Pub Date : 2019-09-28DOI: 10.1136/jech-2019-212858
Yukari Yamada, T. Ikenoue, Yoshiyuki Saito, S. Fukuma
Background The effectiveness of identifying and monitoring early-stage chronic kidney disease (CKD) is not fully recognised. This study quantified people with undiagnosed CKD among the middle-aged Japanese population and clarified potential risks of untreated CKD. Methods We included 71 233 individuals who underwent annual health check-ups (AHC) in 2014 for both baseline and follow-up proteinuria and serum creatine measurements. CKD was identified by AHC data as proteinuria or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. We differentiated undiagnosed from diagnosed CKD using the medical claims database. In undiagnosed CKD, we assessed risk differences for disease progression, defined as an eGFR decline slope >3 mL/min/1.73 m2/year or proteinuria incidence over 3 years, between those who visited a physician for CKD treatment within 6 months after AHC and those who did not. Results CKD prevalence was 5.7% (5.2% undiagnosed and 0.5% diagnosed). Only 2.1% of the patients with undiagnosed CKD visited a physician for CKD treatment within 6 months after AHC. Between-group risk differences in instrumental variable adjustment models showed that those left untreated progressed to kidney diseases 16.3% more often than those who visited physicians for CKD treatment. Conclusion CKD was undiagnosed in 5.2% of the middle-aged general population. Only a few people visited physicians for CKD treatment. Visiting physicians for CKD treatment during the first 6 months after screening may be associated with a lower risk of kidney disease progression.
{"title":"Undiagnosed and untreated chronic kidney disease and its impact on renal outcomes in the Japanese middle-aged general population","authors":"Yukari Yamada, T. Ikenoue, Yoshiyuki Saito, S. Fukuma","doi":"10.1136/jech-2019-212858","DOIUrl":"https://doi.org/10.1136/jech-2019-212858","url":null,"abstract":"Background The effectiveness of identifying and monitoring early-stage chronic kidney disease (CKD) is not fully recognised. This study quantified people with undiagnosed CKD among the middle-aged Japanese population and clarified potential risks of untreated CKD. Methods We included 71 233 individuals who underwent annual health check-ups (AHC) in 2014 for both baseline and follow-up proteinuria and serum creatine measurements. CKD was identified by AHC data as proteinuria or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. We differentiated undiagnosed from diagnosed CKD using the medical claims database. In undiagnosed CKD, we assessed risk differences for disease progression, defined as an eGFR decline slope >3 mL/min/1.73 m2/year or proteinuria incidence over 3 years, between those who visited a physician for CKD treatment within 6 months after AHC and those who did not. Results CKD prevalence was 5.7% (5.2% undiagnosed and 0.5% diagnosed). Only 2.1% of the patients with undiagnosed CKD visited a physician for CKD treatment within 6 months after AHC. Between-group risk differences in instrumental variable adjustment models showed that those left untreated progressed to kidney diseases 16.3% more often than those who visited physicians for CKD treatment. Conclusion CKD was undiagnosed in 5.2% of the middle-aged general population. Only a few people visited physicians for CKD treatment. Visiting physicians for CKD treatment during the first 6 months after screening may be associated with a lower risk of kidney disease progression.","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":"84157646","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 : 2019-09-25DOI: 10.1136/jech-2018-211995
I. Backhaus, S. Kino, G. La Torre, I. Kawachi
Background Individuals who identify as politically conservative have been previously shown to report better self-rated health compared with liberals. We tested whether this association still holds for right-wing populists, which are gaining strength as a political force in Europe in recent decades. Methods We analysed data from 24 617 respondents nested within 18 European countries included in the 2016 European Social Survey. Multilevel analyses were conducted to assess the association between political ideology and self-rated health, adjusting for other individual covariates (happiness and social capital). Results Individuals who voted for right-wing populist parties were 43% more likely to report fair/poor health compared with traditional conservatives (OR=1.43, 95% CI 1.23 to 1.67). The association was attenuated (OR=1.21, 95% CI 1.03 to 1.42) after controlling for additional individual-level variables, including happiness and access to social capital. Higher levels of social capital (informal networks, OR=0.40, 95% CI 0.29 to 0.56; trust, OR=0.82, 95% CI 0.74 to 0.92) and happiness (OR=0.18, 95% CI 0.15 to 0.22) were protectively correlated with fair/poor self-rated health. Conclusions Individuals voting for right-wing populist parties report worse health compared with conservatives. It remains unclear whether ideology is just a marker for health-related practices, or whether the values and beliefs associated with a particular brand of ideology lead to worse health.
与自由主义者相比，政治上保守的人自我评估的健康状况更好。我们测试了这种联系是否仍然适用于右翼民粹主义者，近几十年来，右翼民粹主义者作为一股政治力量在欧洲越来越强大。我们分析了2016年欧洲社会调查中18个欧洲国家的24617名受访者的数据。在对其他个体协变量(幸福和社会资本)进行调整后，进行了多水平分析，以评估政治意识形态与自评健康之间的关系。结果与传统保守派相比，投票给右翼民粹主义政党的个人报告健康状况一般/较差的可能性要高43% (OR=1.43, 95% CI 1.23至1.67)。在控制了额外的个人层面变量，包括幸福和获得社会资本后，这种关联减弱了(OR=1.21, 95% CI 1.03至1.42)。更高水平的社会资本(非正式网络，OR=0.40, 95% CI 0.29至0.56;信任(OR= 0.82, 95% CI 0.74至0.92)和快乐(OR=0.18, 95% CI 0.15至0.22)与自我评价健康的一般/较差具有保护相关。与保守派相比，投票给右翼民粹主义政党的个人健康状况更差。目前尚不清楚，意识形态是否只是与健康相关的实践的标志，还是与特定意识形态品牌相关的价值观和信仰导致健康状况恶化。
{"title":"Right-wing populism and self-rated health in Europe: a multilevel analysis","authors":"I. Backhaus, S. Kino, G. La Torre, I. Kawachi","doi":"10.1136/jech-2018-211995","DOIUrl":"https://doi.org/10.1136/jech-2018-211995","url":null,"abstract":"Background Individuals who identify as politically conservative have been previously shown to report better self-rated health compared with liberals. We tested whether this association still holds for right-wing populists, which are gaining strength as a political force in Europe in recent decades. Methods We analysed data from 24 617 respondents nested within 18 European countries included in the 2016 European Social Survey. Multilevel analyses were conducted to assess the association between political ideology and self-rated health, adjusting for other individual covariates (happiness and social capital). Results Individuals who voted for right-wing populist parties were 43% more likely to report fair/poor health compared with traditional conservatives (OR=1.43, 95% CI 1.23 to 1.67). The association was attenuated (OR=1.21, 95% CI 1.03 to 1.42) after controlling for additional individual-level variables, including happiness and access to social capital. Higher levels of social capital (informal networks, OR=0.40, 95% CI 0.29 to 0.56; trust, OR=0.82, 95% CI 0.74 to 0.92) and happiness (OR=0.18, 95% CI 0.15 to 0.22) were protectively correlated with fair/poor self-rated health. Conclusions Individuals voting for right-wing populist parties report worse health compared with conservatives. It remains unclear whether ideology is just a marker for health-related practices, or whether the values and beliefs associated with a particular brand of ideology lead to worse health.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88872368","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 : 2019-09-24DOI: 10.1136/jech-2019-213213
J. Klánová, R. Barouki
The exposure of populations to a wide range of chemicals through their outdoor and indoor environments, food, water and consumer products is a matter of growing concern for the public and health authorities. Chemical risk governance is complicated by a lack of knowledge on the composition of chemical mixtures to which populations are exposed, their spatial variability and major drivers of their toxicity, as well as long-term changes in the chemical exposures with respect to age, gender and occupation. A significant attention has been previously given to persistent pollutants or endocrine disrupting chemicals but there are important knowledge gaps related to compounds for which the concern has only recently emerged due to their increasing environmental concentrations, evidence of human exposures or alerting toxicological data. A need for the development of new approaches to the assessment of human health risks accounting for exposures to emerging chemicals and complex chemical mixtures can be demonstrated on the paper on urinary bisphenol A (BPA) and dyslipidaemia.1 The meta-analysis of National …
{"title":"Towards a more reliable assessment of health risks associated with the population exposure to bisphenols","authors":"J. Klánová, R. Barouki","doi":"10.1136/jech-2019-213213","DOIUrl":"https://doi.org/10.1136/jech-2019-213213","url":null,"abstract":"The exposure of populations to a wide range of chemicals through their outdoor and indoor environments, food, water and consumer products is a matter of growing concern for the public and health authorities. Chemical risk governance is complicated by a lack of knowledge on the composition of chemical mixtures to which populations are exposed, their spatial variability and major drivers of their toxicity, as well as long-term changes in the chemical exposures with respect to age, gender and occupation. A significant attention has been previously given to persistent pollutants or endocrine disrupting chemicals but there are important knowledge gaps related to compounds for which the concern has only recently emerged due to their increasing environmental concentrations, evidence of human exposures or alerting toxicological data. A need for the development of new approaches to the assessment of human health risks accounting for exposures to emerging chemicals and complex chemical mixtures can be demonstrated on the paper on urinary bisphenol A (BPA) and dyslipidaemia.1 The meta-analysis of National …","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73994266","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 : 2019-09-12DOI: 10.1136/jech-2018-211933
T. Pförtner, H. Pfaff, K. Hower
Background Precarious employment has increased in Germany by means of labour market flexibilisation throughout the 1990s and 2000s. In this study, trends in the association of self-rated health (SRH) with different dimensions of precarious employment by gender in Germany between 1995 and 2015 were assessed considering different periods of labour market reforms and the Great Recession. Methods Analyses were conducted using the German Socio-Economic Panel from 1995 to 2015. All employed individuals aged 18–67 years and living in private households were considered for analysis to examine the risks of poor SRH by low wage, working poverty, non-standard working time arrangements and perceived job insecurity by gender. Predicted probabilities, adjusted risk ratio (ARR), adjusted risk difference (ARD) and trends were examined using pooled interval logistic regression with individual-clustered standard errors. Results Relative and absolute differences in SRH rose significantly over time by perceived job insecurity for men, but not for women. Working poverty appeared to be significantly associated with SRH in the Great Recession and the post-Recession period for both gender. Non-standard working time arrangements were not significantly associated with SRH for both gender, and low wage appeared to be significantly associated with SRH only for men in the post-Recession period. Conclusions The results highlighted the relevance of labour market reforms of deregulation and flexibilisation in Germany to differences in SRH by specific forms of precarious employment and gender differences in the impact of labour market reforms on precarious employment and health.
{"title":"Trends in the association of different forms of precarious employment and self-rated health in Germany. An analysis with the German Socio-Economic Panel between 1995 and 2015","authors":"T. Pförtner, H. Pfaff, K. Hower","doi":"10.1136/jech-2018-211933","DOIUrl":"https://doi.org/10.1136/jech-2018-211933","url":null,"abstract":"Background Precarious employment has increased in Germany by means of labour market flexibilisation throughout the 1990s and 2000s. In this study, trends in the association of self-rated health (SRH) with different dimensions of precarious employment by gender in Germany between 1995 and 2015 were assessed considering different periods of labour market reforms and the Great Recession. Methods Analyses were conducted using the German Socio-Economic Panel from 1995 to 2015. All employed individuals aged 18–67 years and living in private households were considered for analysis to examine the risks of poor SRH by low wage, working poverty, non-standard working time arrangements and perceived job insecurity by gender. Predicted probabilities, adjusted risk ratio (ARR), adjusted risk difference (ARD) and trends were examined using pooled interval logistic regression with individual-clustered standard errors. Results Relative and absolute differences in SRH rose significantly over time by perceived job insecurity for men, but not for women. Working poverty appeared to be significantly associated with SRH in the Great Recession and the post-Recession period for both gender. Non-standard working time arrangements were not significantly associated with SRH for both gender, and low wage appeared to be significantly associated with SRH only for men in the post-Recession period. Conclusions The results highlighted the relevance of labour market reforms of deregulation and flexibilisation in Germany to differences in SRH by specific forms of precarious employment and gender differences in the impact of labour market reforms on precarious employment and health.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84924598","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 : 2019-09-05DOI: 10.1136/jech-2018-210465
S. Riva
It is difficult enough to persuade people to adopt a healthy lifestyle, such as eating well, doing physical exercise or avoiding smoking— all of which have a direct impact on their lives ; however, it is an even greater challenge to persuade them to take significant actions for the future benefit of others. One such challenge is related to the protection of our environment. Unfortunately, people consider environmental protection as a separate domain to health protection, but it is not: the environment can affect human health, and environmental hazards increase the risk of diseases with adverse consequences for the entire world.1 Various measures are proposed by national and international organisations, agencies and public institutions with the objective of regulating adequate action from citizens regarding the protection of their environment. Generally, economic actions such as taxes, subventions, fee structures and laws are, in many countries, the most frequently adopted measures.2 Recently, however, psychology (particularly cognitive psychology) and behavioural sciences have been involved in a search for solutions and suggestions for improved policies and directives.3 There is a growing awareness that in different fields of human life,4 5 personal behaviours and attitudes can bring about change. With regard to green behaviour, current literature highlights how, in many situations, environmental protection may also be influenced by people’s behaviours and individual choices. Reflecting this, psychology and behavioural sciences can provide specific insight in examining individual people’s actions and behaviours to support the resolution of environmental issues. Their contribution is often called ‘soft’,6 because it is based on techniques and methods that aim to adapt and modify people’s attitudes and perceptions, rather than impose a radical modification through taxes, economical actions or other ‘hard’ mandatory policies (directed by legislation and regulatory monitoring). There are a number of soft techniques. In …
{"title":"Cognitive tips for changing mindsets: improving policies to protect health and environment","authors":"S. Riva","doi":"10.1136/jech-2018-210465","DOIUrl":"https://doi.org/10.1136/jech-2018-210465","url":null,"abstract":"It is difficult enough to persuade people to adopt a healthy lifestyle, such as eating well, doing physical exercise or avoiding smoking— all of which have a direct impact on their lives ; however, it is an even greater challenge to persuade them to take significant actions for the future benefit of others. One such challenge is related to the protection of our environment.\u0000\u0000Unfortunately, people consider environmental protection as a separate domain to health protection, but it is not: the environment can affect human health, and environmental hazards increase the risk of diseases with adverse consequences for the entire world.1\u0000\u0000Various measures are proposed by national and international organisations, agencies and public institutions with the objective of regulating adequate action from citizens regarding the protection of their environment. Generally, economic actions such as taxes, subventions, fee structures and laws are, in many countries, the most frequently adopted measures.2\u0000\u0000Recently, however, psychology (particularly cognitive psychology) and behavioural sciences have been involved in a search for solutions and suggestions for improved policies and directives.3 There is a growing awareness that in different fields of human life,4 5 personal behaviours and attitudes can bring about change. With regard to green behaviour, current literature highlights how, in many situations, environmental protection may also be influenced by people’s behaviours and individual choices. Reflecting this, psychology and behavioural sciences can provide specific insight in examining individual people’s actions and behaviours to support the resolution of environmental issues.\u0000\u0000Their contribution is often called ‘soft’,6 because it is based on techniques and methods that aim to adapt and modify people’s attitudes and perceptions, rather than impose a radical modification through taxes, economical actions or other ‘hard’ mandatory policies (directed by legislation and regulatory monitoring). There are a number of soft techniques. In …","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86662529","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 : 2019-08-20DOI: 10.1136/jech-2019-212689
Joonas Pitkänen, H. Remes, Mikko Aaltonen, P. Martikainen
Introduction Previous studies suggest that childhood experience of parental adversities increases the risk of subsequent offspring self-harm, but studies on distinct paternal and maternal characteristics are few and it remains unclear how these interact with childhood social position. The study aims to assess whether paternal and maternal adversities have different associations with offspring self-harm in adolescence and young adulthood. Interaction by offspring gender and childhood income are investigated, as well as cumulative effects of multiple adversities. Methods The study uses administrative register data on a 20% random sample of Finnish households with children aged 0–14 years in 2000. We follow children born in 1986–1998 (n=155 855) from their 13th birthday until 2011. Parental substance abuse, psychiatric disorders, criminality and hospitalisations due to interpersonal violence or self-harm are used to predict offspring self-harm with Cox proportional hazards models. Results The results show a clear increase in the risk of self-harm among those exposed to maternal or paternal adversities with HRs between 1.5 and 5.4 among boys and 1.7 and 3.9 among girls. The excess risks hold for every measure of maternal and paternal adversities after adjusting for childhood income and parental education. Evidence was found suggesting that low income, accumulation of adversity and female gender may exacerbate the consequences of adversities. Conclusions Our findings suggest that both parents’ adversities increase the risk of self-harm and that multiple experiences of parental adversities in childhood are especially harmful, regardless of parent gender. Higher levels of childhood income can protect from the negative consequences of adverse experiences.
{"title":"Experience of maternal and paternal adversities in childhood as determinants of self-harm in adolescence and young adulthood","authors":"Joonas Pitkänen, H. Remes, Mikko Aaltonen, P. Martikainen","doi":"10.1136/jech-2019-212689","DOIUrl":"https://doi.org/10.1136/jech-2019-212689","url":null,"abstract":"Introduction Previous studies suggest that childhood experience of parental adversities increases the risk of subsequent offspring self-harm, but studies on distinct paternal and maternal characteristics are few and it remains unclear how these interact with childhood social position. The study aims to assess whether paternal and maternal adversities have different associations with offspring self-harm in adolescence and young adulthood. Interaction by offspring gender and childhood income are investigated, as well as cumulative effects of multiple adversities. Methods The study uses administrative register data on a 20% random sample of Finnish households with children aged 0–14 years in 2000. We follow children born in 1986–1998 (n=155 855) from their 13th birthday until 2011. Parental substance abuse, psychiatric disorders, criminality and hospitalisations due to interpersonal violence or self-harm are used to predict offspring self-harm with Cox proportional hazards models. Results The results show a clear increase in the risk of self-harm among those exposed to maternal or paternal adversities with HRs between 1.5 and 5.4 among boys and 1.7 and 3.9 among girls. The excess risks hold for every measure of maternal and paternal adversities after adjusting for childhood income and parental education. Evidence was found suggesting that low income, accumulation of adversity and female gender may exacerbate the consequences of adversities. Conclusions Our findings suggest that both parents’ adversities increase the risk of self-harm and that multiple experiences of parental adversities in childhood are especially harmful, regardless of parent gender. Higher levels of childhood income can protect from the negative consequences of adverse experiences.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84883265","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 : 2019-08-12DOI: 10.1136/jech-2019-212703
G. Airagnes, C. Lemogne, S. Kab, N. Hoertel, M. Goldberg, M. Wahrendorf, J. Siegrist, Y. Roquelaure, F. Limosin, M. Zins
Objectives To examine the association between effort–reward imbalance and incident long-term benzodiazepine use (LTBU). Methods We included 31 077 employed participants enrolled in the French population-based CONSTANCES cohort between 2012 and 2014 who had not undergone LTBU in the 2 years before enrolment. LTBU was examined using drug reimbursement administrative databases. The effort–reward imbalance was calculated in quartiles. We computed ORs (95% CIs) for LTBU according to effort–reward imbalance over a 2-year follow-up period. We adjusted for age, gender, education, occupational grade, income, marital status, tobacco smoking, risk of alcohol use disorder, depressive symptoms and self-rated health. Results Over the 2-year follow-up, 294 (0.9%) participants experienced incident LTBU. In the univariable analysis, effort–reward imbalance was associated with subsequent LTBU with ORs of 1.79 (95% CI 1.23 to 2.62) and 2.73 (95% CI 1.89 to 3.95) for the third and fourth quartiles, respectively, compared with the first quartile. There was no interaction between effort–reward imbalance and any of the considered variables other than tobacco smoking (p=0.033). The association remained significant in both smokers and non-smokers, with higher odds for smokers (p=0.031). In the fully adjusted model, the association remained significant for the third and fourth quartiles, with ORs of 1.74 (95% CI 1.17 to 2.57) and 2.18 (95% CI 1.50 to 3.16), respectively. These associations were dose dependent (p for trend <0.001). Conclusions Effort–reward imbalance was linked with incident LTBU over a 2-year follow-up period after adjustment for sociodemographic and health-related factors. Thus, screening and prevention of the risk of LTBU should be systematised among individuals experiencing effort–reward imbalance, with special attention paid to smokers.
目的探讨长期苯二氮卓类药物使用与努力-回报失衡的关系。方法:我们纳入了2012年至2014年法国人群为基础的constes队列的31,077名在职参与者，他们在入组前2年内未接受过LTBU。使用药品报销管理数据库检查LTBU。付出与回报的不平衡以四分位数计算。我们根据2年随访期间的努力-回报不平衡计算LTBU的or (95% ci)。我们调整了年龄、性别、教育程度、职业等级、收入、婚姻状况、吸烟、酒精使用障碍风险、抑郁症状和自评健康状况。结果在2年的随访中，294名(0.9%)参与者经历了LTBU事件。在单变量分析中，与第一个四分位数相比，第三和第四个四分位数的努力-奖励失衡与随后的LTBU相关，其or分别为1.79 (95% CI 1.23至2.62)和2.73 (95% CI 1.89至3.95)。努力-报酬不平衡与除吸烟外的其他变量均无交互作用(p=0.033)。这种关联在吸烟者和非吸烟者中仍然显著，吸烟者的几率更高(p=0.031)。在完全调整后的模型中，第三和第四个四分位数的相关性仍然显著，or分别为1.74 (95% CI 1.17至2.57)和2.18 (95% CI 1.50至3.16)。这些关联是剂量依赖性的(p表示趋势<0.001)。结论:在调整社会人口统计学和健康相关因素后，2年随访期间，努力-奖励失衡与LTBU事件有关。因此，在经历努力-回报不平衡的个体中筛查和预防LTBU风险应该是系统化的，特别要注意吸烟者。
{"title":"Effort–reward imbalance and long-term benzodiazepine use: longitudinal findings from the CONSTANCES cohort","authors":"G. Airagnes, C. Lemogne, S. Kab, N. Hoertel, M. Goldberg, M. Wahrendorf, J. Siegrist, Y. Roquelaure, F. Limosin, M. Zins","doi":"10.1136/jech-2019-212703","DOIUrl":"https://doi.org/10.1136/jech-2019-212703","url":null,"abstract":"Objectives To examine the association between effort–reward imbalance and incident long-term benzodiazepine use (LTBU). Methods We included 31 077 employed participants enrolled in the French population-based CONSTANCES cohort between 2012 and 2014 who had not undergone LTBU in the 2 years before enrolment. LTBU was examined using drug reimbursement administrative databases. The effort–reward imbalance was calculated in quartiles. We computed ORs (95% CIs) for LTBU according to effort–reward imbalance over a 2-year follow-up period. We adjusted for age, gender, education, occupational grade, income, marital status, tobacco smoking, risk of alcohol use disorder, depressive symptoms and self-rated health. Results Over the 2-year follow-up, 294 (0.9%) participants experienced incident LTBU. In the univariable analysis, effort–reward imbalance was associated with subsequent LTBU with ORs of 1.79 (95% CI 1.23 to 2.62) and 2.73 (95% CI 1.89 to 3.95) for the third and fourth quartiles, respectively, compared with the first quartile. There was no interaction between effort–reward imbalance and any of the considered variables other than tobacco smoking (p=0.033). The association remained significant in both smokers and non-smokers, with higher odds for smokers (p=0.031). In the fully adjusted model, the association remained significant for the third and fourth quartiles, with ORs of 1.74 (95% CI 1.17 to 2.57) and 2.18 (95% CI 1.50 to 3.16), respectively. These associations were dose dependent (p for trend <0.001). Conclusions Effort–reward imbalance was linked with incident LTBU over a 2-year follow-up period after adjustment for sociodemographic and health-related factors. Thus, screening and prevention of the risk of LTBU should be systematised among individuals experiencing effort–reward imbalance, with special attention paid to smokers.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82316799","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 : 2019-07-30DOI: 10.1136/jech-2018-211937
Julia C. Bond, Amanda Mancenido, Divya M Patil, Seth Rowley, J. Goldberg, A. Littman
Background There are few published studies evaluating the impact of perinatal residence change on infant outcomes and whether these associations differ by socioeconomic status. Methods We conducted a population-based cohort study using Washington State birth certificate data from 2007 to 2014 to assess whether women who moved during the first trimester of pregnancy (n=28 011) had a higher risk of low birth weight, preterm birth and small for gestational age than women who did not move during the first trimester (n=112 367). ‘Non-first-trimester movers’ were frequency matched 4:1 to movers by year. We used generalised linear models to calculate risk ratios and risk differences adjusted for maternal age, race, marital status, parity, education, smoking, income and insurance payer for the birth. We also stratified analyses by variables related to socioeconomic status to see whether associations differed across socioeconomic strata. Results Moving in the first trimester was associated with an increased risk of low birth weight (6.4% vs 4.5%, adjusted risk ratio 1.37 (95% CI 1.29 to 1.45)) and preterm birth (9.1% vs 6.4%, adjusted risk ratio 1.42 (95% CI 1.36 to 1.49)) and a slight increased risk of small for gestational age (9.8% vs 8.7%, adjusted risk ratio 1.09 (95% CI 1.00 to 1.09)). Residence change was associated with low birth weight and preterm birth in all socioeconomic strata. Conclusion Moving during the first trimester of pregnancy may be a risk factor for adverse birth outcomes in US women. Healthcare providers may want to consider screening for plans to move and offering support.
背景很少有已发表的研究评估围产期居住改变对婴儿结局的影响，以及这些关联是否因社会经济地位而异。方法采用2007年至2014年华盛顿州出生证明数据进行了一项基于人群的队列研究，以评估在妊娠前三个月搬家的妇女(n= 28011)是否比在妊娠前三个月不搬家的妇女(n= 112367)有更高的低出生体重、早产和小胎龄风险。“非孕早期推动者”与推动者的频率按年份匹配为4:1。我们使用广义线性模型来计算风险比和风险差异，调整了产妇年龄、种族、婚姻状况、性别、教育程度、吸烟、收入和生育保险支付者。我们还通过与社会经济地位相关的变量进行分层分析，以了解社会经济阶层之间的关联是否存在差异。结果妊娠早期运动与低出生体重(6.4% vs 4.5%，调整风险比1.37 (95% CI 1.29 ~ 1.45))和早产(9.1% vs 6.4%，调整风险比1.42 (95% CI 1.36 ~ 1.49))和胎龄小的风险轻微增加(9.8% vs 8.7%，调整风险比1.09 (95% CI 1.00 ~ 1.09))相关。在所有社会经济阶层中，居住地变化与低出生体重和早产有关。结论妊娠前三个月搬家可能是美国妇女不良分娩结局的危险因素。医疗保健提供者可能会考虑为搬家计划进行筛查并提供支持。
{"title":"Residence change during the first trimester of pregnancy and adverse birth outcomes","authors":"Julia C. Bond, Amanda Mancenido, Divya M Patil, Seth Rowley, J. Goldberg, A. Littman","doi":"10.1136/jech-2018-211937","DOIUrl":"https://doi.org/10.1136/jech-2018-211937","url":null,"abstract":"Background There are few published studies evaluating the impact of perinatal residence change on infant outcomes and whether these associations differ by socioeconomic status. Methods We conducted a population-based cohort study using Washington State birth certificate data from 2007 to 2014 to assess whether women who moved during the first trimester of pregnancy (n=28 011) had a higher risk of low birth weight, preterm birth and small for gestational age than women who did not move during the first trimester (n=112 367). ‘Non-first-trimester movers’ were frequency matched 4:1 to movers by year. We used generalised linear models to calculate risk ratios and risk differences adjusted for maternal age, race, marital status, parity, education, smoking, income and insurance payer for the birth. We also stratified analyses by variables related to socioeconomic status to see whether associations differed across socioeconomic strata. Results Moving in the first trimester was associated with an increased risk of low birth weight (6.4% vs 4.5%, adjusted risk ratio 1.37 (95% CI 1.29 to 1.45)) and preterm birth (9.1% vs 6.4%, adjusted risk ratio 1.42 (95% CI 1.36 to 1.49)) and a slight increased risk of small for gestational age (9.8% vs 8.7%, adjusted risk ratio 1.09 (95% CI 1.00 to 1.09)). Residence change was associated with low birth weight and preterm birth in all socioeconomic strata. Conclusion Moving during the first trimester of pregnancy may be a risk factor for adverse birth outcomes in US women. Healthcare providers may want to consider screening for plans to move and offering support.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84758654","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 : 2019-07-29DOI: 10.1136/jech-2019-212257
H. Coo, L. Fabrigar, G. Davies, Renée Fitzpatrick, M. Flavin
Background A high maternal prepregnancy body mass index has been associated with lower offspring IQ, but it is unclear if the relationship is causal. To explore this, our objectives were to compare maternal and paternal estimates and to assess whether certain factors mediate the association. Methods We analysed data from the Avon Longitudinal Study of Parents and Children, which initially recruited 14 541 women residing in Avon, UK, with an expected date of delivery in 1991–1992. Data were collected during and after pregnancy by questionnaire, medical record abstraction and clinical assessment. At approximately 8 years of age, psychologists administered an abbreviated form of the Wechsler Intelligence Scale for Children-III. We fit multivariable logistic regression models to estimate parental prepregnancy obesity and overweight–offspring IQ associations. Counterfactually defined indirect (mediated) effects of maternal prepregnancy obesity on offspring IQ were estimated through path analysis. Results Among 4324 mother–father–child triads and using normal weight as the referent, we observed consistently stronger associations for maternal prepregnancy obesity and offspring performance IQ (eg, adjusted β (95% CI)=−3.4 (−5.7 to −1.2) vs −0.97 (−2.9 to 0.96) for paternal obesity). The indirect effects of maternal obesity on offspring IQ through pathways involving gestational weight gain and duration of breastfeeding were small but significant. Conclusion Our findings are consistent with a weak biologic effect of maternal adiposity in pregnancy on offspring performance IQ. Given the growing prevalence of obesity worldwide, more evidence is needed to resolve the correlation versus causation debate in this area.
{"title":"Are observed associations between a high maternal prepregnancy body mass index and offspring IQ likely to be causal?","authors":"H. Coo, L. Fabrigar, G. Davies, Renée Fitzpatrick, M. Flavin","doi":"10.1136/jech-2019-212257","DOIUrl":"https://doi.org/10.1136/jech-2019-212257","url":null,"abstract":"Background A high maternal prepregnancy body mass index has been associated with lower offspring IQ, but it is unclear if the relationship is causal. To explore this, our objectives were to compare maternal and paternal estimates and to assess whether certain factors mediate the association. Methods We analysed data from the Avon Longitudinal Study of Parents and Children, which initially recruited 14 541 women residing in Avon, UK, with an expected date of delivery in 1991–1992. Data were collected during and after pregnancy by questionnaire, medical record abstraction and clinical assessment. At approximately 8 years of age, psychologists administered an abbreviated form of the Wechsler Intelligence Scale for Children-III. We fit multivariable logistic regression models to estimate parental prepregnancy obesity and overweight–offspring IQ associations. Counterfactually defined indirect (mediated) effects of maternal prepregnancy obesity on offspring IQ were estimated through path analysis. Results Among 4324 mother–father–child triads and using normal weight as the referent, we observed consistently stronger associations for maternal prepregnancy obesity and offspring performance IQ (eg, adjusted β (95% CI)=−3.4 (−5.7 to −1.2) vs −0.97 (−2.9 to 0.96) for paternal obesity). The indirect effects of maternal obesity on offspring IQ through pathways involving gestational weight gain and duration of breastfeeding were small but significant. Conclusion Our findings are consistent with a weak biologic effect of maternal adiposity in pregnancy on offspring performance IQ. Given the growing prevalence of obesity worldwide, more evidence is needed to resolve the correlation versus causation debate in this area.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78641762","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 : 2019-07-17DOI: 10.1136/jech-2019-212436
Kim Nathan, O. Robertson, Polly Atatoa Carr, P. Howden-Chapman, N. Pierse
Background Findings regarding early residential mobility and increased risk for socioemotional and behavioural (SEB) difficulties in preschool children are mixed, with some studies finding no evidence of an association once known covariates are controlled for. Our aim was to investigate residential mobility and SEB difficulties in a population cohort of New Zealand (NZ) children. Methods Data from the Integrated Data Infrastructure were examined for 313 164 children born in NZ since 2004 who had completed the Before School Check at 4 years of age. Residential mobility was determined from address data. SEB difficulty scores were obtained from the Strengths and Difficulties Questionnaire administered as part of the Before School Check. Results The prevalence of residential mobility was 69%; 12% of children had moved ≥4 times. A linear association between residential mobility and increased SEB difficulties was found (B=0.58), which remained robust when controlling for several known covariates. Moves >10 km and moving to areas of higher socioeconomic deprivation were associated with increased SEB difficulties (B=0.08 and B=0.09, respectively), while residential mobility before 2 years of age was not. Children exposed to greater residential mobility were 8% more likely to obtain SEB difficulties scores of clinical concern than children exposed to fewer moves (adjusted OR 1.08). Conclusion This study found a linear association between residential mobility and increased SEB difficulties in young children. This result highlights the need to consider residential mobility as a risk factor for SEB difficulties in the preschool years.
{"title":"Residential mobility and socioemotional and behavioural difficulties in a preschool population cohort of New Zealand children","authors":"Kim Nathan, O. Robertson, Polly Atatoa Carr, P. Howden-Chapman, N. Pierse","doi":"10.1136/jech-2019-212436","DOIUrl":"https://doi.org/10.1136/jech-2019-212436","url":null,"abstract":"Background Findings regarding early residential mobility and increased risk for socioemotional and behavioural (SEB) difficulties in preschool children are mixed, with some studies finding no evidence of an association once known covariates are controlled for. Our aim was to investigate residential mobility and SEB difficulties in a population cohort of New Zealand (NZ) children. Methods Data from the Integrated Data Infrastructure were examined for 313 164 children born in NZ since 2004 who had completed the Before School Check at 4 years of age. Residential mobility was determined from address data. SEB difficulty scores were obtained from the Strengths and Difficulties Questionnaire administered as part of the Before School Check. Results The prevalence of residential mobility was 69%; 12% of children had moved ≥4 times. A linear association between residential mobility and increased SEB difficulties was found (B=0.58), which remained robust when controlling for several known covariates. Moves >10 km and moving to areas of higher socioeconomic deprivation were associated with increased SEB difficulties (B=0.08 and B=0.09, respectively), while residential mobility before 2 years of age was not. Children exposed to greater residential mobility were 8% more likely to obtain SEB difficulties scores of clinical concern than children exposed to fewer moves (adjusted OR 1.08). Conclusion This study found a linear association between residential mobility and increased SEB difficulties in young children. This result highlights the need to consider residential mobility as a risk factor for SEB difficulties in the preschool years.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88167363","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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