Journal of Epidemiology and Community Health最新文献

Background: Socioeconomic exposures related to anaemia in Peruvian children have been modelled assuming additive or log-additive relationships, yet such approaches overlook the fact that illness emerges from the complex interplay of multiple, intersecting determinants. Using data from the 2017-2023 Peruvian Demographic and Health Survey, we cross-classified age, wealth index, maternal education, ethnicity and region of residence to estimate the prevalence of anaemia across their intersections and decompose the total intersectional effects into additive and interaction components on the log-odds scale.

Methods: We applied Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) using two-level random-intercept logistic regression, with individuals (Level 1) nested within 162 intersectional strata (Level 2). The first model estimated crude between-stratum variance, while the second included individual-level covariates to assess how much of that variance they explained.

Results: A total of 255 381 children aged 6-59 months were analysed. The estimated prevalence of anaemia ranged between 10.2% and 68.1% across strata, being higher among the youngest and most disadvantaged (Indigenous, poor, low maternal education, non-Coastal). Most between-stratum differences were captured by the additive main effects of the strata-defining variables, consistent with a modest role for interactions.

Conclusion: Anaemia in Peruvian children is unequally distributed across intersectional social strata, with the highest burden concentrated among the most disadvantaged groups. These estimates and interpretations rely on standard MAIHDA assumptions.

Background: Little is known about the association between direct pollen exposure and cognitive performance. The aim of our study is to investigate the effect of pollen exposure on performance in the Finnish matriculation examination.

Methods: The study was conducted among students who participated in the national high school matriculation examinations in the metropolitan area of Helsinki and Turku in southern Finland between 2006 and 2020. Daily regional pollen counts of alder and hazel were monitored throughout the study period as part of the Finnish pollen monitoring network. Extensive data on matriculation examination results were retrieved from Statistics Finland, and air pollution and weather data from the Finnish Meteorological Institute. A fixed effect regression analysis was used to identify the effect of pollen exposure (as independent variables) on matriculation examination results (as dependent variable) controlling for student-semester fixed effects, pollutants and precipitation.

Results: The regression coefficients indicated that on average an increase of 10 pollen grains in alder and hazel reduced the matriculation examination score by 0.0034 (p<0.01) and 0.0144 (p<0.05) standard deviations (SDs), respectively. Increasing pollen exposure per additional unit (an increase of 10 pollen grains) especially dropped examination scores in mathematical subjects among males (alder -0.0118 (p<0.001) and hazel -0.0328 (p<0.05) SDs). The association between alder pollen exposure (low, moderate and abundant) and examination scores was inversely U-shaped.

Conclusion: Exposure to pollen can hinder a student's performance in the matriculation exam, which strongly determines the future opportunities and emphasises early initiation of medication.

Background: News media have reported that the average height of British children is falling, but these reports have been contested. Child Measurement Programmes (CMPs) operate in schools in England, Scotland and Wales, but their height data have been inaccessible, allowing conflicting claims about trends in child height to remain unresolved. Here, we aim to describe and explain trends and socioeconomic inequalities in child height using the best available evidence.

Methods: Freedom of information requests were submitted to relevant authorities in England, Scotland and Wales, requesting annual CMP height and obesity data, stratified by sex, ethnicity and deprivation to 2023/2024. Mean height and obesity prevalence were plotted against time by age group, sex and deprivation group.

Results: The COVID-19 pandemic prompted school closures in Britain, disrupting CMP data collection. This period was associated with sharp but transient increases in obesity prevalence and mean height. Before COVID-19, mean height increased, particularly among children in deprived areas. Children in deprived areas also showed the greatest increases in obesity and overweight prevalence. Narrowing socioeconomic inequalities in child height in Britain have been associated with widening inequalities in obesity.

Conclusions: This work complements research describing a causal link from child obesity to increased height during childhood and implies mean height may be an unreliable indicator of child health when obesity is prevalent and rising. In Britain, increases in overall mean child height and narrowing socioeconomic inequalities in child height during the 21st century may reflect widening inequalities in obesity and worsening health among deprived children.

Background: Sarcopenia is a major age-related health condition that remains inadequately recognised as a public health concern. While previous studies have primarily focused on physical risk factors, limited evidence exists regarding the distinct contributions of social isolation and loneliness to sarcopenia development. This study investigates the individual and joint effects of social isolation and loneliness on sarcopenia.

Methods: A total of 87 205 middle-aged and older adults from the Health and Retirement Study, the Survey of Health, Ageing and Retirement in Europe, and the China Health and Retirement Longitudinal Study were analysed. Sarcopenia was classified as a state of sarcopenia or severe sarcopenia. Social isolation was assessed based on the number of adverse social events. Loneliness was measured through the revised UCLA Loneliness Scale and the Center for Epidemiologic Studies Depression scale. Cox regression was used, adjusting for sociodemographic covariates, and random-effect meta-analysis was used to pool country-specific estimates. Subgroup analyses were conducted on all covariates.

Results: Social isolation and loneliness were individually and jointly associated with a higher risk of incident sarcopenia, persistent sarcopenia and worsening sarcopenia states. A synergistic effect was found only for the consistent coexistence of both conditions from baseline to the end of the follow-up. Subgroup analyses demonstrated a stronger association among middle-aged participants without chronic diseases.

Conclusion: Our findings suggest social isolation and loneliness should be treated as differentiated measures of social connections in future interventions or studies. Interventions may be more worthwhile before people are exposed to multiple risk factors.

Background: Evolving migration patterns between the USA and Mexico may alter the traditional health advantages associated with Mexican immigrants in the USA. This study examines the relationship between migration status and health, comparing Mexican-origin individuals residing in the USA and Mexico.

Methods: We conducted a binational, population-based, cross-sectional analysis using the Hispanic Community Health Study/Study of Latinos (2008-2011) and the Mexican Family Life Survey (2009-2011). Our sample included 13 486 adults aged 18-65, categorised as US-born Mexican Americans, foreign-born Mexicans in the USA, return migrants in Mexico and non-migrants in Mexico. We analysed cardiovascular risk factors, including body mass index, waist-to-hip ratio, hypertension and self-reported health, using multivariable logistic regression, adjusting for socioeconomic and behavioural covariates.

Results: Compared with non-migrants in Mexico, foreign-born Mexicans in the USA had higher odds of overweight (OR=1.83, 95% CI 1.26 to 2.52) and elevated waist-to-hip ratio (OR=2.87, 95% CI 2.24 to 4.50) but lower odds of clinical hypertension (OR=0.49, 95% CI 0.34 to 0.68) and poor self-rated health (OR=0.26, 95% CI 0.19 to 0.33). US-born Mexican Americans exhibited similar patterns to the foreign-born in the USA. Return migrants had health profiles more aligned with non-migrants in Mexico. Increasing years in the USA for foreign-born migrants was associated with adverse health risks (OR=0.003-0.01, p≤0.001-0.02).

Conclusions: US residency for US-born Mexicans and foreign-born Mexicans is associated with both advantages and risks compared with remaining in Mexico. Return migrants exhibit mixed health outcomes, suggesting that migration trajectories shape long-term cardiovascular risk. These findings point to potential shifts in the Hispanic paradox among Mexicans.

Background: We evaluated the impact of the number of teeth on health expectancy, measured as years of life without limitations in activities of daily living (ADLs) and physical function, among adults aged ≥60 years.

Methods: Data from 3384 older adults in a nationally representative longitudinal study in Singapore were analysed. Health expectancy was estimated using an inverse probability-weighted multistate life table approach with microsimulation. Number of teeth (time-varying) was the exposure, and baseline removable dental prostheses use was the modifier.

Results: Among older adults without removable dental prostheses, those with 20-32 teeth lived significantly more years without limitations than those with no teeth: 5.3 (95% CI 2.4 to 8.6), 4.2 (95% CI 1.9 to 6.5) and 2.6 (95% CI 1.3 to 4.0) additional years without ADL limitations, and 3.7 (95% CI 0.4 to 6.8), 2.5 (95% CI 0.3 to 4.3) and 1.3 (95% CI 0.2 to 2.2) additional years without physical function limitations, at ages 60, 70 and 80, respectively. Stratified analysis among non-prosthesis users detected the largest differences among males and participants with primary or less education. Among prosthesis users with secondary or higher education, those with 20-32 teeth had longer ADL limitation-free life expectancy, while those with 10-19 teeth had longer physical function limitation-free expectancy.

Conclusions: Retaining more teeth may be associated with more years of independent living, without ADLs or physical function limitations. Removable dental prostheses were linked with health expectancy across sexes, highlighting the importance of both tooth retention and prosthetic rehabilitation in promoting healthy ageing.

Background: Chronically absent students miss learning opportunities at school, and as a result, may suffer academically and socially. Student absenteeism is rising across the USA, with 14%-30% of K-12 students being chronically absent (missing ≥10% of school days) each year. In 2012, Michigan started Pathways to Potential (P2P)-placing caseworkers in public schools to address the material needs of students that interfere with attendance. In this study, we evaluated the effect of P2P on chronic absenteeism in public schools across Michigan.

Methods: Our quasi-experimental study included 160 Michigan K-12 public schools that began implementing P2P between 2012 and 2016. We evaluated the effect of P2P on chronic absenteeism using administrative data for academic years 2008-2009 through 2018-2019. We used a staggered interrupted time series (ITS) analysis, first modelling a simple ITS for each school, and then pooling effect estimates using random effects meta-analysis. We estimated meta-regressions to investigate heterogeneous treatment effects.

Results: Results suggest P2P reduced chronic absenteeism rates by 7.88% (incidence rate ratio=0.92 (95% CI 0.88 to 0.96)), preventing 21 students from being chronically absent per school per year (95% CI 17.52 to 24.95). There was significant heterogeneity, with greater effects for schools that received a higher P2P dose, were in the eastern region of the state, had wealthier student bodies, and were less racially diverse.

Conclusion: This school-based intervention represents a feasible and effective programme for preventing chronic absenteeism. Further standardising the programme, while ensuring P2P can address diverse needs, may produce more consistent results across schools.

Background: Relationships and sex education (RSE) impacts some sexual behaviours but could be strengthened by incorporating whole-school approaches (eg, building engagement, providing contraception). These can prevent pregnancies and sexually-transmitted infections but are unevaluated in UK schools.

Methods: A cluster-randomised trial of 'Positive Choices' compared it with usual practice in English secondary schools. Intervention comprised: RSE, school-health-promotion councils involving students, student-needs data to tailor provision; student-led campaigns; review of sexual-health services; and parent information. The primary outcome was prevention of non-competent sexual debut (lacking decision autonomy, judging timing as right, partners' equal willingness or contraception).

Results: Of 2845 schools invited, 50 (1.76%) consented, 1 leaving post-allocation. Of 25 control and 24 intervention schools, 4 withdrew pre-endline. 6970 (77.3%) students participated at baseline and 6268 (77.9%) at 33-month endline. Fidelity of whole-school components was suboptimal. No schools achieved 'good' fidelity; two achieved 'adequate' fidelity across components. 11 achieved 'adequate fidelity on selected components' (student-needs report, school-health-promotion council meetings, lessons, parent information). Control schools delivered similar activities to intervention schools. Among 780 (12.44%) students sexually debuting between baseline and endline, non-competent debut was reported by 268 (64.42%) in the control and 240 (65.93%) in the intervention group (risk difference=0.020 (95% CI -0.05 to 0.09)). There were no effects on secondary outcomes. Incremental costs were £1337 per school (£10 per student).

Conclusion: Positive Choices did not prevent non-competent sexual debut (primary outcome) or impact secondary outcomes compared with usual RSE, possibly explained by weak fidelity of whole-school elements and/or comprehensive RSE in control schools.

Trial registration number: ISRCTN16723909.