Journal of Epidemiology and Community Health最新文献

Introduction: The COVID-19 Claims Reimbursement for Vaccine Administration for the Uninsured Programme (COVID-19 Uninsured Programme), a novel, short-term federal initiative, reimbursed providers for healthcare-related expenses incurred through the vaccination of individuals without healthcare coverage. The present study aimed to characterise the use of the COVID-19 Uninsured Programme in California and estimate the effect of the end of the programme on vaccine administration.

Methods: California vaccine providers who received reimbursements through 5 April 2022 (the programme end date) were linked to providers in the state immunisation registry. Generalised synthetic control methods were used to estimate the effect of the end of the programme on COVID-19 vaccine administration rates during the ensuing 8 weeks in counties with the highest (>3%) versus lowest (<1%) proportion of doses reimbursed.

Results: Overall, 1145 vaccine providers across 48 of California's 58 counties received reimbursement through the COVID-19 Uninsured Programme. The county-level median number and percentage of doses reimbursed through the programme was 2908 (IQR=406-18 578) and 0.9% (IQR=0.4%-2.5%), respectively. Among the 8 counties with the greatest proportion of doses reimbursed, an estimated 6.4 fewer doses were administered per 10 000 vaccine-eligible residents per day (95% CI: -10.4 to -2.5).

Conclusions: The end of the COVID-19 Uninsured Programme was associated with lower vaccine administration rates among counties with high participation in the programme; several counties had low or no participation in the programme, indicating underutilisation.

Background: Evidence on the short-term association between particulate matter with an aerodynamic diameter of ≤1 µm (PM₁) and mortality from chronic obstructive pulmonary disease (COPD) is scarce. We aimed to explore the potential effects of PM₁ on COPD mortality.

Methods: We conducted a province-wide time-stratified case-crossover study in 13 cities of Jiangsu province, China, from 2015 to 2019. Daily mortality data were collected and PM₁ at the individual level was estimated using a gridded dataset (10 km × 10 km) linked to personal residential addresses. The effects of PM₁ on COPD mortality were evaluated using conditional logistic regression. We also investigated the exposure-response relations and potential effect modifiers.

Results: A total of 255 043 COPD deaths were included in data analyses. Each 10 μg/m³ increase in PM₁ was associated with increased mortality risk of 3.32% (2.67%-3.97%) for COPD, 3.75% (2.30%-5.22%) for chronic bronchitis, 3.25% (1.09%-5.45%) for emphysema and 3.35% (2.56%-4.15%) for acute exacerbation of COPD (AECOPD), respectively. Natural cubic splines analysis revealed linear relationships for PM₁ and COPD mortality. Particulate matter with an aerodynamic diameter of ≤2.5 µm (PM_2.5) had slightly weaker effects on COPD mortality than PM₁. Population attributable fractions for PM₁-related mortality from COPD, chronic bronchitis, emphysema and AECOPD were 8.86%, 8.84%, 8.25% and 8.86%, respectively.

Conclusions: This study provides new evidence of an association between short-term exposure to PM₁ and COPD mortality. Our findings suggest a predominant role of PM₁ within PM_2.5 and emphasise the need for targeted strategies to reduce PM₁ concentrations.

Background: This study examined the independent effects of adverse childhood experiences (ACEs) and social support on all-cause mortality among US young adults and assessed whether social support modified the ACEs-mortality association.

Methods: We used data from the National Longitudinal Study of Adolescent to Adult Health, a population-based prospective US cohort. Our study sample included 12 421 children and adolescents aged 11-17 years at baseline (1994-1995) and followed up until 2016-2018. ACEs were assessed from youth and parent responses at baseline. Social support was assessed using a subjective measure of nine items and categorised into high, moderate and low. Weighted multivariable Cox proportional hazards models and Aalen's additive hazards models estimated HRs and hazard differences (HDs) per 10 000 individuals per year.

Results: At baseline, participants' mean age was 15.4 years (SD=1.5), 49% were females and 46% had ≥1 ACEs. 327 deaths (2.6%) occurred during 301 416 person-years of follow-up. High social support was associated with decreased risk of all-cause mortality independent of ACEs after controlling for sociodemographic factors (HR_adjusted: 0.63 (0.42 to 0.93); HD_adjusted: -5.00 (-9.33 to -0.67)). Compared with those without ACEs and high social support, those with ≥1 ACEs and low social support had over two times greater hazards of premature mortality (HR_adjusted: 2.03 (1.45 to 3.49))-equivalent to approximately 9.4 additional deaths per 10 000 people per year (HD_adjusted: 9.41 (2.08 to 16.74)), after adjusting for baseline sociodemographic factors. Stratified analyses showed that ACEs were associated with increased risk of mortality in the low social support group only.

Conclusions: Complementing ACEs prevention efforts with social support interventions could be effective strategies to reduce premature deaths among US young adults.

Background: Child dental caries is highly prevalent worldwide, with significant treatment costs, but its broader societal impact remains underexplored. This cross-sectional study examined associations between child oral health and school absences in Scotland.

Methods: Four population-wide data sets were linked at the individual level, where the outcome was part-day school absence during first primary school year across six academic years (2008/2009-2010/2011, 2012/2013, 2014/2015 and 2016/2017). Oral health was assessed using three metrics: caries experience, urgent need of dental treatment (UNDT) and dental extractions under general anaesthetic (DGA). Gamma-distributed general linear models (identity link) estimated adjusted mean differences, including interaction terms for socioeconomic deprivation (Scottish Index of Multiple Deprivation (SIMD) deciles). Models adjusted for sex, age, academic year and SIMD.

Results: Records from 263 597 children (mean age: 5.5 years) showed 33% had caries experience (median 16 part-day absences), 9% had UNDT (median 19) and 2% had DGA (median 20). Children without caries experience had a median of 11 part-day absences. Adjusted models showed mean differences of 5.0 (95% CI 4.9 to 5.2) more absences for children with caries experience versus none; 6.2 (95% CI 5.9 to 6.5) more absences for UNDT versus no UNDT; and 6.5 (95% CI 5.8 to 7.1) more for DGA versus no DGA. Interaction analysis showed a deprivation gradient: children in the 10% most deprived areas had nearly twice the burden of absences related to poor oral health compared with the 10% least deprived.

Conclusion: Poor oral health was associated with higher absenteeism, with socioeconomic inequalities exacerbating the impact.

Background: Underemployment is an increasing feature of global labour markets. However, the mental health impacts of underemployment remain relatively under-researched. Longitudinal evidence is particularly sparse, as is accounting for gender differences in the association. Addressing key gaps, this study examines the association between time-related underemployment and mental health in Australian adults.

Methods: Pooled panel data from 21 waves (2002-2022) of the Household, Income and Labour Dynamics in Australia survey (n=18 288 participants, 124 531 observations) was used. Fixed-effects linear regression and Mundlak adjustment modelling was conducted to examine how time-related underemployment (not underemployed, underemployed 1-5, 6-10, 11-20 and ≥21 hours) was associated with 5-item mental health scale, with adjustment for time-varying confounders.

Results: A stepwise (or dose-dependent) association was observed between increasing time-related underemployment and mental health for both genders, with the strongest association observed in those underemployed by ≥21 hours for both women (-1.88, 95% CI -3.09 to -0.67) and men (-2.24, 95% CI -3.59 to -0.89). Some gender differences were observed. Most notably, more women in our sample were underemployed compared with men.

Conclusions: Addressing rising underemployment in labour markets has the potential to improve population mental health for everyone. Furthermore, targeted social policy to reduce gendered exposure to underemployment in Australia is also key to mental health gains in working-age women.

Background: Mental disorders contribute substantially to the global burden of disease. The neighbourhood socioeconomic environment is a key determinant of mental health, even after accounting for individual-level socioeconomic factors. However, few longitudinal studies have examined this relationship. This study examined longitudinal associations between neighbourhood socioeconomic disadvantage and psychological distress from three perspectives: overall associations, trends over time and changing neighbourhood exposures.

Methods: Data were from the Household, Income and Labour Dynamics in Australia Survey wave 7 (2007) to wave 21 (2021), a nationally representative household-based cohort study, including 109 604 observations. Mental health was assessed using the Kessler Psychological Distress Scale (K10), analysed as a continuous variable, score range 10-50. Neighbourhood socioeconomic disadvantage was measured using derived spatially and temporally consistent census-based data, analysed in quintiles. Multilevel and fixed effects linear regression models were used.

Results: Psychological distress increased with neighbourhood socioeconomic disadvantage, with K10 scores 1.35 points higher (95% CI 1.14 to 1.55) in the most disadvantaged neighbourhoods compared with the least. However, the rate of change in distress over time did not vary by neighbourhood disadvantage. An association was observed between changes in disadvantage and changes in psychological distress for the most socioeconomically disadvantaged neighbourhoods.

Conclusion: The findings from nationally representative longitudinal data show that individuals living in more disadvantaged neighbourhoods consistently experienced higher psychological distress compared with those in less disadvantaged neighbourhoods. These inequalities remained stable over time, and limited evidence of change suggests that the association may reflect persistent differences between individuals living in different neighbourhoods.

Background: We investigated the association of reproductive history with cardiometabolic health in ethnically diverse women across five continents.

Methods: We pooled cross-sectional survey data on non-pregnant women aged 30-49 years from 15 countries. Multilevel models were used to examine associations between menopausal status, age at first birth (≥20 vs <20 years), parity (1, 2, 3, 4+ vs 0 births) and cardiometabolic indicators: body mass index (BMI), systolic blood pressure (SBP) and fasting blood glucose (FBG), adjusting for age and socioeconomic status.

Results: We included 413 802 women (median age 38 years; 14% postmenopausal). Being in a postmenopausal state was associated with lower BMI (-0.22, 95% CI -0.27 to -0.17 kg/m²) and higher SBP (0.35, 95% CI 0.18, 0.52 mm Hg). In parous premenopausal women (n=332 569), later age at first birth was associated with lower BMI (-0.33, 95% CI -0.36 to -0.30 kg/m²) and lower SBP (-0.59, 95% CI -0.69 to -0.48 mm Hg); higher parity was associated with higher BMI (0.11-0.14 kg/m² for 1-3 births) and lower SBP (-0.77 to -2.04 mm Hg for 1-4+ births). Among parous postmenopausal women (n=55 788), later age at first birth was associated with lower BMI (-0.15, 95% CI -0.23 to -0.07 kg/m²), lower SBP (-0.38, 95% CI -0.67 to -0.08 mm Hg) and higher FBG (2.08, 95% CI 0.08 to 4.11 mg/dL); higher parity was associated with lower SBP (-1.60 to -3.06 mm Hg for 1-4+ births).

Conclusions: Irrespective of menopausal status, later age at first birth was associated with lower BMI and SBP, while higher parity was associated with lower SBP. Reproductive history has implications for cardiometabolic risk in women across diverse settings.

Background: Social networks are known to protect against depressive symptoms in older adults. However, most research relies on retrospective self-reported depression measures and cross-sectional data, which may introduce bias. Ecological momentary assessment with longitudinal data overcomes these limitations by repeatedly measuring the subject's experience in the present moment. This study examined how social network characteristics relate to momentary depressive symptoms and their daily fluctuations in older adults.

Methods: We analysed data from 216 older adults in Paris, France, using the Healthy Aging and Networks in Cities and Promoting Mental Well-Being and Healthy Aging in Cities studies. Social network characteristics included network size and frequency of in-person and digital interactions per week. Depressive symptomatology was assessed using a daily smartphone survey of the Center for Epidemiological Studies-Depression over a week. Linear mixed-effect models estimated associations between social network characteristics and momentary depressive symptoms, while multivariable linear models examined relationships with daily symptom fluctuations.

Results: Network size and frequency of contact from digital communications per week were not associated with fewer depressive symptoms; however, there was suggestion that having more in-person contact was related to fewer depressive symptoms (exp(β) = 0.90, 95% CI 0.82 to 1.00). Moreover, having a larger social network (exp(β) = 0.91, 95% CI 0.85 to 0.98) and more in-person contacts (exp(β) = 0.96, 95% CI 0.93 to 0.98) were associated with less fluctuations in daily depressive symptoms, but no association for the frequency of contact from digital communications was observed.

Conclusion: Findings from this study suggest that larger social networks and more in-person contact may promote more stable and better mental health among older adults.