Journal of Epidemiology and Community Health最新文献

Background: HIV literature shows that gay, bisexual and men who have sex with other men (GBMSM) experience inequities across social and contextual factors. Given growing inequities, this study used complex systems theory, a scientific approach to understanding the interconnected parts, to identify and visualise the system of factors that shape the emergence or (re)production of HIV risk among GBMSM.

Methods: A meta-synthesis of systematic reviews and meta-analyses was conducted to examine risk factors for HIV in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria and quality assessments using A Measurement Tool to Assess Systematic Reviews 2. After screening 255 studies, data were synthesised and visualised from 29 articles with moderate-quality or high-quality assessments. Study characteristics and risk factors for HIV were extracted, and data were thematically analysed into higher-order themes and respective subthemes aligned with Bronfenbrenner's socio-ecological model. Kumu.io, a system mapping software, was used to visualise the system of factors.

Results: Our thematic analysis and visualisation portray a dynamic and complex web of HIV risk that GBMSM experience implicated across all levels of the socio-ecological model: individual, interpersonal, community, institutional/organisational and structural/policy levels. These risk factors, in tandem, interact with one another to create pathways and patterns that generate feedback loops, such that the systems of factors create the emergence of GBMSM's HIV risk beyond that accounted for at the individual level.

Conclusion: GBMSM's HIV risk is socially patterned by a diversity of multilevel and interacting risk factors, which creates a dynamic and reinforcing system of HIV risk that requires attention in its totality to fully address HIV risk.

Background: Adverse health conditions may serve as intermediate states linking loneliness and social isolation with excess mortality. We examined whether loneliness and social isolation are primarily associated with the risk of developing an adverse health condition or with prognosis after diagnosis.

Methods: A cohort of 236 879 individuals from the UK Biobank was followed from baseline in 2006-2010 until death or administrative end of follow-up in 2022. The incidence of three broad categories of adverse health conditions, (1) neoplasms, (2) endocrine, nutritional and metabolic diseases and (3) circulatory diseases, was recorded through self-report or register-based data. Progressive multistate Markov proportional hazards models were used to examine the associations of loneliness and social isolation with transitions from a healthy state to adverse health conditions and mortality, while adjusting for confounding.

Results: Loneliness and social isolation were associated with all three transitions: from a healthy state to adverse health conditions (except for neoplasms), from a healthy state to mortality and from adverse health conditions to mortality. In transitions to adverse health conditions, the HRs were larger for loneliness (HR range 1.12-1.17 for loneliness, 1.05-1.08 for social isolation). In subsequent transitions to mortality, the HRs were larger for social isolation (1.05-1.13 for loneliness, 1.28-1.42 for social isolation).

Conclusion: While both loneliness and social isolation were associated with the onset and prognosis of adverse health conditions, our findings highlight the associations of social isolation, in particular, with mortality.

Background: The Swedish Targeted Health Dialogue (THD) is a widely implemented, individual-focused intervention involving screening and health counselling for mid-life individuals. Previous research has shown somewhat mixed results; therefore, this study aims to provide rigorous evidence on the population-level impact of the THD programme on ischaemic heart disease (IHD) in Sweden.

Methods: This study used the number of recorded county-specific IHD events and mortality among 40-69-year-olds between 1987 and 2023 in Sweden to estimate the effect of the THD programme. Six out of 21 counties had implemented THD fully during the study period. These six counties were used to evaluate the effect of the programme by estimating the change in IHD incidence trend post implementation compared with controls where the programme was not implemented at that specific time. This intervention effect was estimated using generalised multilevel controlled interrupted time-series models.

Results: In men, the intervention showed no statistically significant effect on IHD events compared with the controls, with an estimated increased annual rate of 0.1% (95% CI -0.1% to 0.2%). In women, a similar non-significant increase in incidence rate of 0.2% (95% CI -0.1% to 0.5%) per year was observed in the intervention counties. These figures can be contrasted with an annual linear reduction of 3.2% in IHD incidence among men and 1.5% among women. Similar results were attained regarding IHD mortality.

Conclusion: These findings do not support evidence for any beneficial population effect of the THD programme on future IHD. Hence, revisiting the fundamental concern on the effectiveness of the programme is pertinent.

Background: Is being famous a risk factor for premature death? Previous studies indicate that famous musicians have a higher mortality risk compared with the general population. However, these studies did not disentangle whether fame contributes to this increased risk, or whether it can be explained entirely by the demands of the music profession. The present study addresses this gap by isolating the effect of fame within the profession.

Methods: We used a retrospective matched case-control design in a preregistered study to compare famous singers with matched less famous singers (total N=635) based on the matching criteria of gender, nationality, ethnicity, genre and solo/band status. We compared mortality risk using a Kaplan-Meier curve and used a Cox regression to test the effect of fame.

Results: The results showed that famous singers had a 32 % higher mortality risk compared with less famous singers.

Conclusion: This study provides new evidence suggesting that fame may be associated with increased mortality risk among musicians, beyond occupational factors.

Introduction: Prior studies have observed associations between poverty measured at single or across diffuse periods of the life course and cognitive function measured in later life. Few studies examine the relationship between cumulative poverty exposure and midlife cognition or address confounding of this relationship by early-life cognitive ability.

Methods: To estimate the effect of cumulative poverty with midlife cognitive function, we analysed data from National Longitudinal Survey of Youth 1979 participants with ≥3 family income measures over a 20-year period (1990-2010) who completed the modified Telephone Interview for Cognitive Status when ~48 years of age (N=2923). We defined participants' cumulative poverty status by the proportion of their family income measures <200% of the Federal Poverty Limit: 0 (never), <1/3 but >0 (sometimes), ≥1/3 but less than all (often) and all (always). Armed Forces Qualification Test score defined early-life cognitive ability. We used linear regression models to examine the association between cumulative poverty and sample-standardised z-scores for memory, attention and global cognitive function.

Results: Overall, 37.9% of participants were never, 26.6% were sometimes, 27.5% were often and 8.0% were always in poverty. In fully adjusted models and relative to participants never in poverty, those often (beta: -0.13; 95% CI -0.23 to -0.04) and always (beta: -0.37; 95% CI -0.53 to -0.22) in poverty had lower z-scores for midlife global cognitive function. Likewise, their z-scores were lower for midlife memory function.

Conclusions: Longer durations of poverty exposure may be more detrimental for midlife cognition. This relationship was not fully explained by early-life cognitive ability.

Background: Problematic gaming is a known risk factor for adolescent well-being. Yet, socioeconomic factors that might contribute to problematic gaming in adolescence have not been fully explored. This study examined the association between relative deprivation, defined as an individual's financial gap relative to their classmates, and problematic gaming in a representative sample of Italian adolescents.

Methods: We analysed data on family material assets and self-reported symptoms of problematic gaming from 58 881 participants in the 2021/2022 Italian Health Behaviour in school-aged children study. Relative deprivation was measured using the Yitzhaki index, with classmates as a social reference group. Associations with problematic gaming were tested using a two-level multiple logistic regression model while accounting for the effects of economic, sociodemographic and psychological factors.

Results: Adolescents reporting higher relative deprivation were eight times more likely to be classified as problematic gamers compared with their better-off peers, after controlling for individual and class-level deprivation, and self-efficacy beliefs. Males, younger adolescents and adolescents with lower self-efficacy were more at risk of being problematic gamers.

Conclusion: The current study expands the existing literature on the detrimental impact of inequalities on adolescent behaviours by highlighting the association between relative deprivation and problematic gaming. Policymakers are advised to implement measures to reduce inequalities and mitigate maladaptive gaming patterns among adolescents.

Background: One in seven households in England live in accommodation not meeting housing quality standards. Low-quality housing is linked to adverse child health, but less is known about the relationship with educational outcomes. This study evaluated the relationship between housing quality, school absences and educational attainment.

Methods: Data were drawn from the Millennium Cohort Study, a nationally representative cohort of children born in 2000/2002. Housing quality at age 7 years was computed from six indicators: accommodation type, floor level, access to a garden, damp, heating and overcrowding. Percentage of missed school sessions and standardised test scores in Maths and English at age 7, 11 and 16 were linked from the National Pupil Database. Confounder-adjusted linear regressions with survey weights were fitted.

Results: Approximately 16% of children lived in lower quality housing (ie, disadvantage in ≥2 conditions); after confounder adjustment, these children had 0.74% (or 1.4 days) more absences per year than those living in higher quality housing (n=7272, 95% CI 0.34% to 1.13%). Damp, overcrowding and accommodation type were the strongest predictors of absence. Test scores in Maths and English across compulsory schooling were between 0.07 and 0.13 SD lower for children living in lower versus higher quality housing (n=6741), mainly driven by overcrowding and lack of central heating.

Conclusion: Children living in homes with lower quality housing conditions missed 15.5 days more of school throughout compulsory schooling and performed worse on national tests than those in higher quality housing. Targeting specific housing conditions, such as damp and overcrowding, could be beneficial for children's school outcomes.

Background: Reports on socioeconomic inequalities in cancer mortality are limited in East Asia. We investigated educational inequalities in cancer mortality in Japan, serving as an advanced example of a nationwide census-based surveillance.

Methods: We developed a Japanese census-linked mortality dataset, using our unique linkage method. The dataset encompassed approximately 0.48 million cancer deaths linked to individual-level census data of 80 million Japanese aged 25-84 years in October 2020. We calculated age-standardised all-cancer and 23 site-specific cancer mortality rates (ASMRs) by educational level. Educational inequalities were quantified using the Relative Index of Inequality (RII) and Slope Index of Inequality (SII) by educational level (high, middle and low). Site-specific cancer contribution to absolute educational inequalities in all cancers was evaluated using the proportions of SII (%: SII_Cancer-site/SII_All-cancer×100).

Results: All cancers' RIIs were 1.58 (95% CI 1.56 to 1.60) and 1.43 (1.40 to 1.46) in men and women, respectively. Among men, the rectum, stomach, liver and lung were the leading sites based on site-specific cancer RIIs, while the larynx, cervix uteri, liver and lung were the leading sites among women. In absolute terms, lung cancer contributed the most to educational inequalities, followed by stomach, colorectal and liver cancers. No educational inequality was found for pancreatic cancer. Breast cancer showed higher ASMRs among women with low education levels than among those with high education levels, which differed from the previous inequality pattern.

Conclusions: Equity-focused strategies to enhance primary and secondary prevention are essential and should be supported by comprehensive nationwide monitoring.