Journal of Epidemiology and Community Health最新文献

Background: Inequalities in colorectal cancer (CRC) staging and outcomes exist across numerous sociodemographic axes. Early-stage CRC diagnosis is important for treatment success and survival. In this study, we investigate inequalities in CRC staging using registry data for 186 713 first-time CRC cancer diagnoses from 2013 to 2019 in England.

Methods: We employ the novel Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) approach to National Cancer Registry data. We investigate inequalities in CRC staging (early vs advanced stage) via a logistic MAIHDA. We examine a range of intersectional inequalities in CRC staging, across different age, ethnicity, gender and area-level deprivation groups.

Results: Just over half of the staged cancers in the sample were diagnosed at advanced stage (62%). Results demonstrate notable inequalities in the risk of advanced CRC staging, with a gap of 17 percentage points between the strata with the lowest and highest predicted probability of advanced stage CRC diagnosis. These inequalities exist between age groups, ethnicity and deprivation level, with no evidence of gender-related inequalities when other variables are controlled. However, unexpectedly, we find these inequalities to be almost entirely additive in nature.

Conclusions: These results suggest substantial inequalities in advanced stage CRC diagnosis exist, but that these are driven largely by universal processes of inequality, rather than disadvantages associated with single intersectional strata beyond an additive layering of disadvantage. Policy tools to encourage prompt screening engagement and symptom awareness campaigns in pre-screening age groups may benefit from considering the groups most disadvantaged by that additive layering.

Background: Layoffs may affect the health of those who lose their jobs as well as those who remain employed. Existing studies have found that remaining employed through layoffs is associated with poorer mental health in the short term, but the implications for long-term outcomes such as mortality remain unclear.

Methods: We estimated adjusted HRs for all-cause and cause-specific mortality associated with layoff intensity while employed among white men, non-white men and women in a cohort of 9761 autoworkers who worked at one of three plants in Michigan between the years 1950 and 1980. We defined layoff intensity as the number of layoff months endured while employed divided by duration of employment. We identified layoff months as those in which the percentage of the workforce leaving employment was 1.96 SD above the predicted value from an autoregressive integrated moving average model.

Results: We found statistically significant associations among non-white men but not women or white men. Relative to layoff intensity below the first quartile, the adjusted HR associated with layoff intensity between the first and second quartiles was 1.35 (95% CI 1.05 to 1.74) for all-cause mortality among non-white men. The adjusted HRs associated with layoff intensity between the second and third quartiles were 1.85 (95% CI 1.08 to 3.17) and 2.41 (95% CI 1.00 to 5.84) for death due to all cancers and lung cancer, respectively.

Conclusion: Layoffs endured while employed may lead to early mortality among non-white male employees. Reducing workforce instability may reduce racial disparities in health.

Background: Alcohol consumption is a well-established risk factor for injuries, yet the role of socioeconomic status (SES) in modifying this relationship remains underexplored. This study examines how SES influences the association between alcohol use and injury events, including both fatal and non-fatal injuries as well as the risk of repeated injuries requiring hospitalisation.

Methods: Using data from the UK Biobank, we applied Cox proportional hazards models to assess whether SES modifies the relationship between different dimensions of alcohol use, average level and heavy episodic drinking (HED), and injury events. For injuries requiring hospitalisation, we fitted negative binomial regression models to estimate incidence rate ratios (IRRs) for the total number of unique injury admissions per individual.

Results: Among 482 078 participants, 48 045 injuries were recorded during follow-up. A statistically significant interaction was observed between alcohol use and low education, with individuals in lower education groups showing elevated injury risk compared with the high education group, particularly among those consuming 20-40 g/day with HED (HR: 1.17, 95% CI 1.06 to 1.28) and those consuming over 40 g/day (HR: 1.13, 95% CI 1.04 to 1.23). For non-fatal injuries, similar statistically significant interactions were found (IRR 1.17, 95% CI 1.06 to 1.28; and 1.18, 95% CI 1.08 to 1.29, respectively).

Conclusion: Our findings highlight that individuals with lower SES face higher risks of alcohol-related injuries. Future research should investigate specific mechanisms underlying these disparities to inform more targeted policies. Population-based pricing policies could be combined with community-based programmes and tailored health messaging to address SES-related vulnerabilities.

Objectives/background: This study examines the relationship between occupational transitions out of agriculture and functional health outcomes among rural adults in Bangladesh, with a focus on gender differences and variation by duration of exposure to non-agricultural work.

Methods: Data come from three waves (2011-2012, 2015 and 2018-2019) of a nationally representative panel of rural households. The analytic sample includes 4648 adults aged 15 and older observed in all three waves. Functional health outcomes (difficulty standing up from a seated position, walking 5 km and carrying a load of ~18.5 kg) were self-reported. Occupational transition was defined at the individual level as a shift from agriculture to non-agricultural work. Propensity scores were estimated using machine learning estimators. Gender-disaggregated and exposure-duration-stratified estimates are also reported.

Results: Exiting agriculture was associated with a modest but meaningful increase in reported functional health limitations. Among all individuals who transitioned to non-agricultural work, the probability of reporting difficulty standing, walking or carrying a load increased by 1.9-2.8 percentage points (pp). These effects were concentrated among women, who experienced statistically significant increases in all outcomes (2.5-3.2 pp), while effects for men were small and not statistically distinguishable from zero. Stratified analyses by timing of exit show that adverse effects for women persist across early and late exiters, with walking difficulties increasing in intensity, underscoring the durability of these health impacts.

Conclusions: While structural transformation is widely associated with socioeconomic gains, this study highlights potential physical health burdens that may emerge alongside these broader benefits. In Bangladesh, transitions out of agriculture were linked to increased functional limitations, particularly among women. These findings suggest that the overall welfare gains from rural labour transitions may be tempered by under-recognised costs to physical functioning. Policies supporting structural change should incorporate occupational health safeguards and gender-responsive measures to ensure that development benefits are more equitably realised.

Background: Socioeconomic inequalities in mortality persist across welfare systems. Income, a key determinant of material resources and long-term security, is rarely measured at the individual level in epidemiological studies due to data limitations. This study addresses this gap by combining individual-level income and mortality data in Italy, focusing on the elderly, for whom income may be a more sensitive socioeconomic indicator than education.

Methods: A nationwide retrospective cohort study was conducted on residents aged ≥65 years (n=12.8 million), as of 31 December 2018. Individual income for 2018 was obtained from administrative tax and social security data and integrated with 2019 mortality using national population registers. Mortality Rate Ratios (MRRs) with 95% CIs were estimated using negative binomial regression models, both age-adjusted and fully adjusted for marital status, education and geographic area. Analyses were stratified by sex.

Results: A clear income gradient in mortality was observed. Excess mortality gradually decreased across ascending income groups. In fully adjusted models, individuals in the lowest income class had significantly higher mortality than those in the highest (MRR=1.65, 95% CI 1.61 to 1.70 in men; MRR=1.47, 95% CI 1.43 to 1.50 in women). Education and marital status also influenced mortality, while geographic differences were minimal.

Conclusions: In Italy, substantial income-related inequalities in mortality persist among the older population, showing that socioeconomic disparities remain marked even with broad access to healthcare. Individual-level income is a key predictor of mortality and should be prioritised in addressing health inequalities in ageing societies, as it better reflects material conditions relevant to health than educational attainment.

Background: Evidence regarding the association between maternal exposure to PM_2.5 and its major components and the risk of gestational diabetes mellitus (GDM) is still limited. Our study aimed to fill this research gap with a case-control study in Southern China.

Methods: 191 cases and 764 controls were enrolled during 2013-2020. Daily mean PM_2.5 and component concentrations were obtained from the ChinaHighAirPollutants. GDM was diagnosed using the WHO criteria. We used logistic regression integrated with inverse probability weighting and generalised weighted quantile sum regression models to estimate the association between PM_2.5 components during multiple trimesters and GDM risk.

Results: A positive association was observed between PM_2.5 exposure and GDM risk, with ORs of 1.36 (95% CI 1.11 to 1.66) and 1.34 (95% CI 1.08 to 1.67) per IQR increase in the first (18.8 µg/m³) and second (20.6 µg/m³) trimesters, respectively. Women with low income and education levels were particularly vulnerable to GDM following particulate exposure. Black carbon (weight: 0.33), nitrate (weight: 0.22) and sulfate (weight: 0.20) contributed most of the overall PM_2.5 mixture effect in the first trimester, while in the second trimester, sulfate (weight: 0.38) made the most significant contribution, followed by black carbon (weight: 0.22) and nitrate (weight: 0.20).

Conclusions: The risk of GDM was significantly associated with PM_2.5 exposure in the first and second trimesters. The mixture impact in the first trimester was mainly attributed to black carbon, nitrate and sulfate, while that in the second trimester was mainly attributed to sulfate, black carbon and nitrate.

Background: Understanding views about body size and weight is key to addressing both obesity and weight stigma. The views of younger children are not well understood and may differ in important ways from those of adults and young people. This review aimed to fill this gap.

Methods: Systematic review of qualitative evidence. We searched 19 database sources in February 2025 and included qualitative studies from the UK published since 2008 reporting data on children's (4-12 years) views of obesity, body size, body shape or weight. We assessed study quality using the Critical Appraisal Skills Programme checklist and conducted a thematic synthesis of the data.

Results: We included 34 studies. Study quality overall was fairly high. Children reported a range of perceived impacts of body weight, including health impacts, limitations on activities, bullying and teasing, which generated negative perceptions of overweight and fear of fatness. Ideas about body shape may be influenced by family members and by media or social media content. Children identified diet and physical activity as the main influences on body weight. There may be differences in views between girls and boys at older ages, although both are concerned about weight. We found very little data on differences relating to ethnicity or socioeconomic status. Children with overweight or obesity reported a pervasive experience of negative attitudes and bullying, which could be a barrier to participating in activities.

Conclusion: Children, including very young children, generally hold very negative views of overweight and obesity. Overweight is seen to be linked with unhealthiness, limited agency and with being bullied. These links may influence how children understand messages about weight and health.

Prospero registration number: CRD42025650306.

Background: Most minority populations in Europe generally exhibit lower childhood vaccine uptake compared with the general population. Improving uptake in these populations requires contextually tailored interventions. We conducted a realist review to identify interventions effective at improving measles, mumps and rubella (MMR) and human papillomavirus (HPV) vaccine uptake among underserved communities.

Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane and ProQuest for English language publications from 2005 to 2022. Following title and abstract screening, full texts were assessed for relevance. Grey literature and reference lists were also examined. Data extraction and analysis were performed independently by two reviewers. Programme theories were generated from included articles and data extraction focusing on context-mechanism-outcome configurations.

Results: Of 1942 screened titles, 87 studies underwent full-text review of which 34 met inclusion criteria. 10 primary intervention categories were identified: parental and youth education; clinical outreach; data infrastructure/quality improvement; health provider training; school-based education; digital technology for patients; cash incentives; home visits; comic books; community leaders' education; and consent policy changes. Analysis highlighting contextual factors enabling or hindering each intervention category's success was conducted.

Conclusions: Multicomponent strategies proved the most effective, with strongest evidence supporting home visits, parental and youth education, school-based programmes, data infrastructure and quality improvement and healthcare provider training. Moderate evidence supported reminders/recall strategies, comic books and consent policy changes, while digital technology for patients and cash incentives showed limited effectiveness. Importantly, there is no one-size-fits-all solution. Policymakers and practitioners should tailor and adapt interventions to the unique cultural, social and economic contexts of each group to ensure success.

Prospero registration number: CRD42021268068.

Background: Suicide is one of the leading causes of death in children and young people (CYP) globally. Over the past decade, there has been a steady increase in the number of suicide deaths in CYP in the UK. This study aims to identify sociodemographic differences in the risk of suicide in CYP.

Methods: Using linked 2011 Census and death registrations data, we created a cohort of 7 747 345 CYP aged 10 to 17 years in England. We estimated adjusted incidence rate ratios (IRRs) using generalised linear models with a Poisson link function, to identify sociodemographic characteristics associated with death by suicide in CYP.

Results: The rate of suicide was lowest in females compared with males (IRR=0.6, 95% CI 0.5 to 0.7) and highest in CYP of Mixed or Multiple ethnic groups (IRR=1.5, 95% CI 1.1 to 2.0) compared with those who were White. We also found an increased risk of suicide where the household reference person's (HRPs) highest level of education was a degree-level or above qualification (IRR=1.5, 95% CI 1.1 to 1.9) compared with households where the HRP had no qualifications.

Conclusion: We found some similar risk factors in CYP as have been found for adults, including being male and from a Mixed or Multiple ethnic group; however, some, which are protective in adults, including employment status and education, increase the risk of suicide in CYP at the household level. Our findings suggest CYP living in households with better educated parents may be a key group at risk of dying by suicide in England.