Journal of Epidemiology and Community Health最新文献

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: Lower socioeconomic positions (SEP) and poor academic achievement increase children's risk for mental health problems. The Finnish education system is officially non-selective and unified, but a part of children can be selected into emphasised teaching classes by aptitude tests, which are known to segregate students by SEP and academic achievement. We study here if allocation of students to mainstream and selective classes segregates students by mental health, too.

Methods: Students from primary school (6th grade) were followed to lower secondary school (7th grade). The number in selective classes was n=209 and in mainstream classes n=551. Outcomes were depressed mood, anxiety and daily health complaints. Association between class type and the outcomes was analysed by cross-tabulation and logistic regression models. Gender, academic achievement, SEP and previous mental health were independent and confounding/moderating variables.

Results: Students in selective classes had better academic achievement and higher SEP compared with students in mainstream classes. Girls reported poorer mental health than boys. Depressive mood did not vary by class type, but anxiety and daily health complaints were more common among girls in mainstream classes. When academic achievement and background factors were considered, among girls only anxiety was more common in mainstream classes, but among boys, anxiety appeared to be statistically significantly more common in selective classes.

Conclusion: Grouping students by aptitude tests to different classes may select them by mental health, too. Longer follow-up and gender-specific studies would give more reliable answers for education policy makers about student grouping by aptitude test and its effects on segregation.

Background: The prevalence of congenital heart defects (CHD) in Down syndrome (DS) varies considerably across studies (from 16% to 84%). This study aimed to estimate the prevalence of CHD in people with DS (CHD-DS).

Methods: PubMed, Web of Science and the Chinese National Knowledge Infrastructure databases were searched through to 5 January 2023. English-language and Chinese-language articles reporting data on the prevalence of CHD in people with DS were included. Two independent observers performed data extraction and we used a random effects model for all statistical analyses by the Comprehensive Meta-Analysis V.3.3.070 software.

Results: A pooled analysis, based on 102 studies that included 60 610 individuals, revealed the prevalence of CHD was 49.9% (95% CI: 46.8% to 53.0%) in people with DS. Most of the studies included in this meta-analysis were from North America, Europe and Asia, and subgroup analyses showed a slightly higher prevalence of CHD-DS in Asia (27 studies) compared with North America (28 studies) and Europe (35 studies) (Asia vs North America vs Europe; 54.2% vs 51.6% vs 46.2%).

Conclusion: These results demonstrated that approximately one-half of people with DS had CHD, reinforcing the need to screen all newborns suspected of Down syndrome for CHD.

Background: The transition to retirement is a significant turning point in life, which may lead to changes in food habits.

Objective: To examine changes in red meat, fish, vegetables and fruit consumption during the retirement transition and whether these changes vary between sociodemographic groups.

Methods: The data were from the Whitehall II study, a cohort of 10 308 British civil servants aged 35-55 years at study induction (1985-1988). Data collection has taken place every 2-3 years. Food consumption (n=2484-2491) was assessed with the Food Frequency Questionnaire in the periods before (max. 16 years) and after retirement (max. 16 years). Changes in preretirement and postretirement consumption were compared in the total cohort and subgroups by sex, marital status, preretirement occupation status and financial hardship using linear regression analyses with generalised estimating equations.

Results: Weekly red meat consumption was stable before retirement but increased after retirement (p=0.02), especially among women, single and lower occupational status participants. Fish consumption increased during the follow-up and the increase was steeper before retirement than postretirement period (p=0.02). Vegetable and fruit consumption also increased during the entire follow-up, but more strongly during preretirement than postretirement period (p<0.001 for both).

Conclusion: The transition to retirement is accompanied by favourable (increase in fruit, vegetable and fish) and unfavourable (increase in red meat) dietary changes, varied to some extent by sex, marital status and preretirement occupational status. Our findings suggest that attention should be paid to this transitional phase to promote eating habits in accordance with the recommendations for retirement.

Background: The association between change in high-sensitivity cardiac troponin T (hs-cTnT) and stroke risk in the general population remains unknown. We aimed to assess the association of a 6-year change in hs-cTnT with incident stroke and its subtypes in the general American adult population.

Methods: 8675 middle-aged adults without prevalent cardiovascular disease from the Atherosclerosis Risk in Communities study were included. Hs-cTnT was measured at two time points (visits 2 and 4), 6 years apart. The relative percentage change of hs-cTnT was defined as hs-cTnT at visit 4 minus that at visit 2, divided by hs-cTnT at visit 2. The study outcome was incident stroke and its subtypes. All data were analysed in 2023.

Results: Over a median follow-up of 20.1 years, 682 incident strokes occurred, including 593 ischaemic and 89 haemorrhagic strokes. For absolute change, using low/low group as reference category, the low/high (adjusted HR 1.44, 95% CI 1.03 to 2.02) and high/high (adjusted HR 1.47, 95% CI 0.93 to 2.34) groups were associated with higher risk of stroke. Moreover, the relative percentage change in hs-cTnT with stroke followed an inverted L-shaped association, levelling off at about 75% increase in hs-cTnT (P for nonlinearity=0.009). Compared with those with ≤50% change in hs-cTnT, participants with >50% increase in hs-cTnT had a higher risk of stroke (adjusted HR 1.30, 95% CI 1.03 to 1.64). Similar results were found for ischaemic stroke. No significant association was found for haemorrhagic stroke.

Conclusion: Temporal increase in hs-cTnT was associated with a higher risk of incident total and ischaemic stroke in the general population.

Background: The UK legalised same-sex marriage in 2014. We examine whether same-sex marriage legalisation (SSML), an exogenous policy change, affected the health outcomes among ethnic minority lesbian, gay, bisexual and other (LGB+) individuals.

Methods: Using the UK Household Longitudinal Survey, we applied the Callaway and Sant'Anna difference-in-differences to compare physical and mental health across (a) ethnic LGB+ individuals (treatment group), (b) ethnic heterosexual individuals (control group 1) and (c) British white LGB+ individual (control group 2). The study cohort (n=7054) comprised individuals aged 16+ years at baseline in 2011, and were employed in the study period (2011-2019). The outcomes included physical component scores from the short-form 12 health survey (physical component score (PCS-12)), long-standing illnesses and psychological distress (General Health Questionnaire (GHQ)).

Results: After SSML, the PCS-12 among the ethnic LGB+ individuals improved significantly compared with both ethnic heterosexuals and British white LGB+ individuals (2.081, 95% CI 0.487 to 3.675). While no clear patterns were found for long-standing illnesses, the GHQ in the treatment group had modest decreases relative to ethnic heterosexuals, and relative to British white LGB+ individuals, by year 2 after SSML.

Conclusion: SSML in the UK led to improved physical functioning and reduced psychological distress in ethnic minority LGB+ individuals. Our study shows that ethnic LGB+ individuals may derive even greater health benefits than British white LGB+ people, providing evidence that SSML may help address racial health inequalities within LGB+ communities. As countries worldwide consider legalising same-sex marriage, it is imperative for policymakers to consider the health consequences for sexual and ethnic minorities.

Background: The opioid overdose mortality crisis in the USA is an ongoing public health epidemic. Ongoing law enforcement strategies to disrupt local unregulated drug markets can have an iatrogenic effect of increasing overdose by driving consumers towards new suppliers with unpredictable drug products of unknown potency.

Methods: Cross-sectional study using point-level information on law enforcement opioid-related drug seizures from property room data, opioid-related non-fatal overdose events from emergency medical services and block group-level social determinants of health data from multiple sources. Using an endemic-epidemic spatiotemporal regression model, we estimated the degree to which exposure to drug supply disruptions triggers future overdose events within small space-time distances in Indianapolis, Indiana.

Results: Neighbourhoods with more structural racism, economic deprivation or urban blight were associated with higher rates of non-fatal overdose. Exposure to an opioid-related drug seizure event had a significant and positive effect on the epidemic probability of non-fatal overdose. An opioid seizure that occurred within 250 m and 3 days, 250 m and 7 days, and 250 m and 14 days of an overdose event increased the risk of a new non-fatal overdose by 2.62 (rate ratio (RR)=2.62, 95% CI 1.87 to 3.67), 2.17 (RR=2.17, 95% CI 1.87 to 2.59) and 1.83 (RR=1.83, 95% CI 1.66 to 2.02), respectively. Similar spatiotemporal patterns were observed in a smaller spatial bandwidth.

Conclusions: Results demonstrated that overdoses exhibit a community spread process, which is exacerbated following law enforcement strategies to disrupt the unregulated drug market. We discuss decriminalisation and increasing resources that promote safer drug use to combat this public health crisis.

Background: Deaths of despair are a key contributor to stagnating life expectancy in the USA, especially among those without a university-level education, but these findings have not been compared internationally.

Methods: Mortality and person-year population exposure data were collected in 14 Organisation for Economic Co-operation and Development member countries and stratified by age, sex, educational attainment and cause of death. The sample included 1.4 billion person-year observations from persons aged ≥25 years between 2013 and 2019. Country-specific and sex-specific contributions of deaths of despair to: (a) the life expectancy gap at age 25 and (b) rate differences in age-standardised mortality rates between high and low educational attainment groups were calculated.

Results: Eliminating deaths of despair could reduce the life expectancy gap in the USA by 1.1 years for men and 0.6 years for women was second only to Korea, where it would reduce the gap by 3.4 years for men and 2.2 years for women. In Italy, Spain and Türkiye, eliminating deaths of despair would improve life expectancy gains by less than 0.1 years for women and 0.3 years for men, closing the educational gap by <1%. Findings were robust to controls for differences in population structures.

Conclusions: Deaths of despair are a major determinant of educational inequalities in longevity in Korea and the USA, while having limited impact in Southern European countries, indicating substantial international variation and scope for improvement in high burden high-income countries.

Background: Low family socioeconomic position is a well-established determinant of poor health in youth. Much less is known about the social patterning of youth medication use, and the current evidence is mixed. Furthermore, previous studies have not assessed important confounders of the associations. We analyse differences in youth medication use by childhood family income and medication type.

Methods: Administrative register data on full Finnish cohorts born in 1979-2003 (n=1 490 666) and survival analysis were used to assess the risk of using common prescription medications between ages 16 and 20 according to mean household income in ages 11-15, accounting for several observed familial characteristics including parental health. We also compared siblings with discordant childhood income exposures to assess whether any differences are explained by unobserved familial confounding.

Results: For each 10% increase in childhood family income, there was a 0.6%-1.7% increase in the probability of using the most common prescription medications: antibiotics, painkillers, and allergy and asthma medications. In contrast, a 10% increase in childhood income was related to a 2.5% decrease in the probability of psychotropic medication use. In sibling comparisons, childhood income was not associated with any type of medication use.

Conclusion: Apart from psychotropics, the results may indicate medication underuse among youth from low-income families. The sibling comparisons suggest that moderate differences in childhood income are unlikely to cause differences in youth medication use and thus, in contexts of relative income equality, income differences in medication use are likely to reflect other, unobserved, family factors shared by siblings.