Archives of Public Health最新文献

Background: Diabetes mellitus and chronic kidney disease (CKD) are major global public health issues and the leading causes of mortality and morbidity worldwide. Disability-adjusted life years (DALYs) are one of the most commonly used health gap summary measures in public health and have become an important metric for quantifying burden of disease. The primary objective of this study was to quantify the sub-national burden of diabetes mellitus and CKD in France in 2017 using age-standardized DALY rates (ASDRs), and secondary objective was to assess the relationship between these ASDRs and the French Deprivation Index (FDep), as a measure of socioeconomic disparities.

Methods: We used national French health databases to estimate the burden of diabetes mellitus and chronic kidney disease (CKD) in 2017. Disability-adjusted life years (DALYs) were calculated by summing years of life lost (YLL) and years lived with disability (YLD). We calculated ASDRs by applying the age structure of the 2013 European Standard to the observed age-specific rates in France, which were calculated using French population.

Results: In 2017, the age-standardized DALY rates per 100 000 population were 685 (95% UI: 552-810) for diabetes mellitus and 251 (95% UI: 205-296) for CKD. ASDRs were lower among females than males (528 vs. 874 for diabetes; 200 vs. 323 for CKD, respectively). The mortality component contributed more to the overall DALYs than the ill-health component, accounting for around 65% for CKD and for diabetes mellitus, the morbidity contributed 55%, in both females and males. Sub-national disparities in DALYs were evident for both diseases, with lower rates observed in metropolitan France compared with the French overseas departments and regions (DROM).

Conclusions: These results provide a comprehensive understanding of the disease burden due to diabetes mellitus and CKD in France at sub-national level in 2017, providing valuable insights to inform decision-making processes in health policy. Targeted, evidence-based health interventions and prevention strategies tailored to regional needs can significantly enhance public health outcomes for diabetes mellitus and CKD. Future research should take into account the contribution of various risk factors and determinants of health inequalities to these diseases at regional levels.

Background: The KIDSCREEN is a transcultural and standardized instrument designed to assess health-related quality of life (HRQoL) in children and adolescents. Its shorter version, the KIDSCREEN-10 Index, has shown appropriate psychometric properties in various languages, but evidence supporting its validity and reliability in the Spanish version remains limited. The aim of the present study was to provide additional psychometric properties of the KIDSCREEN-10 Index in a representative sample of Spanish adolescents.

Methods: A stratified cluster random sampling method was used to select 2,235 students aged 12 to 18 years from schools in La Rioja, Spain, during 2022. Confirmatory factor analysis was conducted to examine the dimensional structure of the scores, and measurement invariance was tested across sex, age, socioeconomic status, sexual minority status, and nationality. Internal consistency was evaluated using McDonald's omega and Cronbach's alpha coefficients. Moreover, associations with emotional wellbeing and emotional and behavioural difficulties were examined.

Results: Confirmatory factor analysis revealed adequate goodness-of-fit indices for the unidimensional structure of the scores. Furthermore, measurement invariance was found across sex, age, socioeconomic status, nationality, and whether or not participants belonged to sexual minorities, allowing for the analysis of differences between subgroups. Females, older participants, those with lower socioeconomic status, foreign nationals, and participants belonging to sexual minorities scored significantly lower than their respective comparison groups. Moreover, a three-way interaction between sex, age, and sexual minority status was found indicating possible intersectional effects. High internal consistency of the KIDSCREEN-10 Index scores was also observed (Ω = 0.874; α = 0.872). A significant positive correlation was found between the KIDSCREEN-10 Index score and emotional wellbeing, while a significant negative correlation was observed with emotional and behavioural difficulties.

Conclusions: The Spanish version of the KIDSCREEN-10 Index showed adequate psychometric properties, supporting its potential as a reliable and valid tool to measure the HRQoL in adolescents.

Background: China is experiencing rapid population aging and increasing dementia cases. Although existing evidence suggests a link between social participation (SP) and cognitive function (CF) in older adults, few studies have explored their long-term patterns and interplay across urban-rural groups.

Methods: We utilized five waves (2011, 2013, 2015, 2018 and 2020) of multivariate longitudinal data from the China Health and Retirement Longitudinal Study, categorizing participants into urban and rural groups by residence. A group-based dual trajectory model was employed to examine the heterogeneous trajectories and bidirectional association of social participation and cognitive function among 4,133 participants. Binary and multinomial logistic regression analyses were used to explore the predictors of different trajectories. A multigroup cross-lagged panel model was applied to explore the bidirectional associations between social participation and cognitive function.

Results: Among the rural participants, three social participation trajectories were identified: "No SP" (45.2%), "Low SP" (47.5%) and "Moderate SP" (7.3%), and the urban areas included two: "No SP" (62.3%) and "Low SP" (37.7%). There were three patterns of cognitive function in rural areas: "Low-Decline CF" (28.4%), "Moderate-Decline CF" (39.0%) and "High-Decline CF" (32.6%), while urban areas had two: "Low-Decline CF" (49.8%) and "High-Decline CF" (50.2%). Sleep duration was a common risk factor for SP and CF in rural participants (p < 0.05). Individuals with higher levels of social participation were also more likely to exhibit better cognitive function (rural: 79.08%; urban: 65.89%). The cross-lagged analysis showed that cognitive function at the previous wave had a significant positive effect on subsequent social participation (p < 0.05).

Conclusions: The long-term developmental trajectories of social participation and cognitive function are synchronized, primarily driven by the positive effect of cognitive function on social participation. Rural older adults exhibited greater heterogeneity in their trajectories and more complex predictors than their urban counterparts. Interventions targeted at the urban‒rural context are recommended to reduce cognitive decline and promote health equity.

Aim:  Long COVID (LC) presents significant challenges for working age individuals, leading to major inequalities in access to work, employment and relevant support. This study investigates the workplace support provided to people with Long COVID (PwLC) in the UK, focusing on their return-to-work (RTW) experiences. It encompasses perspectives from both PwLC and managers of PwLC.

Methods: Semi-structured interviews were conducted with 20 PwLC and two managers experienced in managing employees with LC. Inductive thematic analysis was performed using NVivo14.

Findings: This qualitative research explored barriers and facilitators to supporting PwLC's RTW. LC is characterised by a wide range of mostly "invisible" and fluctuating symptoms and unpredictable recovery trajectories during which relapses can occur. Existing support mechanisms for RTW with LC include phased return, reduced hours, Occupational Health services, work adjustments, and government support. However, the study identified challenges in implementing these measures, such as unrealistic phased return plans, managers neglecting advice or guidance (e.g. from Occupational Health), unsuitable work adjustments and the burden of navigating government support. The financial impact of reduced hours or sick leave was one of the main reasons for returning to work. Both PwLC and managers highlighted significant gaps in knowledge, resources, policy and guidance for RTW support, emphasising the need for tailored support. Managers reported limited resources and inflexible policies as main challenges, which they addressed through creative solutions.

Conclusion: This qualitative study highlights potential barriers, challenges and gaps in supporting PwLC's RTW. To ensure equitable access to work for PwLC, a flexible and personalised approach is crucial, given the variability in LC symptoms and recovery rates. RTW support that fails to accommodate these characteristics may exacerbate symptoms or cause relapses. A supportive work environment is essential, as LC symptoms can be invisible and concerns about stigma may prevent PwLC from communicating openly and seeking support. Lack of resources is a major barrier for managers in supporting PwLC. Effective government support can potentially fill this gap but must be well-designed and implemented to reduce the burden on applicants.

Background: Physical activity (PA) is critical for healthy ageing, helping prevent chronic and cardiometabolic conditions, improving quality of life (QoL), and preventing premature mortality among older adults. However, determinants of PA levels and their association with QoL among older adults in Ghana remain understudied. This study examined factors influencing PA levels and QoL among older adults in the Cape Coast Metropolis, Ghana.

Methods: This descriptive cross-sectional study involved 234 individuals aged 60 years and above who participated in the Cardiometabolic Risk (CarMeR) study. The International Physical Activity Questionnaire (IPAQ) and WHO Quality of Life: Brief Version (WHOQOL-BREF) were adapted for data collection. Descriptive statistics, simple linear regression, and multiple linear regression were conducted.

Results: The majority of participants (68.4%) were female. Only one-third (30.3%) engaged in vigorous PA, while a significant portion (61.1%) did not meet the recommended PA levels (mean MET min/week = 500.33 ± 573.53). Overall, QoL was reduced, with 50.4% of the participants reporting low QoL. Higher PA levels were significantly associated with better QoL (p < 0.001). Gender (β = 0.531) and financial status (β = 0.484) showed the strongest influence on PA, followed by health status (β = 0.433). Social support (β = 0.173), age (β = 0.149), and safety from crime (β = 0.122) also had smaller but statistically significant effects. Collectively, these factors explained 52.6% of the variation in activity levels (p < 0.001).

Conclusion: Higher PA levels are strongly linked to improved QoL among older adults in Ghana. Since factors like safety from crime, social support, financial stability, being male, and good health status significantly influence PA participation, targeted public health initiatives could incorporate PA programs into existing health and social care systems, encouraging social engagement, addressing financial and environmental barriers, and developing safe and age-appropriate community spaces that promote active ageing.

Background: Human and economic burden of psychological distress (PD) are well known. However, how PD and its various classifications impact health-related quality of life (HRQoL) and its various domains such as physical function (PF), role physical (RP), mental health (MH) and role emotional (RE) is poorly understood.

Objectives: To measure the longitudinal decline in HRQoL related to PD and its various dimensions, and to examine sociodemographic factors associated with HRQoL.

Methods: Data on SF-36 profiles, Kessler Psychological Distress (K10) scale scores and other sociodemographic characteristics of individuals with PD aged ≥ 15 were sourced from 8 waves (7, 11, 13, 15, 17, 19, 21, n = 41,545) of the Household, Income, and Labour Dynamics in Australia (HILDA) survey spanning the years 2007 to 2021. PD severity was classified as no (K10 score: 10-19), mild (K10: 20-24), moderate (K10: 25-29) and severe PD (K10: 30-50). HRQoL was measured as health state utilities (HSUs) via the SF-6D algorithm aligned with Australian population norms. Five separate linear mixed models were estimated, each with HSUs, PF, RP, MH, or RE as the outcome variable.

Results: The mean age of the respondents was 44.88 years (53% female), and the most common age group was 24-44 years (34%). HRQoL declined over time; however, the time coefficients became insignificant after accounting for other sources of variation, including age, sex, English proficiency, Indigenous status, region of residence, marital status, education, employment, physical activity, body mass index (BMI), club membership, smoking, drinking, and income. The adverse impact of PD on HSUs intensified with increasing severity, ranging from - 0.086 in mild PD to -0.177 in severe PD. HRQoL differed across age (from - 0.016 in 25-44 years to -0.059 in 65 + years) and sex groups (disutility difference - 0.012). Different domains of HRQoL were affected by PD disproportionally with the highest and lowest effect recorded in the domain of MH (-0.364) and PF (-0.114), respectively in the category of severe PD. Factors such as education, physical activity, being employed, drinking, and income were positively associated with PD while BMI level and smoking negatively affected HRQoL.

Conclusions: Effective HRQoL management in individuals with PD requires tailored interventions that consider disease severity, age, and sex. The insights on the association of time and other sociodemographic determinants with HRQoL have potential applications in PD-related cost-effective analyses of health interventions.

Background: Sub-Saharan Africa is still the region having the highest burden of under-five mortality rate in the world. Of 4.8 million under-five deaths in 2023, more than 80 percent of under-five death reported from Sub-Saharan Africa and Southern Asia. While previous studies have examined the determinants of under-five mortality in individual countries, there is limited evidence on its spatial distribution and multilevel determinants across the region. This study aimed to examine the spatial pattern and identify significant factors of under-five mortality in Sub-Saharan African countries.

Method: This study explored the Demographic and Health Survey (DHS) data from nine Sub-Saharan African countries conducted between 2016 and 2022, and used a total of 115,335 live births for analysis. The multilevel logistic regression model was considered and several nested models were compared using the likelihood ratio test, AIC and BIC criteria. Significant predictors of under-five mortality were reported using adjusted odds ratios (AOR) with 95% Confidence Intervals (CI) and p-values < 0.05.

Results: The spatial distribution of under-five mortality in Sub-Saharan Africa was significantly clustered, as indicated by Moran's Index of 0.552 (p < 0.001). High mortality rates were observed in Burundi (58.5 per 1,000 live births) and low rates in Kenya (33.9), with an overall rate of 48.9 per 1,000 live births. Increased risk was associated with low maternal education (AOR = 1.57, 95% CI: 1.28-1.91), large family size (AOR = 2.60, 95% CI: 2.41-2.81), and multiple births (AOR = 5.73, 95% CI: 5.01-6.36). On the other hand, a lower risk was observed among children born to employed mothers (AOR = 0.90, 95% CI: 0.84-0.97), whose mothers used contraceptives (AOR = 0.59, 95% CI: 0.55-0.63), and those delivered at health facilities (AOR = 0.83, 95% CI: 0.77-0.90).

Conclusions: The study reveals a significant spatial clustering of under-five mortality across Sub-Saharan Africa, with an overall rate that exceeds the Sustainable Development Goal (SDG) target of 25 deaths per 1,000 live births by 2030. Family planning, maternal education, and safe delivery practices would be essential in reducing under-five mortality in Sub-Saharan African countries. Empowering women through education and promoting family planning, safe delivery, and income-generating programs are vital to reduce child mortality. Regional collaboration and sharing best practices can further advance child survival across Sub-Saharan Africa.

Background: Financial risk protection is a core component of Universal Health Coverage. Rural residents in China continue to face the higher risk of catastrophic health expenditure. Developing a health insurance system for rural residents that ensures affordability and sustainability is critical to advancing Universal Health Coverage. This study aims to assess rural residents' preferences and willingness to pay for inclusive commercial health insurance.

Methods: This cross-sectional study was conducted among 520 rural households in Zhucheng County, China, using a structured questionnaire. A discrete choice experiment was employed to measure respondents' preferences and willingness to pay for inclusive commercial health insurance, followed by scenario simulations to estimate enrollment probabilities.

Results: Based on 497 valid responses, all attributes significantly influenced rural residents' preferences for inclusive commercial health insurance, except the deductible. Respondents preferred plans with government participation, equal compensation regardless of preexisting conditions, 80% reimbursement ratio, coverage for special medications, and low premiums. Government participation had the greatest impact. The optimal plan configuration increased the predicted enrollment probability by 99.6%.

Conclusions: Strengthening government responsibility is the most effective strategy to increase rural enrollment in inclusive commercial health insurance. Additional measures include equitable coverage for preexisting conditions, optimizing benefit design, and setting reasonable premiums and deductibles. These findings offer actionable insights for improving inclusive commercial health insurance uptake among rural residents and provide transferable evidence for other countries seeking to advance financial risk protection under the UHC agenda through public-private insurance partnerships.

Background: Placental malaria (PM) is among the leading public health problems associated with adverse outcomes for the mother, the foetus, and the newborn, particularly in sub-Saharan Africa (SSA). Although there are many studies published on PM in SSA, comprehensive evidence for targeted interventions is limited. Thus, this study aimed to synthesize evidence on the prevalence, predictors, and adverse perinatal outcomes of PM in SSA.

Methods: Pertinent studies online searching, selection, data extraction, and quality assessment were conducted. Data were extracted using Microsoft Excel and analyzed by STATA Version 17.0. Pooled estimates were determined by random-effect meta-analyses. Sub-group analysis was conducted to account for sources of heterogeneity.

Results: Overall, 178 observational studies published from 2000 to 2024 involving 93,809 parturient women from 23 countries were included. The overall pooled prevalence of PM in SSA was 25.1% (95% CI: 22.0-28.3), which was 16.9% (95% CI: 12.3-21.6), 19.1% (95% CI: 17.4-20.9), 24.8% (95% CI: 20.9-28.8), and 34.8% (95% CI: 29.3-40.2) by RDT, microscopy, PCR, and histopathology, respectively. Predictors of PM were: younger age (OR = 2.50 95% CI: 1.89-3.12), primigravidae (OR = 2.65 95% CI: 2.12-3.18), primiparae (OR = 1.62 95% CI: 1.23-2.01), not using insecticide-treated nets (OR = 2.11 95% CI: 1.34-2.89), not using ANC (OR = 7.43 95% CI: 2.47-12.40), not using intermittent preventive treatment during pregnancy (OR = 1.98 95% CI: 1.42-2.54), MiP history (OR = 3.05 95% CI: 1.85-4.25), HIV infection (OR = 2.67 95% CI: 1.22-4.62), and delivering during rainy season (OR = 2.24 95% CI: 1.05-4.07). The pooled prevalence of gestational malaria and congenital malaria was 22.1% (95% CI: 19.8-24.5) and 7.6% (95% CI: 6.5-8.8), respectively. The pooled prevalence of LBW, maternal anaemia, preterm delivery, small-for-gestational age, stillbirth and neonatal malaria was 12.7% (95% CI: 11.1-14.3), 39.0% (95% CI: 34.1-44.0), 11.2% (95% CI: 9.0-13.4), 17.9% (95% CI: 13.7-22.1), 3.4% (95% CI: 2.0-5.1), and 6.9% (95% CI: 3.9-9.8), respectively. PM increased the odds of maternal anaemia (OR = 2.18 95% CI: 1.73-2.63) and LBW (OR = 1.71 95% CI: 1.26-2.16).

Conclusion: Placental malaria was a multifactorial and multifaceted significant health problem with many adverse perinatal outcomes in SSA. Concerted efforts targeting the identified predictors through multidimensional approaches are needed. The protocol of this systematic review and meta-analysis was registered on PROSPERO with the code number: CRD42024528199.