Journal of Epidemiology and Community Health最新文献

Public health problems are complex; investigating them requires a framework that both accounts for multiple interactions among individuals and their intermediate and broader environment and also integrates equity concerns. Incorporating internal and external influences at the individual level, the health capability profile (HCP)'s 15 different health capabilities address this need.Using a systematic three-step deductive content analysis process, we examine hypothetical case studies representing leading causes of death in the USA (eg, heart disease, cancer and diabetes) as well as pressing public health issues such as COVID-19, alcohol use disorder, stigma and discrimination, intimate partner violence and firearm violence. After reviewing the profile (1), each case study is analysed through the framework of the HCP and developed into a flow diagram, through which we identify shortfalls between the observed and optimal levels of each health capability, as well as detrimental or enabling interactions among capabilities (2). We then determine factors and interventions that could help improve overall health capability (3).The HCP harnesses the multitude of unique individual profiles, and through aggregation and analysis, reveals common vulnerabilities (eg, discriminatory social norms and non-evidence-based information), and strengths. It recommends cross-cutting structural policy and programme reforms for institutions, schools, community resources and for individuals to develop a positive set of norms, knowledge, goals, attitudes and habits to chart the path towards health and well-being for all.

Background: Seasonal fluctuations in mortality affect annual life expectancy at birth (e₀). Nevertheless, evidence on the impact of seasonal mortality on longevity is very limited and mainly restricted to assessing season-specific mortality levels due to shocks (e.g., heatwaves and influenza epidemics). We investigated the influence of seasonality in mortality on life expectancy levels and temporal trends across 20 European countries during 2000-2019.

Data and methods: We used harmonised weekly population-level mortality data from the Human Mortality Database. Seasonal contributions to life expectancy at birth and age 65, by sex, were estimated using the excess mortality approach and decomposition analysis. Time-series analysis was used to evaluate the impact on long-term mortality trends.

Results: Seasonal mortality had a substantial but stable impact on e₀ between 2000 and 2019. On average, we found an annual reduction in life expectancy due to seasonal excess mortality of 1.14 years for males and 0.80 years for females. Deaths in the elderly population (65+) were the main driver of this impact: around 70% and 90% of these reductions in life expectancy were attributable to older ages. Excess mortality in winter had the strongest impact on annual life expectancy, especially in Portugal and Bulgaria (around 0.8-year loss on e₀).

Conclusions: The study revealed significant cross-country variations in contributions of seasonal mortality. The most pronounced effects were observed in winter months and at older ages. These findings underscore the need for timely and targeted public health interventions to mitigate excess seasonal mortality.

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.

Background: Differential vulnerability to alcohol contributes to socioeconomic inequities in alcohol-attributable harm. This study aimed to estimate the sex-/gender-specific joint effects of socioeconomic position (SEP) and heavy episodic drinking or volume of alcohol use on 100% alcohol-attributable emergency department (ED) visits.

Methods: We conducted a cohort study among 36 900 men and 39 700 women current and former alcohol consumers aged 15-64 from population-representative Canadian Community Health Surveys (2003-2008) linked to administrative ED visit data through 2017 in Ontario and Alberta. We estimated sex-/gender-specific associations between SEP (both education and income) and heavy episodic drinking (≥5 standard drinks on one occasion, at least monthly) or volume of alcohol use (standard drinks per week) on incident alcohol-attributable ED visits and assessed additive interactions using the Synergy Index (S).

Results: Lower levels of education (eg, less than high school vs Bachelor's degree or above: men: adjusted HR (aHR)=3.71, 95% CI 2.47 to 5.58; women: aHR=1.75, 95% CI 1.15 to 2.68) and income (eg, quintile (Q)1 vs Q5, men: aHR=2.07, 95% CI 1.35 to 3.17; women: aHR=1.84, 95% CI 0.91 to 3.71) were associated with increased rates of alcohol-attributable ED visits. Among men and women, superadditive joint effects (ie, greater than the sum of both exposures experienced independently) were observed between low SEP (education and income) and heavy episodic drinking and higher volume of alcohol use on alcohol-attributable ED visits.

Interpretation: Our results indicate that individuals with lower SEP experience increased vulnerability to alcohol use and related harms. These findings highlight the urgent need for population-level interventions that reduce both the high burden and socioeconomic inequities in alcohol-attributable harm.

Background: This study examines the longitudinal patterns of dental care use from adolescence to middle adulthood (ages 11-43) and investigates racial and ethnic disparities in these patterns.

Methods: Data from Waves I through V of the National Longitudinal Study of Adolescent to Adult Health (1993-2018; ages 11-43). Semiparametric group-based trajectory model identified distinct dental care use trajectories. Multinomial logistic regression was used to estimate membership in these trajectory groups by race/ethnicity while accounting for covariates, including socioeconomic status, biological sex, nativity and unmet healthcare needs.

Results: The analysis identified four distinct dental care use trajectories (1): Intermittent decreasing dental care use (37.9%), (2) intermittent increasing dental care use (22.5%), (3) high dental care use (22.5%) and (4) low dental care use (17.0%). Non-Hispanic black and Hispanic respondents were more likely than non-Hispanic white respondents to belong to low dental care use and intermittent decreasing dental care use groups relative to high dental care use. Additionally, non-Hispanic black respondents were more likely than non-Hispanic white respondents to belong to the Intermittent Increasing Dental Use group. Higher socioeconomic status was inversely associated with low and intermittent use group membership. Males and those with unmet healthcare needs at Wave I were also more likely to belong to trajectories with low and intermittent dental care use.

Conclusions: Findings reveal persistent racial disparities in dental care use from adolescence into adulthood. Further research is needed to understand the individual and structural factors perpetuating racial disparities in dental care use over the life course.

Background: Uptake of human papillomavirus (HPV) vaccination is generally high in high-income countries with school-based vaccination programmes; however, lower uptake in certain population subgroups could continue pre-immunisation inequalities in cervical cancer.

Methods: Six electronic databases were searched for quantitative articles published between 1 September 2006 and 20 February 2023, which were representative of the general population, with individual-level data on routine school-based vaccination (with >50% coverage) and sociodemographic measures. Titles, abstracts and full-text articles were screened for eligibility criteria and assessed for bias. A second independent reviewer randomly screened 20% of articles at each stage. A narrative synthesis summarised findings.

Results: 24 studies based in eight countries (Australia, Belgium, Canada, New Zealand, Norway, Sweden, Switzerland, UK) were included. Studies reported vaccination uptake by individual-level and area-level socioeconomic status (SES), parental education, religion, ethnicity and/or country of birth. 19 studies reported that more than 70% were vaccinated (range: 50.7%-93.0%). Minority ethnic groups and migrants were more likely to have lower vaccination uptake than White groups and non-migrants (11/11 studies). Lower SES was also associated with lower uptake of vaccination (11/17 studies). Associations with other sociodemographic characteristics, such as parental education and religion, were less clear.

Conclusions: Even in high-income countries with high coverage school-based vaccination programmes, inequalities are seen. The totality of available evidence suggests girls from lower SES and minority ethnic groups tend to be less likely to be vaccinated. Findings could inform targeted approaches to mop-up vaccination and cervical cancer screening amidst changing HPV epidemiology in a vaccine era.

Trial registration number: CRD42023399648.

Climate change is a major threat to global health. Its effects on physical health are increasingly recognised, but mental health impacts have received less attention. The mental health effects of climate change can be direct (resulting from personal exposure to acute and chronic climatic changes), indirect (via the impact on various socioeconomic, political and environmental determinants of mental health) and overarching (via knowledge, education and awareness of climate change). These impacts are unequally distributed according to long-standing structural inequities which are exacerbated by climate change. We outline key concepts and pathways through which climate change may affect mental health and explore the responses to climate change at different levels, from emotions to politics, to highlight the need for multilevel action. We provide a broad reference to help guide researchers, practitioners and policy-makers in the use and understanding of different terms in this rapidly growing interdisciplinary field.

Background: Extreme weather events, or natural disasters, present a large and increasing threat to human health, infrastructure and food security, including in sub-Saharan Africa (SSA), where the burden of undernutrition is high. However, research about associations between natural disasters and undernutrition in early childhood is limited.

Methods: We combined anthropometric data of children aged 0-59 months from 51 Demographic and Health Surveys datasets collected from 2010 to 2019 in 30 countries in SSA with information on natural disaster events (flood, drought, other) from the Emergency Events Database database to determine disaster exposure. The analytic sample included 320 479 children. We used generalised estimating equations to predict stunting, wasting and anaemia by disaster exposure and selected covariates.

Results: Almost 20% (19.7%) of children under five were exposed to a natural disaster in the preceding year. In adjusted analysis, children exposed to at least one disaster in the preceding year had a relative risk (RR) of wasting 1.17 times higher than unexposed children (95% CI 1.12, 1.22). Adjusted models examining exposure to drought or flood consistently estimated higher risks of wasting post-disaster (drought RR 1.36, 95% CI 1.26, 1.47; flood RR 1.07, 95% CI 1.02, 1.12). RRs increased when using a 3-month exposure period. However, exposure to natural disaster was not consistently associated with significant differences in RR of stunting or anaemia.

Conclusion: Natural disasters are prevalent in SSA. Given the high risk of wasting associated with disaster exposure, policymakers should prioritise interventions to address wasting in post-disaster settings.

Background: Psychiatric disorder diagnoses are linked to long-term socioeconomic 'shadows' into adulthood, but little is known about how these diagnoses are associated with adulthood payment problems in Norway and whether these associations are moderated by parental and area characteristics.

Methods: We combine Norwegian registry data with payment problem records from the public debt enforcement agency for the 1995-1997 birth cohorts (n=173 750). We ascertain behavioural, neurotic, mood and substance use disorder diagnoses from specialised care at ages 13-17. Payment problems are defined as any records of mandatory deductions in wages or benefits up to age 23. Causal forests are used to explore the potential moderating role of sociodemographic variables.

Results: Some 6% of the sample have payment problems, but the share is higher among men and among people with low childhood socioeconomic status. After adjusting for background characteristics, behavioural problem diagnoses are linked to a 4.6 percentage point higher risk of payment problems (95% CI 4.1 to 5), mood disorder diagnoses to a 2.2 percentage point higher risk (95% CI 1.5 to 2.9), neurotic disorder diagnoses to a 2.5 percentage point higher risk (95% CI 2 to 3.1) and substance use disorder diagnoses to a 9.3 percentage point higher risk (95% CI 7.6 to 10.9). The associations between substance use and behavioural diagnoses and payment problems are stronger for people with low childhood socioeconomic status.

Conclusion: The associations between adolescent substance and behavioural diagnoses and adulthood payment problems are particularly strong among people with low childhood socioeconomic status. Reducing these associations is critical for preventing the accumulation of disadvantages.

Background: Women sex workers face substantial health inequities due to structural barriers including criminalisation and stigma. Stigma has been associated with HIV-related inequities among marginalised populations, however, we know less about the impacts of sex work-specific occupational stigma on HIV/sexually transmitted infection (STI) risk among women sex workers. Given these research gaps and the disproportionate burden of stigma faced by sex workers, we evaluated the association between sex work occupational stigma and recent inconsistent condom use with clients, over an 8-year period (2014-2022).

Methods: Baseline and semiannual questionnaire data from a prospective, community-based cohort of sex workers in Vancouver, Canada from September 2014 to February 2022 were used. We employed complete-case bivariate and multivariate logistic regression analysis using generalised estimating equations to analyse the relationship between sex work occupational stigma and inconsistent condom use for vaginal/anal sex with clients in the past 6 months.

Results: Among 574 participants, the cumulative prevalence of inconsistent condom use by clients and sex work occupational stigma in the last 6 months was 32.1% (n=184) and 59.9% (n=344), respectively, over the 8-year period. In adjusted multivariable analysis, exposure to sex work occupational stigma was associated with almost twofold increased odds of recent inconsistent condom use with clients (adjusted OR 1.93, 95% CI 1.23 to 3.03) over the 8-year period.

Conclusion: Multilevel interventions addressing the role of occupational stigma are needed for HIV and STI prevention efforts, including scale-up of sex worker-led/delivered sexual health services and structural changes to decriminalise and destigmatise sex work.