Journal of Epidemiology and Community Health最新文献

Background: Athletes who have a history of participation in contact sports appear to subsequently experience elevated rates of neurodegenerative diseases such as dementia but have a lower incidence of cardiovascular disease and selected cancers. We quantified the occurrence of little-examined cardiometabolic and mental health outcomes, plus associated lifestyle factors, in a group of former contact sports athletes and a general population sample.

Methods: In this cohort study, male former elite athletes active between 1920 and 1965 in soccer (N=303), boxing (N=281), and wrestling (N=318) were recruited using sports yearbooks and the administrative records of sports associations. A population control group was identified using data from a compulsory medical examination (N=1712). All study members were linked to hospital registers (1970-2015) and a self-completion questionnaire was circulated in 1985.

Results: Across 12 health outcomes, the general pattern of association was null. On the few occasions when statistically significant differences did occur, there were in fact more favourable health characteristics and behaviours in former athletes. For instance, in comparison to population controls, we found a lower prevalence of ever having smoked cigarettes in all contact sports groups (range in odds ratios (95% confidence intervals) of 0.32 (0.21, 0.48) to 0.52 (0.36, 0.75)).

Conclusion: In this study, male retired contact sports athletes had similar cardiometabolic and mental health profiles to those of population controls.

Background: This study examines the associations between device-measured sleep regularity and the risk of major adverse cardiovascular events (MACE), and aims to determine whether sufficient sleep duration attenuates or eliminates the effects of irregular sleep on MACE risk.

Methods: A prospective cohort study of adults aged 40-79 years from the UK Biobank who wore wrist-attached accelerometers for 7 days was conducted. Sleep Regularity Index (SRI) scores were calculated for each participant using a validated algorithm, and categorised as irregular (SRI <71.6), moderately irregular (SRI between 71.6 and 87.3), and regular (SRI >87.3 (reference group)). Information on MACE and its subtypes (myocardial infarction, heart failure, stroke) was obtained from inpatient hospitalisation and death records.

Results: We analysed data from 72 269 individuals followed for 8 years, without a previous history of MACE and without an event in the first year of follow-up. Irregular (HR 1.26, 95% CI 1.16 to 1.37) and moderately irregular sleepers (HR 1.08, 95% CI 1.01 to 1.70) were at higher risk of MACE compared with regular sleepers. Dose-response analyses treating SRI as a continuous measure showed that SRI was associated with MACE risk in a near-linear fashion, with a steeper MACE risk reduction at higher (better) SRI scores. Joint SRI and sleep duration analyses showed that meeting the age-specific sleep duration recommendation offsets MACE risk for moderately irregular sleepers (HR 1.07, 95% CI 0.96 to 1.18), but not for irregular sleepers (HR 1.19, 95% CI 1.06 to 1.35).

Conclusions: Irregular sleep was strongly associated with higher MACE risk. Adequate sleep duration was not sufficient to offset these adverse effects among irregular sleepers. This study supports the inclusion of sleep regularity in public health guidelines and clinical practice as a risk factor for cardiovascular disease.

Background: Food insecurity poses a substantial threat to mental health. However, there is limited understanding of how food-insecure adults experience mental health challenges and access necessary health services. We examined the association of food insecurity with mental health status, mental health service utilisation and general healthcare utilisation among US adults.

Methods: A retrospective longitudinal cohort study was conducted to analyse data from 9906 US adults participating in the 2016-2017 Medical Expenditure Panel Survey. Outcomes included mental health status, mental health service utilisation and general healthcare utilisation. The primary independent variable was food insecurity measured using the 10-item Food Security Survey Module. Two separate models were used: A lagged-dependent model and a fixed-effect model.

Results: The lagged dependent model showed that food insecurity in 1 year was associated with a higher likelihood of reporting mental health symptoms based on the Patient Health Questionnaire and the Kessler 6 Psychological Distress Scale (3.5 percentage points (95% CI: 1.3 to 5.8)) and self-reported poor mental health (5.8 percentage points (2.9 to 8.7)) in the subsequent year. However, compared with food-secure adults, food-insecure adults were no more likely to have outpatient mental health visits, specialty mental health visits or psychotropic medication fills. Moreover, food-insecure adults were 4.1 (1.2 to 7.0) percentage points more likely to have an emergency room visit than food-secure adults. These findings were consistent with the fixed-effect model.

Conclusion: Food insecurity is associated with worse mental health. However, food-insecure adults may not access adequate mental health services and instead rely on emergency room visits.

Background: Although the mental health burden of diabetes has received substantial attention, there is limited evidence on whether the risk of suicide-a severe consequence of mental health problems-increases among individuals with diabetes. Therefore, this study investigated the association between diabetes and suicide in Japan.

Methods: This nationwide longitudinal cohort study included adults aged 18-74 years, who were enrolled in the Japan Health Insurance Association's health insurance programme between 2015 and 2022. Individuals newly diagnosed with diabetes were matched in a 1:1 ratio with those without diabetes, based on age and sex. We employed multivariable Cox proportional hazard models to estimate the hazard ratios for suicide in relation to the diagnosis of diabetes, adjusting for potential confounders, such as sociodemographic characteristics, history of psychiatric disorders, physical measurements, health behaviours and laboratory data.

Results: Among 4 210 272 individuals in the matched-pair cohort, we observed 337 deaths by suicide among those with diabetes and 250 deaths by suicide among those without diabetes. After conditioning on potential confounders, diabetes diagnosis was linked to an increased risk of suicide (HR (95% CI) = 1.25 (1.06 to 1.47)). The association tended to be larger among those aged younger than 40 years and among women (among those aged 18-39 years, HR=1.69 (95% CI 1.05 to 2.73); among women, HR=1.56 (95% CI 0.92 to 2.64)).

Conclusion: Diabetes diagnosis may increase suicide risk among the working-age population, even after conditioning on potential confounders. Our findings underscore the importance of psychosocial support following a diagnosis.

Background: Physical fitness is an excellent marker of general health and performance. We aimed to calculate trends in physical fitness among Lithuanian adolescents between 1992 and 2022.

Methods: Using a repeated cross-sectional design, body size and physical fitness data for 17 918 Lithuanian adolescents (50.3% female) aged 11-17 years were collected in 1992, 2002, 2012 and 2022. Body mass index (BMI) was calculated from measured height and body mass, with BMI z-scores (zBMI) calculated using WHO growth curves. Physical fitness was measured using the Eurofit test battery, with results converted to z-scores using European norms. With adjustment for zBMI, trends in mean fitness levels were calculated using general linear models. Trends in distributional characteristics were visually described and calculated as the ratio of SDs.

Results: We found significant large declines (standardised effect size (ES) ≥ 0.80) in 20-m shuttle run and bent arm hang performance, and significant small declines (ES=0.20-0.49) in standing broad jump, plate tapping, sit-and-reach and sit-ups performance. In contrast, we found a significant moderate improvement (ES=0.50-0.79) in flamingo balance performance and a significant negligible improvement (ES<0.20) in 10×5-m shuttle run performance. Poorer trends were observed in low performers (below the 20th percentile) compared with high performers (above the 80th percentile).

Conclusion: Health-related fitness (ie, cardiorespiratory and musculoskeletal fitness) levels have declined among Lithuanian adolescents since 1992, particularly among those with low fitness. National health promotion policies are required to improve current trends.

Background: Findings on the link between the number of children and dementia risk are inconsistent, mostly studied in females, suggesting pregnancy-related changes may be a key factor in this association.

Methods: The Adult Changes in Thought Study is a cohort of adults aged ≥65 years from Kaiser Permanente Washington. The primary exposure was the number of children (0, 1, 2, 3 or ≥4), and the outcome was an incident dementia diagnosis. Cox proportional-hazards models were adjusted for demographic and early-life socioeconomic confounders. Models were then stratified by sex and by birth year <1928 versus ≥1928.

Results: Among 4668 participants (average age at enrolment 74.1±SD 6.3 years; 59% female), 967 (21%) had 0 children, 484 (10%) had one child, 1240 (27%) had two children, 968 (21%) had three children and 1009 (22%) had four or more children. We found no association between the number of children and dementia overall or after stratification by birth cohort. When stratified by sex and adjusting for confounders, having ≥4 children compared with two children was associated with a higher rate of dementia in males (HR=1.31, 95% CI 1.01 to 1.71).

Conclusions: The number of children was not consistently associated with the risk of dementia. We observed a greater risk of dementia only among males who had ≥4 children, with the lower bound of the 95% CI marginally exceeding 1. These findings suggest that the number of children may influence the risk of dementia through other than pregnancy-related pathways.

Health policies play a crucial role in shaping people's well-being. While public health often relies on evidence-based policy to improve health outcomes, many non-scientific factors determine the health policy-making process. This article explores how public health advocacy can be strengthened by examining the relationship between political philosophy and the scientistic aspirations of public health.We begin by critically assessing the deliberative decision-making model, offering insights on policy processes that could inspire new directions in health policy research. To enhance these efforts, we delve into the philosophical critique of scientism, aiming to liberate public health from its technocratic inclinations. Our analysis draws on political philosophy from two angles: first, we revisit Renaissance utopias to highlight the risks of a science-driven society devoid of ethics; second, we introduce modern perspectives on democratic justice, advocating for health policies that resist domination.Ultimately, we argue for a new model of health policy science that positions public health as a key political actor. By focusing on the everyday realities of policy-making, public health can tackle two fundamental questions: How are citizens' interests considered in health policy? And how do we deliberate the goals and means of health policy? By addressing these questions, our proposals aim to enhance public health advocacy, promoting research and actions that lead to more just and inclusive health policies, ensuring the protection of everyone's health.

Background: The consideration of unique social housing needs has largely been absent from the COVID-19 response, particularly in tailoring strategies to improve access to testing and vaccine uptake among vulnerable and high-risk populations in Ontario. Given the growing population of social housing residents, this study aimed to compare SARS-CoV-2 testing, positivity, and vaccination rates in a social housing population with those in a general population cohort in Ontario, Canada.

Methods: This population-based cohort study used administrative health data from Ontario to examine SARS-CoV-2 testing, positivity and vaccination rates in social housing residents compared with the general population from 1 January 2020 to 31 December 2021. All comparisons were unadjusted, stratified by sex and age and evaluated using standardised differences.

Results: The rates of SARS-CoV-2 PCR testing were lower among younger age groups and higher among older adults within the social housing cohort, compared with the general population cohort. SARS-CoV-2 test positivity was higher in social housing than in the general population among individuals aged 60-79 years (7.9% vs 5.3%, respectively) and 80 years and older (12.0% vs 7.9%, respectively). Overall, 34.3% of social housing residents were fully vaccinated, compared with 29.6% of the general population cohort. However, a smaller proportion of social housing residents had received a booster vaccine (36.7%) compared with the general population (52.4%).

Conclusion: Improved and targeted outreach strategies are needed to increase the uptake of COVID-19 booster vaccines among social housing residents.

Mitigating climate change requires us to rapidly improve the energy efficiency of our existing housing, a process known as 'retrofit'. However, this creates the risk of 'renoviction', whereby tenants are moved or evicted to allow these renovations to take place. Understanding the potential for renoviction to undermine the potential population health benefits of retrofit is an important new area for research.