Journal of Epidemiology and Community Health最新文献

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.

Background: The incidence of lung cancer is unequally distributed in France. Although several studies have shown a link between the socioeconomic environment of populations and the incidence of cancer, the contribution has not been quantified. We aimed to analyse the geographical variability of lung cancer incidence in Normandy and calculate the proportion explained by the socioeconomic environment.

Methods: We included 7665 lung cancer cases recorded in the General Tumor Registry of Calvados and the Cancer Registry of Manche. A Bayesian model was used to map the spatial variation in the incidence of lung cancer in the territory, and an innovative approach was used to evaluate the influence of geographical variability in the socioeconomic environment on the spatial heterogeneity of lung cancer incidence.

Results: The maps of the spatial components showed high contrasts for both genders, and the socioeconomic environment integration in the model made the maps less contrasting. The socioeconomic environment of the population explained one-third of the spatial variation in the incidence of lung cancer in women and one-fifth in men.

Conclusion: The results showed that a non-negligible part of the spatial variation in the incidence of lung cancer could be explained by the geographical distribution of the socioeconomic environment.

Background: In the USA, states can set higher minimum wages than the federal government. We investigated the association between state minimum wages and racial/ethnic inequities in food insecurity.

Methods: Household-level food insecurity and sociodemographic data were obtained from the cross-sectional Current Population Survey 2015-2019 (n=189 665 households) and merged by state and year with minimum wage and cost-of-living data obtained from the US Department of Labor and US Bureau of Economic Analysis, respectively. We fitted Poisson regression models with robust standard errors with 12-month or 30-day household food insecurity as the outcome, and minimum wage or inflation-adjusted minimum wage (ie, real wage) as the predictor, adjusting for cost of living, sociodemographic covariates and state fixed-effects. We tested interactions between minimum wage and race/ethnicity and ran race/ethnicity-stratified models.

Results: In adjusted models, the real wage was not associated with 12-month or 30-day food insecurity. Minimum wage was associated with 5% lower prevalence rate of 12-month food insecurity (PR 0.95, 95% CI=0.93 to 0.98) and 7% lower prevalence rate of 30-day food insecurity (PR 0.93, 95% CI 0.91 to 0.96) for all households. The interaction p values for race/ethnicity with real wage and minimum wage were p<0.001. In stratified models, results were statistically significant for minimum wage and 12-month food insecurity among non-Hispanic (NH) white households (PR 0.93, 95% CI 0.89 to 0.96) and Hispanic households (PR 0.95, 95% CI 0.92 to 0.98), and minimum wage and 30-day food insecurity among NH white (PR 0.92, 95% CI 0.88 to 0.96), NH black (PR 0.94, 95% CI 0.89 to 0.99) and Hispanic (PR 0.90, 95% CI 0.85 to 0.95) households.

Conclusions: Higher state-level minimum wages, but not real wages, were associated with lower food insecurity prevalence overall and for racial/ethnic subgroups.

Background: Alcohol misuse is a major public health issue. Understanding factors that contribute to alcohol misuse or risky drinking behaviour is important for policy. This study examined if crime rates in the neighbourhood (postcode) where a person lives influences their likelihood of engaging in risky drinking behaviour. We further explored social capital and mental health as channels through which neighbourhood crime influences risky drinking behaviour.

Methods: Using 18 waves of household longitudinal data from the Household, Income and Labour Dynamics in Australia Survey for the period 2002 to 2019 merged with official police statistics on neighbourhood crime rates, we adopted fixed-effect regression models that allow us to address concerns relating to endogenous sorting of participants as well as omitted variable bias.

Results: We find that an increase in neighbourhood crime is associated with an increase in the likelihood of risky drinking (OR=1.107, 95% CI 1.073 to 1.120), alcohol expenditure (b=0.063, 95% CI 0.041 to 0.076), alcohol consumption frequency (b=0.071, 95% CI 0.055 to 0.083) and quantity (b=0.046, 95% CI 0.032 to 0.052). We present exploratory evidence that social capital and mental health mediate the relationship between neighbourhood crime and alcohol use. Specifically, our results suggest that by eroding the level of trust and decreasing mental health, neighbourhood crime tends to increase the probability that people engage in risky alcohol behaviour.

Conclusion: Our findings suggest that targeting crime and in particular the channels through which crime influences risky alcohol behaviour (ie, trust and mental health) can be instrumental in addressing alcohol misuse.

Background: As prevalence of tobacco use falls, socioeconomic inequalities in tobacco use are increasing in many high-income countries. Evidence is lacking on the effect of preventive interventions on socioeconomic inequalities in smoking initiation among adolescents. We evaluated whether a multicomponent school-based prevention programme with parental involvement has differential effects on smoking initiation across socioeconomic groups and affects the magnitude of socioeconomic inequalities in smoking initiation.

Methods: A secondary analysis of data from a 3-year cluster randomised controlled trial, the TOPAS study, conducted in Sweden from 2018 to 2021. Schools were randomised either to the full programme (Tobacco-Free Duo, T-DUO) or minimal intervention (EDU). The analysis was conducted according to intention to treat for the primary outcome, the probability of remaining a non-user of cigarettes at the end of compulsory school (ages 15-16). Parents' educational attainment was the socioeconomic variable. Differential effects were analysed by comparing adolescents exposed to T-DUO with those exposed to EDU within each socioeconomic group. The effect of the intervention on the magnitude of inequalities was analysed by comparing several measures of absolute and relative inequalities between T-DUO and EDU.

Results: At the end of follow-up, the full programme had a similar, at most moderate effect on smoking initiation in all socioeconomic groups (relative risk 1.13 (95% CI 1.02 to 1.25) in the middle group). The programme did not significantly affect the magnitude of inequalities (Slope Index of Inequality difference 1.49 (95% CI -15.34 to 18.32)).

Discussion: Socioeconomic inequalities in smoking initiation remain substantial. Our results indicate the absence of an effect of the programme T-DUO on these inequalities.

Objectives: This study aims to study the association between socioeconomic factors and risk of prevalent eye diseases, including glaucoma, cataract and retinal vein occlusion (RVO) in an elderly Danish population.

Design: This study was a nationwide cohort study.

Setting and participants: The included subjects were extracted from Danish nationwide health registers, and the association between socioeconomic factors and prevalent eye diseases was assessed by estimating the incidence rate and the cumulative incidence. The differences between the investigated groups were quantified using the Cox proportional hazard model.

Results: Based on a 10-year follow-up period, the highest levels of education and household income were associated with higher rates and risks of glaucoma compared with the lowest and middle levels. This results in absolute risks ranging from 3.2% (3.1%-3.3%) in both the lowest educational and income group to 4.0% (3.9-4.1%) and 3.8% (3.8-3.9%) in the highest educational and income group, respectively. For cataract, the middle and lowest educational and income levels were associated with increased rates and risks, which were statistically significant compared with the highest levels. The risk of cataract ranged from 6.5% (6.4%-6.7%) to 8.1% (8.0%-8.2%) and 6.0% (5.9%-6.1%) to 8.7% (8.5%-8.8%) in the highest to the lowest educational and income group, respectively. For RVO, the event rate was low, showing no statistically significant differences. The risk of RVO remained constant in all investigated socioeconomic groups, with a risk of 0.3% (0.3%-0.3%).

Conclusion: Our findings indicate that socioeconomic factors, such as education and household income, are associated with the diagnosis glaucoma and cataract. Incorporating socioeconomic considerations into public health initiatives may enhance the management of eye diseases and improve information and awareness about these conditions.

Background: Older adults living in social housing report poor health and access to healthcare services. This study aimed to estimate the prevalence of chronic diseases, influenza vaccination and cancer screenings among social housing residents versus non-residents in Ontario, Canada.

Methods: We conducted a population-based cohort study for all health-insured Ontarians alive and aged 40 or older as of 1 January 2020. Social housing residents were identified using postal codes. Validated health administrative data case definitions were used to identify individuals with diabetes, hypertension, chronic obstructive pulmonary disease, asthma, congestive heart failure and cardiovascular disease. Influenza vaccination and mammography, Pap and colorectal cancer screenings were identified among screen-eligible residents using health administrative data.

Results: The prevalence of all chronic diseases was higher among social housing residents across all age groups: 40-59, 60-79 and 80+ years. Influenza vaccination rates in 2018-2019 were lower among social housing residents aged 60-79 and 80+ years. Mammography rates for women aged 50-69 years in 2018-2019 were 10-11% lower among social housing residents across all age groups compared with non-residents. Pap screening rates for women aged 40-69 in 2018-2019 were 6-8% lower among social housing residents. The percentage of colorectal screening in both women and men aged 52-74 was lower (9-10% in men and 6-7% in women) in social housing compared with the general population in 2019-2020.

Conclusion: There is a higher prevalence of chronic diseases and lower cancer screening rates among the growing population of older adults in social housing in Ontario, Canada.

Purpose: This retrospective cohort study aimed to investigate the association between chronic postsurgical pain (CPSP) and the risk of postoperative depression in patients undergoing major surgery.

Methods: Data from Taiwan's National Health Insurance Research Database were analysed for patients aged over 20 years who underwent major surgery between 2004 and 2018. CPSP was defined as the use of prescribed analgesics for over 3 months postsurgery, with a prescription exceeding 90 cumulative defined daily doses. Propensity score matching (PSM) was employed to match patients with and without CPSP. Cox regression analysis and competing risk analysis were conducted to evaluate the risk of postoperative depression in the CPSP group compared with the no CPSP group.

Results: Before PSM, 141 466 patients were included, with 37 303 (26.37%) experiencing CPSP. After PSM, 74 606 patients were matched in both groups. The incidence of depression was significantly higher in the CPSP group compared with the no CPSP group (p<0.0001). Cox regression analysis revealed a significantly elevated risk of depression in the CPSP group (adjusted HR: 1.41; 95% CI 1.35 to 1.48; p<0.0001), which persisted across various adjustment models and competing risk analysis. The cumulative depression risk increased over the follow-up period.

Conclusions: This study demonstrates a strong association between CPSP and postoperative depression risk. Addressing CPSP may offer a promising approach to reducing the incidence of postoperative depression and its socioeconomic and familial burdens. Further research is needed to elucidate underlying mechanisms and optimise preventive interventions.