Public Health最新文献_第6页

“Us versus Them”: is the voice of the community heard when planning communication screening programmes for preschoolers? "我们与他们"：在规划学龄前儿童传播筛查计划时是否听取了社区的声音？

IF 3.9 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2024-09-16 DOI: 10.1016/j.puhe.2024.08.003

Objectives

Community consultation is necessary to ensure the uptake and use of community-based screening intervention to detect early childhood disabilities, as its absence can result in poor service acceptance and usage. To document stakeholders' perspectives regarding planning a community-based communication disorder (an impairment in the ability to receive, send, process and comprehend concepts or verbal, non-verbal and graphic symbol systems) screening programmes for pre-schoolers.

Study design

This qualitative research design used purposive and random sampling to recruit 46 participants from eThekwini Municipality, South Africa. These stakeholders consisted of caregivers/parents of children who underwent screening for communication disorders, People who are Deaf, their parents, early childhood development practitioners, health professionals and government officials involved with children with disabilities. All participants were adults aged between 19 and 79 years, with an average age of 39.7 years.

Methods

Data was collected through focus group discussions and individual interviews, which were thematically analysed.

Results

The four emergent themes were screening approaches, methods, location and personnel. Service users expected greater access to screening and reliable tests to identify problems by trained personnel at sites within the community. Service providers preferred a targeted approach to screening with parental input. Task shifting and sharing were seen as a solution to address staff shortages and provide services at health facilities, as resource constraints made it challenging to provide outreach services.

Conclusion

Stakeholder engagement revealed diverging views between service users and providers, with implications for programme provision and uptake. There is a need for ongoing, inclusive discussion to ensure consensus during the planning stage, in order to render services that address issues of equity and accessibility for people with disabilities in marginalised communities.

目的社区咨询对于确保社区筛查干预措施被接受和使用以检测早期儿童残疾非常必要，因为缺乏社区咨询可能导致服务接受度和使用率低下。研究设计该定性研究设计采用了有目的的随机抽样方法，在南非 eThekwini 市招募了 46 名参与者。这些利益相关者包括接受沟通障碍筛查的儿童的照顾者/家长、聋人、他们的父母、儿童早期发展从业人员、卫生专业人员以及与残疾儿童相关的政府官员。所有参与者都是年龄在 19 至 79 岁之间的成年人，平均年龄为 39.7 岁。方法通过焦点小组讨论和个别访谈收集数据，并对数据进行主题分析。结果四个新出现的主题是筛查方式、方法、地点和人员。服务使用者希望能有更多机会接受筛查，并通过社区内经过培训的人员进行可靠的测试来发现问题。服务提供者倾向于采用有针对性的筛查方法，并听取家长的意见。由于资源限制，提供外展服务具有挑战性，因此任务转移和分担被视为解决人员短缺和在卫生设施提供服务的一种解决方案。有必要持续开展包容性讨论，以确保在规划阶段达成共识，从而为边缘化社区的残疾人提供解决公平和无障碍问题的服务。

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引用次数: 0

Leprosy in Brazil: an analysis of the Global Burden of Disease estimates between 1990 and 2019 巴西的麻风病：1990 年至 2019 年全球疾病负担估算分析

IF 3.9 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2024-09-16 DOI: 10.1016/j.puhe.2024.07.035

Objective

To analyze the occurrence of leprosy in Brazil and its states between 1990 and 2019, according to Global Burden of Disease (GBD) estimates, and its correlation with development status.

Study design

A descriptive and analytical ecological epidemiological study.

Methods

Rates of incidence, prevalence, and years lived with disability (YLD) due to leprosy, standardized by age, per 100,000 inhabitants, were analyzed. The trend analysis consisted of the joinpoint regression model and the average annual percentage change. The correlation between the incidence rate and the sociodemographic index (SDI) was investigated (Spearman test) at a 5% significance level. Incidence, prevalence and YLD rates were presented by country's states, sex, and age.

Results

There was an average percentage decrease of −1.1% per year (P < 0.001) in the incidence rate in the country and, between 1990 and 2019, a decline from 4.8 to 3.5 per 100,000 inhabitants; prevalence from 26.1 to 22.2, and YLD from 1.1 to 1.0. The incidence rate was higher among men and the elderly. Maranhão (7.0 in 1990; 4.2 in 2019), Alagoas (6.6 in 1990; 4.1 in 2019), Acre (6.1 in 1990; 4.0 in 2019), Mato Grosso (5.2 in 1990 and 3.7 in 2019), and Mato Grosso do Sul (4.8 in 1990 and 3.7 in 2019) presented the highest incidence rates. A negative correlation was observed between SDI levels and leprosy incidence rates in 1990 (R = −0.71; P < 0.0001) and 2019 (R = −0.81; P < 0.0001).

Conclusions

Despite the decrease in the rates of leprosy incidence, prevalence, and YLDs over the analyzed period, Brazil has a long way towards achieving its eradication. The greater burden of the disease in males stands out. The estimated risk of the disease was higher in the states with the lowest SDI levels. Therefore, interventions must consider the heterogeneity of the disease burden geographically and between sociodemographic groups.

研究设计一项描述性和分析性生态流行病学研究。方法分析每 10 万名居民中麻风病的发病率、流行率和因麻风病致残的年数（YLD），并按年龄进行标准化。趋势分析包括连接点回归模型和年均百分比变化。研究了发病率与社会人口指数（SDI）之间的相关性（斯皮尔曼检验），显著性水平为 5%。结果全国的发病率平均每年下降-1.1%（P< 0.001），1990 年至 2019 年期间，每 10 万居民的发病率从 4.8 降至 3.5，发病率从 26.1 降至 22.2，YLD 从 1.1 降至 1.0。男性和老年人的发病率较高。马拉尼昂州（1990 年为 7.0；2019 年为 4.2）、阿拉戈斯州（1990 年为 6.6；2019 年为 4.1）、阿克里州（1990 年为 6.1；2019 年为 4.0）、马托格罗索州（1990 年为 5.2；2019 年为 3.7）和南马托格罗索州（1990 年为 4.8；2019 年为 3.7）的发病率最高。1990年（R = -0.71; P <0.0001）和2019年（R = -0.81; P <0.0001），SDI水平与麻风病发病率之间呈负相关。男性麻风病人的负担更重。在 SDI 水平最低的州，估计的患病风险较高。因此，干预措施必须考虑到疾病负担在地理上和社会人口群体之间的异质性。

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引用次数: 0

Associations between adherence to 24-Hour Movement Guidelines with continuous metabolic syndrome score among Chinese children and adolescents 中国儿童和青少年遵守《24 小时运动指南》与代谢综合征连续得分之间的关系

IF 3.9 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2024-09-14 DOI: 10.1016/j.puhe.2024.08.005

Objectives

The objective of this study was to evaluate the associations between adherence to 24-Hour Movement Guidelines (24-HMG) with continuous metabolic syndrome score (cMetS) among Chinese children.

Study design

Cross-sectional study.

Methods

We conducted a cross-sectional study among 4604 children aged 6–17 years from Shenzhen, China. The 24-HMG was constructed using the self-report information on moderate-to-vigorous physical activity (MVPA), screen time (ST), and sleep duration. The cMetS was calculated based on waist circumference, homoeostatic model assessment for insulin resistance, mean arterial blood pressure, high-density lipoprotein cholesterol, and triglyceride. Multivariate linear regression models were used to assess the associations between adherence to recommendations of 24-HMG and cMetS.

Results

Among the participants, 563 (12.23%) students adhered to 3 recommendations of the 24-HMG. We found that adhering to more recommendations was negatively associated with cMetS (P for trend: <0.001). For specific combinations, meeting the ST + MVPA recommendations was negatively associated with cMetS (coefficients [β]: −0.686; 95% confidence interval [CI]: −1.148, −0.223). Individuals who adhered to all recommendations had a lower cMetS (β: −0.693; 95% CI: −1.147, −0.238) than those who met none of the recommendations.

Conclusions

Our study showed that adherence to more recommendations of the 24-HMG was associated with lower levels of cMetS in Chinese children and adolescents.

研究设计横断面研究。方法我们对来自中国深圳的 4604 名 6-17 岁儿童进行了横断面研究。根据中到剧烈运动（MVPA）、屏幕时间（ST）和睡眠时间的自我报告信息构建了24-HMG。cMetS 根据腰围、胰岛素抵抗同源模型评估、平均动脉血压、高密度脂蛋白胆固醇和甘油三酯计算得出。我们使用多变量线性回归模型来评估 24-HMG 建议的遵守情况与 cMetS 之间的关系。结果在参与者中，有 563 名学生（12.23%）遵守了 24-HMG 中的 3 项建议。我们发现，坚持更多建议与 cMetS 负相关（趋势 P：<0.001）。就具体组合而言，符合 ST + MVPA 建议与 cMetS 负相关（系数 [β]：-0.686；95% 置信区间 [CI]：-1.148, -0.223）。结论我们的研究表明，遵守 24-HMG 的更多建议与中国儿童和青少年较低的 cMetS 水平有关。

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引用次数: 0

Explaining the role of socioeconomic, healthcare access and infrastructural shifts in nutritional transition among women in Bangladesh between 2004 and 2018 解释 2004 年至 2018 年孟加拉国妇女营养转型中社会经济、医疗保健机会和基础设施变化的作用

IF 3.9 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2024-09-14 DOI: 10.1016/j.puhe.2024.08.010

Objectives

Shifts in socioeconomic factors, healthcare access, lifestyle and infrastructure facilities have resulted in increased body mass index (BMI) of populations in developing countries. These shifts result in a large increase in overweight and obese individuals, with a corresponding decline in the number of those who are underweight. Although this nutritional transition among women in Bangladesh is evident, studies elucidating such change are scarce. This study aimed to explain how socioeconomic, healthcare access and infrastructural shifts contributed to the nutritional transition among women of childbearing age in Bangladesh between 2004 and 2018.

Study design

Repeated cross-sectional study of respondents who participated in the latest five rounds of Bangladesh Demographic Health Surveys (BDHS) from 2004 to 2017–18.

Methods

Applying counterfactual decomposition techniques to data from the latest five rounds of BDHS, this study examined how variations in observed nutrition-related determinants, and returns to them across rounds, contributed to the nutritional transition among women of childbearing age.

Results

Shifts in nutritional outcomes were primarily attributed to gains in partner's education, improved access to healthcare, a decline in breastfeeding practice and the number of births. Wealth accumulation, contraception and improved sanitation facilities appeared as secondary contributing factors. Additionally, this study identified that the BMI gap widened between the lower and the upper quantile of the distribution over the study period.

Conclusions

Addressing the rise in BMI and the prevalence of overnutrition is imperative for the future health of the population in Bangladesh. Considering the study findings and existing national nutrition policies and programmes, it is evident that targeted policy interventions, programmatic approaches and multisectoral collaborations are essential.

目标社会经济因素、医疗保健服务、生活方式和基础设施的变化导致发展中国家人口的体重指数（BMI）上升。这些变化导致超重和肥胖的人数大幅增加，而体重不足的人数则相应减少。虽然孟加拉国妇女的这种营养转变很明显，但阐明这种变化的研究却很少。本研究旨在解释 2004 年至 2018 年间，社会经济、医疗保健获取途径和基础设施的转变如何促进了孟加拉国育龄妇女的营养转型。研究设计对参加 2004 年至 2017-18 年最新五轮孟加拉国人口健康调查（BDHS）的受访者进行重复横断面研究。方法本研究对最新五轮孟加拉国人口与健康调查的数据采用了反事实分解技术，研究了观察到的营养相关决定因素的变化以及这些因素在各轮调查中的回报是如何促成育龄妇女营养转型的。结果营养结果的转变主要归因于伴侣受教育程度的提高、医疗保健服务的改善、母乳喂养做法的减少以及生育数量的增加。财富积累、避孕和卫生设施的改善则是次要因素。此外，本研究还发现，在研究期间，BMI 分布的低分位数和高分位数之间的差距有所扩大。考虑到研究结果以及现有的国家营养政策和计划，有针对性的政策干预、计划方法和多部门合作显然至关重要。

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引用次数: 0

Prevalence and risk factors associated with undiagnosed hypertension among adults aged 15–49 years in India: insights from the National Family Health Survey (NFHS-5) 印度 15-49 岁成年人中未确诊高血压的患病率和相关风险因素：全国家庭健康调查（NFHS-5）的启示

IF 3.9 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2024-09-14 DOI: 10.1016/j.puhe.2024.07.032

Objectives

To estimate the prevalence and identify the factors associated with undiagnosed hypertension in India.

Study design

A secondary data analysis using the National Family Health Survey (NFHS-5) covering the period 2019–2021.

Methods

Information on hypertension among individuals aged 15–49 years was extracted from the survey dataset. We estimated the prevalence of undiagnosed hypertension using physical measurements along with self-reported data from the survey. A log-binomial model with survey-adjusted Poisson regression was used to estimate the prevalence ratio between undiagnosed and diagnosed hypertension. Multinomial logistic regression analysis examined the factors associated with diagnosed hypertension (vs healthy) and undiagnosed hypertension (vs healthy). All the analyses were survey-weight adjusted and stratified by gender.

Results

The survey-adjusted prevalence of undiagnosed hypertension was 8.75% (8.62%–8.87%) and was higher among males [13.56% (13.03%–14.12%)] than in females [8.14% (8.03%–8.25%)]. The proportion of individuals with undiagnosed hypertension among total hypertension was 44.99% (44.44%–45.55%) and was higher in males [65.94% (64.25%–67.60%)] than in females [42.18% (41.66%–42.71%)].

Conclusions

Our findings revealed that age, higher body mass index, no access to health care, and having no comorbidities were risk factors for undiagnosed hypertension. One in twelve people had undiagnosed hypertension, and of those with hypertension, one in two were undiagnosed, with males being disproportionately affected. Targeted public health interventions are crucial to improve hypertension screening, particularly among middle-aged and obese individuals without comorbidities.

目标估算印度未确诊高血压的患病率并确定相关因素。研究设计利用覆盖 2019-2021 年的全国家庭健康调查 (NFHS-5) 进行二次数据分析。方法从调查数据集中提取 15-49 岁人群的高血压信息。我们利用调查中的物理测量数据和自我报告数据估算了未确诊高血压的患病率。我们采用对数二叉模型和调查调整后的泊松回归来估算未确诊高血压与确诊高血压的患病率比。多项式逻辑回归分析研究了与确诊高血压（与健康人相比）和未确诊高血压（与健康人相比）相关的因素。结果经调查调整后，未确诊高血压患病率为 8.75%（8.62%-8.87%），男性患病率[13.56%（13.03%-14.12%）]高于女性[8.14%（8.03%-8.25%）]。未确诊的高血压患者占高血压患者总数的比例为 44.99%（44.44%-45.55%），男性[65.94%（64.25%-67.60%）]高于女性[42.18%（41.66%-42.71%）]。每 12 人中就有 1 人患有未确诊的高血压，而在患有高血压的人群中，每 2 人中就有 1 人未确诊，其中男性所占比例更高。有针对性的公共卫生干预措施对于改善高血压筛查至关重要，尤其是在无并发症的中年肥胖人群中。

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引用次数: 0

A longitudinal study of learning difficulties in adolescence and biomarkers of cardiometabolic risk in adulthood: A gendered pathways approach 青少年时期学习困难与成年后心脏代谢风险生物标志物的纵向研究：性别路径方法

IF 3.9 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2024-09-14 DOI: 10.1016/j.puhe.2024.09.008

Objectives

Little is known about the relationship between learning difficulties (LD) in adolescence and physical health in adulthood. This study investigates the gender-specific pathways through which LD is longitudinally associated with cardiometabolic risk in adulthood.

Study design

We used data from the National Longitudinal Study of Adolescent to Adult Health (N = 11,342). To assess cardiometabolic risk, 11 biomarkers related to cardiovascular functioning, glucose metabolism, lipid metabolism, and inflammation were utilized.

Methods

We first estimated the association between LD in adolescence and cardiometabolic risk in adulthood. Then, we examined whether this association is mediated by educational attainment and body mass index (BMI). Finally, we employed a moderated mediation model to determine whether gender moderates these mediation patterns.

Results

LD in adolescence was positively associated with cardiometabolic risk in adulthood (b = 0.165, p < 0.001). LD also predicted lower educational attainment (b = −0.724, p < 0.001) and higher BMI (b = 0.589, p < 0.05). Educational attainment and BMI explained 18 and 25 percent of the positive association between LD and cardiometabolic risk, respectively. A moderated mediation model revealed that indirect effects of LD on cardiometabolic risk via educational attainment and BMI were more pronounced among women than men.

Conclusion

LD in adolescence is a significant predictor of cardiometabolic risk in adulthood. Interventions focusing on the academic and health behaviors of girls with LD may be effective in improving their adult physical health.

研究目的人们对青少年时期学习困难（LD）与成年后身体健康之间的关系知之甚少。本研究调查了学习困难与成年后心脏代谢风险纵向相关的性别特异性途径。研究设计我们使用了全国青少年到成人健康纵向研究（N = 11342）的数据。为了评估心血管代谢风险，我们使用了与心血管功能、糖代谢、脂代谢和炎症有关的 11 种生物标志物。然后，我们研究了这种关联是否受教育程度和体重指数（BMI）的影响。最后，我们采用了调节中介模型来确定性别是否会调节这些中介模式。结果显示，青少年时期的低密度脂蛋白血症与成年后的心脏代谢风险呈正相关（b = 0.165，p <0.001）。低密度脂蛋白胆固醇还预示着较低的教育程度（b = -0.724，p < 0.001）和较高的体重指数（b = 0.589，p < 0.05）。教育程度和体重指数分别解释了 LD 与心脏代谢风险之间 18% 和 25% 的正相关关系。调节中介模型显示，LD 通过教育程度和体重指数对心脏代谢风险的间接影响在女性中比在男性中更明显。对患有 LD 的女孩的学习和健康行为进行干预可能会有效改善她们成年后的身体健康。

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引用次数: 0

Predicting the risk of nursing home placement of elderly persons using a population-based stratification score 利用基于人口的分层评分预测老年人入住养老院的风险

IF 3.9 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2024-09-13 DOI: 10.1016/j.puhe.2024.08.030

Objective

To develop and validate a novel score predictive of nursing home placement in elderly.

Study design

Population-based case-control study based on healthcare utilization databases of Lombardy, a region of Northern Italy.

Methods

The 2.4 million citizens aged ≥65 years who on January 1, 2018 lived outside nursing home formed the target population. Cases were citizens who experienced nursing home admission (the outcome of interest) until December 31, 2019. Cases were matched 1:1 by gender, age, and municipality of residence to one control. Conditional logistic regression was fitted to select candidate predictors (the exposure to 69 clinical conditions and 11 social and healthcare services) independently associated with the outcome. The model was built from the 26,156 cases, and as many controls (training set), and applied to a validation set (15,807 case-control couples). Predictive performance was assessed by discrimination and calibration.

Results

Twenty-one factors were identified as predictive of nursing home admission and were included in the “Elderly Nursing Home Placement” (ENHP) score. Mental health disorders and chronic neurological illnesses contributed most to prediction of nursing home admission. ENHP performance showed an area under the receiver operating characteristic curve of 0.77 and a remarkable calibration of observed and predicted outcome risk.

Conclusions

A simple score derived from data used for public health management may reliably predict the risk of nursing home placement in elderly. Its use by healthcare decision makers allows to accurately identify high-risk individuals who need home services, thereby avoiding admission to nursing homes.

研究设计基于意大利北部伦巴第大区医疗保健利用率数据库的人群病例对照研究方法目标人群为 2018 年 1 月 1 日在养老院外居住的 240 万年龄≥65 岁的公民。病例为截至 2019 年 12 月 31 日入住养老院（相关结果）的公民。根据性别、年龄和居住城市，病例与一名对照进行 1:1 匹配。通过条件逻辑回归筛选出与结果独立相关的候选预测因子（69 种临床症状和 11 种社会和医疗保健服务）。该模型由 26156 个病例和相同数量的对照（训练集）建立，并应用于验证集（15807 对病例对照夫妇）。结果有 21 个因素被确定为预测入住养老院的因素，并被纳入 "老年人养老院安置"（ENHP）评分中。精神疾病和慢性神经疾病对入住养老院的预测作用最大。ENHP 的表现显示，接收者操作特征曲线下的面积为 0.77，观察到的结果风险与预测的结果风险之间的校准效果显著。医疗决策者使用它可以准确识别需要居家服务的高风险人群，从而避免入住养老院。

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引用次数: 0

The impact of climate and demographic changes on future mortality in Brussels, Belgium 气候和人口变化对比利时布鲁塞尔未来死亡率的影响

IF 3.9 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2024-09-13 DOI: 10.1016/j.puhe.2024.07.028

Objectives

City populations are particularly vulnerable to climate change, but it is difficult to reliably estimate the impact on health due to the lack of high-resolution data. We used recently developed regional climate model projections at kilometre resolution combined with demographic projections to estimate the future mortality burden associated with temperatures in the region of Brussels, Belgium.

Study design

The study incorporated a time-series analysis.

Methods

Based on quasi-Poisson regression with distributed-lag non-linear models for the historical temperature–mortality relationship, we derive the mortality burden for the near (2020–2044) and mid (2045–2069) future and disaggregated the contributions of demographic and climate changes.

Results

The cold-related attributable fraction of deaths is expected to decrease from 6.22% (95% empirical confidence interval: 1.76%; 10.52%) in 1994–2019 to 5.17% (1.08%; 9.09%) in 2045–2069, whereas for heat, this fraction will increase from 1.02% (0.59%; 1.47%) to 1.83% (0.82%; 2.96%), with contributions of both climate and demographic changes. In stratified analyses by age, we found that because of demographic changes, the number of cold-attributable deaths will increase for people aged above 85 years, with 6815 (95% empirical confidence interval: 1424; 12,003) deaths expected in 2045–2069 compared to 5245 (1462; 8867) deaths in 1994–2019. For people aged below 65 years, on the other hand, the number of heat-related deaths will decrease from 456 (265; 658) to 344 (154; 561) deaths.

Conclusions

Public health policies that especially target the elderly and the summer-time period are needed to limit the impact of climate change on health.

目标城市人口特别容易受到气候变化的影响，但由于缺乏高分辨率数据，很难可靠地估计气候变化对健康的影响。我们利用最近开发的千米分辨率区域气候模型预测与人口预测相结合，估算了比利时布鲁塞尔地区未来与气温相关的死亡负担。研究设计该研究采用了时间序列分析法。方法基于准泊松回归与分布式滞后非线性历史气温-死亡率关系模型，我们得出了近期（2020-2044 年）和中期（2045-2069 年）的死亡率负担，并对人口和气候变化的贡献进行了分解。结果与寒冷相关的可归因死亡比例预计将从 1994-2019 年的 6.22% （95% 经验置信区间：1.76%; 10.52%）下降到 2045-2069 年的 5.17% （1.08%; 9.09%），而与高温相关的可归因死亡比例将从 1.02% （0.59%; 1.47%）上升到 1.83% （0.82%; 2.96%），其中气候和人口变化均有贡献。在按年龄进行的分层分析中，我们发现，由于人口结构的变化，85 岁以上人群因感冒导致的死亡人数将会增加，预计 2045-2069 年将有 6815 人（95% 经验置信区间：1424；12003）死亡，而 1994-2019 年则为 5245 人（1462；8867）。结论要限制气候变化对健康的影响，需要制定特别针对老年人和夏季的公共卫生政策。

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引用次数: 0

Mortality due to cervical and breast cancer in health regions of Brazil: impact of public policies on cancer care 巴西卫生保健地区宫颈癌和乳腺癌死亡率：癌症护理公共政策的影响

IF 3.9 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2024-09-13 DOI: 10.1016/j.puhe.2024.07.034

Objective

This analysis assessed the association between regional income, screening coverage for cervical and breast cancer, and temporal trends in mortality from these cancers in different Brazilian health regions.

Study design

Spatiotemporal ecological study across 450 health regions of Brazil.

Methods

Data from 2010 Demographic Census were used to assess income. Variations in income distribution within health regions were measured using the Gini index. Data on screening coverage were obtained from the Ambulatory Information System (SIA/SUS). Mortality was assessed from the Global Burden of Disease Study 2019 data. The average annual percentage change (AAPC) in cervical and breast cancer mortality rates, 2010–2018, was calculated by health regions. Results were presented in regional maps. The associations between income, screening coverage and mortality changes were estimated by bivariate spatial correlation.

Results

Health regions located in the South and Southeast regions of Brazil had the greatest percentages of screening coverage and highest per capita incomes with the lowest Gini index values. From 2010 to 2018, mortality rates for cervical cancer were highest in the North and Northeast health regions. Breast cancer mortality rates were highest in the South and Southeast health regions. The AAPC in breast and cervical cancer mortality had a negative association with per capita income and screening coverage, and a positive association with the Gini index.

Conclusions

There are large regional variations in income, screening coverage, and mortality rates for women with breast and cervical cancer. These inequities could be mitigated by policies to address income disparities and improved access to screening.

这项分析评估了巴西不同卫生区的地区收入、宫颈癌和乳腺癌筛查覆盖率与这些癌症死亡率的时间趋势之间的关联。使用基尼指数衡量卫生区内收入分配的差异。筛查覆盖率数据来自门诊信息系统（SIA/SUS）。死亡率根据 2019 年全球疾病负担研究数据进行评估。按卫生区域计算了 2010-2018 年宫颈癌和乳腺癌死亡率的年均百分比变化（AAPC）。结果以区域地图的形式呈现。通过双变量空间相关性估算了收入、筛查覆盖率和死亡率变化之间的关联。结果位于巴西南部和东南部地区的卫生区筛查覆盖率百分比最高，人均收入最高，基尼指数值最低。从 2010 年到 2018 年，北部和东北部卫生区的宫颈癌死亡率最高。南部和东南部卫生区的乳腺癌死亡率最高。乳腺癌和宫颈癌死亡率的 AAPC 与人均收入和筛查覆盖率呈负相关，与基尼指数呈正相关。这些不平等现象可以通过解决收入差距和改善筛查机会的政策来缓解。

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引用次数: 0

Occupational class inequalities in all-cause and cardiovascular mortality in Norwegian men and women: a population-based approach with 45 years follow-up 挪威男女全因死亡率和心血管死亡率中的职业等级不平等：基于人口的 45 年跟踪方法

IF 3.9 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2024-09-13 DOI: 10.1016/j.puhe.2024.07.033

Objectives

This study assessed associations of three theoretically different occupational class schemes with all-cause and cardiovascular mortality in Norwegian men and women.

Study design

Pooled survey and register data from four Norwegian cohort studies.

Methods

We pooled survey data from four general population cohorts (N = 97,469) linked to national mortality registries with follow-up over 45 years. Survival was modelled using accelerated failure time models stratified by sex for three class schemes: The European Socio-Economic Classification (ESeC), The Oslo Register Data Class scheme (ORDC) and The International Socio-Economic Index (ISEI). Main analyses were adjusted for age, birth cohort, and study. Secondary analyses included smoking behaviour as a mediator.

Results

During median 27.6 years of observation, 37,488 participants had died (13,243 from cardiovascular disease). Hazard ratios for male all-cause mortality were lowest in the highest occupational class categories ORDC 2: 0.68 (0.65–0.72), ESeC 1: 0.76 (0.73–0.79) and ISEI 5th quintile: 0.80 (0.77–0.82) compared to working class reference categories. Female mortality risks were lowest for Cultural Lower Middle class ORDC 7: 0.84 (0.72–0.98), Small Employers and Self-employed ESeC4: 0.70 (0.50–0.97) and ISEI 5th quintile: 0.79 (0.70–0.90). Patterns for cardiovascular mortality were similar to all-cause mortality. Including smoking behaviour as a mediator attenuated associations, but overall mortality patterns according to occupational class remained unchanged.

Conclusion

The results underline that mortality inequalities do not simply consist of higher risks in the most disadvantaged groups. The association of occupational class with mortality is found across different categories of occupational class schemes, illustrating their continued relevance for studying social determinants of health.

研究设计汇集了来自四项挪威队列研究的调查和登记数据。方法我们汇集了来自四项普通人群队列（N = 97,469）的调查数据，这些数据与随访时间超过 45 年的国家死亡率登记相联系。我们使用加速衰竭时间模型对三个等级方案进行了性别分层：欧洲社会经济分类 (ESeC)、奥斯陆登记数据分类计划 (ORDC) 和国际社会经济指数 (ISEI)。主要分析对年龄、出生队列和研究进行了调整。结果在中位 27.6 年的观察期间，37,488 名参与者死亡（13,243 人死于心血管疾病）。与工人阶级参考类别相比，男性全因死亡率的危险比在最高职业类别 ORDC 2：0.68（0.65-0.72）、ESeC 1：0.76（0.73-0.79）和 ISEI 第 5 五分位数：0.80（0.77-0.82）中最低。女性死亡风险最低的是文化中下层 ORDC 7：0.84（0.72-0.98），小雇主和自营职业者 ESeC4：0.70（0.50-0.97），ISEI 第 5 个五分位数：0.79（0.70-0.90）。心血管疾病死亡率的模式与全因死亡率相似。将吸烟行为作为中介因素削弱了相关性，但根据职业等级划分的总体死亡率模式保持不变。在不同类别的职业等级计划中都发现了职业等级与死亡率之间的关联，这说明职业等级计划对于研究健康的社会决定因素仍然具有重要意义。

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引用次数: 0