Pub Date : 2019-11-01DOI: 10.1136/jech-2019-213332
S. Jivraj
Timonin et al article adds weight to a need to address geographical health inequalities in Russia.1 They show, for the first time, how inequalities between districts are much greater than the inequalities between larger regional geographical containers. The difference in life expectancy between the best-performing and worst-performing groups of districts, each accounting for 5% of the Russian population, was as large as 16 years for men and 10 years for women. The mortality inequality was 2.6 times larger between districts than it was between regions. There is hope that these geographical inequalities in health can be reduced with the appropriate political will and infrastructure. Evidence from England has shown how life expectancy …
{"title":"To Russia, with love (and back again, hopefully)","authors":"S. Jivraj","doi":"10.1136/jech-2019-213332","DOIUrl":"https://doi.org/10.1136/jech-2019-213332","url":null,"abstract":"Timonin et al article adds weight to a need to address geographical health inequalities in Russia.1 They show, for the first time, how inequalities between districts are much greater than the inequalities between larger regional geographical containers. The difference in life expectancy between the best-performing and worst-performing groups of districts, each accounting for 5% of the Russian population, was as large as 16 years for men and 10 years for women. The mortality inequality was 2.6 times larger between districts than it was between regions.\u0000\u0000There is hope that these geographical inequalities in health can be reduced with the appropriate political will and infrastructure. Evidence from England has shown how life expectancy …","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81349550","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 : 2019-11-01Epub Date: 2019-09-06DOI: 10.1136/jech-2019-212623
Jayamalathi Priyanka Vakkalanka, Karisa K Harland, Amy Wittrock, Margaret Schmidt, Luke Mack, Matthew Nipe, Elaine Himadi, Marcia M Ward, Nicholas M Mohr
Objective: The purpose of this study was to evaluate the impact of telemedicine in clinical management and patient outcomes of patients presenting to rural critical access hospital emergency departments (EDs) with suicidal ideation or attempt.
Methods: Retrospective propensity-matched cohort study of patients treated for suicidal attempt and ideation in 13 rural critical access hospital EDs participating in a telemedicine network. Patients for whom telemedicine was used were matched 1:1 to those who did not have telemedicine as an exposure (n=139 TM+, n=139 TM-) using optimal matching of propensity scores based on administrative data. Our primary outcome was ED length-of-stay (LOS), and secondary outcomes included admission proportion, use of chemical or physical restraint, 30 day ED return, involuntary detention orders, treatment/follow-up plan and 6-month mortality. Analyses for multivariable models were conducted using conditional linear and logistic regression clustered on matched pairs with purposeful selection of covariates.
Results: Mean ED LOS was not associated with telemedicine consultation among all patients, but was associated with a 29.3% decrease in transferred patients (95% CI 11.1 to 47.5). The adjusted odds of hospital admission (either local or through transfer) was 2.35 (95% CI 1.10 to 5.00) times greater among TM+ patients compared with TM- patients. Involuntary hold placement was lower in those exposed to telemedicine (adjusted odds ratio (aOR): 0.48; 95% CI 0.23 to 0.97). We did not observe significant differences in other outcomes.
Conclusion: The role of telemedicine in influencing access, quality and efficiency of care in underserved rural hospitals is critically important as these networks become more prevalent in rural healthcare environments.
研究目的本研究旨在评估远程医疗对农村危急重症医院急诊科（ED）中有自杀意念或企图自杀的患者的临床管理和患者预后的影响：方法：对参与远程医疗网络的 13 家农村危急重症医院急诊科的自杀未遂和意念患者进行倾向匹配队列回顾性研究。使用基于管理数据的倾向评分进行优化匹配，将使用远程医疗的患者与未使用远程医疗的患者（n=139 TM+，n=139 TM-）进行 1:1 匹配。我们的主要结果是急诊室停留时间（LOS），次要结果包括入院比例、使用化学或物理约束、30 天急诊室返院率、非自愿拘留令、治疗/随访计划和 6 个月死亡率。多变量模型的分析采用条件线性回归和逻辑回归的方法，对匹配对进行聚类，并有目的地选择协变量：结果：所有患者的平均 ED LOS 与远程医疗咨询无关，但转院患者的平均 ED LOS 缩短了 29.3%（95% CI 11.1 至 47.5）。与远程医疗患者相比，远程医疗+患者入院（本地或转院）的调整后几率是远程医疗-患者的 2.35 倍（95% CI 1.10 至 5.00）。接受远程医疗的患者非自愿留院的比例较低（调整后的几率比（aOR）：0.48；95% CI 0.23 至 0.97）。我们没有观察到其他结果有明显差异：结论：随着远程医疗网络在农村医疗环境中的日益普及，远程医疗在影响医疗服务不足的农村医院的医疗服务获取、质量和效率方面的作用至关重要。
{"title":"Telemedicine is associated with rapid transfer and fewer involuntary holds among patients presenting with suicidal ideation in rural hospitals: a propensity matched cohort study.","authors":"Jayamalathi Priyanka Vakkalanka, Karisa K Harland, Amy Wittrock, Margaret Schmidt, Luke Mack, Matthew Nipe, Elaine Himadi, Marcia M Ward, Nicholas M Mohr","doi":"10.1136/jech-2019-212623","DOIUrl":"10.1136/jech-2019-212623","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to evaluate the impact of telemedicine in clinical management and patient outcomes of patients presenting to rural critical access hospital emergency departments (EDs) with suicidal ideation or attempt.</p><p><strong>Methods: </strong>Retrospective propensity-matched cohort study of patients treated for suicidal attempt and ideation in 13 rural critical access hospital EDs participating in a telemedicine network. Patients for whom telemedicine was used were matched 1:1 to those who did not have telemedicine as an exposure (n=139 TM+, n=139 TM-) using optimal matching of propensity scores based on administrative data. Our primary outcome was ED length-of-stay (LOS), and secondary outcomes included admission proportion, use of chemical or physical restraint, 30 day ED return, involuntary detention orders, treatment/follow-up plan and 6-month mortality. Analyses for multivariable models were conducted using conditional linear and logistic regression clustered on matched pairs with purposeful selection of covariates.</p><p><strong>Results: </strong>Mean ED LOS was not associated with telemedicine consultation among all patients, but was associated with a 29.3% decrease in transferred patients (95% CI 11.1 to 47.5). The adjusted odds of hospital admission (either local or through transfer) was 2.35 (95% CI 1.10 to 5.00) times greater among TM+ patients compared with TM- patients. Involuntary hold placement was lower in those exposed to telemedicine (adjusted odds ratio (aOR): 0.48; 95% CI 0.23 to 0.97). We did not observe significant differences in other outcomes.</p><p><strong>Conclusion: </strong>The role of telemedicine in influencing access, quality and efficiency of care in underserved rural hospitals is critically important as these networks become more prevalent in rural healthcare environments.</p>","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81639456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1136/jech-2019-212977
Yingqi Guo, Shu-Sen Chang, C. Chan, Qingsong Chang, Chia-Yueh Hsu, P. Yip
Background Previous studies investigating the independent effects of neighbourhood-level factors on depression are rare within the Asian context, especially in the elderly population. Methods Data for 29 099 older adults aged 65 years or above who have received health examinations at elderly health centres in Hong Kong in 2008–2011 were analysed. Using multilevel regression modelling, the cross-sectional associations of neighbourhood social attributes (neighbourhood poverty, ethnic minority, residential stability and elderly concentration) and physical (built) attributes (recreational services and walkability) with depression outcomes (depressive symptoms and depression) after adjusting for individual-level characteristics were investigated. Gender interaction effects were also examined. Results Neighbourhood poverty was associated with both depressive symptoms and depression in the elderly. Neighbourhood elderly concentration, recreational services and walkability were associated with fewer depressive symptoms. The association between neighbourhood poverty and elderly depressive symptoms was found in women only and not in men. Conclusion Policies aimed at reducing neighbourhood poverty, increasing access to recreational services and enhancing walkability might be effective strategies to prevent depression in older adults in the urban settings.
{"title":"Association of neighbourhood social and physical attributes with depression in older adults in Hong Kong: a multilevel analysis","authors":"Yingqi Guo, Shu-Sen Chang, C. Chan, Qingsong Chang, Chia-Yueh Hsu, P. Yip","doi":"10.1136/jech-2019-212977","DOIUrl":"https://doi.org/10.1136/jech-2019-212977","url":null,"abstract":"Background Previous studies investigating the independent effects of neighbourhood-level factors on depression are rare within the Asian context, especially in the elderly population. Methods Data for 29 099 older adults aged 65 years or above who have received health examinations at elderly health centres in Hong Kong in 2008–2011 were analysed. Using multilevel regression modelling, the cross-sectional associations of neighbourhood social attributes (neighbourhood poverty, ethnic minority, residential stability and elderly concentration) and physical (built) attributes (recreational services and walkability) with depression outcomes (depressive symptoms and depression) after adjusting for individual-level characteristics were investigated. Gender interaction effects were also examined. Results Neighbourhood poverty was associated with both depressive symptoms and depression in the elderly. Neighbourhood elderly concentration, recreational services and walkability were associated with fewer depressive symptoms. The association between neighbourhood poverty and elderly depressive symptoms was found in women only and not in men. Conclusion Policies aimed at reducing neighbourhood poverty, increasing access to recreational services and enhancing walkability might be effective strategies to prevent depression in older adults in the urban settings.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81482078","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 : 2019-10-29DOI: 10.1136/jech-2018-211856
S. L. Newell, Michelle L. Dion, Nancy Doubleday
Background Previous research association increased levels of cultural continuity and decreased rates of youth suicide in First Nations communities. We investigate the relationship between cultural continuity and self-rated health looking specifically at Inuit living in the Canadian Arctic. Methods The Arctic Supplements of the Aboriginal Peoples Survey from years 2001 and 2006 were appended to explore the relationship between various measures of cultural continuity and self-rated health. These measures include access to government services in an Aboriginal language, Inuit cultural variables, community involvement and governance. Literature related to Inuit social determinants of health and health-related behaviours were used to build the models. Results All measures of cultural continuity were shown to have a positive association with self-rated health for Inuit participants. Background and other control variables influenced the strength of the association but not the direction of the association. Access to services in an Aboriginal language, harvesting activities and government satisfaction were all significantly related to the odds of better health outcomes. Finally, the study contributes a baseline from a known data horizon against which future studies can assess changes and understand future impacts of changes. Conclusion The Canadian government and other agencies should address health inequalities between Inuit and non-Inuit people through programmes designed to foster cultural continuity at a community level. Providing access to services in an Aboriginal language is a superficial way of promoting cultural alignment of these services; however, more inclusion of Inuit traditional knowledge is needed to have a positive influence on health.
{"title":"Cultural continuity and Inuit health in Arctic Canada","authors":"S. L. Newell, Michelle L. Dion, Nancy Doubleday","doi":"10.1136/jech-2018-211856","DOIUrl":"https://doi.org/10.1136/jech-2018-211856","url":null,"abstract":"Background Previous research association increased levels of cultural continuity and decreased rates of youth suicide in First Nations communities. We investigate the relationship between cultural continuity and self-rated health looking specifically at Inuit living in the Canadian Arctic. Methods The Arctic Supplements of the Aboriginal Peoples Survey from years 2001 and 2006 were appended to explore the relationship between various measures of cultural continuity and self-rated health. These measures include access to government services in an Aboriginal language, Inuit cultural variables, community involvement and governance. Literature related to Inuit social determinants of health and health-related behaviours were used to build the models. Results All measures of cultural continuity were shown to have a positive association with self-rated health for Inuit participants. Background and other control variables influenced the strength of the association but not the direction of the association. Access to services in an Aboriginal language, harvesting activities and government satisfaction were all significantly related to the odds of better health outcomes. Finally, the study contributes a baseline from a known data horizon against which future studies can assess changes and understand future impacts of changes. Conclusion The Canadian government and other agencies should address health inequalities between Inuit and non-Inuit people through programmes designed to foster cultural continuity at a community level. Providing access to services in an Aboriginal language is a superficial way of promoting cultural alignment of these services; however, more inclusion of Inuit traditional knowledge is needed to have a positive influence on health.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80003440","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 : 2019-10-28DOI: 10.1136/jech-2019-212699
P. Hagedoorn, P. Groenewegen, Hannah Roberts, M. Helbich
Background Neighbourhood social fragmentation and socioeconomic deprivation seem to be associated with suicide mortality. However, results are inconclusive, which might be because dynamics in the social context are not well-represented by administratively bounded neighbourhoods at baseline. We used individualised neighbourhoods to examine associations between suicide mortality, social fragmentation, and deprivation for the total population as well as by sex and age group. Methods Using a nested case-control design, all suicides aged 18–64 years between 2007 and 2016 were selected from longitudinal Dutch register data and matched with 10 random controls. Indices for social fragmentation and deprivation were calculated annually for 300, 600 and 1000 metre circular buffers around each subject’s residential address. Results Suicide mortality was significantly higher in neighbourhoods with high deprivation and social fragmentation. Accounting for individual characteristics largely attenuated these associations. Suicide mortality remained significantly higher for women living in highly fragmented neighbourhoods in the fully adjusted model. Age-stratified analyses indicate associations with neighbourhood fragmentation among women in older age groups (40–64 years) only. Among men, suicide risk was lower in fragmented neighbourhoods for those aged 18–39 years and for short-term residents. In deprived neighbourhoods, suicide risk was lower for men aged 40–64 years and long-term residents. Associations between neighbourhood characteristics and suicide mortality were comparable across buffer sizes. Conclusion Our findings suggest that next to individual characteristics, the social and economic context within which people live may both enhance and buffer the risk of suicide.
{"title":"Is suicide mortality associated with neighbourhood social fragmentation and deprivation? A Dutch register-based case-control study using individualised neighbourhoods","authors":"P. Hagedoorn, P. Groenewegen, Hannah Roberts, M. Helbich","doi":"10.1136/jech-2019-212699","DOIUrl":"https://doi.org/10.1136/jech-2019-212699","url":null,"abstract":"Background Neighbourhood social fragmentation and socioeconomic deprivation seem to be associated with suicide mortality. However, results are inconclusive, which might be because dynamics in the social context are not well-represented by administratively bounded neighbourhoods at baseline. We used individualised neighbourhoods to examine associations between suicide mortality, social fragmentation, and deprivation for the total population as well as by sex and age group. Methods Using a nested case-control design, all suicides aged 18–64 years between 2007 and 2016 were selected from longitudinal Dutch register data and matched with 10 random controls. Indices for social fragmentation and deprivation were calculated annually for 300, 600 and 1000 metre circular buffers around each subject’s residential address. Results Suicide mortality was significantly higher in neighbourhoods with high deprivation and social fragmentation. Accounting for individual characteristics largely attenuated these associations. Suicide mortality remained significantly higher for women living in highly fragmented neighbourhoods in the fully adjusted model. Age-stratified analyses indicate associations with neighbourhood fragmentation among women in older age groups (40–64 years) only. Among men, suicide risk was lower in fragmented neighbourhoods for those aged 18–39 years and for short-term residents. In deprived neighbourhoods, suicide risk was lower for men aged 40–64 years and long-term residents. Associations between neighbourhood characteristics and suicide mortality were comparable across buffer sizes. Conclusion Our findings suggest that next to individual characteristics, the social and economic context within which people live may both enhance and buffer the risk of suicide.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87678585","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 : 2019-10-25DOI: 10.1136/jech-2019-212311
L. Davis, Emma Bogner, N. Coburn, T. Hanna, P. Kurdyak, P. Groome, A. Mahar
Introduction Individuals with a pre-existing mental illness, especially those experiencing reduced social, occupational and functional capacity, are at risk for cancer care disparities. However, uncertainty surrounding the effect of a mental illness on cancer outcomes exists. Methods We conducted a systematic review and meta-analysis of observational studies using MEDLINE and PubMed from 1 January 2005 to 1 November 2018. Two reviewers evaluated citations for inclusion. Advanced stage was defined as regional, metastatic or according to a classification system. Cancer survival was defined as time survived from cancer diagnosis. Pooled ORs and HRs were presented. The Newcastle-Ottawa bias risk assessment scale was used. Random-effects models used the Mantel-Haenszel approach and the generic inverse variance method. Heterogeneity assessment was performed using I2. Results 2381 citations were identified; 28 studies were included and 24 contributed to the meta-analysis. Many demonstrated methodological flaws, limiting interpretation and contributing to significant heterogeneity. Data source selection, definitions of a mental illness, outcomes and their measurement, and overadjustment for causal pathway variables influenced effect sizes. Pooled analyses suggested individuals with a pre-existing mental disorder have a higher odds of advanced stage cancer at diagnosis and are at risk of worse cancer survival. Individuals with more severe mental illness, such as schizophrenia, are at a greater risk for cancer disparities. Discussion This review identified critical gaps in research investigating cancer stage at diagnosis and survival for individuals with pre-existing mental illness. High-quality research is necessary to support quality improvement for the care of psychiatric patients and their families during and following a cancer diagnosis.
{"title":"Stage at diagnosis and survival in patients with cancer and a pre-existing mental illness: a meta-analysis","authors":"L. Davis, Emma Bogner, N. Coburn, T. Hanna, P. Kurdyak, P. Groome, A. Mahar","doi":"10.1136/jech-2019-212311","DOIUrl":"https://doi.org/10.1136/jech-2019-212311","url":null,"abstract":"Introduction Individuals with a pre-existing mental illness, especially those experiencing reduced social, occupational and functional capacity, are at risk for cancer care disparities. However, uncertainty surrounding the effect of a mental illness on cancer outcomes exists. Methods We conducted a systematic review and meta-analysis of observational studies using MEDLINE and PubMed from 1 January 2005 to 1 November 2018. Two reviewers evaluated citations for inclusion. Advanced stage was defined as regional, metastatic or according to a classification system. Cancer survival was defined as time survived from cancer diagnosis. Pooled ORs and HRs were presented. The Newcastle-Ottawa bias risk assessment scale was used. Random-effects models used the Mantel-Haenszel approach and the generic inverse variance method. Heterogeneity assessment was performed using I2. Results 2381 citations were identified; 28 studies were included and 24 contributed to the meta-analysis. Many demonstrated methodological flaws, limiting interpretation and contributing to significant heterogeneity. Data source selection, definitions of a mental illness, outcomes and their measurement, and overadjustment for causal pathway variables influenced effect sizes. Pooled analyses suggested individuals with a pre-existing mental disorder have a higher odds of advanced stage cancer at diagnosis and are at risk of worse cancer survival. Individuals with more severe mental illness, such as schizophrenia, are at a greater risk for cancer disparities. Discussion This review identified critical gaps in research investigating cancer stage at diagnosis and survival for individuals with pre-existing mental illness. High-quality research is necessary to support quality improvement for the care of psychiatric patients and their families during and following a cancer diagnosis.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83191132","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 : 2019-10-23DOI: 10.1136/jech-2019-212557
N. Escobar, E. Plugge
Background and objectives Imprisoned women have higher rates of abnormalities at cervical screening and some studies suggest that cervical cancer is the most common cancer in this population. The aim of this work was to summarise the current evidence on the prevalence of human papilloma virus (HPV) infection, cervical cancer and precancerous lesions in women in prison worldwide and to compare these rates with the general population. Methods We systematically searched and reviewed published and unpublished data reporting the prevalence of any HPV infection, cervical intraepithelial neoplasia (CIN) and cervical cancer in imprisoned women. We created forest plots with prevalence estimates from studies with comparable outcomes and of prevalence ratios using data from national screening programmes as a comparison group. Findings A total of 53 533 imprisoned women from 10 countries and 35 studies were included in the review. The prevalence of HPV among prisoners ranged from 10.5% to 55.4% with significant heterogeneity. The prevalence of CIN diagnosed by cytology in prisoners ranged from 0% to 22%. Ratios comparing the prevalence of CIN in imprisoned women to that in the community ranged from 1.13 to 5.46. Cancer prevalence estimates were at least 100 times higher than in populations participating in national screening programmes. Conclusion Imprisoned women are at higher risk of cervical cancer than the general population. There is a high prevalence of HPV infection and precancerous lesions in this population. Targeted programmes for control of risk factors and the development of more effective cervical screening programmes are recommended. PROSPERO registration number CRD42014009690.
{"title":"Prevalence of human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer in imprisoned women worldwide: a systematic review and meta-analysis","authors":"N. Escobar, E. Plugge","doi":"10.1136/jech-2019-212557","DOIUrl":"https://doi.org/10.1136/jech-2019-212557","url":null,"abstract":"Background and objectives Imprisoned women have higher rates of abnormalities at cervical screening and some studies suggest that cervical cancer is the most common cancer in this population. The aim of this work was to summarise the current evidence on the prevalence of human papilloma virus (HPV) infection, cervical cancer and precancerous lesions in women in prison worldwide and to compare these rates with the general population. Methods We systematically searched and reviewed published and unpublished data reporting the prevalence of any HPV infection, cervical intraepithelial neoplasia (CIN) and cervical cancer in imprisoned women. We created forest plots with prevalence estimates from studies with comparable outcomes and of prevalence ratios using data from national screening programmes as a comparison group. Findings A total of 53 533 imprisoned women from 10 countries and 35 studies were included in the review. The prevalence of HPV among prisoners ranged from 10.5% to 55.4% with significant heterogeneity. The prevalence of CIN diagnosed by cytology in prisoners ranged from 0% to 22%. Ratios comparing the prevalence of CIN in imprisoned women to that in the community ranged from 1.13 to 5.46. Cancer prevalence estimates were at least 100 times higher than in populations participating in national screening programmes. Conclusion Imprisoned women are at higher risk of cervical cancer than the general population. There is a high prevalence of HPV infection and precancerous lesions in this population. Targeted programmes for control of risk factors and the development of more effective cervical screening programmes are recommended. PROSPERO registration number CRD42014009690.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88753230","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 : 2019-10-19DOI: 10.1136/jech-2019-212488
Ian W Watson, S. C. Oancea
Background The influenza virus caused 48.8 million people to fall ill and 79 400 deaths during the 2017–2018 influenza season, yet less than 50% of US adults receive an annual flu vaccination (AFV). Having health insurance coverage influences whether individuals receive an AFV. The current study aims to determine if an association exists between an individual’s health plan type (HPT) and their receipt of an AFV. Methods Data from the 2017 Behavioral Risk Factor Surveillance System and the optional ‘Health Care Access’ module were used for this study. The final study sample size was 35 684. Multivariable weighted and adjusted logistic regression models were conducted to investigate the association between HPT and AFV. Results Medicare coverage was significantly associated with an increase in AFV for both men (adjusted OR (AOR) 1.62 (95% CI 1.28 to 2.06)) and women (AOR 1.28 (95% CI 1.00 to 1.53)). For men, other sources of coverage were also significantly positively associated with AFV (AOR 1.67 (95% CI 1.27 to 2.19)), while for women obtaining coverage on their own was significantly negatively associated with AFV (AOR 0.75 (95% CI 0.59 to 0.97)). Conclusion These findings are of interest to health policy makers as these show there are HPTs which are effective at improving vaccination rates. Adopting methods used by these HPTs could help the USA reach its Healthy People 2020 AFV coverage goal of 70%.
2017-2018年流感季节期间，流感病毒导致4880万人患病，79400人死亡，但只有不到50%的美国成年人每年接种流感疫苗(AFV)。是否有健康保险会影响个人是否接受AFV。目前的研究旨在确定个人的健康计划类型(HPT)和他们收到AFV之间是否存在关联。方法采用2017年行为风险因素监测系统和可选的“卫生保健获取”模块的数据进行研究。最终研究样本量为35 684。采用多变量加权和调整后的logistic回归模型来研究HPT与AFV之间的关系。结果医疗保险覆盖率与男性(调整后的OR (AOR) 1.62 (95% CI 1.28至2.06)和女性(AOR 1.28 (95% CI 1.00至1.53))的AFV增加显著相关。对于男性，其他来源的保险也与AFV显著正相关(AOR 1.67 (95% CI 1.27至2.19))，而对于女性，自行获得保险与AFV显著负相关(AOR 0.75 (95% CI 0.59至0.97))。结论这些发现引起了卫生政策制定者的兴趣，因为这些发现表明存在有效提高疫苗接种率的hpt。采用这些hpt使用的方法可以帮助美国实现其健康人2020年AFV覆盖率70%的目标。
{"title":"Does health plan type influence receipt of an annual influenza vaccination?","authors":"Ian W Watson, S. C. Oancea","doi":"10.1136/jech-2019-212488","DOIUrl":"https://doi.org/10.1136/jech-2019-212488","url":null,"abstract":"Background The influenza virus caused 48.8 million people to fall ill and 79 400 deaths during the 2017–2018 influenza season, yet less than 50% of US adults receive an annual flu vaccination (AFV). Having health insurance coverage influences whether individuals receive an AFV. The current study aims to determine if an association exists between an individual’s health plan type (HPT) and their receipt of an AFV. Methods Data from the 2017 Behavioral Risk Factor Surveillance System and the optional ‘Health Care Access’ module were used for this study. The final study sample size was 35 684. Multivariable weighted and adjusted logistic regression models were conducted to investigate the association between HPT and AFV. Results Medicare coverage was significantly associated with an increase in AFV for both men (adjusted OR (AOR) 1.62 (95% CI 1.28 to 2.06)) and women (AOR 1.28 (95% CI 1.00 to 1.53)). For men, other sources of coverage were also significantly positively associated with AFV (AOR 1.67 (95% CI 1.27 to 2.19)), while for women obtaining coverage on their own was significantly negatively associated with AFV (AOR 0.75 (95% CI 0.59 to 0.97)). Conclusion These findings are of interest to health policy makers as these show there are HPTs which are effective at improving vaccination rates. Adopting methods used by these HPTs could help the USA reach its Healthy People 2020 AFV coverage goal of 70%.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79713320","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 : 2019-10-19DOI: 10.1136/jech-2019-212987
Natalie A. Rosenquist, D. Cook, Amy Ehntholt, Anthony T Omaye, P. Muennig, R. Pabayo
Background Compared to other Organisation for Economic Co-operation and Development (OECD) nations, US infant mortality rates (IMRs) are particularly high. These differences are partially driven by racial disparities, with non-Hispanic black having IMRs that are twice those of non-Hispanic white. Income inequality (the gap between rich and poor) is associated with infant mortality. One proposed way to decrease income inequality (and possibly to improve birth outcomes) is to increase the minimum wage. We aimed to elucidate the relationship between state-level minimum wage and infant mortality risk using individual-level and state-level data. We also determined whether observed associations were heterogeneous across racial groups. Methods Data were from US Vital Statistics 2010 Cohort Linked Birth and Infant Death records and the 2010 US Bureau of Labor Statistics. We fit multilevel logistic models to test whether state minimum wage was associated with infant mortality. Minimum wage was standardised using the z-transformation and was dichotomised (high vs low) at the 75th percentile. Analyses were stratified by mother's race (non-Hispanic black vs non-Hispanic white). Results High minimum wage (adjusted OR (AOR)=0.93, 95% CI 0.83 to 1.03) was associated with decreased odds of infant mortality but was not statistically significant. High minimum wage was significantly associated with reduced infant mortality among non-Hispanic black infants (AOR=0.80, 95% CI 0.68 to 0.94) but not among non-Hispanic white infants (AOR=1.04, 95% CI 0.92 to 1.17). Conclusions Increasing the minimum wage might be beneficial to infant health, especially among non-Hispanic black infants, and thus might decrease the racial disparity in infant mortality.
与其他经济合作与发展组织(OECD)国家相比，美国的婴儿死亡率(IMRs)特别高。这些差异部分是由种族差异造成的，非西班牙裔黑人的imr是非西班牙裔白人的两倍。收入不平等(贫富差距)与婴儿死亡率有关。减少收入不平等(并可能改善生育结果)的一种方法是提高最低工资。我们的目的是利用个人水平和州水平的数据来阐明州一级最低工资与婴儿死亡率风险之间的关系。我们还确定了观察到的关联是否在种族群体中是异质的。方法数据来自美国生命统计2010年队列相关出生和婴儿死亡记录和2010年美国劳工统计局。我们拟合多层逻辑模型来检验国家最低工资是否与婴儿死亡率有关。使用z变换对最低工资进行标准化，并在第75个百分位数处进行二分类(高与低)。根据母亲的种族(非西班牙裔黑人vs非西班牙裔白人)对分析进行分层。结果较高的最低工资(调整后的OR (AOR)=0.93, 95% CI 0.83 ~ 1.03)与婴儿死亡率降低相关，但无统计学意义。在非西班牙裔黑人婴儿中，高最低工资与婴儿死亡率的降低显著相关(AOR=0.80, 95% CI 0.68至0.94)，但在非西班牙裔白人婴儿中无显著相关性(AOR=1.04, 95% CI 0.92至1.17)。结论提高最低工资可能有利于婴儿健康，特别是非西班牙裔黑人婴儿的健康，从而可能降低婴儿死亡率的种族差异。
{"title":"Differential relationship between state-level minimum wage and infant mortality risk among US infants born to white and black mothers","authors":"Natalie A. Rosenquist, D. Cook, Amy Ehntholt, Anthony T Omaye, P. Muennig, R. Pabayo","doi":"10.1136/jech-2019-212987","DOIUrl":"https://doi.org/10.1136/jech-2019-212987","url":null,"abstract":"Background Compared to other Organisation for Economic Co-operation and Development (OECD) nations, US infant mortality rates (IMRs) are particularly high. These differences are partially driven by racial disparities, with non-Hispanic black having IMRs that are twice those of non-Hispanic white. Income inequality (the gap between rich and poor) is associated with infant mortality. One proposed way to decrease income inequality (and possibly to improve birth outcomes) is to increase the minimum wage. We aimed to elucidate the relationship between state-level minimum wage and infant mortality risk using individual-level and state-level data. We also determined whether observed associations were heterogeneous across racial groups. Methods Data were from US Vital Statistics 2010 Cohort Linked Birth and Infant Death records and the 2010 US Bureau of Labor Statistics. We fit multilevel logistic models to test whether state minimum wage was associated with infant mortality. Minimum wage was standardised using the z-transformation and was dichotomised (high vs low) at the 75th percentile. Analyses were stratified by mother's race (non-Hispanic black vs non-Hispanic white). Results High minimum wage (adjusted OR (AOR)=0.93, 95% CI 0.83 to 1.03) was associated with decreased odds of infant mortality but was not statistically significant. High minimum wage was significantly associated with reduced infant mortality among non-Hispanic black infants (AOR=0.80, 95% CI 0.68 to 0.94) but not among non-Hispanic white infants (AOR=1.04, 95% CI 0.92 to 1.17). Conclusions Increasing the minimum wage might be beneficial to infant health, especially among non-Hispanic black infants, and thus might decrease the racial disparity in infant mortality.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73052619","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 : 2019-10-16DOI: 10.1136/jech-2019-212720
E. D. Lunde, A. M. Joensen, S. Lundbye-Christensen, K. Fonager, S. Paaske Johnsen, M. Larsen, M. Berg Johansen, S. Riahi
Aim To examine the association between socioeconomic position and the risk of atrial fibrillation (AF) in different stages of life in a population of Danish citizens. Methods Register-based study. We followed all individuals turning 35, 50, 65 or 80 years from 1 January 1996 to 31 December 2005 until AF, death, emigration or the end of study period (31 December 2015). Exposure was education and income. We used Cox regression for the HRs (95% CI) and the pseudo-observation method for the adjusted risk difference (RD) (%). Results A total of 2 173 857 participants were enrolled and 151 340 incident cases of AF occurred over a median of 13.6 years of follow-up. Adjusted HR (95% CI) of incident AF for the youngest age group with the highest education (ref lowest) was 0.62 (0.50 to 0.77) (women) and 0.85 (0.76 to 0.96) (men). The associations attenuated with increasing age, that is, HRs for the oldest age group were 1.04 (0.97 to 1.10) and 0.98 (0.96 to 1.04), respectively. The corresponding adjusted RDs (%) were: −0.28 (−0.43 to −0.14), −0.18 (−0.36 to −0.01), 3.04 (−0.55 to 6.64) and −0.74 (−3.38 to 2.49), respectively. Similar but weaker associations were found for income. Conclusion Higher level of education and income was associated with a lower risk of being diagnosed with AF in young individuals but the association decreased with increasing age and was almost absent for the oldest age cohort. However, since AF is relatively rare in the youngest the RDs were low.
{"title":"Socioeconomic position and risk of atrial fibrillation: a nationwide Danish cohort study","authors":"E. D. Lunde, A. M. Joensen, S. Lundbye-Christensen, K. Fonager, S. Paaske Johnsen, M. Larsen, M. Berg Johansen, S. Riahi","doi":"10.1136/jech-2019-212720","DOIUrl":"https://doi.org/10.1136/jech-2019-212720","url":null,"abstract":"Aim To examine the association between socioeconomic position and the risk of atrial fibrillation (AF) in different stages of life in a population of Danish citizens. Methods Register-based study. We followed all individuals turning 35, 50, 65 or 80 years from 1 January 1996 to 31 December 2005 until AF, death, emigration or the end of study period (31 December 2015). Exposure was education and income. We used Cox regression for the HRs (95% CI) and the pseudo-observation method for the adjusted risk difference (RD) (%). Results A total of 2 173 857 participants were enrolled and 151 340 incident cases of AF occurred over a median of 13.6 years of follow-up. Adjusted HR (95% CI) of incident AF for the youngest age group with the highest education (ref lowest) was 0.62 (0.50 to 0.77) (women) and 0.85 (0.76 to 0.96) (men). The associations attenuated with increasing age, that is, HRs for the oldest age group were 1.04 (0.97 to 1.10) and 0.98 (0.96 to 1.04), respectively. The corresponding adjusted RDs (%) were: −0.28 (−0.43 to −0.14), −0.18 (−0.36 to −0.01), 3.04 (−0.55 to 6.64) and −0.74 (−3.38 to 2.49), respectively. Similar but weaker associations were found for income. Conclusion Higher level of education and income was associated with a lower risk of being diagnosed with AF in young individuals but the association decreased with increasing age and was almost absent for the oldest age cohort. However, since AF is relatively rare in the youngest the RDs were low.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81492092","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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