Journal of Epidemiology and Community Health最新文献

Social epidemiological studies have shown for decades that wealth shows associations to various health outcomes in addition to more frequently used and established indicators like income, education and occupational status. Measurements of income alone are not able to assess the economic position and resources of individuals, while they neglect transgenerational and cumulative pathways of shaping socioeconomic status (SES) and their impact on health. Despite this established knowledge, the use of measurements of wealth in epidemiological studies is very rare and heterogeneous.Therefore, a number of open questions still need to be answered: How does wealth relate to other socioeconomic and sociodemographic indicators with associations to health? On which pathways is wealth influencing individuals' health? What role does wealth play as a driver for health disparities across populations? Moreover, how does wealth interact with age, gender and race?To further research on these questions, we use this essay to elaborate on the term wealth and its role in social epidemiological research, review results from observational studies, discuss inconsistent results and conclude why it is important to consider wealth as a dimension of SES. In addition, we present a conceptual idea for integrating wealth in a life course-based concept of SES and show what information an assessment of wealth could provide in addition to other established SES indicators.

Background: This study assessed whether supplementary nutrition provided to pregnant women under the Integrated Child Development Service (ICDS) programme in India has reduced the burden of low birth weight or LBW (weight at birth: <2500 g), very low birth weight (VLBW: <1500 g) and extremely low birth weight (ELBW: <1000 g), among their newborns.

Methods: We analysed data of 148 265 index children from the nationally representative 2019-2021 National Family Health Survey. A quasi-experimental method, Coarsened Exact Matching (CEM), was employed to estimate the causal effects of mother's receipt of supplementary nutrition during pregnancy on the prevalence of LBW, VLBW and ELBW. CEM outperforms conventional matching methods by reducing imbalance between treatment and control groups, model dependence, estimation error, bias, variance, mean square error and related criteria that can challenge study findings.

Results: Mothers of only 62.6% children always benefited from supplementary nutrition programme. The survey-weighted prevalence of LBW, VLBW and ELBW was 17.8% (95% CI: 17.5% to 18%), 1.14% (95% CI: 1.06% to 1.22%) and 0.13% (95% CI: 0.11% to 0.15%), respectively. The CEM analysis revealed that supplementary nutrition reduced the prevalence of LBW in pregnant women by an estimated 1.35 percentage points (β: -0.0135; 95% CI: -0.0211 to -0.0060, p: 0.001) or 7.5%, and VLBW by 0.26 percentage points (β: -0.0026; 95% CI: -0.0046 to -0.0005; p: 0.018) or 20.2%. No effect of supplementary nutrition on ELBW was identified (p: 0.114).

Conclusions: Supplementary nutrition provided to pregnant women under the ICDS programme could be helpful in mitigating the burden of LBW and VLBW in India. Intensified efforts to increase uptake of the programme are warranted.

Background: With global population ageing, frailty poses a growing public-health challenge. Many countries have promoted social participation to mitigate frailty among older adults, but the cross-national consistency of this association remains unclear.

Methods: We harmonised data from four longitudinal cohort studies (N=20 947) conducted in England, the USA, China and Mexico with respect to measures of social participation and frailty. We employed fixed-effects models and cross-national meta-analyses to examine the longitudinal relationship between social participation and frailty. The Arellano-Bond estimator model was further used to evaluate the lagged effects of this association. Finally, a multilevel analysis incorporating country-level factors was conducted to investigate the moderating effects of macro-level variables.

Results: Substantial differences in social participation were observed across countries, ranging from 41.76% in Mexico to 83.43% in the USA. After adjusting for confounders, higher social participation was significantly associated with lower frailty levels (pooled effect=-0.52; 95% CI -0.80 to -0.24), with evidence of a lagged temporal effect. Neither the strength of this association nor the overall rate of social participation was significantly influenced by country-level factors.

Conclusion: The consistent findings across diverse national contexts suggest that promoting equitable social engagement among older adults may effectively reduce the prevalence of frailty. Public-health policies and community programmes should prioritise initiatives that encourage social participation among the elderly, and healthcare services may consider integrating social activities into routine care to foster active ageing.

Background: Children and young adults with attention-deficit/hyperactivity disorder (ADHD) may be at increased risk of criminal offending. This study examines the risk of first-time and repeat offending among individuals with ADHD and potential effect of stimulant medication.

Methods: A population-based, data linkage cohort study of individuals born in New South Wales, Australia between 1990 and 2005 and followed until May 2016. All individuals authorised for stimulant treatment for ADHD were frequency matched (1:10) to controls without ADHD. Proven criminal offences were identified using court records. First and repeat offences were examined separately using modified Cox regression and Prentice-Williams-Peterson models.

Results: The cohort included 75 650 individuals with ADHD (147 855 treated and 525 595 untreated person years) and 745 634 non-ADHD controls. The risk of first offence was higher among cases, but reduced by stimulants (males 10-17 years, untreated HR 2.02, 95% CI 1.95 to 2.10; treated HR 1.52, 95% CI 1.41 to 1.62). The effect estimates for males were reduced for repeat offences (10-17 years: untreated HR 1.09, 95% CI 1.05 to 1.13; treated HR 0.97, 95% CI 0.90 to 1.04). No association with reoffending was found in females, except treated individuals aged 10-17 years had a higher risk (HR 1.26, 95% CI 1.02 to 1.56).

Conclusions: ADHD was associated with higher risk of a first criminal offence, but stimulant prescription was associated with lower risk among individuals with ADHD. This association was reduced among repeat offenders, with only modest apparent benefit of treatment among males. Adequate treatment resources may help keep individuals with ADHD out of the criminal justice system.

Background: Food insecurity is associated with worse diabetes outcomes, but how that association may vary across individuals is unclear. We sought to better understand possible heterogeneity in the association between food insecurity and diabetes outcomes.

Methods: Longitudinal cohort study of adults with type 2 diabetes assessed for food insecurity in community-based health centres. Diabetes outcomes were haemoglobin A1c (HbA1c), systolic and diastolic blood pressure, and low-density lipoprotein cholesterol (LDL), 12 months after food insecurity assessment. We used three machine learning methods (generalised random forest (GRF), X-Learner and Doubly Robust Learner) to assess outcome heterogeneity across the following variables: age, sex, race and ethnicity, health insurance, income, comorbidity, baseline outcome and social vulnerability index.

Results: Among 41 581 individuals (mean age 56.2 (SD: 12.8) years, 56.9% female), mean baseline HbA1c was 7.8% (SD: 1.9%) and 10 399 (25.0%) reported food insecurity. Food insecurity was associated with 0.1% greater HbA1c at 12 months, with little heterogeneity. For example, using GRF, the mean difference in HbA1c in the quartile with the lowest estimated HbA1c difference associated with experiencing, versus not experiencing, food insecurity was 0.0%, while the mean difference in the quartile with the greatest estimated difference was 0.2%. Results were similar for other outcomes, except that there was no association between food insecurity and LDL.

Conclusions: In this study, we did not observe meaningful heterogeneity in the associations between food insecurity and diabetes outcomes.

Background: Global warming is expected to increase the risk of cardiovascular morbidity and mortality. The effects of climate variability on sudden cardiac arrest (SCA) have not been studied in tropical climates. We aimed to study this in Singapore, a city-state with a tropical climate.

Methods: We included all nationally reported SCA cases from 1 April 2010 to 31 December 2021. Using negative binomial regression adjusted for long-term trend, periodicity and public holidays, we estimated the temperature and absolute humidity effects on SCA risk within the Distributed Lag Non-Linear Model framework. We compared the seasonal trend components of SCA cases, temperature and absolute humidity.

Results: There were 27 209 cases. The majority were 65 years of age and above (62.3%), male (63.4%) and of Chinese ethnicity (68.4%). SCA risk increased by 13% (RR: 1.13, 95% CI: 1.07 to 1.20) at 29°C and by 33% (RR: 1.33, 95% CI: 1.04 to 1.70) at 24°C (relative to 27°C) when these temperatures sustained over 8 days. SCA risk increased by 78% (RR: 1.78, 95% CI: 1.34 to 2.37) when absolute humidity was sustained over 7 days at 18 g/m³ (relative to 25 g/m³). The cooler temperature effects on SCA risk were higher at lower levels of absolute humidity, suggesting effect modification. SCA had its highest peak in the first half of the calendar year, occurring concurrent to a seasonal trough in absolute humidity while its second peak was preceded by the seasonal peak in temperature.

Conclusion: Temperature and absolute humidity were independently associated with SCA risk.

Background: Negative associations between neighbourhood socioeconomic disadvantage and health are well documented. However, limited longitudinal evidence exists on the dynamic nature of the neighbourhood context and implications for health disparities. Using rich register data, we examined how neighbourhood disadvantage in Denmark changed over three decades and explored associations with mortality rates.

Methods: This ecological study used nationwide register data from 1987 to 2018. A neighbourhood socioeconomic disadvantage index was created using aggregated data on neighbourhood-level educational attainment, unemployment and family income. Trends in the neighbourhood index were assessed using descriptive and geospatial analyses. Associations with age-standardised mortality rates were plotted and examined in regression-based models.

Results: Neighbourhood socioeconomic conditions generally improved over the three decades, and the mean difference between disadvantaged quartiles narrowed. The location of the most and least disadvantaged quartiles was largely stable across the period. Mortality rates generally decreased over time; however, rates of decline differed, leading to increased mortality disparities by quartile of neighbourhood disadvantage. Regression analysis demonstrated an increase in the association between neighbourhood disadvantage and mortality rates over time. First-difference regression models showed no association between change in neighbourhood disadvantage and change in mortality rates.

Conclusions: Despite general improvements in neighbourhood socioeconomic conditions and neighbourhood mortality rates across the last three decades in Denmark, we found growing health inequality between more and less disadvantaged neighbourhoods. A strong concentration of disadvantage over time and space and growing segregation of income levels may have contributed to this development, with important implications for public policy and health policy investments.