Journal of Epidemiology and Community Health最新文献

Background: The aim was to investigate trends in obesity prevalence by gender and educational level in the general population aged 30-69 years, based on large surveys conducted in Mid-Sweden in 2012, 2017 and 2022.

Methods: The study included 22 082, 15 264 and 17 055 respondents, respectively. Obesity (body mass index ≥30 kg/m²) was based on self-reported weight and height. Trends in obesity prevalence, including comparisons across educational levels, were estimated by age-standardised proportions with corresponding 95% CIs. Differences between genders, educational levels and survey years were tested using multiple logistic regression.

Results: The overall age-standardised prevalence of obesity increased from 17.6% in 2012 to 20.1% in 2017 and to 23.3% in 2022. There was no statistically significant difference in obesity prevalence between men and women. Large and persisting inequalities between educational levels were however observed. In 2022, the prevalence of obesity was about 30% among persons with low/middle education and 18% among persons with high education.

Conclusion: Efforts to tackle the obesity epidemic are urgently required in Sweden, taking into consideration the circumstances of groups with low and middle levels of education.

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: 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: Socioeconomic risk factors are known drivers of adverse birth outcomes. Housing is a key target for policy interventions.

Objective: To estimate the associations of housing tenure (renting vs owning) and unaffordable housing with preterm birth and other adverse birth outcomes.

Methods: We used 2014-2016 Canadian birth registration data linked with the 2016 long-form census and included singleton births among homeowners and renters. Unaffordable housing was defined at the family level as the proportion of pre-tax income spent on shelter, using a 30% cut-off. The primary outcome was preterm birth. Secondary outcomes were stillbirth and infant death. Log-binomial regression estimated the association of housing tenure and unaffordability with outcomes adjusting for sociodemographic risk factors and parity.

Results: Among 162 700 live births and stillbirths (52 740 renters, 109 960 owners), 31% of renters and 17% of owners experienced unaffordable housing. Renting was associated with an increased risk of preterm birth (7.5% vs 6.1%; adjusted risk ratio (aRR) 1.13; 95% CI 1.08 to 1.17), stillbirth (9.5 vs 6.6 per 1000; aRR 1.33, 95% CI 1.14 to 1.56) and infant death (4.2 vs 3.0 per 1000; aRR 1.52, 95% CI 1.26 to 1.82). There was no association of housing unaffordability with preterm birth or other adverse birth outcomes among owners or renters.

Conclusions: This nationally representative study in Canada found associations between renting versus owning and preterm birth, stillbirth and infant death, as well as a high burden of unaffordable housing, particularly among renters. This study suggests that home tenure itself is a social determinant of adverse birth outcomes.

Background: 10% of postmenopausal breast cancer cases are attributed to a high body mass index (BMI). BMI underestimates body fat, particularly in older women, and therefore the cancer burden attributable to obesity may be even higher. However, this is not clear. CUN-BAE (Clínica Universidad de Navarra-Body Adiposity Estimator) is an accurate validated estimator of body fat, taking into account sex and age. The objective of this study was to compare the burden of postmenopausal breast cancer attributable to excess body fat calculated using BMI and CUN-BAE.

Methods: This case-control study included 1033 cases of breast cancer and 1143 postmenopausal population controls from the multicase-control MCC-Spain study. Logistic regression models were used to calculate odds ratios (ORs). The population attributable fraction (PAF) of excess weight related to breast cancer was estimated with both anthropometric measures. Stratified analyses were carried out for hormone receptor type.

Results: Excess body weight attributable to the risk of breast cancer was 23.0% when assessed using a BMI value ≥30 kg/m² and 38.0% when assessed using a CUN-BAE value of ≥40% body fat. Hormone receptor stratification showed that these differences in PAFs were only observed in hormone receptor positive cases, with an estimated burden of 19.9% for BMI and 41.9% for CUN-BAE.

Conclusion: These findings suggest that the significance of excess body fat in postmenopausal hormone receptor positive breast cancer could be underestimated when assessed using only BMI. Accurate estimation of the cancer burden attributable to obesity is crucial for planning effective prevention initiatives.

Background: We investigated whether having children and their socioeconomic resources are associated with receiving coronary angiogram (CAG) and coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) among older adults with non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris.

Methods: The study included 13 046 older adults diagnosed with first-time NSTEMI and unstable angina pectoris between 2002 and 2018. Logistic regression analyses were used to examine the associations of having children and their socioeconomic resources with receiving a CAG examination within the first 3 days of their diagnosis and CABG or PCI within 30 days of their diagnosis following CAG examination, respectively, adjusted for sociodemographic factors.

Results: Within 3 days, 7158 older adults (54.9%) received a CAG, and of those, 4514 older adults (63.1%) received CABG or PCI within 30 days after their diagnosis following CAG examination. In the adjusted analyses, having children was associated with 21% (OR: 1.21, 95% CI 1.08; 1.36) higher odds of receiving CAG within 3 days and 20% (OR: 1.20, 95% CI 1.01; 1.42) higher odds of receiving CABG or PCI within 30 days after being diagnosed with NSTEMI and unstable angina pectoris, respectively, compared with those not having children. In adults with children aged ≥30 years, having children with short education was associated with 13% lower odds (OR: 0.87, 95% CI 0.77; 0.99) of receiving CAG, compared with older adults with children with long education.

Conclusion: Older adults with children had higher odds of receiving examination and treatment after diagnosis with NSTEMI or unstable angina pectoris. Older adults with children with short education had lower odds of receiving examination compared with older adults with children with long education.

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: Despite the different conditions, frailty and sarcopenia overlap regarding their common link: the assessment of walking speed and muscle strength. This study aimed to compare the frailty phenotype to the sarcopenia using different cut-off points for low grip strength to determine which better identifies mortality risk over a 14-year follow-up period.

Methods: 4597 participants in the English Longitudinal Study of Ageing. Frailty was measured using the Fried phenotype. Sarcopenia (European Working Group on Sarcopenia in Older People 2) was defined using different cut-off points for low grip strength (<36, <32, <30, <27 and <26 kg for men and <23, <21, <20 and <16 kg for women), low skeletal muscle mass index (<9.36 kg/m² for men and<6.73 kg/m² for women) and slowness (gait speed: ≤0.8 m/s). Cox models were run and adjusted for sociodemographic, behavioural and clinical factors.

Results: When the coexistence of frailty and sarcopenia is considered, only the cut-off points <36 kg for men and <23 kg for women to define low grip strength identified the risk of mortality among individuals classified as having probable sarcopenia (HR=1.17, 95% CI 1.02 to 1.34), sarcopenia (HR=1.31, 95% CI 1.07 to 1.60) and severe sarcopenia (HR=1.62, 95% CI 1.33 to 1.96). In this situation, frailty identified the mortality risk (HR=1.49, 95% CI 1.22 to 1.81), whereas pre-frailty did not. Sarcopenia using other cut-off points for defining low grip strength did not identify mortality risk.

Conclusion: Sarcopenia using <36 kg for men and <23 kg for women as cut-off points seems to be better than the frailty phenotype for identifying the risk of mortality in older adults.

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.