Journal of Epidemiology and Community Health最新文献

Background: Income is one of the most widely used indicators of socioeconomic position in studies of health inequalities. Despite its frequent use, no empirical-driven guidelines exist on how to operationalise and analytically handle income. In this study, we develop straightforward step-by-step graphical guidelines based on a comprehensive comparative examination.

Methods: We followed the entire population aged 30-65 residing in Denmark in 2010 (n=2 699 296) until death, diagnosis of either severe mental disorder or neurotic, stress-related somatoform or depressive disorders, respectively, or censoring. Adjusted HRs were estimated for four tax-reported income measures, examining variations due to the handling of extreme values, income categorisation and reference categories, both overall and stratified by sex.

Results: Across all income measures and handling strategies, lower baseline incomes were consistently associated with an elevated risk of experiencing adverse health outcomes with reversed patterns at the lowest end of the income spectrum. At these low-income levels, lower income was associated with a steep increase in corresponding household assets, with very high asset values observed at both ends of the income spectrum. Associations varied mainly for the lowest income categories with some differences in these patterns between males and females depending on the handling of extreme values, income categorisation and choice of reference category.

Conclusion: The findings indicate a misclassification of financial capability for the lowest tax-reported incomes and emphasise the need for methodological clarity in income-based health research. The step-by-step graphical guidelines, informed by the findings, offer a methodological framework aiming to enhance the precision, comparability and relevance of future studies.

Background: Health effects of multiple role occupancy and their mechanism are not fully addressed. We examined (1) the association between the number of social roles and self-rated health (SRH) and (2) the mediation effects of ikigai (the sense of life worth living) and the size of close social networks to the association.

Methods: We analysed the cross-sectional baseline questionnaire data of the Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT) of 22 180 men and 26 616 women in age 40-59 years. The independent variable was the number of social roles, counting five social roles as a spouse, parent, child, worker and a role in a community. The dependent variable was poor SRH. Logistic regression was used to estimate the ORs for poor SRH by the number of social roles and to test linear trends. Mediation analyses were conducted to estimate the proportion mediated by ikigai and the size of close social networks.

Results: Compared with people with 0-1 social role, those who had two or more roles had a lower OR of poor SRH in both men and women. There was a linear inverse trend in the association; people having the largest (5) versus lowest (0-1) number of social roles had the lowest ORs: 0.55 (95% CI 0.46 to 0.66) in men and 0.72 (95% CI 0.61 to 0.86) in women. The estimated proportion mediated by ikigai was over 50%, whereas the size of close social networks mediated the association by approximately 20%.

Conclusion: An inverse association between the number of social roles and poor SRH and mediation effects of ikigai and the size of close social networks were identified. Having even one more social role might benefit subjective health via increased ikigai and the size of close social networks.

Background: We investigated whether having children and their socioeconomic resources are associated with receiving coronary angiogram (CAG) and coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) among older adults with non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris.

Methods: The study included 13 046 older adults diagnosed with first-time NSTEMI and unstable angina pectoris between 2002 and 2018. Logistic regression analyses were used to examine the associations of having children and their socioeconomic resources with receiving a CAG examination within the first 3 days of their diagnosis and CABG or PCI within 30 days of their diagnosis following CAG examination, respectively, adjusted for sociodemographic factors.

Results: Within 3 days, 7158 older adults (54.9%) received a CAG, and of those, 4514 older adults (63.1%) received CABG or PCI within 30 days after their diagnosis following CAG examination. In the adjusted analyses, having children was associated with 21% (OR: 1.21, 95% CI 1.08; 1.36) higher odds of receiving CAG within 3 days and 20% (OR: 1.20, 95% CI 1.01; 1.42) higher odds of receiving CABG or PCI within 30 days after being diagnosed with NSTEMI and unstable angina pectoris, respectively, compared with those not having children. In adults with children aged ≥30 years, having children with short education was associated with 13% lower odds (OR: 0.87, 95% CI 0.77; 0.99) of receiving CAG, compared with older adults with children with long education.

Conclusion: Older adults with children had higher odds of receiving examination and treatment after diagnosis with NSTEMI or unstable angina pectoris. Older adults with children with short education had lower odds of receiving examination compared with older adults with children with long education.

Background: The aim was to investigate trends in obesity prevalence by gender and educational level in the general population aged 30-69 years, based on large surveys conducted in Mid-Sweden in 2012, 2017 and 2022.

Methods: The study included 22 082, 15 264 and 17 055 respondents, respectively. Obesity (body mass index ≥30 kg/m²) was based on self-reported weight and height. Trends in obesity prevalence, including comparisons across educational levels, were estimated by age-standardised proportions with corresponding 95% CIs. Differences between genders, educational levels and survey years were tested using multiple logistic regression.

Results: The overall age-standardised prevalence of obesity increased from 17.6% in 2012 to 20.1% in 2017 and to 23.3% in 2022. There was no statistically significant difference in obesity prevalence between men and women. Large and persisting inequalities between educational levels were however observed. In 2022, the prevalence of obesity was about 30% among persons with low/middle education and 18% among persons with high education.

Conclusion: Efforts to tackle the obesity epidemic are urgently required in Sweden, taking into consideration the circumstances of groups with low and middle levels of education.

Background: Socioeconomic position (SEP) is among the most important determinants of variations in health outcomes. This systematic review aimed to summarise the association between socioeconomic disadvantage and the risk of severe maternal morbidity (SMM) and maternal mortality (MM) across high-income countries.

Methods: A comprehensive search was conducted in the MEDLINE, EMBASE, CINAHL and PsycInfo databases and Google Scholar from January 2000 to June 2023. Peer-reviewed papers from observational studies conducted in Organisation for Economic Co-operation and Development countries were included. Meta-analyses of comparable studies, a narrative summary and a harvest plot were undertaken.The risk of bias was assessed using a modified Newcastle-Ottawa tool.

Results: The final review included 52 papers. In the meta-analyses, compared with the least amount of neighbourhood deprivation, neighbourhood income, neighbourhood poverty and years of education, the ORs for SMM in the highest group were 1.45 (95% CI 1.13 to 1.85), 1.48 (95% CI 1.34 to 1.63), 1.61 (95% CI 0.97 to 2.66) and 1.29 (95% CI 1.22 to 1.37), respectively. Similarly, the ORs for MM among least versus highest amount of neighbourhood deprivation, unemployed versus employed, lower versus higher occupational group and years of education were 2.10 (95% CI 1.57 to 2.81), 1.86 (95% CI 0.95 to 3.66), 1.61 (95% CI 1.03 to 2.51) and 1.90 (95% CI 1.29 to 2.79), respectively.

Discussion: In high-income countries across the different measures of SEP, socioeconomic disadvantage is associated with increased risk for SMM and MM. There is a need for interventions across multiple societal levels that will be effective in reducing these inequitable outcomes.

Prospero registration number: CRD42023399267.

Background: Socioeconomic risk factors are known drivers of adverse birth outcomes. Housing is a key target for policy interventions.

Objective: To estimate the associations of housing tenure (renting vs owning) and unaffordable housing with preterm birth and other adverse birth outcomes.

Methods: We used 2014-2016 Canadian birth registration data linked with the 2016 long-form census and included singleton births among homeowners and renters. Unaffordable housing was defined at the family level as the proportion of pre-tax income spent on shelter, using a 30% cut-off. The primary outcome was preterm birth. Secondary outcomes were stillbirth and infant death. Log-binomial regression estimated the association of housing tenure and unaffordability with outcomes adjusting for sociodemographic risk factors and parity.

Results: Among 162 700 live births and stillbirths (52 740 renters, 109 960 owners), 31% of renters and 17% of owners experienced unaffordable housing. Renting was associated with an increased risk of preterm birth (7.5% vs 6.1%; adjusted risk ratio (aRR) 1.13; 95% CI 1.08 to 1.17), stillbirth (9.5 vs 6.6 per 1000; aRR 1.33, 95% CI 1.14 to 1.56) and infant death (4.2 vs 3.0 per 1000; aRR 1.52, 95% CI 1.26 to 1.82). There was no association of housing unaffordability with preterm birth or other adverse birth outcomes among owners or renters.

Conclusions: This nationally representative study in Canada found associations between renting versus owning and preterm birth, stillbirth and infant death, as well as a high burden of unaffordable housing, particularly among renters. This study suggests that home tenure itself is a social determinant of adverse birth outcomes.

Background: The purpose of this report is to examine to what extent the COVID-19 pandemic affected pre-existing trends in mental health, with a focus on subgroup differences across age, gender and socioeconomic status.

Methods: Our analysis uses data from two survey periods (HUNT4: 2017-2019 and HUNT-COVID: 2021-2023) from the Trøndelag Health Study in Norway. We estimate overall and stratified (by age, sex and educational attainment) prevalence values for above-threshold (≥8) anxiety and depression scores using the Hospital Anxiety and Depression Scale. For each outcome, we compare prevalences between HUNT-4 and HUNT-Covid within each subgroup.

Results: Above-threshold levels of anxiety were higher among women than men, while the opposite was true for depression. Symptoms generally decrease with age. Between HUNT4 and HUNT-COVID, for both women and men, anxiety symptoms decreased (except among women between 18-29 and 30-39) while depression symptoms increased (except for individuals over 80). Anxiety symptoms decreased across education levels between HUNT4 and HUNT-COVID while depression symptoms increased across education levels.

Conclusion: The findings illustrate the negative long-term effects of a shock such as a pandemic while also illustrating the potential positive effects of generous welfare benefits on inequalities in mental health.

Background: Influenza vaccines are crucial in reducing the risk of influenza symptoms. We aimed to: (1) estimate the association between public health unit (PHU) funding per capita and influenza vaccination among individuals aged 12 and older in Ontario in 2013/2014 and 2018/2019 and (2) determine whether any observed associations were heterogeneous across household income groups, gender and age categories.

Methods: Cross-sectional studies were conducted using the Canadian Community Health Survey, a population-representative survey that collects annual health data. PHU funding per capita was measured using the approved provincial funding for mandatory programmes and the Canadian Census Population Estimates. Self-reported influenza vaccination status in the past year was used. Multilevel logistic regression was used to estimate the association.

Results: A case-complete weighted dataset revealed that 33.2% in 2013/2014 and 35.1% in 2018/2019 of respondents were vaccinated. In 2013/2014, every standard deviation (SD) increase in PHU funding per capita was associated with vaccination (OR: 1.08; 95% CI: 1.01, 1.15; SD: 14.1). Furthermore, for every SD increase in PHU funding per capita in 2013/2014, individuals from the lowest household income and between the ages of 50 and 64 years were 29% (95% CI: 1.10, 1.50) and 13% (95% CI: 1.03, 1.23) more likely to be vaccinated, respectively, while adjusting for confounders. No heterogeneous associations were observed in 2018/2019.

Conclusion: Funding may have the potential to support PHU's role in preventing diseases, promoting health and reducing health inequities among the population.

Background: Our aim was to analyse the prospective association between psychological distress during early adulthood and physical activity trajectories between early and middle adulthood.

Methods: We used data from the 1958 National Child Development Study (NCDS) (n=8994, 4388 women) and the 1970 British Cohort Study (BCS) (n=7014, 4388 women). Psychological distress was assessed using the Malaise inventory at 23 years in the 1958 NCDS and at 26 years at the 1970 BCS. Self-report leisure-time physical activity (LTPA) was assessed at 33 years, 42 years, 46 years, 50 years and 55 years in the 1958 NCDS as well as at 30 years, 34 years, 42 years and 46 years in the 1970 BCS. We created physical activity trajectories, using latent class growth analysis. Poisson regression analysis was used for association.

Results: We identified three trajectories of physical activity during adulthood in both cohorts. Participants with psychological distress at 23 years were less likely to be in the persistently high trajectory (RR_adjusted: 0.79; 95% CI 0.64 to 0.98) in the 1958 NCDS. In addition, participants with psychological distress at 26 years were less likely to be in the increased LTPA (0.73; 0.59 to 0.89) and persistently high (0.59; 0.50 to 0.69) trajectories, comparing with participants without psychological distress.

Conclusion: Elevated psychological distress during early adulthood is associated with a lower probability of adopting positive trajectories of LTPA during adulthood.

Background: The COVID-19 pandemic and associated restrictions on human activities have greatly changed lifestyles, which might have deteriorated the cardiometabolic profile.

Objective: This study aimed to examine the effect of the COVID-19 pandemic on the incidence of cardiometabolic risk factors among Japanese workers in fiscal years (FY) 2020 and 2021 compared with the prepandemic period.

Method: This study comprised an average of 71 025 employees in Japan who underwent annual health check-ups for at least two successive years from 2015 to 2021. Annual incidence rates from 2016 to 2021 were assessed for obesity, diabetes, hypertension, dyslipidaemia and metabolic syndrome (MetS). The observed incidence rates in 2020 and 2021 were compared with the predicted incidence based on prepandemic trends (2016 to 2019).

Results: Relative to the prepandemic, the incidence of all the outcomes, except for dyslipidaemia, significantly increased in 2020. Between FY 2016 and 2019, the adjusted mean incidence of obesity, diabetes, hypertension, dyslipidaemia and MetS was 5.0%, 1.4%, 5.3%, 17.4% and 7.6%, respectively. In FY 2020, the adjusted incidence (95% CI) of these outcomes increased to 6.02 (5.80 to 6.24), 1.84 (1.73 to 1.96), 6.62 (6.40 to 6.83), 19.31 (18.83 to 19.78) and 8.51 (8.23 to 8.78), which were higher than the predicted incidence of 5.24 (4.99 to 5.49), 1.54 (1.41 to 1.67), 6.02 (5.76 to 6.27), 18.58 (18.00 to 19.16) and 8.05 (7.71 to 8.38) for 2020, respectively. The incidence returned to the prepandemic levels in FY 2021.

Conclusion: Results showed a worsening of the cardiometabolic profile during the initial year of the pandemic, which was reverted in the second year to the levels before the pandemic.