Journal of Epidemiology and Community Health最新文献

Background: Employment insecurity is a socioeconomic factor influencing mental health, yet the empirical evidence supporting this claim has important limitations. The fluctuations in employment insecurity throughout the COVID-19 pandemic offered a distinctive opportunity to delve deeper into this issue. By viewing employment as a dynamic process, this study explores the within-person relationship between shifts in employment status and corresponding changes in mental health.

Methods: 24 waves of data between April 2020 and March 2021 from the Understanding America Study (N=3824) were analysed using a within-person multilevel model. Employment security was modelled as a dynamic process involving transitions between secure employment, underemployment and unemployment with or without benefits. Mental health was measured by questionnaires on core symptoms of depression and anxiety.

Results: Downward transitions in employment security, from secure employment to underemployment or unemployment without benefits, were associated with worse mental health. Persisting in unemployment without benefits was also associated with poorer mental health, and regaining job security did not immediately improve it. Timely provision of unemployment benefits mitigated the adverse mental health impacts. Significant cross-level moderation effects were observed for prepandemic mental health status, Hispanic ethnicity and education level.

Conclusion: Downward transitions in employment security compromise mental health, and certain segments of the population experience worse consequences. Regaining job security is not associated with immediate improvement in mental health. Timely provision of unemployment benefits, providing support for both unemployment and underemployment and targeting vulnerable groups are vital for alleviating adverse mental health impacts from losing job security.

Background: This study investigated inequalities in the distribution of green space (GS) and the association between inequalities in amounts of GS and preventable deaths across urban neighbourhoods with different Index of Multiple Deprivation (IMD) scores in the UK.

Methods: Data on preventable deaths, IMD, percentage of grassland and woodland, urban/rural, population size, and density were sourced for each of 6791 middle-layer super output areas (MSOAs) in England, 410 MSOAs in Wales, 1279 intermediate zones (IZs) in Scotland, and 890 super output areas (SOAs) in Northern Ireland (NI). While appreciating the potential for ecological fallacy we related area-based measures of deprivation to deaths. Concentration curves, Lorenz dominance tests, and negative binomial regression models were used to analyse the data.

Results: In urban areas of England, Scotland, and NI, the percentage of grassland was significantly lower among the more deprived neighbourhoods (Lorenz test, p<0.0001). In England, a 1% increase in grassland area was associated with a 37% reduction in annual preventable deaths among the most deprived urban MSOAs (incidence rate ratio (IRR) 0.63, 95% CI 0.52 to 0.76). In NI and Scotland, a 1% increase in grassland area was associated with a 37% (IRR 0.63, 95% CI 0.43 to 0.91) and 41% (IRR 0.59, 95% CI 0.42 to 0.81) reduction in 5-year accumulated preventable deaths in the most deprived urban SOAs/IZs, respectively.

Conclusions: Results suggest that investment in GS in urban areas may be an important public health prevention strategy. There is evidence that investments in the most deprived urban neighbourhoods where the highest inequality currently exists would see the largest effect on preventable deaths.

Background: Long-term outcomes in cardiovascular diseases are historically under-reported in Eastern Europe. Our aim was to report long-term survival and to identify survival predictors in a prospective Romanian percutaneous coronary intervention (PCI) registry, with an emphasis on important under-resourced minorities, such as Hungarian and Roma ethnicities.

Methods: An all-comers patient population treated by PCI in a tertiary cardiovascular centre that has been included prospectively in the local registry since January 2016 was analysed. Cardiovascular cause and all-cause mortality data were available as of December 2023.

Results: A total of 6867 patients with 8442 PCI procedures were included. Romanian group consisted of 5095 (74.2%) patients, the Hungarian group consisted of 1417 (20.6%) patients and the Roma group consisted of 355 (5.1%) patients. During a median follow-up of 3.60 (1.35-5.75) years, a total of 1064 cardiovascular-cause and 1374 all-cause events occurred. Romanian, Hungarian and Roma patients suffered 5.12, 5.89 and 7.71 all-cause deaths per 100 patient-years, respectively. Romanian, Hungarian and Roma patients suffered 3.94, 4.63 and 6.22 cardiovascular-cause deaths per 100 patient-years, respectively. Both Hungarian and Roma patients presented significantly higher all-cause mortality than Romanian patients (adjusted HR (aHR)=1.20 (1.05-1.36), p=0.005 and aHR=1.51 (1.21-1.88), p=0.0001). Similarly, Hungarian and Roma patients presented significantly higher cardiovascular cause mortality than Romanian patients (aHR=1.22 (1.05-1.41), p=0.006 and aHR=1.51 (1.18-1.92), p=0.0008).

Conclusions: High long-term cardiovascular and all-cause mortality was observed for the entire included population. Long-term survival was significantly lower in ethnic minorities, such as the Hungarian and Roma minority than in the Romanian population.

Background: Material disadvantage is associated with poor health, but commonly available area-based metrics provide a poor proxy for it. We investigate if a measure of material disadvantage could be constructed from UK primary care electronic health records.

Methods: Using data from Clinical Practice Research Datalink Aurum (May 2022) linked to the 2019 English Index of Multiple Deprivation (IMD), we sought to (1) identify codes that signified material disadvantage, (2) aggregate these codes into a binary measure of material disadvantage and (3) compare the proportion of people with this binary measure against IMD quintiles for validation purposes.

Results: We identified 491 codes related to benefits, employment, housing, income, environment, neglect, support services and transport. Participants with one or more of these codes were defined as being materially disadvantaged. Among 30,897,729 research-acceptable patients aged ≥18 with complete data, only 6.1% (n=1,894,225) were classified as disadvantaged using our binary measure, whereas 42.2% (n=13,038,085) belonged to the two most deprived IMD quintiles.

Conclusion: Data in a major primary care research database do not currently contain a useful measure of individual-level material disadvantage. This represents an omission of one of the most important health determinants. Consideration should be given to creating codes for use by primary care practitioners.

Background: Child mental health has become an increasingly important issue in the UK, especially in the context of significant welfare reforms. Universal Credit (UC) has introduced substantial changes to the UK's social security system, significantly impacting low-income families. Our aim was to assess the effects of UC's introduction on children's mental health for families eligible for UC versus a comparable non-eligible sample.

Methods: Using Understanding Society data from 5806 observations of 4582 children (aged 5 or 8 years) in Great Britain between 2012 and 2018, we created two groups: children whose parents were eligible for UC (intervention group) and children whose parents were ineligible for UC (comparison group). Child mental health was assessed using a parent-reported Strengths and Difficulties Questionnaire. The OR and percentage point change in the prevalence of children experiencing mental health difficulties between the intervention group and the comparison group following the introduction of UC were analysed. We also investigated whether the utilisation of childcare services and changes in household income were mechanisms by which UC impacted children's mental health.

Results: Logistic regression results demonstrated that the prevalence of mental health problems among eligible children whose parents were unemployed increased by an OR of 2.18 (95% CI 1.14 to 4.18), equivalent to an 8-percentage point increase (95% CI 1 to 14 percentage points) following the introduction of UC, relative to the comparison group. Exploring potential mechanisms, we found neither reduced household income nor increased use of childcare services, which served as a proxy for reduced time spent with parents, significantly influenced children's mental health.

Conclusions: UC has led to an increase in mental health problems among recipient children, particularly for children in larger families and those aged 8. Policymakers should carefully evaluate the potential health consequences for specific demographics when introducing new welfare policies.

Background: Research has long documented the increased emergency department usage by persons who are homeless compared with their housed counterparts, as well as an increased prevalence of infectious diseases. However, there is a gap in knowledge regarding the comparative treatment that persons who are homeless receive. This study seeks to describe this potential difference in treatment, including diagnostic services tested, procedures performed and medications prescribed.

Methods: This study used a retrospective, cohort study design to analyse data from the 2007-2010 United States National Hospital Ambulatory Medical Care Survey database, specifically looking at the emergency department subset. Complex sample logistic regression analysis was used to compare variables, including diagnostic services, procedures and medication classes prescribed between homeless and private residence individuals seeking emergency department treatment for infectious diseases. Findings were then adjusted for potential confounding variables.

Results: Compared with private residence individuals, persons who are homeless and presenting with an infectious disease were more likely (adjusted OR: 10.99, CI 1.08 to 111.40, p<0.05) to receive sutures or staples and less likely (adjusted OR: 0.29, CI 0.10 to 0.87, p<0.05) to be provided medications when presenting with an infectious disease in US emergency departments. Significant differences were also detected in prescribing habits of multiple anti-infective medication classes.

Conclusion: This study detected a significant difference in suturing/stapling and medication prescribing patterns for persons who are homeless with an infectious disease in US emergency departments. While some findings can likely be explained by the prevalence of specific infectious organisms in homeless populations, other findings would benefit from further research.

Background: Prescribing is the most common intervention made by healthcare professionals. Our study aimed to compare prescribing between general practitioner (GP) practices with the highest and lowest levels of deprivation.

Methods: The deprivation level of each GP practice was determined using data from the income domain of the Welsh Index of Multiple Deprivation and individual patient postcodes. We compared prescribing data between the highest and lowest deprivation quintiles for selected groups of medicines. The prescribing measures used were selected as the most appropriate to the specific medicine group being considered. Data were analysed across the period of April 2018-March 2023.

Results: For the medicine groups of statins, hypnotics and anxiolytics, and antidepressants, there was a statistically significantly higher level of prescribing in the highest deprivation quintile. For anticoagulants, there was no significant difference in prescribing between the different quintiles. For hormone replacement therapy, there was a significantly higher level of prescribing in the quintile of lowest deprivation.

Conclusion: Our study shows variation in the prescribing of different medicine groups between the highest and lowest deprivation quintiles in Wales. Further investigation into this variation is required.

Background: The purpose of this study was to examine the association between racial and economic segregation and diabetes mortality among US counties from 2016 to 2020.

Methods: We conducted a cross-sectional ecological study that combined county-level diabetes mortality data from the National Vital Statistics System and sociodemographic information drawn from the 2016-2020 American Community Survey (n=2380 counties in the USA). Racialized economic segregation was measured using the Index Concentration at the Extremes (ICE) for income (ICE_income), race (ICE_race) and combined income and race (ICE_combined). ICE measures were categorised into quintiles, Q1 representing the highest concentration and Q5 the lowest concentration of low-income, non-Hispanic (NH) black and low-income NH black households, respectively. Diabetes was ascertained as the underlying cause of death. County-level covariates included the percentage of people aged ≥65 years, metropolitan designation and population size. Multilevel Poisson regression was used to estimate the adjusted mean mortality rate and adjusted risk ratios (aRR) comparing Q1 and Q5.

Results: Adjusted mean diabetes mortality rate was consistently greater in counties with higher concentrations of low-income (ICE_income) and low-income NH black households (ICE_combined). Compared with counties with the lowest concentration (Q1), counties with the highest concentration (Q5) of low-income (aRR 1.96; 95% CI 1.81 to 2.11 for ICE_income), NH black (aRR 1.32; 95% CI 1.18 to 1.47 for ICE_race) and low-income NH black households (aRR 1.70; 95% CI 1.56 to 1.84 for ICE_combined) had greater diabetes mortality.

Conclusion: Racial and economic segregation is associated with diabetes mortality across US counties.

During the last decade, a multitude of epidemiological studies with different designs have been published assessing the association between the use of digital media and psychological well-being, including the incidence of mental disorders and suicidal behaviours. Particularly, available research has very often focused on smartphone use in teenagers, with highly addictive potential, coining the term 'problematic smartphone use' and developing specific scales to measure the addictive or problematic use of smartphones. Available studies, despite some methodological limitations and gaps in knowledge, suggest that higher screen time is associated with impaired psychological well-being, lower self-esteem, higher levels of body dissatisfaction, higher incidence of eating disorders, poorer sleeping outcomes and higher odds of depressive symptoms in adolescents. Moreover, a significant association has also been found between screen time and higher suicide risk. Finally, problematic pornography has been shown to be highly prevalent and it is a strong cause of concern to many public health departments and national governments because it might be eventually associated with aggressive sexual behaviours.