Pub Date : 2024-02-01DOI: 10.1136/jech-2023-221438
Zachary H McCann, Howard H Chang, Rohan D'Souza, Noah Scovronick, Stefanie Ebelt
Introduction Ambient particulate matter ≤ 2.5 µm in aerodynamic diameter (PM2.5) exposure elevates the risk for cardiovascular disease morbidity (CVDM). The aim of this study is to characterise which area-level measures of socioeconomic position (SEP) modify the relationship between PM2.5 exposure and CVDM in Missouri at the census-tract (CT) level. Methods We use individual level Missouri emergency department (ED) admissions data (n=3 284 956), modelled PM2.5 data, and yearly CT data from 2012 to 2016 to conduct a two-stage analysis. Stage one uses a case-crossover approach with conditional logistic regression to establish the baseline risk of ED visits associated with IQR changes in PM2.5. In the second stage, we use multivariate metaregression to examine how CT-level SEP modifies the relationship between ambient PM2.5 exposure and CVDM. Results We find that overall, ambient PM2.5 exposure is associated with increased risk for CVDM. We test effect modification in statewide and urban CTs, and in the warm season only. Effect modification results suggest that among SEP measures, poverty is most consistently associated with increased risk for CVDM. For example, across Missouri, the highest poverty CTs are at an elevated risk for CVDM (OR=1.010 (95% CI 1.007 to 1.014)) compared with the lowest poverty CTs (OR=1.004 (95% CI 1.000 to 1.008)). Other SEP modifiers generally display an inconsistent or null effect. Conclusion Overall, we find some evidence that area-level SEP modifies the relationship between ambient PM2.5 exposure and CVDM, and suggest that the relationship between air-pollution, area-level SEP and CVDM may be sensitive to spatial scale. Data are available upon reasonable request.
{"title":"Assessment of census-tract level socioeconomic position as a modifier of the relationship between short-term PM2.5 exposure and cardiovascular emergency department visits in Missouri","authors":"Zachary H McCann, Howard H Chang, Rohan D'Souza, Noah Scovronick, Stefanie Ebelt","doi":"10.1136/jech-2023-221438","DOIUrl":"https://doi.org/10.1136/jech-2023-221438","url":null,"abstract":"Introduction Ambient particulate matter ≤ 2.5 µm in aerodynamic diameter (PM2.5) exposure elevates the risk for cardiovascular disease morbidity (CVDM). The aim of this study is to characterise which area-level measures of socioeconomic position (SEP) modify the relationship between PM2.5 exposure and CVDM in Missouri at the census-tract (CT) level. Methods We use individual level Missouri emergency department (ED) admissions data (n=3 284 956), modelled PM2.5 data, and yearly CT data from 2012 to 2016 to conduct a two-stage analysis. Stage one uses a case-crossover approach with conditional logistic regression to establish the baseline risk of ED visits associated with IQR changes in PM2.5. In the second stage, we use multivariate metaregression to examine how CT-level SEP modifies the relationship between ambient PM2.5 exposure and CVDM. Results We find that overall, ambient PM2.5 exposure is associated with increased risk for CVDM. We test effect modification in statewide and urban CTs, and in the warm season only. Effect modification results suggest that among SEP measures, poverty is most consistently associated with increased risk for CVDM. For example, across Missouri, the highest poverty CTs are at an elevated risk for CVDM (OR=1.010 (95% CI 1.007 to 1.014)) compared with the lowest poverty CTs (OR=1.004 (95% CI 1.000 to 1.008)). Other SEP modifiers generally display an inconsistent or null effect. Conclusion Overall, we find some evidence that area-level SEP modifies the relationship between ambient PM2.5 exposure and CVDM, and suggest that the relationship between air-pollution, area-level SEP and CVDM may be sensitive to spatial scale. Data are available upon reasonable request.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"143 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661949","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 : 2023-12-13DOI: 10.1136/jech-2023-220664
Jin Sun, Ning Wang, Shengxiang Li, Man Li, Anhang Zhang, Bangguo Qin, Qiligeer Bao, Bokai Cheng, Shuang Cai, Shuxia Wang, Ping Zhu
Background To assess the applicability of the association between estimated glucose disposal rate (eGDR) and all-cause mortality in the elderly population, and the mediating role of brachial-ankle pulse wave velocity (baPWV). Methods This was a follow-up cohort study based on the cross-sectional survey of community-dwelling elderly. All participants in the study were included between September 2009 and June 2010, and the follow-up time was December 2020. Participants included 1862 Chinese community-dwelling elderly aged 60 years and above. Insulin resistance assessed by eGDR and arterial stiffness assessed by baPWV were the primary exposures of interest. Mortality, which was followed up until December 2020, was the primary outcome. Cox proportional hazards regression models were used to estimate the association of eGDR with mortality. The mediating effect of baPWV in this association was assessed by mediation analysis. Results A total of 1826 participants with a mean age of 71.03 years old were included in the study. During the median follow-up of 10.75 years, 334 participants died. The adjusted HR comparing the highest versus the lowest eGDR quartile was 0.22 (95% CI 0.09 to 0.54; p<0.001) in the Cox proportional hazards model. The results of mediation analysis showed that baPWV had a significant mediation impact on the link between eGDR and all-cause mortality both as continuous or categorical variables. Conclusion eGDR is an independent predictor of all-cause mortality in the elderly population. baPWV partially mediated the association of eGDR and long-term all-cause mortality as a mediator factor. Data are available upon reasonable request. The research data used to support the finding of this study are available from the corresponding authors upon request.
背景:探讨老年人群中葡萄糖处理速率(eGDR)与全因死亡率相关性的适用性，以及臂踝脉波速度(baPWV)的中介作用。方法采用横断面调查对社区居住老年人进行随访队列研究。本研究的所有参与者均于2009年9月至2010年6月纳入，随访时间为2020年12月。参与者包括1862名60岁及以上的中国社区老年人。eGDR评估的胰岛素抵抗和baPWV评估的动脉硬度是主要的研究对象。随访至2020年12月的死亡率是主要结果。采用Cox比例风险回归模型估计eGDR与死亡率的关系。通过中介分析评估baPWV在该关联中的中介作用。结果共纳入1826名参与者，平均年龄71.03岁。在中位10.75年的随访期间，334名参与者死亡。比较最高和最低eGDR四分位数的校正HR为0.22 (95% CI 0.09 ~ 0.54;p<0.001)。中介分析结果显示，无论是作为连续变量还是分类变量，baPWV对eGDR与全因死亡率之间的关系都具有显著的中介作用。结论eGDR是老年人群全因死亡率的独立预测因子。baPWV作为中介因子部分介导了eGDR和长期全因死亡率的关联。如有合理要求，可提供资料。用于支持本研究发现的研究数据可应要求从通讯作者处获得。
{"title":"Estimated glucose disposal rate and risk of arterial stiffness and long-term all-acuse mortality: a 10-year prospective study","authors":"Jin Sun, Ning Wang, Shengxiang Li, Man Li, Anhang Zhang, Bangguo Qin, Qiligeer Bao, Bokai Cheng, Shuang Cai, Shuxia Wang, Ping Zhu","doi":"10.1136/jech-2023-220664","DOIUrl":"https://doi.org/10.1136/jech-2023-220664","url":null,"abstract":"Background To assess the applicability of the association between estimated glucose disposal rate (eGDR) and all-cause mortality in the elderly population, and the mediating role of brachial-ankle pulse wave velocity (baPWV). Methods This was a follow-up cohort study based on the cross-sectional survey of community-dwelling elderly. All participants in the study were included between September 2009 and June 2010, and the follow-up time was December 2020. Participants included 1862 Chinese community-dwelling elderly aged 60 years and above. Insulin resistance assessed by eGDR and arterial stiffness assessed by baPWV were the primary exposures of interest. Mortality, which was followed up until December 2020, was the primary outcome. Cox proportional hazards regression models were used to estimate the association of eGDR with mortality. The mediating effect of baPWV in this association was assessed by mediation analysis. Results A total of 1826 participants with a mean age of 71.03 years old were included in the study. During the median follow-up of 10.75 years, 334 participants died. The adjusted HR comparing the highest versus the lowest eGDR quartile was 0.22 (95% CI 0.09 to 0.54; p<0.001) in the Cox proportional hazards model. The results of mediation analysis showed that baPWV had a significant mediation impact on the link between eGDR and all-cause mortality both as continuous or categorical variables. Conclusion eGDR is an independent predictor of all-cause mortality in the elderly population. baPWV partially mediated the association of eGDR and long-term all-cause mortality as a mediator factor. Data are available upon reasonable request. The research data used to support the finding of this study are available from the corresponding authors upon request.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138632105","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 : 2023-12-12DOI: 10.1136/jech-2023-221223
Antonio Ivan Lazzarino, Jessica Ann Salkind, Federica Amati, Tamsin Robinson, Shamini Gnani, Dasha Nicholls, Dougal Hargreaves
Background Mental healthcare services for children and young people (CYP) are a very limited resource in the UK. To prevent health inequalities, measures to increase overall capacity must sit alongside measures that ensure utilisation matches need. Aim Our aim was to identify subgroups of CYP with unexpectedly low mental health service utilisation, presumably representing unmet need, and to assess whether there is area variation in the socioeconomic gradient of mental healthcare use. Methods This is a cross-sectional population survey of CYP (aged 5–24 years) using electronic health records from the Discover Now research platform, covering approximately 95% of the Northwest London resident population of 2.4 million people. Results The total sample comprised 764 327 CYP, of whom 2.1% attended a mental healthcare appointment in 2021 (95% CI 2.1% to 2.2%), our outcome measure. Lower socioeconomic status (our main exposure factor) was related to higher occurrence of mental healthcare appointments (+5% for each quintile increase in deprivation (95% CI 2% to 7%, p<0.001]). However, interaction analyses showed that the boroughs with unexpectedly low utilisation rates were also those not showing a clear trend between socioeconomic conditions and services utilisation (interaction p<0.001), suggesting that in these boroughs the occurrence of mental disorders in disadvantaged people was not captured by our analysis based on service utilisation. In some London boroughs, we found lower-than-expected activity for the most disadvantaged CYP. Conclusions The mental healthcare needs of many CYP from socioeconomically deprived areas of Northwest London may be unmet. More information is needed to confirm our results. Data are available in a public, open access repository.
{"title":"Inequalities in mental health service utilisation by children and young people: a population survey using linked electronic health records from Northwest London, UK","authors":"Antonio Ivan Lazzarino, Jessica Ann Salkind, Federica Amati, Tamsin Robinson, Shamini Gnani, Dasha Nicholls, Dougal Hargreaves","doi":"10.1136/jech-2023-221223","DOIUrl":"https://doi.org/10.1136/jech-2023-221223","url":null,"abstract":"Background Mental healthcare services for children and young people (CYP) are a very limited resource in the UK. To prevent health inequalities, measures to increase overall capacity must sit alongside measures that ensure utilisation matches need. Aim Our aim was to identify subgroups of CYP with unexpectedly low mental health service utilisation, presumably representing unmet need, and to assess whether there is area variation in the socioeconomic gradient of mental healthcare use. Methods This is a cross-sectional population survey of CYP (aged 5–24 years) using electronic health records from the Discover Now research platform, covering approximately 95% of the Northwest London resident population of 2.4 million people. Results The total sample comprised 764 327 CYP, of whom 2.1% attended a mental healthcare appointment in 2021 (95% CI 2.1% to 2.2%), our outcome measure. Lower socioeconomic status (our main exposure factor) was related to higher occurrence of mental healthcare appointments (+5% for each quintile increase in deprivation (95% CI 2% to 7%, p<0.001]). However, interaction analyses showed that the boroughs with unexpectedly low utilisation rates were also those not showing a clear trend between socioeconomic conditions and services utilisation (interaction p<0.001), suggesting that in these boroughs the occurrence of mental disorders in disadvantaged people was not captured by our analysis based on service utilisation. In some London boroughs, we found lower-than-expected activity for the most disadvantaged CYP. Conclusions The mental healthcare needs of many CYP from socioeconomically deprived areas of Northwest London may be unmet. More information is needed to confirm our results. Data are available in a public, open access repository.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138579529","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 : 2023-12-11DOI: 10.1136/jech-2023-221325
Rajesh Kumar Rai, Sabri Bromage
Background Age of marriage among women is considered an important indicator of their readiness for familial integration and parenting. This study estimated the effect of age of marriage of young mothers (aged 15–24 years) on utilisation of various services for their children, provided under the Integrated Child Development Service (ICDS) programme in India. Methods Data from the nationally representative 2019–2021 National Family Health Survey of India were analysed. Mothers’ age of menarche was used as an instrumental variable to isolate the effect of age of marriage on whether their children received (1) food, (2) health check-up, (3) immunisation, (4) early childhood care or preschooling or (5) weight measurement services from ICDS. Results Nationally, 67.9% (95% CI 67.6%, 68.3%) of children received food (sample: 60 578), 61.8% (95% CI 61.4%, 62.1%) received a health check-up (sample: 60 316), 60.0% (95% CI 59.6%, 60.4%) received immunisation services (sample: 60 537), 52.0% (95% CI 51.6%, 52.4%) received early childhood care or preschooling (sample: 60 458) and 62.9% (95% CI 62.5%, 63.3%) received weight measurement services (sample: 60 278). Findings from instrumental variable analysis suggest that a 1-year increase in age of marriage could yield a 9 percentage point increase (95% CI 4%–13%; p<0.001) in utilisation of immunisation services. Although postponement of marriage positively affected utilisation of each of the other four ICDS components, these effects were not statistically significant. Conclusion Postponing age of marriage among young women is an effective intervention for promoting uptake of child immunisation services. Our findings support the Government of India’s 2021 Bill to raise legal age of marriage of women. Data may be obtained from a third party and are not publicly available. The 2019–2021 National Family Health Survey dataset used for this study could be accessed from the official website of DHS Program:
背景 妇女的结婚年龄被认为是衡量她们是否准备好融入家庭和养育子女的一个重要指标。本研究估计了年轻母亲（15-24 岁）的结婚年龄对其子女利用印度儿童综合发展服务计划（ICDS）提供的各种服务的影响。方法 分析了具有全国代表性的 2019-2021 年印度全国家庭健康调查的数据。母亲的初潮年龄被用作工具变量，以分离出结婚年龄对其子女是否接受 ICDS 提供的（1）食品、（2）健康检查、（3）免疫接种、（4）幼儿保育或学前教育或（5）体重测量服务的影响。结果 在全国范围内，67.9%（95% CI 67.6%，68.3%）的儿童获得了食物（样本：60 578），61.8%（95% CI 61.4%，62.1%）的儿童获得了健康检查（样本：60 316），60.0%（95% CI 59.6%，60.4%）接受了免疫接种服务（样本：60 537），52.0%（95% CI 51.6%，52.4%）接受了幼儿保育或学前教育（样本：60 458），62.9%（95% CI 62.5%，63.3%）接受了体重测量服务（样本：60 278）。工具变量分析结果表明，结婚年龄每提高 1 岁，体重测量结果就会增加 9 个百分点（95% CI 4%-13%；p
{"title":"Estimated effect of age of marriage on utilisation of India’s Integrated Child Development Service programme","authors":"Rajesh Kumar Rai, Sabri Bromage","doi":"10.1136/jech-2023-221325","DOIUrl":"https://doi.org/10.1136/jech-2023-221325","url":null,"abstract":"Background Age of marriage among women is considered an important indicator of their readiness for familial integration and parenting. This study estimated the effect of age of marriage of young mothers (aged 15–24 years) on utilisation of various services for their children, provided under the Integrated Child Development Service (ICDS) programme in India. Methods Data from the nationally representative 2019–2021 National Family Health Survey of India were analysed. Mothers’ age of menarche was used as an instrumental variable to isolate the effect of age of marriage on whether their children received (1) food, (2) health check-up, (3) immunisation, (4) early childhood care or preschooling or (5) weight measurement services from ICDS. Results Nationally, 67.9% (95% CI 67.6%, 68.3%) of children received food (sample: 60 578), 61.8% (95% CI 61.4%, 62.1%) received a health check-up (sample: 60 316), 60.0% (95% CI 59.6%, 60.4%) received immunisation services (sample: 60 537), 52.0% (95% CI 51.6%, 52.4%) received early childhood care or preschooling (sample: 60 458) and 62.9% (95% CI 62.5%, 63.3%) received weight measurement services (sample: 60 278). Findings from instrumental variable analysis suggest that a 1-year increase in age of marriage could yield a 9 percentage point increase (95% CI 4%–13%; p<0.001) in utilisation of immunisation services. Although postponement of marriage positively affected utilisation of each of the other four ICDS components, these effects were not statistically significant. Conclusion Postponing age of marriage among young women is an effective intervention for promoting uptake of child immunisation services. Our findings support the Government of India’s 2021 Bill to raise legal age of marriage of women. Data may be obtained from a third party and are not publicly available. The 2019–2021 National Family Health Survey dataset used for this study could be accessed from the official website of DHS Program: <https://dhsprogram.com/>","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138572484","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 : 2023-12-11DOI: 10.1136/jech-2023-220626
Angela Donin, Claire M Nightingale, Naveed Sattar, William D Fraser, Chris G Owen, Derek G Cook, Peter H Whincup
Background Lower circulating vitamin D 25-hydroxyvitamin D (25(OH)D) concentrations are associated with higher type 2 diabetes risk in adults, although causality remains uncertain. However, associations between 25(OH)D and type 2 diabetes risk markers in children have been little studied, particularly in ethnic minority populations. We examined whether 25(OH)D concentrations were associated with insulin resistance in children and whether lower 25(OH)D concentrations in South Asians and black African Caribbeans could contribute to their higher insulin resistance. Methods Cross-sectional study of 4650 UK primary school children aged 9–10 years of predominantly South Asian, black African Caribbean and white European ethnicity. Children had fasting blood measurements of circulating 25(OH)D metabolite concentrations, insulin and glucose. Results Lower 25(OH)D concentrations were observed in girls, South Asians and black African Caribbeans. In analyses adjusted for age, sex, month, ethnic group and school, circulating 25(OH)D was inversely associated with fasting insulin (−0.38%, 95% CI −0.49% to −0.27%), homoeostasis model assessment (HOMA) insulin resistance (−0.39%, 95% CI −0.50% to −0.28%) and fasting glucose (−0.03%, 95% CI −0.05% to –0.02%) per nmol/L increase in 25(OH)D; associations did not differ between ethnic groups. Ethnic differences in fasting insulin and HOMA insulin resistance (higher among South Asian and black African Caribbeans) were reduced by >40% after adjustment for circulating 25(OH)D concentrations. Conclusion Circulating vitamin D was inversely associated with insulin resistance in all ethnic groups; higher insulin resistance in South Asian and black African children were partly explained by their lower vitamin D levels. Whether vitamin D supplementation can reduce emerging type 2 diabetes risk needs further evaluation. Data are available on reasonable request.
背景 循环中维生素 D 25-羟基维生素 D（25(OH)D）浓度较低与成人 2 型糖尿病风险较高有关，但因果关系仍不确定。然而，有关儿童体内 25（OH）D 与 2 型糖尿病风险指标之间关系的研究却很少，尤其是在少数民族人群中。我们研究了25（OH）D浓度是否与儿童的胰岛素抵抗有关，以及南亚人和非洲加勒比黑人较低的25（OH）D浓度是否会导致他们较高的胰岛素抵抗。方法 对 4650 名年龄在 9-10 岁的英国小学生进行横断面研究，他们主要是南亚人、非洲加勒比黑人和欧洲白人。儿童空腹抽血测量循环中 25(OH)D 代谢物的浓度、胰岛素和葡萄糖。结果 观察到女孩、南亚人和非洲加勒比黑人的 25（OH）D 浓度较低。在对年龄、性别、月份、种族群体和学校进行调整后的分析中，每增加一毫摩尔/升 25（OH）D，循环 25（OH）D 与空腹胰岛素（-0.38%，95% CI -0.49%至-0.27%）、均质模型评估（HOMA）胰岛素抵抗（-0.39%，95% CI -0.50%至-0.28%）和空腹血糖（-0.03%，95% CI -0.05%至-0.02%）呈负相关；不同种族群体之间的相关性没有差异。在对循环 25(OH)D 浓度进行调整后，空腹胰岛素和 HOMA 胰岛素抵抗的种族差异（南亚人和非洲加勒比黑人更高）减少了 40%以上。结论 在所有种族群体中，循环维生素 D 与胰岛素抵抗成反比；南亚和黑非洲儿童胰岛素抵抗较高的部分原因是他们的维生素 D 水平较低。补充维生素 D 是否能降低新出现的 2 型糖尿病风险还需要进一步评估。如有合理要求，可提供相关数据。
{"title":"Cross-sectional study of the associations between circulating vitamin D concentrations and insulin resistance in children aged 9–10 years of South Asian, black African Caribbean and white European origins","authors":"Angela Donin, Claire M Nightingale, Naveed Sattar, William D Fraser, Chris G Owen, Derek G Cook, Peter H Whincup","doi":"10.1136/jech-2023-220626","DOIUrl":"https://doi.org/10.1136/jech-2023-220626","url":null,"abstract":"Background Lower circulating vitamin D 25-hydroxyvitamin D (25(OH)D) concentrations are associated with higher type 2 diabetes risk in adults, although causality remains uncertain. However, associations between 25(OH)D and type 2 diabetes risk markers in children have been little studied, particularly in ethnic minority populations. We examined whether 25(OH)D concentrations were associated with insulin resistance in children and whether lower 25(OH)D concentrations in South Asians and black African Caribbeans could contribute to their higher insulin resistance. Methods Cross-sectional study of 4650 UK primary school children aged 9–10 years of predominantly South Asian, black African Caribbean and white European ethnicity. Children had fasting blood measurements of circulating 25(OH)D metabolite concentrations, insulin and glucose. Results Lower 25(OH)D concentrations were observed in girls, South Asians and black African Caribbeans. In analyses adjusted for age, sex, month, ethnic group and school, circulating 25(OH)D was inversely associated with fasting insulin (−0.38%, 95% CI −0.49% to −0.27%), homoeostasis model assessment (HOMA) insulin resistance (−0.39%, 95% CI −0.50% to −0.28%) and fasting glucose (−0.03%, 95% CI −0.05% to –0.02%) per nmol/L increase in 25(OH)D; associations did not differ between ethnic groups. Ethnic differences in fasting insulin and HOMA insulin resistance (higher among South Asian and black African Caribbeans) were reduced by >40% after adjustment for circulating 25(OH)D concentrations. Conclusion Circulating vitamin D was inversely associated with insulin resistance in all ethnic groups; higher insulin resistance in South Asian and black African children were partly explained by their lower vitamin D levels. Whether vitamin D supplementation can reduce emerging type 2 diabetes risk needs further evaluation. Data are available on reasonable request.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138572498","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 : 2023-12-09DOI: 10.1136/jech-2023-221077
Xiao Zhang, Michele Battisti, Eugenio Proto
Background China was the first country affected by the COVID-19 virus, and it is a very important case to study the effects of the virus and the consequent restrictions. However, national representative studies of how the COVID-19 pandemic affects mental health in China are still limited. Methods Using two waves of the China Family Panel Studies, we follow the same individuals before and during the pandemic. We compare weighted means using 95% CIs to explore mental health deterioration, and we and perform several linear regressions with the Ordinaly Least Square (OLS) estimator to identify individuals most affected by the COVID-19 pandemic. Results The prevalence of severe cases of depression, measured using an eight-item version of the common Centre for Epidemiologic Studies Depression Scale (CES-D), increased from 6.68% in 2018 to 7.86% in 2020; quantifiable as around a 18% increase. This deterioration is higher for individuals subject to strict lockdowns, about 0.4 symptoms more on average, and it is stronger among those who already reported symptoms of depression in the 2018 wave of data. Individuals with more open personalities tend to experience more severe deterioration: a 1 SD change in the openness trait corresponds to 0.05 more symptoms. On the other hand, more neurotic individuals seem less negatively affected. Conclusion We find clear evidence of a moderate level of mental health deterioration between 2018 and 2020. These effects are larger for individuals subject to stricter lockdowns and for individuals with more open personalities. Data are available on reasonable request. This paper uses data from China Family Panel Studies (wave 2018 and wave 2020), which are available to researchers on request. The datasets generated and/or analysed during the current study are available in the (CFPS Data Platform) repository, (). Please contact the China Family Panel Studies project team for data access. Their mailing address is Office of China Family Panel Studies, Science Building #5, Peking University, 5 Yiheyuan Road, Haidian District, Beijing, P.R. China; Postal Code：100871; email: isss.cfps@pku.edu.cn.The authors will make replication files (Stata do file) available.
{"title":"COVID-19 and mental health in China: the effects of personality","authors":"Xiao Zhang, Michele Battisti, Eugenio Proto","doi":"10.1136/jech-2023-221077","DOIUrl":"https://doi.org/10.1136/jech-2023-221077","url":null,"abstract":"Background China was the first country affected by the COVID-19 virus, and it is a very important case to study the effects of the virus and the consequent restrictions. However, national representative studies of how the COVID-19 pandemic affects mental health in China are still limited. Methods Using two waves of the China Family Panel Studies, we follow the same individuals before and during the pandemic. We compare weighted means using 95% CIs to explore mental health deterioration, and we and perform several linear regressions with the Ordinaly Least Square (OLS) estimator to identify individuals most affected by the COVID-19 pandemic. Results The prevalence of severe cases of depression, measured using an eight-item version of the common Centre for Epidemiologic Studies Depression Scale (CES-D), increased from 6.68% in 2018 to 7.86% in 2020; quantifiable as around a 18% increase. This deterioration is higher for individuals subject to strict lockdowns, about 0.4 symptoms more on average, and it is stronger among those who already reported symptoms of depression in the 2018 wave of data. Individuals with more open personalities tend to experience more severe deterioration: a 1 SD change in the openness trait corresponds to 0.05 more symptoms. On the other hand, more neurotic individuals seem less negatively affected. Conclusion We find clear evidence of a moderate level of mental health deterioration between 2018 and 2020. These effects are larger for individuals subject to stricter lockdowns and for individuals with more open personalities. Data are available on reasonable request. This paper uses data from China Family Panel Studies (wave 2018 and wave 2020), which are available to researchers on request. The datasets generated and/or analysed during the current study are available in the (CFPS Data Platform) repository, (<http://www.isss.pku.edu.cn/cfps/download>). Please contact the China Family Panel Studies project team for data access. Their mailing address is Office of China Family Panel Studies, Science Building #5, Peking University, 5 Yiheyuan Road, Haidian District, Beijing, P.R. China; Postal Code：100871; email: isss.cfps@pku.edu.cn.The authors will make replication files (Stata do file) available.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138563731","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 : 2022-09-06DOI: 10.1136/jech-2021-218331
Garazi Ruiz de Azua, I. Vaz-Luis, T. Bovagnet, A. Di Meglio, J. Havas, E. Caumette, E. Martin, B. Pistilli, C. Coutant, P. Cottu, P. Rouanet, A. Arnaud, O. Arsene, Mahmoud Ibrahim, J. Wassermann, R. Rouzier, Anne-Laure Martin, S. Everhard, A. Dumas, G. Menvielle
Background We assessed the prevalence of self-reported perceived discrimination in the workplace after the end of treatment among breast cancer (BC) survivors and studied its association with social, health-related and work-related factors. Methods We used data from a French prospective cohort (CANcer TOxicities) including women diagnosed with stage I–III BC. Our analysis included 2130 women who were employed, <57 years old at BC diagnosis and were working 2 years afterwards. We assessed the association between social, health-related and work-related factors and perceived discrimination in the workplace using logistic regression models. Results Overall, 26% of women reported perceived discrimination in the workplace after the end of treatment. Women working for a small company, in the public sector or with better overall health status were less likely to report perceived discrimination. Women who benefited from easing dispositions at their workplace, who did not feel supported by their colleagues and those who returned to work because of fear of job loss were more likely to report perceived discrimination. Conclusions One in four BC survivors perceives discrimination in the workplace. Health and work-related factors are associated with increased likelihood of reporting perceived discrimination. Trial registration number NCT01993498.
{"title":"Perceived discrimination at work: examining social, health and work-related factors as determinants among breast cancer survivors – evidence from the prospective CANTO cohort","authors":"Garazi Ruiz de Azua, I. Vaz-Luis, T. Bovagnet, A. Di Meglio, J. Havas, E. Caumette, E. Martin, B. Pistilli, C. Coutant, P. Cottu, P. Rouanet, A. Arnaud, O. Arsene, Mahmoud Ibrahim, J. Wassermann, R. Rouzier, Anne-Laure Martin, S. Everhard, A. Dumas, G. Menvielle","doi":"10.1136/jech-2021-218331","DOIUrl":"https://doi.org/10.1136/jech-2021-218331","url":null,"abstract":"Background We assessed the prevalence of self-reported perceived discrimination in the workplace after the end of treatment among breast cancer (BC) survivors and studied its association with social, health-related and work-related factors. Methods We used data from a French prospective cohort (CANcer TOxicities) including women diagnosed with stage I–III BC. Our analysis included 2130 women who were employed, <57 years old at BC diagnosis and were working 2 years afterwards. We assessed the association between social, health-related and work-related factors and perceived discrimination in the workplace using logistic regression models. Results Overall, 26% of women reported perceived discrimination in the workplace after the end of treatment. Women working for a small company, in the public sector or with better overall health status were less likely to report perceived discrimination. Women who benefited from easing dispositions at their workplace, who did not feel supported by their colleagues and those who returned to work because of fear of job loss were more likely to report perceived discrimination. Conclusions One in four BC survivors perceives discrimination in the workplace. Health and work-related factors are associated with increased likelihood of reporting perceived discrimination. Trial registration number NCT01993498.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"1 1","pages":"918 - 924"},"PeriodicalIF":0.0,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88327449","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 : 2022-05-13DOI: 10.1136/jech-2022-219176
J. Zelner, R. Naraharisetti
In their recent letter in J Epidemiol Community Health, Schultes et al examined patterns of declining race/ ethnic disparities in COVID19 mortality in Connecticut from March 2020 to December 2021. This work is a helpful contribution to the expanding literature on race/ethnic disparities in SARSCoV2 mortality, and due to its attention to the differential toll of SARSCoV2 in congregate versus noncongregate settings by race/ethnicity is particularly important. However, motivated by our shared concern about the inequities highlighted by Schultes et al, we feel compelled to address the authors’ contention that their ‘findings suggest that attenuation of racial and ethnic disparities is an achievable public health goal’. We believe that this statement reflects a broadly held misapprehension about the meaningfulness of declining mortality rate ratios (MRRs) as evidence of progress against inequity in pandemicrelated mortality. While changes in the MRR for nonwhites as compared with whites—the main indicator of disparity used in the paper—may reflect some progress against race/ethnic and classbased disparities SARSCoV2 in infection and mortality, a narrow focus on declining groupspecific MRRs may paint a far more optimistic picture of this progress than is warranted. On a methodological level, ratiobased measures of SARSCoV2 inequality are made difficult to interpret because of their susceptibility to distortion from change in the denominator: Diminishing MRRs by race may reflect declines in the numerator (the minoritised group in question) or increases in the denominator (an advantaged group, typically whites). In fact, Lawton et al found that much of the declines in countylevel SARSCoV2 MRRs by race were better explained by increasing overall prevalence reflecting increased infection and death among whites than precipitous declines in infection among nonwhites. From a health justice perspective, it is critical that withinpandemic successes in attenuating disparities not be conflated with success in combating racial capitalism and other manifestations of structural racism which contributed to differential participation in hazardous ‘essential work’ and other risks that made irreversible earlypandemic mortality disparities inevitable. We suggest that, at a minimum, researchers and policymakers contemplate a simple thought experiment before concluding that secular declines in race/ ethnic MRRs for COVID19 suggest progress against infection inequity: If a novel pandemic characterised by similar lethality and transmissibility to SARSCoV2 was to emerge in the coming months, would the factors that led to declining MRRs during this pandemic translate into dramatically decreased disparities in death at the beginning of the next one? We doubt it and advocate for caution in interpretation of these declines as a result.
{"title":"Declining COVID-19 mortality risk ratios must be interpreted with caution","authors":"J. Zelner, R. Naraharisetti","doi":"10.1136/jech-2022-219176","DOIUrl":"https://doi.org/10.1136/jech-2022-219176","url":null,"abstract":"In their recent letter in J Epidemiol Community Health, Schultes et al examined patterns of declining race/ ethnic disparities in COVID19 mortality in Connecticut from March 2020 to December 2021. This work is a helpful contribution to the expanding literature on race/ethnic disparities in SARSCoV2 mortality, and due to its attention to the differential toll of SARSCoV2 in congregate versus noncongregate settings by race/ethnicity is particularly important. However, motivated by our shared concern about the inequities highlighted by Schultes et al, we feel compelled to address the authors’ contention that their ‘findings suggest that attenuation of racial and ethnic disparities is an achievable public health goal’. We believe that this statement reflects a broadly held misapprehension about the meaningfulness of declining mortality rate ratios (MRRs) as evidence of progress against inequity in pandemicrelated mortality. While changes in the MRR for nonwhites as compared with whites—the main indicator of disparity used in the paper—may reflect some progress against race/ethnic and classbased disparities SARSCoV2 in infection and mortality, a narrow focus on declining groupspecific MRRs may paint a far more optimistic picture of this progress than is warranted. On a methodological level, ratiobased measures of SARSCoV2 inequality are made difficult to interpret because of their susceptibility to distortion from change in the denominator: Diminishing MRRs by race may reflect declines in the numerator (the minoritised group in question) or increases in the denominator (an advantaged group, typically whites). In fact, Lawton et al found that much of the declines in countylevel SARSCoV2 MRRs by race were better explained by increasing overall prevalence reflecting increased infection and death among whites than precipitous declines in infection among nonwhites. From a health justice perspective, it is critical that withinpandemic successes in attenuating disparities not be conflated with success in combating racial capitalism and other manifestations of structural racism which contributed to differential participation in hazardous ‘essential work’ and other risks that made irreversible earlypandemic mortality disparities inevitable. We suggest that, at a minimum, researchers and policymakers contemplate a simple thought experiment before concluding that secular declines in race/ ethnic MRRs for COVID19 suggest progress against infection inequity: If a novel pandemic characterised by similar lethality and transmissibility to SARSCoV2 was to emerge in the coming months, would the factors that led to declining MRRs during this pandemic translate into dramatically decreased disparities in death at the beginning of the next one? We doubt it and advocate for caution in interpretation of these declines as a result.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"60 1","pages":"840 - 840"},"PeriodicalIF":0.0,"publicationDate":"2022-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81959099","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 : 2022-04-27DOI: 10.1136/jech-2020-216000corr1
M. ScannellBryan
{"title":"Correction: Associations between age of menarche and genetic variation in women of African descent: genome-wide association study and polygenic score analysis","authors":"M. ScannellBryan","doi":"10.1136/jech-2020-216000corr1","DOIUrl":"https://doi.org/10.1136/jech-2020-216000corr1","url":null,"abstract":"","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"62 1","pages":"628 - 628"},"PeriodicalIF":0.0,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86371386","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 : 2022-04-25DOI: 10.1136/jech-2021-218042
J. Morton, J. Ilomäki, S. Wood, J. Bell, Q. Huynh, D. Magliano, J. Shaw
Aims We evaluated variation in treatment for, and outcomes following, myocardial infarction (MI) by diabetes status, sex and socioeconomic disadvantage. Methods We included all people aged ≥30 years who were discharged alive from hospital following MI between 1 July 2012 and 30 June 2017 in Victoria, Australia (n=43 272). We assessed receipt of inpatient procedures and discharge dispensing of cardioprotective medications for each admission, as well as 1-year all-cause, cardiovascular, and MI readmission rates and 1-year all-cause mortality. Results Risk of all-cause (HR: 1.22 (1.19–1.26)), cardiovascular (1.29 (1.25–1.34)), MI (1.52 (1.43–1.62)) and heart failure readmission (1.62 (1.50–1.75)) and mortality (1.18 (1.11–1.26)) were higher in people with diabetes. Males and people in more disadvantaged areas were at increased risk of readmission and mortality following MI. People with diabetes (vs without) were more likely to receive coronary artery bypass grafting (CABG) but less likely to receive percutaneous coronary intervention (PCI) during, or within 30 days of, their index admission. Females were less likely to receive either (eg, 87% of males with a STEMI received PCI or CABG vs 70% of females), and people in more disadvantaged areas were less likely to receive PCI. People with diabetes, males and people in more disadvantaged areas were more likely to be dispensed cardioprotective medications at or within 90 days of discharge. Conclusions Following an MI, people with diabetes and males had poorer outcomes but received more intensive cardiovascular treatments. However, socioeconomic disadvantage was associated with both less intensive inpatient treatment and poorer outcomes.
{"title":"Treatment gaps, 1-year readmission and mortality following myocardial infarction by diabetes status, sex and socioeconomic disadvantage","authors":"J. Morton, J. Ilomäki, S. Wood, J. Bell, Q. Huynh, D. Magliano, J. Shaw","doi":"10.1136/jech-2021-218042","DOIUrl":"https://doi.org/10.1136/jech-2021-218042","url":null,"abstract":"Aims We evaluated variation in treatment for, and outcomes following, myocardial infarction (MI) by diabetes status, sex and socioeconomic disadvantage. Methods We included all people aged ≥30 years who were discharged alive from hospital following MI between 1 July 2012 and 30 June 2017 in Victoria, Australia (n=43 272). We assessed receipt of inpatient procedures and discharge dispensing of cardioprotective medications for each admission, as well as 1-year all-cause, cardiovascular, and MI readmission rates and 1-year all-cause mortality. Results Risk of all-cause (HR: 1.22 (1.19–1.26)), cardiovascular (1.29 (1.25–1.34)), MI (1.52 (1.43–1.62)) and heart failure readmission (1.62 (1.50–1.75)) and mortality (1.18 (1.11–1.26)) were higher in people with diabetes. Males and people in more disadvantaged areas were at increased risk of readmission and mortality following MI. People with diabetes (vs without) were more likely to receive coronary artery bypass grafting (CABG) but less likely to receive percutaneous coronary intervention (PCI) during, or within 30 days of, their index admission. Females were less likely to receive either (eg, 87% of males with a STEMI received PCI or CABG vs 70% of females), and people in more disadvantaged areas were less likely to receive PCI. People with diabetes, males and people in more disadvantaged areas were more likely to be dispensed cardioprotective medications at or within 90 days of discharge. Conclusions Following an MI, people with diabetes and males had poorer outcomes but received more intensive cardiovascular treatments. However, socioeconomic disadvantage was associated with both less intensive inpatient treatment and poorer outcomes.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"6 1","pages":"637 - 645"},"PeriodicalIF":0.0,"publicationDate":"2022-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76013815","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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