Journal of Epidemiology and Community Health最新文献

Background: Socioeconomic status (SES) is a potentially important upstream determinant of late-life cognitive health, but a review which captures the dynamic influence of SES across the life-course is lacking. We conducted a systematic review of studies reporting associations between life-course SES and dementia/late-life cognitive decline.

Methods: On 21 February 2024, we searched Medline, Embase, PsycINFO, CINAHL, British Education Index, Web of Science, Scopus and Advanced Google for studies related to life-course SES and dementia. We included studies employing trajectory or mediation analysis that measured dementia/cognitive decline as outcomes. Two researchers independently screened articles and assessed risk of bias. Results were synthesised narratively and in Harvest plots.

Results: We included 18 out of 6040 studies screened (n=7 trajectory studies, n=8 mediation studies, n=3 both). Most (13/23) trajectory analyses reported that stable low SES and downward social mobility, relative to stable high SES/upward mobility, were linked to higher dementia and/or cognitive decline risk. Half (5/10) of the mediation analyses reported full mediation of adulthood SES on the association between childhood SES and dementia/cognitive decline, and 4/10 reported partial mediation. Overall, study quality was moderate.

Conclusion: SES has a dynamic life-course association with dementia risk. Increases in dementia risk are compounded by sustained life-course disadvantage. Policies to address socioeconomic disadvantage across the life-course are needed to address this upstream determinant of dementia.

Prospero registration number: CRD42024505975.

Background: In the USA, HIV remains a pressing public health challenge (~37 400 new diagnoses in 2018) and pronounced racialised inequities persist. In 2018, Black and Latine people represented 43% and 26% of new diagnoses but only 13% and 18% of the population, respectively. Antiracist laws may help mitigate these inequities, yet research investigating specific laws is lacking. This study aimed to examine associations between state minimum wage laws and new HIV diagnosis rates by racialised group and sex/gender.

Methods: We linked data on inflation-adjusted state minimum wage and state-level new HIV diagnosis rates among US adults aged 13-59 years. We fit two-way fixed-effects models to examine associations between changes in minimum wage and changes in new HIV diagnosis rates per 100 000 people from 2010 to 2019 by racialised group (Black/Latine/White) and sex/gender (women/men). Additional analyses tested for effect heterogeneity by racialised group and by sex/gender within racialised group.

Results: Findings show an inverse association between state minimum wage and new HIV diagnosis rates across all racialised and sex/gender groups, except White women. Among Black adults, a 1 US Dollar ($) increase in state minimum wage was associated with a 5.81 per 100 000 decrease in new HIV diagnosis rate, followed by Latine (2.81/100 000) and White adults (1.50/100 000). The inverse association was larger among Latine (4.73/100 000) and White men (2.88/100 000) than Latine (0.98/100 000) and White women (0.07/100 000), respectively. There was no evidence of effect heterogeneity comparing Black men to Black women.

Conclusions: State minimum wage laws may represent a critical policy intervention to address racialised HIV inequities.

Background: Genomic information is transforming public health and personalised medicine by identifying genetic and environmental contributors to disease. However, Hispanic populations remain under-represented in global genomic datasets, limiting the relevance of findings for groups such as the Mexican population. The oriGen project, launched by Tecnológico de Monterrey, aims to address this disparity by establishing a nationally representative cohort of 100 000 Mexican adults. The project integrates clinical, lifestyle and genomic data to enable the study of gene-environment interactions, disease susceptibility and health disparities in Mexico and Latin America.

Methods: oriGen is a prospective, population-based biobank recruiting participants from 18 metropolitan areas across 19 Mexican states using probabilistic, stratified, multistage sampling based on national statistical frameworks. Data collection includes electronic questionnaires, anthropometric measurements, vital signs and biological samples for biochemical analysis and genomic sequencing. Whole-genome and whole-exome sequencing are conducted in collaboration with national and international partners.

Results: As of April 2025, 83 764 individuals (61% female) have been enrolled. The cohort slightly over-represents older adults and women. Baseline data show a high prevalence of obesity (40%), elevated blood pressure (mean 127.4/81.7 mm Hg) and elevated blood glucose (mean 133.3 mg/dL). Initial genomic analyses (n=1318) indicate an average admixture of 61.8% Native American, 32.4% European and 5.1% African ancestry, with regional variation.

Conclusion: oriGen represents one of the most comprehensive genomic epidemiology efforts in Mexico, offering a valuable resource for advancing equitable precision medicine and public health research in under-represented populations.

Background: Community resilience is a relevant concept in public health, but its empirical relationship with health outcomes remains underexplored. This study examines whether a Community Resilience Index (CRI) is associated with population health outcomes in England, and whether it offers explanatory added value beyond the Index of Multiple Deprivation (IMD).

Methods: The CRI comprises 44 indicators reflecting community-level resilience to chronic stressors. Associations between CRI scores and five health outcomes, deaths of despair, cardiovascular disease (CVD) mortality, COVID-19 mortality, excess all-cause mortality during two waves of COVID-19 and self-rated health were assessed at local authority district level. IMD was adjusted to remove health-related indicators. Linear regression models assessed the explanatory power of the CRI and IMD, using likelihood ratio tests to compare model fit. Interaction and stratified analyses explored effect modification by IMD.

Results: Higher CRI scores were associated with lower Deaths of Despair and CVD mortality, and higher self-rated health; these associations remained significant after adjusting for IMD. CRI was not significantly associated with COVID-19 outcomes. IMD remained the stronger predictor of health outcomes, but CRI significantly improved model fit. The interaction between CRI and IMD was significant for deaths of despair and self-rated health. Stratified analyses showed the CRI-deaths of despair association was strongest in more deprived areas.

Conclusions: Community resilience is associated with health outcomes in England. While not a substitute for deprivation-based measures, resilience indices offer complementary insight into structural and social factors shaping health. Resilience-building efforts may be particularly impactful in areas of greatest disadvantage.

Disadvantaged groups are often defined by characteristics such as income or ethnicity. Reducing health disparities by directly manipulating such exposures may be infeasible. Instead, interventions can target mediators between these exposures and health outcomes. Indirect effects estimated using mediation analysis, interventional effects or the interventional disparity measure can quantify the expected impact of such disparity-reducing interventions. They capture the impact of changing the mediator distribution evaluated among the total population. This means keeping individuals in their exposure group but hypothetically assigning them the mediator distribution of another group. However, when indirect effects are intended to inform about disparity-reducing interventions implemented among disadvantaged groups, estimating effects in the total population does not quantify the effect among those targeted. Instead, we propose evaluating the interventional disparity indirect effect directly among the disadvantaged individuals. We introduce the estimand and illustrate it using a register-based study examining a potential intervention improving medication initiation in low-income heart failure patients. We compare the expected change in 1-year mortality in a hypothetical world where low-income patients were as likely to initiate medication as high-income patients. We included 1700 patients and assessed intervention effects in low-income patients and the total population, respectively. Under the intervention, the 1-year mortality declined from 10.3% to 9.3% (95% CI 8.6% to 10.1%) among low-income patients but 6.6% to 6.2% (95% CI 6.0% to 6.5%) in the total population. In disparity research, evaluating intervention effects in the total population, rather than among disadvantaged groups, may impact the effect size. Therefore, when guiding future disparity-targeted interventions, measuring effects within disadvantaged groups is important.

Background: While C-section (CS) deliveries exhibit significant socioeconomic inequalities in low- and middle-income countries (LMICs), the extent and underlying drivers of these inequalities remain poorly understood. This study assesses these inequalities and identifies key contributing factors.

Methods: The most recent nationally representative samples of live births (n=652 539) from the Demographic and Health Surveys, conducted between 2014 and 2024 in 44 LMICs, were used to calculate the CS delivery rates. The Wagstaff (WI) and Erreygers (EI) indices were used to measure the relative and absolute socioeconomic inequalities in CS delivery. Meta-regression analyses were performed to identify the proximate determinants of the observed socioeconomic inequalities in CS delivery across the selected LMICs.

Results: CS delivery rates varied across LMICs, with a median of 6.25% (IQR=16.18). The WI and EI indicated that CS deliveries were concentrated among high socioeconomic backgrounds, with only one country exhibiting no inequality. The pooled estimates (WI: 0.32, 95% CI 0.28 to 0.36 and EI: 0.11, 95% CI 0.09 to 0.14) further demonstrate the concentration of CS among the rich in LMICs. Meta-regression analyses indicated that inequalities in education and antenatal care were significantly and positively associated with the concentration of CS deliveries among wealthier women.

Conclusion: CS delivery concentration among wealthier women remains a health concern in LMICs. Given the positive link between higher education and antenatal care with CS deliveries, country-specific policies promoting health education and targeted messaging during antenatal care visits on the adverse health effects of unnecessary CS deliveries may help reduce socioeconomic inequalities in CS delivery.

Background: Housing is a critical social determinant of health for migrant and refugee populations in high-income countries; however, the causal pathways linking housing affordability to health outcomes remain underexplored. This study aimed to examine the relationship between housing affordability stress and both mental and general health, and to assess the role of economic deprivation as a mediator of this relationship.

Methods: This study uses data from the five waves (2013-2018) of the Building a New Life in Australia study, which followed 2399 humanitarian migrants who arrived in Australia or were granted a permanent protection visa in 2013. Causal mediation analyses using marginal structural models were conducted to decompose the total effect of housing affordability stress on mental and general health into the natural direct effect and natural indirect effect mediated through economic deprivation.

Results: The total effect of housing affordability stress on mental health was 1.56 (95% CI 1.26 to 1.92). Economic deprivation mediated 37% (95% CI 19.5% to 68.8%) of the total effect, and 79.6% (95% CI 60.3% to 113.9%) of the total effect could potentially be eliminated by intervening on economic deprivation. For self-rated general health, the total effect of housing affordability stress was 1.43 (95% CI 1.15 to 1.74). Economic deprivation accounted for 27.7% (95% CI 5.3% to 62.6%) of the total effect, and 65.9% (95% CI 29.9% to 101.9%) of the total effect could potentially be eliminated by intervening on economic deprivation.

Conclusions: The findings demonstrate that housing affordability stress leads to elevated psychological distress and poor self-rated general health among humanitarian migrants. A substantial portion of this impact occurs through economic deprivation, which could be attenuated by targeting economic deprivation as a key intervention point during early years of resettlement.

Background: Prehospital delays remain critical barriers to timely acute coronary syndrome (ACS) care, particularly for patients referred from resource-constrained primary healthcare to hospitals with percutaneous coronary intervention (PCI) capabilities. This study evaluated the associations between China Chest Pain Unit (CPU) programme, with prehospital delays, management and in-hospital outcomes for ACS patients.

Methods: This retrospective cohort study used registry data from the Chinese Cardiovascular Association Database. We included patients diagnosed with ACS who were referred from primary healthcare facilities to chest pain centres (CPCs). The CPU-referral group received standardised triage and referral protocols; the non-CPU-referral group received routine referral. All patients were treated at CPCs. Primary outcomes included in-hospital heart failure, in-hospital mortality, door-in-door-out (DIDO) time and time from onset to CPC door. Secondary outcomes included time from onset to first medical contact, door-to-balloon time, discharge medication use, length of stay and total hospital expenditure. Propensity score matching and generalised linear mixed models were used to evaluate the associations.

Results: A cohort consisting of 8834 patients was constructed by propensity score matching among 119 723 eligible referred ACS patients (5000 CPU-referrals and 114 723 non-CPU-referrals). CPU referral was associated with lower odds of in-hospital heart failure (OR 0.16, 95% CI 0.08 to 0.30) and in-hospital mortality (OR 0.68, 95% CI 0.50 to 0.92), shorter DIDO time (β=-0.33, 95% CI -0.40 to -0.25) and shorter times from onset to arrival at the CPC door (β=-0.19, 95% CI -0.27 to -0.11). CPU referral was also associated with shorter time to first medical contact and door-to-balloon time, improved adherence to guideline-recommended discharge medications, reduced length of stay and lower total hospital expenditure.

Conclusions: The regionalised quality improvement programme for CPUs was associated with reduced prehospital delays, lower in-hospital heart failure and mortality, better care quality and lower costs among referred ACS patients.

Background: Suicide is a leading cause of death among young adults in South Korea. We investigated the association between triglyceride-glucose (TyG) index and suicide mortality in young adults.

Methods: This nationwide study analysed data from 6 667 138 individuals aged 20-39 using the National Health Insurance Database. Participants were grouped into TyG index quartiles. The primary outcome was suicide mortality.

Results: During a median follow-up duration of 10.7 years, 41 004 (0.6%) suicidal deaths occurred. The cumulative event rates for suicide mortality were highest among participants in TyG index quartile 4. Multivariable Cox analysis showed significant increases in the risks of suicide mortality in participants with TyG index quartile 4 compared with those in the low quartiles (adjusted HR 1.17, 95% CI 1.11 to 1.23, vs quartile 1; adjusted HR 1.15, 95% CI 1.10 to 1.20, vs quartile 1-3). The association between the TyG index and the risks of suicide mortality was positive and quasi-linear. Subgroup analysis showed a consistent trend of increasing HRs for suicide mortality with higher TyG index quartiles, with significant interactions between TyG index, sex and depression.

Conclusion: TyG index can be useful in identifying young individuals at an increased risk of suicide mortality.