Pub Date : 2019-10-14DOI: 10.1136/jech-2019-212425
Jennifer L. Moss, Rebecca C Ehrenkranz, L. Perez, Brionna Y. Hair, Anne K Julian
Background Cancer screening in the USA is suboptimal, particularly for individuals living in vulnerable communities. This study aimed to understand how rurality and racial segregation are independently and interactively associated with cancer screening and cancer fatalism. Methods We used data from a nationally representative sample of adults (n=17 736) from National Cancer Institute’s Health Information National Trends Survey, 2011–2017, including cancer screening (colorectal, breast, cervical, prostate) among eligible participants and cancer fatalism. These data were linked to county-level metropolitan status/rurality (US Department of Agriculture) and racial segregation (US Census). We conducted multivariable analyses of associations of geographic variables with screening and fatalism. Results Breast cancer screening was lower in rural (92%, SE=1.5%) than urban counties (96%, SE=0.5%) (adjusted OR (aOR)=0.52, 95% CI 0.31 to 0.87). Colorectal cancer screening was higher in highly segregated (70%, SE=1.0%) than less segregated counties (65%, SE=1.7%) (aOR=1.28, 95% CI 1.04 to 1.58). Remaining outcomes did not vary by rurality or segregation, and these variables did not interact in their associations with screening or fatalism. Conclusion Similar to previous studies, breast cancer screening was less common in rural areas. Contrary to expectations, colorectal cancer screening was higher in highly segregated counties. More research is needed on the influence of geography on cancer screening and beliefs, and how access to facilities or information may mediate these relationships.
背景:美国的癌症筛查是次优的，特别是对于生活在脆弱社区的个人。本研究旨在了解乡村性和种族隔离如何与癌症筛查和癌症宿命论独立互动地联系在一起。方法:我们使用2011-2017年美国国家癌症研究所健康信息全国趋势调查中具有全国代表性的成年人样本(n= 17736)的数据，包括符合条件的参与者的癌症筛查(结直肠癌、乳腺癌、宫颈癌、前列腺癌)和癌症宿命论。这些数据与县级大都市地位/乡村性(美国农业部)和种族隔离(美国人口普查)有关。我们对地理变量与筛选和宿命论的关系进行了多变量分析。结果农村地区乳腺癌筛查率(92%，SE=1.5%)低于城市县(96%，SE=0.5%)(调整后OR (aOR)=0.52, 95% CI 0.31 ~ 0.87)。高度隔离县的结直肠癌筛查率(70%，SE=1.0%)高于隔离程度较低的县(65%，SE=1.7%) (aOR=1.28, 95% CI 1.04 ~ 1.58)。其余的结果没有因乡村性或隔离而变化，这些变量与筛查或宿命论之间没有相互作用。结论与之前的研究类似，乳腺癌筛查在农村地区较不普遍。与预期相反，在高度隔离的县，结直肠癌筛查率更高。需要对地理位置对癌症筛查和信念的影响，以及获得设施或信息如何调节这些关系进行更多的研究。
{"title":"Geographic disparities in cancer screening and fatalism among a nationally representative sample of US adults","authors":"Jennifer L. Moss, Rebecca C Ehrenkranz, L. Perez, Brionna Y. Hair, Anne K Julian","doi":"10.1136/jech-2019-212425","DOIUrl":"https://doi.org/10.1136/jech-2019-212425","url":null,"abstract":"Background Cancer screening in the USA is suboptimal, particularly for individuals living in vulnerable communities. This study aimed to understand how rurality and racial segregation are independently and interactively associated with cancer screening and cancer fatalism. Methods We used data from a nationally representative sample of adults (n=17 736) from National Cancer Institute’s Health Information National Trends Survey, 2011–2017, including cancer screening (colorectal, breast, cervical, prostate) among eligible participants and cancer fatalism. These data were linked to county-level metropolitan status/rurality (US Department of Agriculture) and racial segregation (US Census). We conducted multivariable analyses of associations of geographic variables with screening and fatalism. Results Breast cancer screening was lower in rural (92%, SE=1.5%) than urban counties (96%, SE=0.5%) (adjusted OR (aOR)=0.52, 95% CI 0.31 to 0.87). Colorectal cancer screening was higher in highly segregated (70%, SE=1.0%) than less segregated counties (65%, SE=1.7%) (aOR=1.28, 95% CI 1.04 to 1.58). Remaining outcomes did not vary by rurality or segregation, and these variables did not interact in their associations with screening or fatalism. Conclusion Similar to previous studies, breast cancer screening was less common in rural areas. Contrary to expectations, colorectal cancer screening was higher in highly segregated counties. More research is needed on the influence of geography on cancer screening and beliefs, and how access to facilities or information may mediate these relationships.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82586283","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 : 2019-10-14DOI: 10.1136/jech-2019-213325
E. Lahelma, O. Rahkonen
Surprisingly little attention has been devoted to the theories, concepts and measurement of social class and socioeconomic position in social epidemiology. This is particularly surprising as the number studies on health inequalities has increased exponentially over the decades.1 Guidelines have though been proposed for the use of socioeconomic position in health research and we have learnt a lot about the nature, measurement and use of various socioeconomic indicators.2–4 However, the suggested socioeconomic classifications have often been pragmatic, based on occupation, education and income, grouped hierarchically following statistical authorities or ad hoc principles. So far, theoretical and conceptual issues and their integration to empirical analysis of health inequalities have remained largely a white spot. The theoretical work within the sociology of class has had almost non-existent consequences for research on health inequalities. Similarly, research on socioeconomic inequalities in health has seldom been considered in the sociology of class. Cross-fertilisation between theoretical and empirical work as well as between sociology of class and social epidemiology would deepen our understanding of social class and socioeconomic position in the production of health inequalities. The Marxian and the Weberian theories are the dominant social class traditions and these have influenced some subsequent class schemes and classifications. Wright’s neo-Marxian class theory draws on the Marxian tradition in its emphasis on people’s location in the occupational hierarchy based on production relations as well as power and control over access to economic and productive resources.5 Additionally, Wright’s theory draws on the Weberian tradition in its emphasis on skill and expertise, rendering the theory a …
{"title":"Class and health in changing societies: the need for novel approaches","authors":"E. Lahelma, O. Rahkonen","doi":"10.1136/jech-2019-213325","DOIUrl":"https://doi.org/10.1136/jech-2019-213325","url":null,"abstract":"Surprisingly little attention has been devoted to the theories, concepts and measurement of social class and socioeconomic position in social epidemiology. This is particularly surprising as the number studies on health inequalities has increased exponentially over the decades.1 Guidelines have though been proposed for the use of socioeconomic position in health research and we have learnt a lot about the nature, measurement and use of various socioeconomic indicators.2–4 However, the suggested socioeconomic classifications have often been pragmatic, based on occupation, education and income, grouped hierarchically following statistical authorities or ad hoc principles.\u0000\u0000So far, theoretical and conceptual issues and their integration to empirical analysis of health inequalities have remained largely a white spot. The theoretical work within the sociology of class has had almost non-existent consequences for research on health inequalities. Similarly, research on socioeconomic inequalities in health has seldom been considered in the sociology of class. Cross-fertilisation between theoretical and empirical work as well as between sociology of class and social epidemiology would deepen our understanding of social class and socioeconomic position in the production of health inequalities.\u0000\u0000The Marxian and the Weberian theories are the dominant social class traditions and these have influenced some subsequent class schemes and classifications. Wright’s neo-Marxian class theory draws on the Marxian tradition in its emphasis on people’s location in the occupational hierarchy based on production relations as well as power and control over access to economic and productive resources.5 Additionally, Wright’s theory draws on the Weberian tradition in its emphasis on skill and expertise, rendering the theory a …","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91316401","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 : 2019-10-14DOI: 10.1136/jech-2019-212487
E. Murray, E. Carr, P. Zaninotto, J. Head, B. Xue, S. Stansfeld, B. Beach, N. Shelton
Background UK state pension eligibility ages are linked to average life expectancy, which ignores wide socioeconomic disparities in both healthy and overall life expectancy. Objectives Investigate whether there are occupational social class differences in the amount of time older adults live after they stop work, and how much of these differences are due to health. Methods Participants were 76 485 members of the Office for National Statistics Longitudinal Study (LS), who were 50–75 years at the 2001 census and had stopped work by the 2011 census. Over 10 years of follow-up, we used censored linear regression to estimate mean differences in years between stopping work and death by occupational social class. Results After adjustment for age, both social class and health were independent predictors of postwork duration (mean difference (95% CI): unskilled class vs professional: 2.7 years (2.4 to 3.1); not good vs good health: 2.4 years (1.9 to 2.9)), with LS members in the three manual classes experiencing ~1 additional year of postwork duration than professional workers (interaction p values all <0.001). Further adjustment for gender and educational qualifications was reduced but did not eliminate social class and postwork duration associations. We estimate the difference in postwork years between professional classes in good health and unskilled workers not in good health as 5.1 years for women (21.0 vs 26.1) and 5.5 years for men (19.5 vs 25.0). Conclusions Lower social class groups are negatively affected by uniform state pension ages, because they are more likely to stop work at younger ages due to health reasons.
英国国家养老金资格年龄与平均预期寿命有关，这忽略了健康和总体预期寿命方面广泛的社会经济差异。目的调查老年人停止工作后的生活时间是否存在职业社会阶层差异，以及这些差异中有多少是由于健康造成的。方法研究对象为美国国家统计局(Office for National Statistics Longitudinal Study, LS)的76485名2001年人口普查时年龄为50-75岁，2011年人口普查时已停止工作的人。在10年的随访中，我们使用审查线性回归来估计按职业社会阶层停止工作与死亡之间的平均年数差异。结果在调整年龄后，社会阶层和健康状况都是工作后持续时间的独立预测因素(平均差异(95% CI)):非技术阶层vs专业阶层:2.7年(2.4 - 3.1);不健康vs健康:2.4年(1.9到2.9))，三个手工班的LS成员比专业工人多经历了1年的工作后持续时间(相互作用p值均<0.001)。减少了对性别和教育资格的进一步调整，但没有消除社会阶层和工作后持续时间的联系。我们估计，健康状况良好的专业阶层与健康状况不佳的非技术工人之间的工作后年限差异，女性为5.1年(21.0年对26.1年)，男性为5.5年(19.5年对25.0年)。结论国家统一的养老金领取年龄对社会底层群体产生了负面影响，因为他们更有可能在更年轻的时候因为健康原因而停止工作。
{"title":"Inequalities in time from stopping paid work to death: findings from the ONS Longitudinal Study, 2001–2011","authors":"E. Murray, E. Carr, P. Zaninotto, J. Head, B. Xue, S. Stansfeld, B. Beach, N. Shelton","doi":"10.1136/jech-2019-212487","DOIUrl":"https://doi.org/10.1136/jech-2019-212487","url":null,"abstract":"Background UK state pension eligibility ages are linked to average life expectancy, which ignores wide socioeconomic disparities in both healthy and overall life expectancy. Objectives Investigate whether there are occupational social class differences in the amount of time older adults live after they stop work, and how much of these differences are due to health. Methods Participants were 76 485 members of the Office for National Statistics Longitudinal Study (LS), who were 50–75 years at the 2001 census and had stopped work by the 2011 census. Over 10 years of follow-up, we used censored linear regression to estimate mean differences in years between stopping work and death by occupational social class. Results After adjustment for age, both social class and health were independent predictors of postwork duration (mean difference (95% CI): unskilled class vs professional: 2.7 years (2.4 to 3.1); not good vs good health: 2.4 years (1.9 to 2.9)), with LS members in the three manual classes experiencing ~1 additional year of postwork duration than professional workers (interaction p values all <0.001). Further adjustment for gender and educational qualifications was reduced but did not eliminate social class and postwork duration associations. We estimate the difference in postwork years between professional classes in good health and unskilled workers not in good health as 5.1 years for women (21.0 vs 26.1) and 5.5 years for men (19.5 vs 25.0). Conclusions Lower social class groups are negatively affected by uniform state pension ages, because they are more likely to stop work at younger ages due to health reasons.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79999747","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 : 2019-10-14DOI: 10.1136/jech-2019-212952
L. Kokkinen, C. Muntaner, A. Koskinen, A. Väänänen
Background Disparities in mortality have been firmly established across occupational grades and the incomes they earn, but this line of research has failed to include individuals’ relationships to capital, as suggested by class analysists. Methods According to Wright’s classification, the research generated 10 mutually exclusive classes based on occupation and investment income: worker; capitalist worker; professional; capitalist professional; supervisor; capitalist supervisor; manager; capitalist manager; self-employed; and capitalist self-employed. The study participants (n=268 239) were randomly selected from the Statistics Finland population database and represent 33% of Finnish men aged 30–64 years. The mortality data were monitored over the 1995–2014 period. Results The sociodemographic-adjusted HRs for mortality were lowest for capitalist managers (HR 0.50; 95% CI 0.36 to 0.69) as compared with that for workers without a capitalist class advantage. A positive occupational class gradient was found from managers to supervisors to workers. The capitalist class advantage independently affected the disparities in mortality within this occupational hierarchy. Conclusion Different occupational class locations protect against premature death differently, and the capitalist class advantage widens the premature-death disparities among the occupational classes. To monitor and explain social inequalities in health in a more nuanced way, future research on investment income as well as the operationalisation of the capitalist class advantage is encouraged.
死亡率的差异已经在职业等级和收入之间牢固地建立起来，但这条研究路线未能包括个人与资本的关系，正如阶级分析师所建议的那样。方法根据Wright的分类方法，根据职业和投资收益划分出10个相互排斥的阶层:工人阶层;资本主义工人;专业;资本主义专业;主管;资本主义的上司;经理;资本主义经理;自主创业;和资本主义个体经营者。研究参与者(n=268 239)是从芬兰统计局人口数据库中随机选择的，占30-64岁芬兰男性的33%。1995-2014年期间对死亡率数据进行了监测。结果资本主义管理人员的死亡率经社会人口统计学调整后的HR最低(HR 0.50;95% CI 0.36至0.69)，与没有资产阶级优势的工人相比。从经理到主管再到工人，存在正的职业阶层梯度。资产阶级的优势独立地影响了这个职业等级中死亡率的差异。结论不同的职业阶层位置对过早死亡的保护作用不同，资产阶级优势扩大了不同职业阶层之间的过早死亡差异。为了以更细致入微的方式监测和解释健康方面的社会不平等，鼓励未来对投资收入以及资产阶级优势的运作进行研究。
{"title":"Occupational class, capitalist class advantage and mortality among working-age men","authors":"L. Kokkinen, C. Muntaner, A. Koskinen, A. Väänänen","doi":"10.1136/jech-2019-212952","DOIUrl":"https://doi.org/10.1136/jech-2019-212952","url":null,"abstract":"Background Disparities in mortality have been firmly established across occupational grades and the incomes they earn, but this line of research has failed to include individuals’ relationships to capital, as suggested by class analysists. Methods According to Wright’s classification, the research generated 10 mutually exclusive classes based on occupation and investment income: worker; capitalist worker; professional; capitalist professional; supervisor; capitalist supervisor; manager; capitalist manager; self-employed; and capitalist self-employed. The study participants (n=268 239) were randomly selected from the Statistics Finland population database and represent 33% of Finnish men aged 30–64 years. The mortality data were monitored over the 1995–2014 period. Results The sociodemographic-adjusted HRs for mortality were lowest for capitalist managers (HR 0.50; 95% CI 0.36 to 0.69) as compared with that for workers without a capitalist class advantage. A positive occupational class gradient was found from managers to supervisors to workers. The capitalist class advantage independently affected the disparities in mortality within this occupational hierarchy. Conclusion Different occupational class locations protect against premature death differently, and the capitalist class advantage widens the premature-death disparities among the occupational classes. To monitor and explain social inequalities in health in a more nuanced way, future research on investment income as well as the operationalisation of the capitalist class advantage is encouraged.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80680900","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 : 2019-10-08DOI: 10.1136/jech-2019-212802
Enora Le Roux, Marta Mari Muro, Martine Novic, F. Chauvin, Philippe Zerr, C. Alberti, A. Faye
The health service ( service sanitaire in French) was set up in September 2018 by the French government.1 This initiative enforces every health student to carry out a practical exercise of health promotion or primary prevention during their initial training, mainly towards children, adolescents and young adults. For this first year of application, 49 000 students (nurses, physiotherapists, doctors, pharmacists, dentists and midwives) completed their health service. Students from all other health disciplines will be involved from the 2019/2020 academic year. The health service is a major component of the French national health strategy, whose objective is to develop health promotion, in line with the international guidance of the WHO. This prioritisation of prevention in youth is based on numerous data showing the deleterious impact of health behaviours adopted in adolescence and early adulthood. Indeed, evidence suggests that 17% of the total disease burden for all age groups may be associated with risky behaviour in adolescence. In France, young people’s health behaviours are a major challenge. According to an international survey in 2013/2014, in France, 32% of 15-year-olds consumed soft drinks daily (vs 16% in England and 11% in Canada); 90% reported less than 60 min of moderate to vigorous daily activity (current worldwide recommendation) (vs 86% in England and 78% in Canada); and 19% smoked at least once a week (vs 7% in England and 5% in Canada).2 In light of those numbers, France will probably have a high prevalence of chronic diseases in the next generation of adults. At this time, the prevalence of self-reported chronic diseases is 16% in French employees aged 25–64 years.3 In addition, the burden of non-communicable …
{"title":"Health students to relaunch health prevention in France: gamble of the health service","authors":"Enora Le Roux, Marta Mari Muro, Martine Novic, F. Chauvin, Philippe Zerr, C. Alberti, A. Faye","doi":"10.1136/jech-2019-212802","DOIUrl":"https://doi.org/10.1136/jech-2019-212802","url":null,"abstract":"The health service ( service sanitaire in French) was set up in September 2018 by the French government.1 This initiative enforces every health student to carry out a practical exercise of health promotion or primary prevention during their initial training, mainly towards children, adolescents and young adults. For this first year of application, 49 000 students (nurses, physiotherapists, doctors, pharmacists, dentists and midwives) completed their health service. Students from all other health disciplines will be involved from the 2019/2020 academic year.\u0000\u0000The health service is a major component of the French national health strategy, whose objective is to develop health promotion, in line with the international guidance of the WHO. This prioritisation of prevention in youth is based on numerous data showing the deleterious impact of health behaviours adopted in adolescence and early adulthood. Indeed, evidence suggests that 17% of the total disease burden for all age groups may be associated with risky behaviour in adolescence. In France, young people’s health behaviours are a major challenge. According to an international survey in 2013/2014, in France, 32% of 15-year-olds consumed soft drinks daily (vs 16% in England and 11% in Canada); 90% reported less than 60 min of moderate to vigorous daily activity (current worldwide recommendation) (vs 86% in England and 78% in Canada); and 19% smoked at least once a week (vs 7% in England and 5% in Canada).2 In light of those numbers, France will probably have a high prevalence of chronic diseases in the next generation of adults. At this time, the prevalence of self-reported chronic diseases is 16% in French employees aged 25–64 years.3 In addition, the burden of non-communicable …","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72964951","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 : 2019-10-05DOI: 10.1136/jech-2019-212591
G. Masukume, F. McCarthy, J. Russell, P. Baker, L. Kenny, S. Morton, A. Khashan
Background Epidemiological studies have reported conflicting results in the association between Caesarean section (CS) birth and childhood obesity. Many of these studies had small sample sizes, were unable to distinguish between elective/planned and emergency CS, and did not adjust for the key confounder maternal pre-pregnancy body mass index (BMI). We investigated the association between CS delivery, particularly elective/planned and childhood obesity, using the Growing Up in New Zealand prospective longitudinal cohort study. Methods Pregnant women planning to deliver their babies on the New Zealand upper North Island were invited to participate. Mode of delivery was categorised into spontaneous vaginal delivery (VD) (reference), assisted VD, planned CS and emergency CS. The main outcome was childhood obesity defined according to the International Obesity Taskforce criteria at age 24 and 54 months. Multinomial logistic regression and mixed-effects linear regression models were fitted with associations adjusted for several potential confounders. Results Of the 6599 infants, 1532 (23.2%) were delivered by CS. At age 24 months, 478 (9.3%) children were obese. There was a statistically significant association between planned CS adjusted relative risk ratio (aRRR=1.59; (95% CI 1.09 to 2.33)) and obesity but not for emergency CS (aRRR=1.27; (95% CI 0.89 to 1.82)). At age 54 months there was no association between planned CS (aRRR=0.89; (95% CI 0.54 to 1.45)) and obesity as well as for emergency CS (aRRR=1.19; (95% CI 0.80 to 1.77)). At all-time points those born by planned CS had a higher mean BMI (adjusted mean difference=0.16; (95% CI 0.00 to 0.31), p=0.046). Conclusions Planned CS was an independent predictor of obesity in early childhood. This suggests that birth mode influences growth, at least in the short term. This association occurred during a critical phase of human development, the first 2 years of life, and if causal might result in long-term detrimental cardiometabolic changes.
流行病学研究报告了关于剖腹产(CS)分娩与儿童肥胖之间关系的相互矛盾的结果。其中许多研究样本量较小，无法区分选择性/计划性和紧急性CS，也没有对孕妇孕前体重指数(BMI)的关键混杂因素进行调整。我们利用新西兰的前瞻性纵向队列研究，调查了CS分娩，特别是选择性/计划分娩与儿童肥胖之间的关系。方法对计划在新西兰上北岛分娩的孕妇进行问卷调查。分娩方式分为自然阴道分娩(VD)(参考)、辅助阴道分娩、计划阴道分娩和紧急阴道分娩。研究的主要结果是根据国际肥胖工作组(International obesity Taskforce)在24个月和54个月的标准定义的儿童肥胖。多项逻辑回归和混合效应线性回归模型经若干潜在混杂因素校正后进行拟合。结果6599例患儿中，1532例(23.2%)采用CS分娩。在24月龄时，478名(9.3%)儿童肥胖。计划CS调整后的相对风险比(aRRR=1.59;(95% CI 1.09 ~ 2.33))和肥胖，但与紧急CS无关(aRRR=1.27;(95% CI 0.89 ~ 1.82))。在54月龄时，计划CS与计划CS无相关性(aRRR=0.89;(95% CI 0.54 - 1.45))和肥胖以及紧急CS (aRRR=1.19;(95% CI 0.80 ~ 1.77))。在所有时间点上，计划CS出生的人的平均BMI更高(调整后的平均差=0.16;(95% CI 0.00 ~ 0.31)， p=0.046)。结论:计划CS是儿童早期肥胖的独立预测因子。这表明，至少在短期内，出生方式会影响生长。这种关联发生在人类发育的关键阶段，即生命的头2年，如果是因果关系，可能会导致长期有害的心脏代谢变化。
{"title":"Caesarean section delivery and childhood obesity: evidence from the growing up in New Zealand cohort","authors":"G. Masukume, F. McCarthy, J. Russell, P. Baker, L. Kenny, S. Morton, A. Khashan","doi":"10.1136/jech-2019-212591","DOIUrl":"https://doi.org/10.1136/jech-2019-212591","url":null,"abstract":"Background Epidemiological studies have reported conflicting results in the association between Caesarean section (CS) birth and childhood obesity. Many of these studies had small sample sizes, were unable to distinguish between elective/planned and emergency CS, and did not adjust for the key confounder maternal pre-pregnancy body mass index (BMI). We investigated the association between CS delivery, particularly elective/planned and childhood obesity, using the Growing Up in New Zealand prospective longitudinal cohort study. Methods Pregnant women planning to deliver their babies on the New Zealand upper North Island were invited to participate. Mode of delivery was categorised into spontaneous vaginal delivery (VD) (reference), assisted VD, planned CS and emergency CS. The main outcome was childhood obesity defined according to the International Obesity Taskforce criteria at age 24 and 54 months. Multinomial logistic regression and mixed-effects linear regression models were fitted with associations adjusted for several potential confounders. Results Of the 6599 infants, 1532 (23.2%) were delivered by CS. At age 24 months, 478 (9.3%) children were obese. There was a statistically significant association between planned CS adjusted relative risk ratio (aRRR=1.59; (95% CI 1.09 to 2.33)) and obesity but not for emergency CS (aRRR=1.27; (95% CI 0.89 to 1.82)). At age 54 months there was no association between planned CS (aRRR=0.89; (95% CI 0.54 to 1.45)) and obesity as well as for emergency CS (aRRR=1.19; (95% CI 0.80 to 1.77)). At all-time points those born by planned CS had a higher mean BMI (adjusted mean difference=0.16; (95% CI 0.00 to 0.31), p=0.046). Conclusions Planned CS was an independent predictor of obesity in early childhood. This suggests that birth mode influences growth, at least in the short term. This association occurred during a critical phase of human development, the first 2 years of life, and if causal might result in long-term detrimental cardiometabolic changes.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78386150","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 : 2019-10-05DOI: 10.1136/jech-2018-211561
F. Benavides, C. Serra, G. Delclos
Background The welfare state has a long history of uncertain future. Nonetheless, health indicators of people living in countries with a more universal and generous welfare state remain better than those living under less generous and more individualist welfare regimes. In this essay, we reflect on how occupational health, as part of public health, can contribute to the sustainability of the welfare state. Methods Over the course of the political and social transformations of the State, from single guarantor of security to assuming civil and social rights, the practice of public health has added, to its original objectives related to the control of epidemics of contagious diseases, the promotion of health and the reduction of inequalities in health. In the context of the 2030 Agenda of Sustainable Development Goals, there is a great opportunity to expand the welfare state through public health policies. Results On the other hand, the welfare state is only possible when persons are employed in the formal sector. Through their taxes, workers and employers support the welfare state. Occupational health, by preventing injury and illness, and promoting the health of working people, can contribute significantly to the existence of decent work and a quality labour market. Conclusion The mission of occupational health is to help people enjoy a healthy and prolonged working life, as a critical component of human well-being.
{"title":"What can public health do for the welfare state? Occupational health could be an answer","authors":"F. Benavides, C. Serra, G. Delclos","doi":"10.1136/jech-2018-211561","DOIUrl":"https://doi.org/10.1136/jech-2018-211561","url":null,"abstract":"Background The welfare state has a long history of uncertain future. Nonetheless, health indicators of people living in countries with a more universal and generous welfare state remain better than those living under less generous and more individualist welfare regimes. In this essay, we reflect on how occupational health, as part of public health, can contribute to the sustainability of the welfare state. Methods Over the course of the political and social transformations of the State, from single guarantor of security to assuming civil and social rights, the practice of public health has added, to its original objectives related to the control of epidemics of contagious diseases, the promotion of health and the reduction of inequalities in health. In the context of the 2030 Agenda of Sustainable Development Goals, there is a great opportunity to expand the welfare state through public health policies. Results On the other hand, the welfare state is only possible when persons are employed in the formal sector. Through their taxes, workers and employers support the welfare state. Occupational health, by preventing injury and illness, and promoting the health of working people, can contribute significantly to the existence of decent work and a quality labour market. Conclusion The mission of occupational health is to help people enjoy a healthy and prolonged working life, as a critical component of human well-being.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82645021","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 : 2019-10-05DOI: 10.1136/jech-2019-212282
Carly S Molloy, M. O’Connor, Shuaijun Guo, Colleen Lin, Christopher Harrop, Nicholas Perini, S. Goldfeld
Background Early childhood interventions are critical for reducing child health and development inequities. While most research focuses on the efficacy of single interventions, combining multiple evidence-based strategies over the early years of a child’s life may yield greater impact. This study examined the association between exposure to a combination of five evidence-based services from 0 to 5 years on children’s reading at 8–9 years. Methods Data from the nationally representative birth cohort (n=5107) of the Longitudinal Study of Australian Children were utilised. Risk and exposure measures across five services from 0 to 5 years were assessed: antenatal care, nurse home-visiting, early childhood education and care, parenting programme and the early years of school. Children’s reading at 8–9 years was measured using a standardised direct assessment. Linear regression analyses examined the cumulative effect of five services on reading. Interaction terms were examined to determine if the relationship differed as a function of level of disadvantage. Results A cumulative benefit effect of participation in more services and a cumulative risk effect when exposed to more risks was found. Each additional service that the child attended was associated with an increase in reading scores (b=9.16, 95% CI=5.58 to 12.75). Conversely, each additional risk that the child was exposed to was associated with a decrease in reading skills (b=−14.03, 95% CI=−16.61 to −11.44). Effects were similar for disadvantaged and non-disadvantaged children. Conclusion This study supports the potential value of ‘stacking’ early interventions across the early years of a child’s life to maximise impacts on child outcomes.
{"title":"Potential of ‘stacking’ early childhood interventions to reduce inequities in learning outcomes","authors":"Carly S Molloy, M. O’Connor, Shuaijun Guo, Colleen Lin, Christopher Harrop, Nicholas Perini, S. Goldfeld","doi":"10.1136/jech-2019-212282","DOIUrl":"https://doi.org/10.1136/jech-2019-212282","url":null,"abstract":"Background Early childhood interventions are critical for reducing child health and development inequities. While most research focuses on the efficacy of single interventions, combining multiple evidence-based strategies over the early years of a child’s life may yield greater impact. This study examined the association between exposure to a combination of five evidence-based services from 0 to 5 years on children’s reading at 8–9 years. Methods Data from the nationally representative birth cohort (n=5107) of the Longitudinal Study of Australian Children were utilised. Risk and exposure measures across five services from 0 to 5 years were assessed: antenatal care, nurse home-visiting, early childhood education and care, parenting programme and the early years of school. Children’s reading at 8–9 years was measured using a standardised direct assessment. Linear regression analyses examined the cumulative effect of five services on reading. Interaction terms were examined to determine if the relationship differed as a function of level of disadvantage. Results A cumulative benefit effect of participation in more services and a cumulative risk effect when exposed to more risks was found. Each additional service that the child attended was associated with an increase in reading scores (b=9.16, 95% CI=5.58 to 12.75). Conversely, each additional risk that the child was exposed to was associated with a decrease in reading skills (b=−14.03, 95% CI=−16.61 to −11.44). Effects were similar for disadvantaged and non-disadvantaged children. Conclusion This study supports the potential value of ‘stacking’ early interventions across the early years of a child’s life to maximise impacts on child outcomes.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83565746","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 : 2019-10-01DOI: 10.1136/jech-2019-212256
P. Correa-Burrows, E. Blanco, S. Gahagan, R. Burrows
Aim To explore the association of selected cardiometabolic biomarkers and metabolic syndrome (MetS) with educational outcomes in adolescents from Chile. Methods Of 678 participants, 632 (52% males) met criteria for the study. At 16 years, waist circumference (WC), systolic blood pressure, triglycerides (TG), high-density lipoprotein and glucose were measured. A continuous cardiometabolic risk score (zMetS) using indicators of obesity, lipids, glucose and blood pressure was computed, with lower values denoting a healthier cardiometabolic profile. MetS was diagnosed with the International Diabetes Federation/American Heart Association/National Heart, Lung, and Blood Institute joint criteria. Data on high school (HS) graduation, grade point average (GPA), college examination rates and college test scores were collected. Data were analysed controlling for sociodemographic, lifestyle and educational confounders. Result zMetS, WC, TG and homeostatic model assessment of insulin resistance at 16 years were negatively and significantly associated with the odds of completing HS and taking college exams. Notably, for a one-unit increase in zMetS, we found 52% (OR: 0.48, 95% CI 0.227 to 0.98) and 39% (OR: 0.61, 95% CI 0.28 to 0.93) reduction in the odds of HS completion and taking college exams, respectively. The odds of HS completion and taking college exams in participants with MetS were 37% (95% CI 0.14 to 0.98) and 33% (95% CI 0.15 to 0.79) that of participants with no cardiometabolic risk factors. Compared with adolescents with no risk factors, those with MetS had lower GPA (515 vs 461 points; p=0.002; Cohen’s d=0.55). Adolescents having the MetS had significantly lower odds of passing the mathematics exam for college compared with peers with no cardiometabolic risk factors (OR: 0.49; 95% CI 0.16 to 0.95). Conclusion In Chilean adolescents, cardiometabolic health was associated with educational outcomes.
目的探讨智利青少年选定的心脏代谢生物标志物和代谢综合征(MetS)与教育结果的关系。方法678名受试者中，632名(52%为男性)符合研究标准。16岁时，测量腰围(WC)、收缩压、甘油三酯(TG)、高密度脂蛋白和葡萄糖。使用肥胖、血脂、血糖和血压等指标计算连续心脏代谢风险评分(zMetS)，值越低表示心脏代谢状况越健康。MetS是根据国际糖尿病联合会/美国心脏协会/国家心脏、肺和血液研究所的联合标准诊断的。收集高中(HS)毕业、平均绩点(GPA)、大学考试率和大学考试成绩等数据。对数据进行分析，控制社会人口、生活方式和教育混杂因素。结果16岁时胰岛素抵抗的zMetS、WC、TG和稳态模型评估与完成HS和参加大学考试的几率呈显著负相关。值得注意的是，zMetS每增加一个单位，我们发现完成HS和参加大学考试的几率分别降低52% (OR: 0.48, 95% CI 0.227至0.98)和39% (OR: 0.61, 95% CI 0.28至0.93)。与没有心脏代谢危险因素的参与者相比，met参与者完成HS和参加大学考试的几率分别为37% (95% CI 0.14至0.98)和33% (95% CI 0.15至0.79)。与没有危险因素的青少年相比，met患者的GPA较低(515比461分;p = 0.002;科恩的d = 0.55)。与没有心脏代谢危险因素的同龄人相比，患有met的青少年通过大学数学考试的几率显著降低(OR: 0.49;95% CI 0.16 ~ 0.95)。结论在智利青少年中，心脏代谢健康与教育成果相关。
{"title":"Cardiometabolic health in adolescence and its association with educational outcomes","authors":"P. Correa-Burrows, E. Blanco, S. Gahagan, R. Burrows","doi":"10.1136/jech-2019-212256","DOIUrl":"https://doi.org/10.1136/jech-2019-212256","url":null,"abstract":"Aim To explore the association of selected cardiometabolic biomarkers and metabolic syndrome (MetS) with educational outcomes in adolescents from Chile. Methods Of 678 participants, 632 (52% males) met criteria for the study. At 16 years, waist circumference (WC), systolic blood pressure, triglycerides (TG), high-density lipoprotein and glucose were measured. A continuous cardiometabolic risk score (zMetS) using indicators of obesity, lipids, glucose and blood pressure was computed, with lower values denoting a healthier cardiometabolic profile. MetS was diagnosed with the International Diabetes Federation/American Heart Association/National Heart, Lung, and Blood Institute joint criteria. Data on high school (HS) graduation, grade point average (GPA), college examination rates and college test scores were collected. Data were analysed controlling for sociodemographic, lifestyle and educational confounders. Result zMetS, WC, TG and homeostatic model assessment of insulin resistance at 16 years were negatively and significantly associated with the odds of completing HS and taking college exams. Notably, for a one-unit increase in zMetS, we found 52% (OR: 0.48, 95% CI 0.227 to 0.98) and 39% (OR: 0.61, 95% CI 0.28 to 0.93) reduction in the odds of HS completion and taking college exams, respectively. The odds of HS completion and taking college exams in participants with MetS were 37% (95% CI 0.14 to 0.98) and 33% (95% CI 0.15 to 0.79) that of participants with no cardiometabolic risk factors. Compared with adolescents with no risk factors, those with MetS had lower GPA (515 vs 461 points; p=0.002; Cohen’s d=0.55). Adolescents having the MetS had significantly lower odds of passing the mathematics exam for college compared with peers with no cardiometabolic risk factors (OR: 0.49; 95% CI 0.16 to 0.95). Conclusion In Chilean adolescents, cardiometabolic health was associated with educational outcomes.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90362237","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 : 2019-09-28DOI: 10.1136/jech-2019-212693
M. Rogers
Background In the USA, the epidemiologic features of type 1 diabetes are not well-defined across all 50 states. However, the advent of large nationwide insurance databases enables the investigation of where type 1 diabetes cases occur throughout the country. Methods An integrated database from a large nationwide health insurer in the USA (Clinformatics Data Mart Database) was used, from 2001 to 2017. The database contained longitudinal information on approximately 77 million people. Results The incidence of type 1 diabetes was greatest in areas of low population density across the 50 states. Individuals in the lowest population density areas had rates that were 2.28 times (95% CI 2.08 to 2.50) that of persons living in high-density areas. This association was consistent across various measures of rural status (p<0.001 for population density; p<0.001 for per cent rural as defined by the US Census Bureau; p=0.026 for farmland). The association between rural areas and the incidence of type 1 diabetes was evident across all four general regions of the USA. Conclusions The predilection of type 1 diabetes in rural areas provides clues to potential factors associated with the onset of this autoimmune disease.
在美国，1型糖尿病的流行病学特征在所有50个州都没有明确定义。然而，大型全国保险数据库的出现使调查1型糖尿病病例在全国范围内发生的地方成为可能。方法使用2001 - 2017年美国一家大型全国性健康保险公司的综合数据库(Clinformatics Data Mart database)。该数据库包含大约7700万人的纵向信息。结果美国50个州的1型糖尿病发病率以低人口密度地区最高。人口密度最低地区的个体发病率是高密度地区的2.28倍(95% CI 2.08 ~ 2.50)。这种关联在农村状况的各种测量中是一致的(人口密度p<0.001;按照美国人口普查局的定义，农村人口的比例p<0.001;农田的P =0.026)。农村地区与1型糖尿病发病率之间的联系在美国所有四个一般地区都很明显。结论1型糖尿病在农村地区的易感性为1型糖尿病发病的潜在因素提供了线索。
{"title":"Onset of type 1 diabetes mellitus in rural areas of the USA","authors":"M. Rogers","doi":"10.1136/jech-2019-212693","DOIUrl":"https://doi.org/10.1136/jech-2019-212693","url":null,"abstract":"Background In the USA, the epidemiologic features of type 1 diabetes are not well-defined across all 50 states. However, the advent of large nationwide insurance databases enables the investigation of where type 1 diabetes cases occur throughout the country. Methods An integrated database from a large nationwide health insurer in the USA (Clinformatics Data Mart Database) was used, from 2001 to 2017. The database contained longitudinal information on approximately 77 million people. Results The incidence of type 1 diabetes was greatest in areas of low population density across the 50 states. Individuals in the lowest population density areas had rates that were 2.28 times (95% CI 2.08 to 2.50) that of persons living in high-density areas. This association was consistent across various measures of rural status (p<0.001 for population density; p<0.001 for per cent rural as defined by the US Census Bureau; p=0.026 for farmland). The association between rural areas and the incidence of type 1 diabetes was evident across all four general regions of the USA. Conclusions The predilection of type 1 diabetes in rural areas provides clues to potential factors associated with the onset of this autoimmune disease.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80093981","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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