Journal of Epidemiology and Community Health最新文献

Objectives/background: This study examines the relationship between occupational transitions out of agriculture and functional health outcomes among rural adults in Bangladesh, with a focus on gender differences and variation by duration of exposure to non-agricultural work.

Methods: Data come from three waves (2011-2012, 2015 and 2018-2019) of a nationally representative panel of rural households. The analytic sample includes 4648 adults aged 15 and older observed in all three waves. Functional health outcomes (difficulty standing up from a seated position, walking 5 km and carrying a load of ~18.5 kg) were self-reported. Occupational transition was defined at the individual level as a shift from agriculture to non-agricultural work. Propensity scores were estimated using machine learning estimators. Gender-disaggregated and exposure-duration-stratified estimates are also reported.

Results: Exiting agriculture was associated with a modest but meaningful increase in reported functional health limitations. Among all individuals who transitioned to non-agricultural work, the probability of reporting difficulty standing, walking or carrying a load increased by 1.9-2.8 percentage points (pp). These effects were concentrated among women, who experienced statistically significant increases in all outcomes (2.5-3.2 pp), while effects for men were small and not statistically distinguishable from zero. Stratified analyses by timing of exit show that adverse effects for women persist across early and late exiters, with walking difficulties increasing in intensity, underscoring the durability of these health impacts.

Conclusions: While structural transformation is widely associated with socioeconomic gains, this study highlights potential physical health burdens that may emerge alongside these broader benefits. In Bangladesh, transitions out of agriculture were linked to increased functional limitations, particularly among women. These findings suggest that the overall welfare gains from rural labour transitions may be tempered by under-recognised costs to physical functioning. Policies supporting structural change should incorporate occupational health safeguards and gender-responsive measures to ensure that development benefits are more equitably realised.

Background: Socioeconomic inequalities in mortality persist across welfare systems. Income, a key determinant of material resources and long-term security, is rarely measured at the individual level in epidemiological studies due to data limitations. This study addresses this gap by combining individual-level income and mortality data in Italy, focusing on the elderly, for whom income may be a more sensitive socioeconomic indicator than education.

Methods: A nationwide retrospective cohort study was conducted on residents aged ≥65 years (n=12.8 million), as of 31 December 2018. Individual income for 2018 was obtained from administrative tax and social security data and integrated with 2019 mortality using national population registers. Mortality Rate Ratios (MRRs) with 95% CIs were estimated using negative binomial regression models, both age-adjusted and fully adjusted for marital status, education and geographic area. Analyses were stratified by sex.

Results: A clear income gradient in mortality was observed. Excess mortality gradually decreased across ascending income groups. In fully adjusted models, individuals in the lowest income class had significantly higher mortality than those in the highest (MRR=1.65, 95% CI 1.61 to 1.70 in men; MRR=1.47, 95% CI 1.43 to 1.50 in women). Education and marital status also influenced mortality, while geographic differences were minimal.

Conclusions: In Italy, substantial income-related inequalities in mortality persist among the older population, showing that socioeconomic disparities remain marked even with broad access to healthcare. Individual-level income is a key predictor of mortality and should be prioritised in addressing health inequalities in ageing societies, as it better reflects material conditions relevant to health than educational attainment.

Background: Evidence regarding the association between maternal exposure to PM_2.5 and its major components and the risk of gestational diabetes mellitus (GDM) is still limited. Our study aimed to fill this research gap with a case-control study in Southern China.

Methods: 191 cases and 764 controls were enrolled during 2013-2020. Daily mean PM_2.5 and component concentrations were obtained from the ChinaHighAirPollutants. GDM was diagnosed using the WHO criteria. We used logistic regression integrated with inverse probability weighting and generalised weighted quantile sum regression models to estimate the association between PM_2.5 components during multiple trimesters and GDM risk.

Results: A positive association was observed between PM_2.5 exposure and GDM risk, with ORs of 1.36 (95% CI 1.11 to 1.66) and 1.34 (95% CI 1.08 to 1.67) per IQR increase in the first (18.8 µg/m³) and second (20.6 µg/m³) trimesters, respectively. Women with low income and education levels were particularly vulnerable to GDM following particulate exposure. Black carbon (weight: 0.33), nitrate (weight: 0.22) and sulfate (weight: 0.20) contributed most of the overall PM_2.5 mixture effect in the first trimester, while in the second trimester, sulfate (weight: 0.38) made the most significant contribution, followed by black carbon (weight: 0.22) and nitrate (weight: 0.20).

Conclusions: The risk of GDM was significantly associated with PM_2.5 exposure in the first and second trimesters. The mixture impact in the first trimester was mainly attributed to black carbon, nitrate and sulfate, while that in the second trimester was mainly attributed to sulfate, black carbon and nitrate.

Background: Understanding views about body size and weight is key to addressing both obesity and weight stigma. The views of younger children are not well understood and may differ in important ways from those of adults and young people. This review aimed to fill this gap.

Methods: Systematic review of qualitative evidence. We searched 19 database sources in February 2025 and included qualitative studies from the UK published since 2008 reporting data on children's (4-12 years) views of obesity, body size, body shape or weight. We assessed study quality using the Critical Appraisal Skills Programme checklist and conducted a thematic synthesis of the data.

Results: We included 34 studies. Study quality overall was fairly high. Children reported a range of perceived impacts of body weight, including health impacts, limitations on activities, bullying and teasing, which generated negative perceptions of overweight and fear of fatness. Ideas about body shape may be influenced by family members and by media or social media content. Children identified diet and physical activity as the main influences on body weight. There may be differences in views between girls and boys at older ages, although both are concerned about weight. We found very little data on differences relating to ethnicity or socioeconomic status. Children with overweight or obesity reported a pervasive experience of negative attitudes and bullying, which could be a barrier to participating in activities.

Conclusion: Children, including very young children, generally hold very negative views of overweight and obesity. Overweight is seen to be linked with unhealthiness, limited agency and with being bullied. These links may influence how children understand messages about weight and health.

Prospero registration number: CRD42025650306.

Background: Most minority populations in Europe generally exhibit lower childhood vaccine uptake compared with the general population. Improving uptake in these populations requires contextually tailored interventions. We conducted a realist review to identify interventions effective at improving measles, mumps and rubella (MMR) and human papillomavirus (HPV) vaccine uptake among underserved communities.

Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane and ProQuest for English language publications from 2005 to 2022. Following title and abstract screening, full texts were assessed for relevance. Grey literature and reference lists were also examined. Data extraction and analysis were performed independently by two reviewers. Programme theories were generated from included articles and data extraction focusing on context-mechanism-outcome configurations.

Results: Of 1942 screened titles, 87 studies underwent full-text review of which 34 met inclusion criteria. 10 primary intervention categories were identified: parental and youth education; clinical outreach; data infrastructure/quality improvement; health provider training; school-based education; digital technology for patients; cash incentives; home visits; comic books; community leaders' education; and consent policy changes. Analysis highlighting contextual factors enabling or hindering each intervention category's success was conducted.

Conclusions: Multicomponent strategies proved the most effective, with strongest evidence supporting home visits, parental and youth education, school-based programmes, data infrastructure and quality improvement and healthcare provider training. Moderate evidence supported reminders/recall strategies, comic books and consent policy changes, while digital technology for patients and cash incentives showed limited effectiveness. Importantly, there is no one-size-fits-all solution. Policymakers and practitioners should tailor and adapt interventions to the unique cultural, social and economic contexts of each group to ensure success.

Prospero registration number: CRD42021268068.

Background: Suicide is one of the leading causes of death in children and young people (CYP) globally. Over the past decade, there has been a steady increase in the number of suicide deaths in CYP in the UK. This study aims to identify sociodemographic differences in the risk of suicide in CYP.

Methods: Using linked 2011 Census and death registrations data, we created a cohort of 7 747 345 CYP aged 10 to 17 years in England. We estimated adjusted incidence rate ratios (IRRs) using generalised linear models with a Poisson link function, to identify sociodemographic characteristics associated with death by suicide in CYP.

Results: The rate of suicide was lowest in females compared with males (IRR=0.6, 95% CI 0.5 to 0.7) and highest in CYP of Mixed or Multiple ethnic groups (IRR=1.5, 95% CI 1.1 to 2.0) compared with those who were White. We also found an increased risk of suicide where the household reference person's (HRPs) highest level of education was a degree-level or above qualification (IRR=1.5, 95% CI 1.1 to 1.9) compared with households where the HRP had no qualifications.

Conclusion: We found some similar risk factors in CYP as have been found for adults, including being male and from a Mixed or Multiple ethnic group; however, some, which are protective in adults, including employment status and education, increase the risk of suicide in CYP at the household level. Our findings suggest CYP living in households with better educated parents may be a key group at risk of dying by suicide in England.

What is a good society and how might we build one? This essay, an edited version of the Cochrane lecture delivered at the Society for Social Medicine and Population Health in Bradford 2025, sets out my personal vision of what we should be aspiring to and how we might achieve it. I open with evidence connecting socioeconomic inequalities to well-being and highlight that component parts of a utopian place exist, but not all in the same place. Building upon public health lessons around prevention and upstream intervention, I then introduce what I believe are the two most promising policies we can implement: a universal basic income and a wealth tax, underpinned by citizen's assemblies, participatory budgeting and institutional structures to support evidence-based social policymaking. I make the case that we have the evidence and tools needed to collectively create a good society and that it is possible to change course and bequeath a better world on future generations. A good society is one where everyone's physical and mental health is as good as it could be, because prevention is prioritised, and health inequalities are levelled out by addressing the wider determinants of health. It is one where those who need care-whether children, those with disabilities or the elderly-are looked after without incurring financial stress, in settings where their emotional and social well-being are as important as their physical needs. Our children and young people should flourish in an education system that engages their imaginations, inspires their creativity, equips them with skills for life and leaves no one behind.

Background: We investigated whether ghost gun recovery rates are significantly associated with firearm mortality rates in the following year across California's 58 counties from 2014 to 2023.

Methods: We obtained yearly county-level data on ghost guns recovered in California from The Trace's Gun Violence Data Hub. County-level firearm death counts (total, suicide and homicide) were pulled from the Centers for Disease Control and Prevention's Restricted-Use Vital Statistics Data. Spatiotemporal models quantified the covariate-adjusted associations between ghost gun recoveries per capita and firearm death rates (total, suicide and homicide) in the following year. Secondary analyses examined suicide and homicide models stratified by sex and race/ethnicity. RESULTS : For every 20 ghost guns recovered per 100 000 population, there was an associated 6.4% increase in firearm suicide rate (adjusted incidence rate ratio (aIRR): 1.064, 95% credible interval (CrI) 1.019 to 1.111) in the following year. We found no evidence of a significant ghost gun recovery association with total firearm death rate (aIRR: 1.036, 95% CrI 0.999 to 1.075) and firearm homicide rates (aIRR: 1.002, 95% CrI 0.946 to 1.064). Stratified models for firearm suicide rates suggested variations across sex and racial/ethnic groups, with significant positive associations observed for male (6.5% increase; aIRR: 1.065, 95% CrI 1.017 to 1.115), non-Hispanic white (6.2% increase; aIRR: 1.062, 95% CrI 1.005 to 1.122) and Hispanic (12.6% increase; aIRR: 1.126, 95% CrI 1.031 to 1.230) individuals. A different pattern emerged for firearm homicide death rates, where associations across demographic groups were not statistically significant.

Conclusions: Practitioners concentrating on suicide prevention efforts should be advised about the threat that ghost guns may present.

Background: Although voting is recognised as a social determinant of health, the association between electoral participation and subsequent mortality at an individual level has not been established.

Objective: To assess whether voters and non-voters differ in mortality risk.

Methods: We used register-based information on electoral participation in the 1999 parliamentary elections from the full electorate of at least 30-year-old Finnish citizens living in mainland Finland linked to registers containing sociodemographic and mortality information by Statistics Finland. Mortality was assessed with Cox proportional hazards regression models, with follow-up until the end of 2020 (n=3 185 572 individuals; 58 133 493 person-years; 1 053 483 deaths).

Results: The age-adjusted HR of non-voters compared with voters for all-cause mortality was 1.73 (95% CI 1.72 to 1.74) for men and 1.63 (95% CI 1.62 to 1.64) for women. These differences were strongest for external causes of death and for younger age groups. Among the older (age ≥75 years) population, voting men had lower mortality than non-voting women. The difference in mortality between non-voters and voters was stronger than between those with basic and higher education.

Conclusion: Due to a strong relationship, information on voting contributes to a more comprehensive analysis of social differentials in mortality.

Introduction: Accounting for missing data by imputing or weighting conditional on covariates relies on the variable with missingness being observed at least some of the time for all unique covariate values. This requirement is referred to as positivity, and positivity violations can result in bias. Here, we review a novel approach to addressing positivity violations in the context of systolic blood pressure.

Methods: To illustrate the proposed approach, we estimate the mean systolic blood pressure among children and adolescents aged 2-17 years old in the USA using data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). As blood pressure was not measured for those aged 2-7, there exists a positivity violation by design. Using a recently proposed synthesis of statistical and mathematical models, we integrate external information with NHANES to address our motivating question.

Results: With the synthesis model, the estimated mean systolic blood pressure was 100.5 (95% CI 99.9 to 101.0), which is notably lower than either a complete-case analysis or extrapolation from a statistical model. The synthesis results were supported by a diagnostic comparing the performance of the mathematical model in the positive region.

Discussion: Positivity violations pose a threat to quantitative medical research, and standard approaches to addressing non-positivity rely on restrictive untestable assumptions. Using a synthesis model, like the one detailed here, offers a viable alternative.