Journal of Epidemiology and Community Health最新文献

Background: Older adults living in social housing report poor health and access to healthcare services. This study aimed to estimate the prevalence of chronic diseases, influenza vaccination and cancer screenings among social housing residents versus non-residents in Ontario, Canada.

Methods: We conducted a population-based cohort study for all health-insured Ontarians alive and aged 40 or older as of 1 January 2020. Social housing residents were identified using postal codes. Validated health administrative data case definitions were used to identify individuals with diabetes, hypertension, chronic obstructive pulmonary disease, asthma, congestive heart failure and cardiovascular disease. Influenza vaccination and mammography, Pap and colorectal cancer screenings were identified among screen-eligible residents using health administrative data.

Results: The prevalence of all chronic diseases was higher among social housing residents across all age groups: 40-59, 60-79 and 80+ years. Influenza vaccination rates in 2018-2019 were lower among social housing residents aged 60-79 and 80+ years. Mammography rates for women aged 50-69 years in 2018-2019 were 10-11% lower among social housing residents across all age groups compared with non-residents. Pap screening rates for women aged 40-69 in 2018-2019 were 6-8% lower among social housing residents. The percentage of colorectal screening in both women and men aged 52-74 was lower (9-10% in men and 6-7% in women) in social housing compared with the general population in 2019-2020.

Conclusion: There is a higher prevalence of chronic diseases and lower cancer screening rates among the growing population of older adults in social housing in Ontario, Canada.

Purpose: This retrospective cohort study aimed to investigate the association between chronic postsurgical pain (CPSP) and the risk of postoperative depression in patients undergoing major surgery.

Methods: Data from Taiwan's National Health Insurance Research Database were analysed for patients aged over 20 years who underwent major surgery between 2004 and 2018. CPSP was defined as the use of prescribed analgesics for over 3 months postsurgery, with a prescription exceeding 90 cumulative defined daily doses. Propensity score matching (PSM) was employed to match patients with and without CPSP. Cox regression analysis and competing risk analysis were conducted to evaluate the risk of postoperative depression in the CPSP group compared with the no CPSP group.

Results: Before PSM, 141 466 patients were included, with 37 303 (26.37%) experiencing CPSP. After PSM, 74 606 patients were matched in both groups. The incidence of depression was significantly higher in the CPSP group compared with the no CPSP group (p<0.0001). Cox regression analysis revealed a significantly elevated risk of depression in the CPSP group (adjusted HR: 1.41; 95% CI 1.35 to 1.48; p<0.0001), which persisted across various adjustment models and competing risk analysis. The cumulative depression risk increased over the follow-up period.

Conclusions: This study demonstrates a strong association between CPSP and postoperative depression risk. Addressing CPSP may offer a promising approach to reducing the incidence of postoperative depression and its socioeconomic and familial burdens. Further research is needed to elucidate underlying mechanisms and optimise preventive interventions.

Background: Childhood adversities, such as exposure to parental mental illness, domestic violence and abuse, substance use, and family poverty, have been linked to involvement in violence in early adulthood. However, evidence on the cumulative impact of multiple adversities throughout childhood on violence and crime in adolescence remains scarce. This study investigates the associations between trajectories of family adversity and poverty during childhood, and the risk of involvement in violence and contact with police in adolescence.

Methods: We used longitudinal data from the UK Millennium Cohort Study on 9316 children. Exposure trajectories of family adversities and poverty were characterised (from ages 0-14 years) using group-based multi-trajectory models. The outcomes were weapon involvement, for example, carrying a knife, and police contact measured at age 17 years. Odds ratios and 95% confidence intervals (OR, 95% CI) and population attributable fractions were estimated using logistic regression models, adjusting for confounding factors.

Results: The prevalence of weapon involvement and contact with police at age 17 years were 6.1% and 20.0%, respectively. Compared with children who experienced low poverty and family adversity throughout childhood, those exposed to persistent poverty and poor parental mental health were at notably increased risk of carrying weapons (adjusted OR (aOR) 2.2, 95% CI 1.3 to 3.6) and reporting contact with police (aOR 2.1, 95% CI 1.6 to 2.8). We estimate that about 32% of weapon involvement and 23% of contact with police at age 17 were attributable to persistent poverty and family adversity.

Conclusion: Exposure to poverty and poor parental mental health throughout childhood doubles the risk of weapon involvement and police contact in early adulthood. These findings emphasise the importance of lifecourse and anti-poverty approaches to reducing involvement in crime in the UK.

Introduction: Few studies exist examining the long-term effects of urban renewal programmes on health. The purpose of this study is to examine the long-term effects of an urban renewal programme on the health and health inequality outcomes of residents living in the neighbourhoods intervened in Barcelona city by the Neighbourhoods Law (NL), while comparing them to a comparison group of non-intervention neighbourhoods with similar socioeconomic status.

Methods: The Barcelona Health Survey was used for studying changes in self-rated health, mental health, hypertension and meeting walking requirements set by the WHO in pre (2006) and post (2016) years of neighbourhoods intervened by the NL and a group of comparison neighbourhoods with similar socioeconomic characteristics. We used logistic regression models to examine pre-post differences in health outcomes within intervention or comparison neighbourhoods. A difference-in-difference regression was used to assess the overtime impact of the NL intervention on the health outcomes compared with the comparison groups. All models were adjusted by the highest education level attained and age.

Results: In the intervention neighbourhoods, self-rated health improved for manual workers, hypertension dropped in men and more women met the walking requirements compared with similar groups in the comparison neighbourhoods. Across all groups, mental health worsened.

Conclusions: Our study is among the first to examine the long-term effects of urban renewal programmes. Although there exist complexities in studying these long-term effects, they are critical to ensure urban renewal programmes continue to improve health and reduce inequality among residents.

Alienation has been used as a crucial concept to describe the negative psychosocial impacts that stem from the ways production and consumption are organised in Marxist and non-Marxist traditions. The psychosocial impacts it generates are mediated through stress pathways to increase non-communicable physical and mental illnesses. There has been little empirical research on the impact of alienation on health and ways in which the impact might be reduced. This paper sets out an Alienation, Health and Well-being research agenda. We propose two hypotheses: (1) that processes of production and consumption in 21st century capitalism leads to alienation which underpins a significant degree of mental illness and non-communicable disease; and (2) reductions in prevalence of mental illness and non-communicable disease requires public policies which regulate market behaviour in favour of measures which reduce the alienating impacts of processes of production and consumption.

Background: Climate-related health impacts have been a global public health concern. Identifying vulnerable populations is critical in implementing adaptation strategies. This study aimed to examine how heat-related impacts on all-cause emergency hospitalisations differ by area deprivation and urbanicity.

Methods: All-cause emergency hospitalisations were identified in the Japanese nationwide administrative database during the warm season between 2011 and 2019. A time-stratified case-crossover study was conducted to examine short-term associations between daily mean temperature and hospitalisation. Days of heat exposure were defined as days when the daily mean temperature exceeded the minimum morbidity temperature (ie, temperature with the lowest relative risk between the 25th and the 75th percentiles of the daily mean temperature distribution). Analyses were stratified by area deprivation index and urbanicity. Heat-related excess hospitalisations were quantified using the population attributable fraction (PAF), derived as a fraction of heat-attributable emergency hospitalisations to the total number of emergency hospitalisations for all study subjects or within specific subgroups.

Results: We identified 5 914 084 hospitalisations. Among all study subjects, PAF for heat-related excess hospitalisations was 1.69% (95% CI 1.54% to 1.87%). PAF for heat-related excess hospitalisations was more pronounced in people living in the most deprived areas (1.87%, 95% CI 1.68% to 2.06%) than those in the least deprived (1.19%, 95% CI 0.98% to 1.41%) and in urban populations (2.03%, 95% CI 1.78% to 2.30%) than rural ones (1.42% (95%CI 1.24% to 1.60%)). When further stratified by deprivation and urbanicity simultaneously, PAF for heat-related excess hospitalisations was most significant among urban populations living in the most deprived areas (2.62%, 95% CI 2.26% to 3.03%).

Conclusion: These findings revealed that individuals living in the most deprived areas in urban settings were particularly vulnerable to heat exposure. Adaptation strategies tailored to socioeconomic and geographical inequalities can potentially reduce future heat-related health impacts.

Background: Natural disasters may have negative health effects on survivors. However, long-term observations on this are lacking. Therefore, this study investigated the association between the degree of housing damage caused by the Great East Japan Earthquake (GEJE) and all-cause mortality using the data from the cohort study conducted by the Tohoku Medical Megabank (TMM) Project in disaster-stricken areas.

Methods: The community-based cohort study of the TMM Project which conducted a baseline survey from May 2013 to March 2016 collected data using questionnaires and blood and urine tests. The present large-scale prospective cohort study was a follow-up survey in which the degree of house damage and all-cause mortality were analysed using Cox proportional hazards regression, adjusting for sex, age and other potentially confounding variables. The degree of house damage was categorised into 'did not live in the disaster area', 'no damage', 'small-scale damage' and 'large-scale damage'. Among the 58 320 participants, 1763 deaths were confirmed during the follow-up which averaged 6.5 years.

Results: The multivariate analysis showed a hazard ratio (95% CI) of 0.96 (0.82 to 1.13) for those who did not live in the disaster area, 0.98 (0.87 to 1.10) for small-scale damage and 0.98 (0.85 to 1.14) for large-scale damage, compared with no damage, but no significant association with all-cause mortality was observed.

Conclusion: The results of this large-scale prospective cohort study of GEJE survivors showed no significant relationship between the degree of house damage and all-cause mortality. Further long-term follow-up studies are needed to examine the long-term health effects of natural disasters on survivors.

Background: While social support is associated with better cognitive health among cancer-free individuals, this relationship is understudied among cancer survivors. We investigated whether overall social support before and after a cancer diagnosis is related to post-diagnosis memory ageing, overall and by sex/gender.

Methods: Data were from 2044 cancer survivors in the US Health and Retirement Study (HRS; n=1395) and English Longitudinal Study of Ageing (ELSA; n=649) from 2006 to 2018. Incident cancer diagnoses and memory function (immediate and delayed word recall) were assessed biennially. Social support was assessed every 4 years in the HRS and biennially in ELSA. We established three time points relative to a cancer diagnosis: pre-diagnosis (the wave prior to cancer diagnosis), time 1 post-diagnosis (the first wave after a cancer diagnosis) and time 2 post-diagnosis (the second wave after a cancer diagnosis). Multivariable-adjusted marginal structural models incorporating inverse probability of treatment and attrition weights estimated the relationship between overall social support and memory function post-diagnosis.

Results: Prior to a cancer diagnosis, 45.1% of participants reported high social support. Cancer survivors reporting higher social support at time 2 had better memory function post-diagnosis than those with lower social support (0.14 SD units; 95% CI: 0.03 to 0.24) which was stronger among women (0.18 SD units; 95% CI: 0.02 to 0.34) than men (0.10 SD units; 95% CI: -0.03 to 0.24).

Conclusions: Social support may help promote memory function after a cancer diagnosis in mid-to-later life. Further studies with a larger sample size and differentiation of social support are warranted.

Background: Despite the different conditions, frailty and sarcopenia overlap regarding their common link: the assessment of walking speed and muscle strength. This study aimed to compare the frailty phenotype to the sarcopenia using different cut-off points for low grip strength to determine which better identifies mortality risk over a 14-year follow-up period.

Methods: 4597 participants in the English Longitudinal Study of Ageing. Frailty was measured using the Fried phenotype. Sarcopenia (European Working Group on Sarcopenia in Older People 2) was defined using different cut-off points for low grip strength (<36, <32, <30, <27 and <26 kg for men and <23, <21, <20 and <16 kg for women), low skeletal muscle mass index (<9.36 kg/m² for men and<6.73 kg/m² for women) and slowness (gait speed: ≤0.8 m/s). Cox models were run and adjusted for sociodemographic, behavioural and clinical factors.

Results: When the coexistence of frailty and sarcopenia is considered, only the cut-off points <36 kg for men and <23 kg for women to define low grip strength identified the risk of mortality among individuals classified as having probable sarcopenia (HR=1.17, 95% CI 1.02 to 1.34), sarcopenia (HR=1.31, 95% CI 1.07 to 1.60) and severe sarcopenia (HR=1.62, 95% CI 1.33 to 1.96). In this situation, frailty identified the mortality risk (HR=1.49, 95% CI 1.22 to 1.81), whereas pre-frailty did not. Sarcopenia using other cut-off points for defining low grip strength did not identify mortality risk.

Conclusion: Sarcopenia using <36 kg for men and <23 kg for women as cut-off points seems to be better than the frailty phenotype for identifying the risk of mortality in older adults.

Background: Unpaid carers deliver critical social care. We aimed to examine differences by ethnicity in (1) profiles of unpaid caring and (2) associations between caring and physical and mental health trajectories.

Methods: We used 10 waves of data from 47 015 participants from the UK Household Longitudinal Study (2009-2020). Our outcomes were 12-item Short Form Health Survey physical and mental component scores. We performed bivariate comparison of profiles of caring by ethnicity. We used multilevel linear mixed effects models to estimate associations between caring and health trajectories and assess for heterogeneity by ethnicity.

Results: We found that caring profiles differed by ethnicity. The proportion caring for someone within their household ranged from 39.7% of White carers to 70.1% of Pakistani and 74.8% of Bangladeshi carers. The proportion providing 20+ hours/week of care ranged from 26.9% of White carers to 40.6% of Pakistani and 43.3% of Black African carers. Ethnicity moderated associations between caring and physical but not mental health trajectories (test for interaction: p=0.038, p=0.75). Carers showed worse physical health compared with non-carers among Black African (-1.93; -3.52, -0.34), Bangladeshi (-2.01; -3.25, -0.78), Indian (-1.30; -2.33, -0.27) and Pakistani carers (-1.16; -2.25, -0.08); Bangladeshi carers' trajectories converged with non-carers over time (0.24; -0.02, 0.51). White carers showed better baseline physical health than non-carers (0.35; 0.10, 0.60), followed by worsening trajectories versus non-carers (-0.14; -0.18, -0.10).

Conclusions: There are differences by ethnicity in profiles of caring and associations between caring and physical health trajectories. Future research should account for ethnicity to ensure applicability across groups.