Public Health最新文献

{"title":"Alcohol-related cancer risk awareness and support for cancer warning labelling among adults in Estonia","authors":"","doi":"10.1016/j.puhe.2024.09.004","DOIUrl":"10.1016/j.puhe.2024.09.004","url":null,"abstract":"<div><h3>Objectives</h3><p>The aim of this study was to describe alcohol-related cancer risk awareness and examine sociodemographic and alcohol-related variance in attitudes towards implementation of cancer warning labelling on alcohol containers in Estonia.</p></div><div><h3>Study design</h3><p>Nationally representative data from a 2022 cross-sectional survey (n = 2059) among the 15–74-year-old population in Estonia were used.</p></div><div><h3>Methods</h3><p>Descriptive statistics on the prevalence of alcohol-related cancer risk awareness and support for the implementation of cancer risk warning labelling on alcohol containers are presented. Poisson regression analysis was used to investigate whether support for warning labelling varied by sociodemographic variables, individual alcohol consumption and cancer risk awareness indicators.</p></div><div><h3>Results</h3><p>Study found that 73.2% of respondents associated alcohol consumption with increased cancer risk for one or more cancer sites, but implementation of alcohol cancer risk labelling was only supported by 54%. Women, younger age groups, non-Estonians and those with lower education level expressed higher support for warning labelling, whereas lower support was found among those with high-risk alcohol consumption. As expected, awareness of alcohol-related cancer risk and perceiving individual alcohol consumption as a cancer hazard were associated with support for warning labelling.</p></div><div><h3>Conclusions</h3><p>These findings emphasise the need for better communication of alcohol-related cancer risks as public awareness on the link between alcohol consumption and site-specific cancer risk was low. Increased awareness of alcohol as a cancer risk factor would potentially build public support for introducing cancer-risk warning labelling on containers of alcoholic drinks.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early mathematical models of COVID-19 vaccination in high-income countries: a systematic review","authors":"","doi":"10.1016/j.puhe.2024.07.029","DOIUrl":"10.1016/j.puhe.2024.07.029","url":null,"abstract":"<div><h3>Objectives</h3><p>Since COVID-19 first emerged in 2019, mathematical models have been developed to predict transmission and provide insight into disease control strategies. A key research need now is for models to inform long-term vaccination policy. We aimed to review the early modelling methods utilised during the pandemic period (2019–2023) in order to identify gaps in the literature and highlight areas for future model development.</p></div><div><h3>Study design</h3><p>This study was a systematic review.</p></div><div><h3>Methods</h3><p>We searched PubMed, Embase and Scopus from 1 January 2019 to 6 February 2023 for peer-reviewed, English-language articles describing age-structured, dynamic, mathematical models of COVID-19 transmission and vaccination in high-income countries that include waning immunity or reinfection. We extracted details of the structure, features and approach of each model and combined them in a narrative synthesis.</p></div><div><h3>Results</h3><p>Of the 1109 articles screened, 47 were included. Most studies used deterministic, compartmental models set in Europe or North America that simulated a time horizon of 3.5 years or less. Common outcomes included cases, hospital utilisation and deaths. Only nine models included long COVID, costs, life years or quality of life-related measures. Two studies explored the potential impact of new variants beyond Omicron.</p></div><div><h3>Conclusions</h3><p>This review demonstrates a need for long-term models that focus on outcome measures such as quality-adjusted life years, the population-level effects of long COVID and the cost effectiveness of future policies – all of which are essential considerations in the planning of long-term vaccination strategies.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S003335062400341X/pdfft?md5=630cc5111a81dc1efc2e2b9dbf8de6b9&pid=1-s2.0-S003335062400341X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142173124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equal waiting times for all? Empirical evidence for elective surgeries in the Austrian public healthcare system","authors":"","doi":"10.1016/j.puhe.2024.08.007","DOIUrl":"10.1016/j.puhe.2024.08.007","url":null,"abstract":"<div><h3>Objectives</h3><p>This study analyses waiting times for elective surgeries and potential determinants, including supplementary private health insurance, visits in the operating physician's private practice and informal payments for faster treatment.</p></div><div><h3>Study design</h3><p>Retrospective patient questionnaire survey.</p></div><div><h3>Methods</h3><p>The survey was conducted in eleven Austrian rehabilitation centres in 2019. Data was analysed based on bivariate tests (<em>n</em> = 400) and a multivariate negative-binomial regression model (<em>n</em> = 310) with institution- and patient-related characteristics as independent variables.</p></div><div><h3>Results</h3><p>Median waiting times were 8.9 weeks (IQR: 4.5–18.0) for hip replacement and 8.4 weeks (IQR: 5.0–20.0) for knee replacement surgery. 10.9% of the patients reported having received an offer to shorten their waiting time through a visit in the operating physician's private practice before the surgery or through an informal payment directly to the operating physician. Surgery in private for-profit hospitals, supplementary private health insurance and severe pain were associated with shorter waiting times.</p></div><div><h3>Conclusions</h3><p>While waiting times for elective surgeries in Austria are below international levels, shorter waits for patients with private health insurance and offers to reduce waiting times through informal payments point to equitable access concerns in a public healthcare system.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0033350624003512/pdfft?md5=bf2059e9f402c1990f7424839b0e3505&pid=1-s2.0-S0033350624003512-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142173125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increase in suicide rates in the elderly population of the state of São Paulo, Brazil: Could Alzheimer's disease be a risk factor?","authors":"","doi":"10.1016/j.puhe.2024.09.001","DOIUrl":"10.1016/j.puhe.2024.09.001","url":null,"abstract":"<div><h3>Objectives</h3><p>In recent years, there has been an increase in suicide rates in Brazil. From 2015 to 2019, a 34% increase in self-inflicted deaths was observed. The aim of this study was to analyse population data to determine whether some subgroups of the population, specifically the elderly population with Alzheimer's disease, are at a greater risk of suicide.</p></div><div><h3>Study design</h3><p>An analysis of population data was carried out.</p></div><div><h3>Methods</h3><p>Population data from the state of São Paulo, Brazil, were obtained from two platforms: the Brazilian Institute of Geography and Statistics (IBGE); and the Brazilian Ministry of Health (DataSUS). Data were measured and compared in 2010 and 2022 using the two most recent censuses.</p></div><div><h3>Results</h3><p>Between 2010 and 2022, the number of registered deaths of patients with Alzheimer's increased by 21.93%. In addition, there was a 100.37% increase in suicides among the elderly population compared to a 37.78% increase in the general population.</p></div><div><h3>Conclusions</h3><p>In recent years, there has been a notable increase in both suicides among the elderly and mortality rates attributed to Alzheimer's disease within São Paulo state, Brazil. However, it is not possible to conclude that the increase in suicide among the elderly is directly linked to Alzheimer's disease. To determine a correlation between suicide and Alzheimer's disease, further studies are required.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional, and national burden of bladder cancer, 1990–2019: an age-period-cohort analysis based on the Global Burden of Disease 2019 study","authors":"","doi":"10.1016/j.puhe.2024.07.027","DOIUrl":"10.1016/j.puhe.2024.07.027","url":null,"abstract":"<div><h3>Objectives</h3><p>Bladder cancer is a common malignancy worldwide, with substantial morbidity and mortality. This study aimed to assess the global, regional, and national burden of bladder cancer from 1990 to 2019 using data from the Global Burden of Disease (GBD) 2019 study and to analyze the trends using an age-period-cohort (APC) model.</p></div><div><h3>Study design</h3><p>In this cross-sectional study, secondary analyses were conducted to assess the burden of bladder cancer using data from GBD 2019.</p></div><div><h3>Methods</h3><p>Bladder cancer prevalence, incidence, mortality, disability-adjusted life years (DALYs), and their age-standardized rates (ASRs) were obtained from the GBD 2019 study. The estimated annual percentage changes (EAPCs) were calculated to quantify the trends in ASRs. An APC analysis was performed to distinguish the effects of age, period, and cohort on the observed temporal trends.</p></div><div><h3>Results</h3><p>The global prevalence of bladder cancer increased substantially from 1990 to 2019, reaching 2,869,046.4 cases (95% UI: 2,614,200.3–3,114,474.4) in 2019. The age-standardized prevalence rate rose from 20.9 per 100,000 population in 1990 to 37.1 per 100,000 population in 2019, with an EAPC of 1.97 (95% CI: 1.93–2.01). The global burden of bladder cancer, as measured by DALYs, increased from 48.0 per 100,000 population in 1990 to 56.8 per 100,000 population in 2019, with an EAPC of 0.47 (95% CI: 0.4–0.53), demonstrating the growing impact of this disease on population health.</p></div><div><h3>Conclusions</h3><p>This study demonstrates a significant increase in prevalence, incidence, mortality, and DALYs, with substantial variations across sociodemographic index (SDI) quintiles and GBD regions. The findings emphasize the need for concerted efforts at the global, regional, and national levels to reduce the burden of bladder cancer through primary prevention, early detection, and improved access to treatment services.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of cancer prevention practices in primary care: results of a cohort study in Chile 2018–2022","authors":"","doi":"10.1016/j.puhe.2024.08.006","DOIUrl":"10.1016/j.puhe.2024.08.006","url":null,"abstract":"<div><h3>Objectives</h3><p>The burden of cancer is increasing rapidly in Latin America. Primary care has an essential role in cancer prevention, but implementation levels of prevention practices are not well known. This study evaluated implementation levels and associated factors of cancer preventive practices in primary care over time.</p></div><div><h3>Study design</h3><p>The study incorporated a retrospective multicentre cohort study.</p></div><div><h3>Methods</h3><p>A population of 59,949 patients registered at three primary care clinics was followed from January 2018 to December 2022 in Santiago, Chile. We studied human papillomavirus (HPV) and hepatitis B virus (HBV) immunisation, brief counselling for smoking cessation and alcohol consumption, and cervical and breast cancer screening practices. Standardised electronic medical records were utilised as the source of information. Social, clinical, and organisational factors associated with prevention practices were studied.</p></div><div><h3>Results</h3><p>The cohort attrition level was 17.1%. Most of the population was of a low socioeconomic status, and 70% visited a primary health centre yearly. Implementation rates of immunisation practices were 90.84% for HPV and 80.94% for HBV in 2022. In contrast, brief counselling for smoking and alcohol consumption was below 20% during the study period. Cervical cancer screening decreased by 25.58% between 2018 and 2022, whereas breast cancer screening reached only 41.71% of the target population. Opportunistic medical visits were strongly associated with brief counselling and breast cancer screening.</p></div><div><h3>Conclusion</h3><p>Implementation practices for cancer prevention in a Chilean primary care cohort are high for immunisation and very low for brief counselling and screening practices. A comprehensive non-medical-based model is needed to improve cancer prevention in primary care.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0033350624003500/pdfft?md5=a66bfb1eb0d211ef52a584d71f8cc140&pid=1-s2.0-S0033350624003500-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring financial healthcare protection in Brazil: evolution, inequalities, and associated factors","authors":"","doi":"10.1016/j.puhe.2024.08.001","DOIUrl":"10.1016/j.puhe.2024.08.001","url":null,"abstract":"<div><h3>Objectives</h3><p>Although catastrophic health spending is the main measure for assessing financial healthcare protection, it varies considerably in methodological and empirical terms, which hinders comparison between studies. The aim of this study was to measure the prevalence of catastrophic health spending in Brazil in 2003, 2009, and 2018, its associated factors, and disparities in prevalence distribution according to socioeconomic status.</p></div><div><h3>Study design</h3><p>This was a time series study.</p></div><div><h3>Methods</h3><p>Data from the Household Budget Surveys were used. Prevalence of catastrophic health spending was measured as a percentage of the budget and ability to pay, considering thresholds of 10, 25, and 40%. It was determined whether household, family, and household head characteristics influence the likelihood of incurring catastrophic health spending. Households were stratified by income deciles, consumption, and wealth score.</p></div><div><h3>Results</h3><p>There was an increase in prevalence of catastrophic health spending between 2003 and 2009 in Brazil and a slight reduction in 2018. The wealth score showed more pronounced distributional effects between the poor and the rich, with the former being the most affected by catastrophic health spending. Consumption showed greater percentage variations in the prevalence of catastrophic health spending. The prevalence of catastrophic health spending was positively associated with the presence of older adults, age and female household head, rural area, receipt of government benefits, and some degree of food insecurity.</p></div><div><h3>Conclusions</h3><p>The poorest families are most affected by catastrophic health spending in Brazil, requiring more effective and equitable policies to mitigate financial risk.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0033350624003391/pdfft?md5=5a87d04783e7681e7a4e1f6706660802&pid=1-s2.0-S0033350624003391-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142149342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Too far from care? A descriptive analysis of young Australian mental health aeromedical retrievals","authors":"","doi":"10.1016/j.puhe.2024.07.021","DOIUrl":"10.1016/j.puhe.2024.07.021","url":null,"abstract":"<div><h3>Objectives</h3><p>Young Australians living in rural and remote locations have poorer mental health outcomes and higher rates of self-harm and suicide than their major city counterparts. Significant service gaps and barriers exist in accessing general and youth-specific mental health services. With a lack of access, comes delays in treatment and associated poorer outcomes. This paper describes the characteristics of young people requiring an aeromedical retrieval (AR) for acute inpatient psychiatric care.</p></div><div><h3>Study design and methods</h3><p>A retrospective secondary analysis was conducted of Royal Flying Doctor Service ARs for a six-year period from 2016 to 2021. Data were summarised by demographic, geographic, and diagnostic factors.</p></div><div><h3>Results</h3><p>The total sample size was 1534 (60% male, 40% female; and 31% aged 12–17 years, 69% aged 18–24 years), with 668 (43.5%) affected by schizophrenia and related disorders. Port Augusta, 300 km north of Adelaide, had the highest proportion of aeromedical retrievals (4.4%). The Women's and Children's Hospital in Adelaide received the highest proportion of retrievals (25.6%). Statistically significant gender and age differences were identified as were specific high-usage geographical locations across several Australian states.</p></div><div><h3>Conclusions</h3><p>AR is essential for young people in accessing specialist acute health services. Developmentally appropriate, responsive, youth mental health services are mostly located in large, already well-resourced major cities. Our study provides valuable information to assist governments, communities, and services to enhance the resources available for young people who live rurally.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tobacco and alcohol use among lactating women and its association with child nutrition in India: findings from National Family Health Survey 2019–2021","authors":"","doi":"10.1016/j.puhe.2024.07.026","DOIUrl":"10.1016/j.puhe.2024.07.026","url":null,"abstract":"<div><h3>Objectives</h3><p>Tobacco use is one of the greatest public health problems in the world. Prevalence of alcohol and tobacco use among lactating women ranged between 35.9–83.0% and 1.4–6.1%, respectively, in various parts of the world. Both alcohol and nicotine pass quickly into breast milk. The objective of this study is to estimate the prevalence of alcohol and tobacco use in lactating women and its association with having underweight, stunted, and wasted nursing children in India. The study also draws comparisons to identify the common associated socio-economic factors for alcohol and tobacco use among lactating women and having underweight, stunted, and/or wasted children.</p></div><div><h3>Study design</h3><p>A cross-sectional analytical study involving secondary data from the National Family Health Survey-5.</p></div><div><h3>Methods</h3><p>A cross-sectional analytical study involving secondary data from the National Family Health Survey-5 conducted nationally in community settings in two phases during 2019–2021. Alcohol and tobacco use among lactating women was self-reported, and the nutritional status of children was assess anthropometrically during the survey and categorised into under-weight, stunted, and wasted as per standardised growth charts.</p></div><div><h3>Results</h3><p>prevalence of tobacco use among currently lactating mothers in India was 3.24%. Prevalence of alcohol use among currently lactating mothers was 0.57%. Nursing children of mothers consuming alcohol had significantly higher odds of being wasted [OR = 1.44; (95% CI = 1.07–1.92)]. Richer wealth index {compared to poor, poorer [OR = 0.74; (95% CI = 0.59–0.91)], rich [OR = 0.64; (95% CI = 0.50–0.84)], richer [OR = 0.46; (95% CI = 0.33–0.65)], richest [OR = 0.19; (95% CI = 0.11–0.33)]}, higher education status {compared to illiterate, secondary education [OR = 0.79; (95% CI = 0.63–0.97)], higher education [OR = 0.38; (95% CI = 0.24–0.62)]}, and non-tribal ethnicity [OR = 0.40; (95% CI = 0.33–0.50)] were found to be significantly associated with lower odds of alcohol and tobacco use among lactating mothers. Age, religion, residence, and occupation were also found to be significantly associated.</p></div><div><h3>Conclusions</h3><p>Lactating women with lower education status or belonging to lower income groups needs to be prioritised for further qualitative assessment of alcohol and tobacco use during lactation. Our study reflects the national and state-level prevalence of alcohol and tobacco use among lactating women, which often masks the local and community-level intricacies. There is a need to further explore local and community-level factors affecting alcohol use during lactation and its association with child nutrition.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0033350624003159/pdfft?md5=ddcee6c3b03667ce51c6a55a6942a655&pid=1-s2.0-S0033350624003159-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulatory diseases and the wide sex and ethnic life expectancy gaps in Bulgaria since 2010","authors":"","doi":"10.1016/j.puhe.2024.05.031","DOIUrl":"10.1016/j.puhe.2024.05.031","url":null,"abstract":"<div><h3>Objectives</h3><p>Despite extensive public health initiatives, Bulgaria still has the lowest life expectancy at birth (LE) in the European Union. Sex and ethnic differences in LE and mortality are also exceptionally large. We aimed to identify what causes of death drive these wide disparities and thus provide clear targets for future public health interventions.</p></div><div><h3>Design and methods</h3><p>We conducted a retrospective analysis of mortality rates from 2010 to 2022 to assess sex disparities in LE by age and cause of death. Combining mortality data with the 2021 Bulgarian census also allowed us to study LE disparities among the three main ethnic groups (Bulgarians, Turks, and Roma). We implemented standard demographic decomposition methods to quantify the role of seven major causes of death on LE disparities.</p></div><div><h3>Results</h3><p>We found that the difference between male and female LE has persisted for around seven years. Circulatory diseases contribute 3.66 years, or around 50% of the male-female gap. Ethnic LE disparities are larger for women than for men. Circulatory diseases account for more than 60% of these ethnic LE gaps. COVID-19 mortality explained between 0.5 and 1.1 years of the male-female gap. We found minimal differences in COVID-19 mortality across ethnic groups in Bulgaria.</p></div><div><h3>Conclusion</h3><p>In Bulgaria, circulatory diseases contributed more to both the sex and ethnic LE gaps than in any other previously studied country. Our findings suggest that future public health policy initiatives should focus on circulatory diseases to narrow the Bulgarian LE disparities. One possible target for such a policy would be to reduce excessive smoking and alcohol consumption.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0033350624002270/pdfft?md5=671bb1ea746f9e5f1aa3ce80e82fe653&pid=1-s2.0-S0033350624002270-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142077324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}