVD）。本研究确定了与心血管疾病相关的社会化的性别特异性方面。方法 进行了一项纵向研究，涉及9936名（5231名女性和4705名男性）最初健康的、居住在社区的70岁或70岁以上的澳大利亚人，他们来自 "ASPirin in Reducing Events in the Elderly (ASPREE) "研究和 "ASPREE Longitudinal Study of Older Persons "研究，中位随访时间为6.4年。按照二元性别分别采用变量分类、变量选择（使用机器学习（ML）模型；弹性网和极度梯度提升）和 Cox 回归来识别与心血管疾病相关的社会化因素（25 个考虑因素）。结果 使用 ML 模型确定了不同的社会化因素。在 Cox 模型中，男女已婚/有伴侣与心血管疾病风险降低有关（男性：HR 0.76，95% CI 0.60 至 0.96；女性：HR 0.67，95% CI 0.58 至 0.95）。对于男性而言，有 3-8 名亲属与他们关系密切并可向他们求助（HR 0.76，95% CI 0.58 至 0.99；参考值）。
{"title":"Gender-specific aspects of socialisation and risk of cardiovascular disease among community-dwelling older adults: a prospective cohort study using machine learning algorithms and a conventional method","authors":"Achamyeleh Birhanu Teshale, Htet Lin Htun, Alice J. Owen, Joanne Ryan, JR Baker, Mor Vered, Christopher M Reid, Robyn L. Woods, Michael Berk, Andrew Tonkin, Johannes T Neumann, Monique F Kilkenny, Aung Zaw Zaw Phyo, Mark R Nelson, Nigel Stocks, Carlene Britt, Rosanne Freak-Poli","doi":"10.1136/jech-2023-221860","DOIUrl":"https://doi.org/10.1136/jech-2023-221860","url":null,"abstract":"Background Gender influences cardiovascular disease (CVD) through norms, social relations, roles and behaviours. This study identified gender-specific aspects of socialisation associated with CVD. Methods A longitudinal study was conducted, involving 9936 (5,231 women and 4705 men) initially healthy, community-dwelling Australians aged 70 years or more from the ASPirin in Reducing Events in the Elderly (ASPREE) study and ASPREE Longitudinal Study of Older Persons, with a median follow-up time of 6.4 years. Variable categorisation, variable selection (using machine learning (ML) models; Elastic Net and extreme gradient boosting) and Cox-regression were employed separately by binary gender to identity socialisation factors (n=25 considered) associated with CVD. Results Different socialisation factors were identified using the ML models. In the Cox model, for both genders, being married/partnered was associated with a reduced risk of CVD (men: HR 0.76, 95% CI 0.60 to 0.96; women: HR 0.67, 95% CI 0.58 to 0.95). For men, having 3–8 relatives they felt close to and could call on for help (HR 0.76, 95% CI 0.58 to 0.99; reference <3 relatives), having 3–8 relatives they felt at ease talking with about private matters (HR 0.70, 95% CI 0.55 to 0.90; reference <3 relatives) or playing games such as chess or cards (HR 0.82, 95% CI 0.67 to 1.00) was associated with reduced risk of CVD. For women, living with others (HR 0.71, 95% CI 0.55 to 0.91) or having ≥3 friends they felt at ease talking with about private matters (HR 0.74, 95% CI 0.58 to 0.95; reference <3 friends) was associated with a lower risk of CVD. Conclusions This study demonstrates the need to prioritise gender-specific social factors to improve cardiovascular health in older adults. Data may be obtained from a third party and are not publicly available. The ASPREE and ALSOP are not publicly available since they are ongoing. However, they are available to partnering and external researchers for projects of appropriate scientific merit and expressions of interest to analyse data from these datasets are co-ordinated through the ASPREE Access Management Site (AMS) (<https://aspree.org/aus/researchers/>).","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141256470","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}
Pub Date : 2024-04-30DOI: 10.1136/jech-2023-221794
David JO Driscoll, Elizabeth Kiely, Linda M O'Keeffe, Ali S Khashan
Background Poverty is associated with poor outcomes, yet exposure to distinct poverty trajectories in early childhood is not well understood. Objective To understand the prevalence of different trajectories of household poverty and their association with mid-childhood and mother indicators of physical health and psychopathology in Ireland. Methods We used a nationally representative, prospective cohort (Growing Up in Ireland–Infant Cohort). Household poverty included lowest third income decile, subjective poverty and material deprivation when children were aged 9 months, and 3, 5, 9 years. We used group-based multitrajectory cluster modelling to classify trajectories of poverty. Using multivariable logistic regression, adjusted with separate child and mother confounders, we assessed the association of poverty trajectories from 9 months to 9 years with child outcomes (overweight, any longstanding illness and psychopathology) at age 9 years and the same poverty trajectories over the same 9-year period with mother outcomes (overweight, any longstanding illness and depression). Results Of 11 134 participants, 4 trajectories were identified: never in poverty (43.1%), material/subjective>monetary poverty (16.1%), monetary>material poverty (25.6%) and persistent poverty (15.2%). Children in persistent poverty compared with those in never in poverty experienced higher odds of being overweight at 9 years (adjusted OR (aOR) 1.70, 95% CI 1.34, 2.16), having a longstanding illness (aOR 1.51, 95% CI 1.20, 1.91), and psychopathology (aOR 2.06, 95% CI 1.42, 2.99). The outcomes for primary parents (99.7% were mothers) were as follows: having higher odds of being overweight (aOR 1.49, 95% CI 1.16, 1.92), having a longstanding illness (aOR 2.13, 95% CI 1.63, 2.79), and depression (aOR 3.54, 95% CI 2.54, 4.94). Conclusions Any poverty trajectory was associated with poorer psychopathology and physical well-being in late childhood for children and their mothers in Ireland. Data may be obtained from a third party and are not publicly available. The authors received approval from the Central Statistics Office to use the AMF Infant Cohort dataset.
背景 贫困与不良后果相关，但人们对幼儿期不同的贫困轨迹并不十分了解。目标 了解爱尔兰不同家庭贫困轨迹的发生率及其与儿童中期和母亲身体健康和心理病理学指标的关系。方法 我们使用了一个具有全国代表性的前瞻性队列（在爱尔兰成长-婴儿队列）。家庭贫困包括儿童 9 个月、3、5、9 岁时的最低收入十分位数、主观贫困和物质匮乏。我们采用基于群体的多轨迹聚类模型对贫困轨迹进行分类。通过使用多变量逻辑回归，并分别对儿童和母亲的混杂因素进行调整，我们评估了 9 个月至 9 岁期间的贫困轨迹与儿童 9 岁时的结果（超重、任何长期疾病和精神病理学）之间的关系，以及 9 年期间的相同贫困轨迹与母亲的结果（超重、任何长期疾病和抑郁）之间的关系。结果 在 11 134 名参与者中，发现了 4 种贫困轨迹：从未贫困（43.1%）、物质/主观贫困>货币贫困（16.1%）、货币贫困>物质贫困（25.6%）和持续贫困（15.2%）。与从未陷入贫困的儿童相比，持续贫困的儿童在 9 岁时超重（调整 OR (aOR) 1.70，95% CI 1.34，2.16）、长期患病（aOR 1.51，95% CI 1.20，1.91）和心理变态（aOR 2.06，95% CI 1.42，2.99）的几率更高。主要父母（99.7% 为母亲）的结果如下：超重（aOR 1.49，95% CI 1.16，1.92）、长期患病（aOR 2.13，95% CI 1.63，2.79）和抑郁（aOR 3.54，95% CI 2.54，4.94）的几率更高。结论 任何贫困轨迹都与爱尔兰儿童及其母亲童年晚期较差的心理病理学和身体健康有关。数据可能来自第三方，不对外公开。作者使用AMF婴儿队列数据集获得了中央统计局的批准。
{"title":"Poverty trajectories and child and mother well-being outcomes in Ireland: findings from an Irish prospective cohort","authors":"David JO Driscoll, Elizabeth Kiely, Linda M O'Keeffe, Ali S Khashan","doi":"10.1136/jech-2023-221794","DOIUrl":"https://doi.org/10.1136/jech-2023-221794","url":null,"abstract":"Background Poverty is associated with poor outcomes, yet exposure to distinct poverty trajectories in early childhood is not well understood. Objective To understand the prevalence of different trajectories of household poverty and their association with mid-childhood and mother indicators of physical health and psychopathology in Ireland. Methods We used a nationally representative, prospective cohort (Growing Up in Ireland–Infant Cohort). Household poverty included lowest third income decile, subjective poverty and material deprivation when children were aged 9 months, and 3, 5, 9 years. We used group-based multitrajectory cluster modelling to classify trajectories of poverty. Using multivariable logistic regression, adjusted with separate child and mother confounders, we assessed the association of poverty trajectories from 9 months to 9 years with child outcomes (overweight, any longstanding illness and psychopathology) at age 9 years and the same poverty trajectories over the same 9-year period with mother outcomes (overweight, any longstanding illness and depression). Results Of 11 134 participants, 4 trajectories were identified: never in poverty (43.1%), material/subjective>monetary poverty (16.1%), monetary>material poverty (25.6%) and persistent poverty (15.2%). Children in persistent poverty compared with those in never in poverty experienced higher odds of being overweight at 9 years (adjusted OR (aOR) 1.70, 95% CI 1.34, 2.16), having a longstanding illness (aOR 1.51, 95% CI 1.20, 1.91), and psychopathology (aOR 2.06, 95% CI 1.42, 2.99). The outcomes for primary parents (99.7% were mothers) were as follows: having higher odds of being overweight (aOR 1.49, 95% CI 1.16, 1.92), having a longstanding illness (aOR 2.13, 95% CI 1.63, 2.79), and depression (aOR 3.54, 95% CI 2.54, 4.94). Conclusions Any poverty trajectory was associated with poorer psychopathology and physical well-being in late childhood for children and their mothers in Ireland. Data may be obtained from a third party and are not publicly available. The authors received approval from the Central Statistics Office to use the AMF Infant Cohort dataset.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140836834","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}
Pub Date : 2024-04-30DOI: 10.1136/jech-2023-221720
Kimberly Kane, Jeanette Westman, Johan Franck, Mika Gissler
Background Growing up with parental alcohol use disorder (AUD) is a risk factor for psychiatric disorders. This study investigated the risk of mood disorders and of anxiety disorders in the adult children of parents with AUD, adjusted for sociodemographic factors. Methods Individual-level register data on the total population were linked to follow children of parents with AUD from 1973 to 2018 to assess their risk of mood disorders and of anxiety disorders. AUD, mood disorders and anxiety disorders were defined with International Statistical Classification of Diseases and Related Health Problems codes from the National Patient Register. HRs of outcomes were calculated with Cox regression. Model 1 was adjusted for the child’s sex, parental education and death of a parent. Model 2 was adjusted for those factors and parental diagnosis of mood or anxiety disorder. Results Those with ≥1 parent with AUD (99 723 of 2 421 479 children) had a higher risk of mood disorder and of anxiety disorder than those whose parents did not have AUD (HR mood 2.32, 95% CI 2.26 to 2.39; HR anxiety 2.66, 95% CI 2.60 to 2.72). The risk remained elevated after adjustment for sociodemographic factors and parental psychiatric diagnosis (HR mood 1.67, 95% CI 1.63 to 1.72; HR anxiety 1.74, 95% CI 1.69 to 1.78). The highest risks were associated with AUD in both parents, followed by AUD in mothers and then in fathers. Conclusion Adult children of parents with AUD have a raised risk of mood and anxiety disorders even after adjustment for sociodemographic factors and parental mood or anxiety disorder. These population-level findings can inform future policies and interventions. Data may be obtained from a third party and are not publicly available. Because of current data protection legislation, the study data cannot be publicly shared. For access to similar study data, contact Statistics Sweden and the Swedish National Board of Health and Welfare, the public authorities that hold the data.
{"title":"Risk of severe mood and anxiety disorders in the adult children of parents with alcohol use disorder: a nationwide cohort study","authors":"Kimberly Kane, Jeanette Westman, Johan Franck, Mika Gissler","doi":"10.1136/jech-2023-221720","DOIUrl":"https://doi.org/10.1136/jech-2023-221720","url":null,"abstract":"Background Growing up with parental alcohol use disorder (AUD) is a risk factor for psychiatric disorders. This study investigated the risk of mood disorders and of anxiety disorders in the adult children of parents with AUD, adjusted for sociodemographic factors. Methods Individual-level register data on the total population were linked to follow children of parents with AUD from 1973 to 2018 to assess their risk of mood disorders and of anxiety disorders. AUD, mood disorders and anxiety disorders were defined with International Statistical Classification of Diseases and Related Health Problems codes from the National Patient Register. HRs of outcomes were calculated with Cox regression. Model 1 was adjusted for the child’s sex, parental education and death of a parent. Model 2 was adjusted for those factors and parental diagnosis of mood or anxiety disorder. Results Those with ≥1 parent with AUD (99 723 of 2 421 479 children) had a higher risk of mood disorder and of anxiety disorder than those whose parents did not have AUD (HR mood 2.32, 95% CI 2.26 to 2.39; HR anxiety 2.66, 95% CI 2.60 to 2.72). The risk remained elevated after adjustment for sociodemographic factors and parental psychiatric diagnosis (HR mood 1.67, 95% CI 1.63 to 1.72; HR anxiety 1.74, 95% CI 1.69 to 1.78). The highest risks were associated with AUD in both parents, followed by AUD in mothers and then in fathers. Conclusion Adult children of parents with AUD have a raised risk of mood and anxiety disorders even after adjustment for sociodemographic factors and parental mood or anxiety disorder. These population-level findings can inform future policies and interventions. Data may be obtained from a third party and are not publicly available. Because of current data protection legislation, the study data cannot be publicly shared. For access to similar study data, contact Statistics Sweden and the Swedish National Board of Health and Welfare, the public authorities that hold the data.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140837178","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}
Pub Date : 2024-04-16DOI: 10.1136/jech-2023-220553
Tyler J VanderWeele
A framework is put forward for the proper scope of considerations concerning flourishing within medicine, psychiatry, clinical counselling, public health and public policy. Each of these disciplines and associated institutional practices have distinctive contributions to make in advancing flourishing within society. In each case, there are also various aspects of flourishing that extend beyond each practice’s purview; and yet to restrict attention only to health, narrowly conceived, limits what each of these practices can in fact accomplish. A clearer understanding of what aspects of flourishing do, and do not, lie within the bounds of each discipline and practice has the potential to better enable the pursuit of societal well-being.
{"title":"Flourishing and the scope of medicine and public health","authors":"Tyler J VanderWeele","doi":"10.1136/jech-2023-220553","DOIUrl":"https://doi.org/10.1136/jech-2023-220553","url":null,"abstract":"A framework is put forward for the proper scope of considerations concerning flourishing within medicine, psychiatry, clinical counselling, public health and public policy. Each of these disciplines and associated institutional practices have distinctive contributions to make in advancing flourishing within society. In each case, there are also various aspects of flourishing that extend beyond each practice’s purview; and yet to restrict attention only to health, narrowly conceived, limits what each of these practices can in fact accomplish. A clearer understanding of what aspects of flourishing do, and do not, lie within the bounds of each discipline and practice has the potential to better enable the pursuit of societal well-being.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140611371","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}
Pub Date : 2024-04-12DOI: 10.1136/jech-2023-220835
Danielle Solomon, Jo Gibbs, Fiona Burns, Hamish Mohammed, Stephanie J Migchelsen, Caroline A Sabin
Background Women aged 16–24 in England have a high burden of sexual and reproductive morbidity, with particularly poor outcomes among people living in more deprived areas (including racially minoritised populations). This analysis used national data to examine the disparities within sexual and reproductive outcomes among this population and to assess whether the patterns of inequality were consistent across all outcomes. Methods Within this ecological study, univariable and multivariable Poisson regression analyses of neighbourhood-level data from national data sets were carried out to investigate the relationships of deprivation and ethnicity with each of six dependent variables: gonorrhoea and chlamydia testing rates, gonorrhoea and chlamydia test positivity rates, and abortion and repeat abortion rates. Results When comparing Index of Multiple Deprivation (IMD) decile 1 (most deprived) and IMD decile 10 (least deprived), chlamydia (RR 0.65) and gonorrhoea (0.79) testing rates, chlamydia (0.70) and gonorrhoea (0.34) positivity rates, abortion rates (0.45) and repeat abortion rates (0.72) were consistently lower in IMD decile 10 (least deprived). Similarly, chlamydia (RR 1.24) and gonorrhoea positivity rates (1.92) and repeat abortion rates (1.31) were higher among black women than white women. Results were similar when both ethnicity and deprivation were incorporated into multivariable analyses. Conclusion We found similar patterns of outcome inequality across a range of sexual and reproductive outcomes, despite multiple differences in the drivers of each outcome. Our analysis suggests that there are broad structural causes of inequality across sexual and reproductive health that particularly impact the health of deprived and black populations. Data may be obtained from a third party and are not publicly available. Data used in this analysis are held by the Department of Health and Social Care and the UK Health Security Agency, and as such are not publicly available.
{"title":"Inequalities in sexual and reproductive outcomes among women aged 16–24 in England (2012–2019)","authors":"Danielle Solomon, Jo Gibbs, Fiona Burns, Hamish Mohammed, Stephanie J Migchelsen, Caroline A Sabin","doi":"10.1136/jech-2023-220835","DOIUrl":"https://doi.org/10.1136/jech-2023-220835","url":null,"abstract":"Background Women aged 16–24 in England have a high burden of sexual and reproductive morbidity, with particularly poor outcomes among people living in more deprived areas (including racially minoritised populations). This analysis used national data to examine the disparities within sexual and reproductive outcomes among this population and to assess whether the patterns of inequality were consistent across all outcomes. Methods Within this ecological study, univariable and multivariable Poisson regression analyses of neighbourhood-level data from national data sets were carried out to investigate the relationships of deprivation and ethnicity with each of six dependent variables: gonorrhoea and chlamydia testing rates, gonorrhoea and chlamydia test positivity rates, and abortion and repeat abortion rates. Results When comparing Index of Multiple Deprivation (IMD) decile 1 (most deprived) and IMD decile 10 (least deprived), chlamydia (RR 0.65) and gonorrhoea (0.79) testing rates, chlamydia (0.70) and gonorrhoea (0.34) positivity rates, abortion rates (0.45) and repeat abortion rates (0.72) were consistently lower in IMD decile 10 (least deprived). Similarly, chlamydia (RR 1.24) and gonorrhoea positivity rates (1.92) and repeat abortion rates (1.31) were higher among black women than white women. Results were similar when both ethnicity and deprivation were incorporated into multivariable analyses. Conclusion We found similar patterns of outcome inequality across a range of sexual and reproductive outcomes, despite multiple differences in the drivers of each outcome. Our analysis suggests that there are broad structural causes of inequality across sexual and reproductive health that particularly impact the health of deprived and black populations. Data may be obtained from a third party and are not publicly available. Data used in this analysis are held by the Department of Health and Social Care and the UK Health Security Agency, and as such are not publicly available.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140587340","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}
Pub Date : 2024-04-09DOI: 10.1136/jech-2023-221602
Alan Yeung, Max Wilkinson, Jen Bishop, Bob Taylor, Norah Palmateer, Lee Barnsdale, Jaroslaw Lang, Claire Cameron, Duncan McCormick, Tracey Clusker, Andrew McAuley, Sharon Hutchinson
Background There is limited evidence quantifying the risk of severe COVID-19 disease among people with opioid dependence. We examined vaccine uptake and severe disease (admission to critical care or death with COVID-19) among individuals prescribed opioid agonist therapy (OAT). Method A case–control design was used to examine vaccine uptake in those prescribed OAT compared with the general population, and the association between severe disease and OAT. In both analyses, 10 controls from the general population were matched (to each OAT recipient and COVID-19 case, respectively) according to socio-demographic factors. Conditional logistic regression was used to estimate rate ratios (RR) for severe disease. Results Vaccine uptake was markedly lower in the OAT cohort (dose 1: 67%, dose 2: 53% and dose 3: 31%) compared with matched controls (76%, 72% and 57%, respectively). Those prescribed OAT within the last 5 years, compared with those not prescribed, had increased risk of severe COVID-19 (RR 3.38, 95% CI 2.75 to 4.15), particularly in the fourth wave (RR 6.58, 95% CI 4.20 to 10.32); adjustment for comorbidity and vaccine status attenuated this risk (adjusted RR (aRR) 2.43, 95% CI 1.95 to 3.02; wave 4 aRR 3.78, 95% CI 2.30 to 6.20). Increased risk was also observed for those prescribed OAT previously (>3 months ago) compared with recently (aRR 1.74, 95% CI 1.11 to 2.71). Conclusions The widening gap in vaccine coverage for those prescribed OAT, compared with the general population, is likely to have exacerbated the risk of severe COVID-19 in this population over the pandemic. However, continued OAT use may have provided protection from severe COVID-19 among those with opioid dependence. Data may be obtained from a third party and are not publicly available. Access to the individual level data can be sought through approval of the Public Benefit and Privacy Panel for Health and Social Care ([www.informationgovernance.scot.nhs.uk/pbpphsc/home/for-applicants/][1]). [1]: http://www.informationgovernance.scot.nhs.uk/pbpphsc/home/for-applicants/
{"title":"SARS-CoV-2 vaccine uptake and risks of severe COVID-19 disease among people prescribed opioid agonist therapy in Scotland","authors":"Alan Yeung, Max Wilkinson, Jen Bishop, Bob Taylor, Norah Palmateer, Lee Barnsdale, Jaroslaw Lang, Claire Cameron, Duncan McCormick, Tracey Clusker, Andrew McAuley, Sharon Hutchinson","doi":"10.1136/jech-2023-221602","DOIUrl":"https://doi.org/10.1136/jech-2023-221602","url":null,"abstract":"Background There is limited evidence quantifying the risk of severe COVID-19 disease among people with opioid dependence. We examined vaccine uptake and severe disease (admission to critical care or death with COVID-19) among individuals prescribed opioid agonist therapy (OAT). Method A case–control design was used to examine vaccine uptake in those prescribed OAT compared with the general population, and the association between severe disease and OAT. In both analyses, 10 controls from the general population were matched (to each OAT recipient and COVID-19 case, respectively) according to socio-demographic factors. Conditional logistic regression was used to estimate rate ratios (RR) for severe disease. Results Vaccine uptake was markedly lower in the OAT cohort (dose 1: 67%, dose 2: 53% and dose 3: 31%) compared with matched controls (76%, 72% and 57%, respectively). Those prescribed OAT within the last 5 years, compared with those not prescribed, had increased risk of severe COVID-19 (RR 3.38, 95% CI 2.75 to 4.15), particularly in the fourth wave (RR 6.58, 95% CI 4.20 to 10.32); adjustment for comorbidity and vaccine status attenuated this risk (adjusted RR (aRR) 2.43, 95% CI 1.95 to 3.02; wave 4 aRR 3.78, 95% CI 2.30 to 6.20). Increased risk was also observed for those prescribed OAT previously (>3 months ago) compared with recently (aRR 1.74, 95% CI 1.11 to 2.71). Conclusions The widening gap in vaccine coverage for those prescribed OAT, compared with the general population, is likely to have exacerbated the risk of severe COVID-19 in this population over the pandemic. However, continued OAT use may have provided protection from severe COVID-19 among those with opioid dependence. Data may be obtained from a third party and are not publicly available. Access to the individual level data can be sought through approval of the Public Benefit and Privacy Panel for Health and Social Care ([www.informationgovernance.scot.nhs.uk/pbpphsc/home/for-applicants/][1]). [1]: http://www.informationgovernance.scot.nhs.uk/pbpphsc/home/for-applicants/","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140587587","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}
Pub Date : 2024-04-08DOI: 10.1136/jech-2024-221974
Nico Dragano, Domantas Jasilionis
Major sociopolitical upheavals change the course of history. However, this is not to be understood abstractly. The effects of wars, crises, sociopolitical change and technical or cultural innovations are felt first-hand by people in their everyday lives. Numerous findings suggest that social determinants have a lasting impact on the health of individuals and entire societies.1 2 Sociopolitical upheavals are nothing other than a fundamental reorganisation of these determinants—often in a relatively short period—and as such, they are an important subject of epidemiology. One of the fundamental political and social upheavals of recent decades was the collapse of the USSR (Union of Soviet Socialist Republics), which took place gradually from the mid-1980s onwards, reaching a dramatic climax in the early 1990s and whose long-term effects are still being felt today. This world-historical event had some drastic consequences for the population health in the countries primarily affected—both positive and negative.3–5 The article by Hahm et al attempts to build a bridge between …
{"title":"Long echo of sociopolitical upheaval: life events and health in East Germany","authors":"Nico Dragano, Domantas Jasilionis","doi":"10.1136/jech-2024-221974","DOIUrl":"https://doi.org/10.1136/jech-2024-221974","url":null,"abstract":"Major sociopolitical upheavals change the course of history. However, this is not to be understood abstractly. The effects of wars, crises, sociopolitical change and technical or cultural innovations are felt first-hand by people in their everyday lives. Numerous findings suggest that social determinants have a lasting impact on the health of individuals and entire societies.1 2 Sociopolitical upheavals are nothing other than a fundamental reorganisation of these determinants—often in a relatively short period—and as such, they are an important subject of epidemiology. One of the fundamental political and social upheavals of recent decades was the collapse of the USSR (Union of Soviet Socialist Republics), which took place gradually from the mid-1980s onwards, reaching a dramatic climax in the early 1990s and whose long-term effects are still being felt today. This world-historical event had some drastic consequences for the population health in the countries primarily affected—both positive and negative.3–5 The article by Hahm et al attempts to build a bridge between …","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140587652","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}
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