Journal of Epidemiology and Community Health最新文献

Background: Telehealth has become a critical tool for improving access to care among populations facing physical barriers to in-person care. However, its potential role in delivering care to adults with social barriers remains underexplored. We examined whether adults with loneliness or social isolation are more likely to use telehealth care versus in-person care compared to adults without loneliness or social isolation.

Methods: This cross-sectional study analysed data for US adults in the 2021 Medical Expenditure Panel Survey. Loneliness and social isolation were measured using the UCLA Loneliness Scale and the Berkman-Syme Social Network Index. Three indicators of healthcare utilisation were used as outcomes: in-person care only, telehealth care only and a combination of both.

Results: Among adults experiencing loneliness and social isolation, the likelihood of using only in-person care was lower by 4.1 (95% CI -6.1 to -2.1) and 2.8 (95% CI -5 to -0.6) percentage points. In contrast, the likelihood of using only telehealth care was higher by 2.6 (1.1-4.2) and 5.4 (3.9-6.9). The likelihood of using both in-person and telehealth care was also higher by 2.3 (0.7-3.9) and 5.2 (3.7-6.7), but telehealth was used more frequently than in-person care. Furthermore, telehealth utilisation for mental health services was higher among adults experiencing loneliness or social isolation.

Conclusion: Compared with adults who are not lonely or socially isolated, adults experiencing loneliness and social isolation are more likely to use telehealth and less likely to use in-person care. Telehealth may serve as a viable alternative for individuals facing social challenges in accessing in-person services.

Background: Early initiation of antenatal care provides timely screening, advice and support. Inequities in early care initiation exist in high-income countries, but there is scant evidence on effective interventions. The community REACH (Research for Equitable Antenatal Care and Health) trial aimed to assess the effectiveness of co-produced place-based interventions to strengthen community support for early care initiation.

Methods: Matched-pair cluster randomised trial in socially disadvantaged and ethnically diverse areas in England. Electoral wards with low rates of early care initiation were matched and randomly allocated to intervention or control (usual care) (n=10 pairs). Following a 3-month co-design phase, community organisations and volunteers in intervention sites conducted targeted outreach activities over 6 months. The primary outcome was initiation of antenatal care by the 12th completed week of pregnancy.

Results: There was no evidence of a difference in the primary outcome (OR 1.07, 95% CI 0.89 to 1.28). There were also no statistically significant differences in rates of emergency caesarean, preterm birth, low birth weight, smoking or breastfeeding. There was a higher rate of care initiation by 10 weeks and fewer antenatal admissions in the intervention arm during the intervention period, although differences were not sustained after it finished.

Conclusion: This rigorous evaluation found a limited impact of short-term place-based interventions to strengthen community support for early initiation of antenatal care. Future initiatives may benefit from embedding in integrated health and care structures to ensure sufficient time and resources for mobilisation of community assets and focusing on smaller 'hyper-local' neighbourhoods. Actions to tackle wider structural and organisational barriers are also needed.

Trial registration number: ISRCTN registry: registration number 63066975. Registered on 18 August 2015.

Background: The 'right to request' flexible working policy has been gradually extended and, by 2014, extended to cover all workers with at least 26 weeks of continuous employment. The impact of these policy changes is unclear. This research aims to assess the effects of the 2014 policy reform on the uptake of flexible working and its impact on health and well-being, focusing on gender differences.

Methods: Data were drawn from waves 2, 4, 6, 8 and 10 of the UK Household Longitudinal Study (2010-2020). We employed a doubly robust difference-in-differences method to estimate the average treatment effects on the treated of the 2014 policy reform. This analysis examined the effects on the uptake of flexible working, mental and physical health, and satisfaction with life, job and leisure.

Findings: The 2014 policy reform increased women's uptake of reduced hours work arrangements, with the effect growing stronger over time. However, no increase in uptake was observed among men. No strong effects were found for flexitime or teleworking arrangements for either men or women. Additionally, the policy reform resulted in a reduction in psychological distress and improved life satisfaction among women.

Conclusions: The reduction in women's psychological distress and improved life satisfaction might be partly explained by the increased women's uptake of reduced hours arrangements, which may have enabled women to better meet their family care demands. However, even the gender-neutral policies on flexible working may inadvertently exacerbate gender inequalities in labour force participation by pushing women more into part-time work.

Background: Multimorbidity is socially patterned, with lower socioeconomic position (SEP) linked to higher risk. We examined whether a Healthy Lifestyle Index (HLI) mediates the SEP-multimorbidity association and whether pathways differ by sex.

Methods: We used data from 244 886 participants in the European Prospective Investigation into Cancer and Nutrition study. HLI was derived from smoking, alcohol consumption, physical activity, body mass index and diet. SEP was categorised into low, medium and high-SEP based on education. Multimorbidity was defined as the coexistence of at least two diseases among cancer, type 2 diabetes and cardiovascular diseases. Logistic regression assessed SEP-HLI association, Cox regression SEP-multimorbidity and HLI-multimorbidity associations. Counterfactual mediation analysis estimated the natural indirect effect (NIE) and pure direct effect (PDE). Analyses were stratified by sex.

Results: Participants from lower SEP categories were older with worse health outcomes. Women had a healthier lifestyle than men across all SEP levels. In men, the hazard ratio of developing multimorbidity was 1.40 (95% CI: 1.26 to 1.54) for those with low SEP compared with high SEP, in women 1.74 (95% CI: 1.52 to 2.00). Comparing low versus high SEP, PDE for men was 1.28 (95% CI: 1.15 to 1.41), NIE was 1.09 (95% CI: 1.07 to 1.11) (proportion mediated (PM)=29%). In women, PDE was 1.65 (95% CI: 1.47 to 1.90), NIE 1.05 (95% CI: 1.03 to 1.06) (PM=11%).

Conclusions: Lifestyle behaviours partly mediated the SEP-multimorbidity association, underscoring the need to integrate considerations of socioeconomic disparities into the planning of lifestyle interventions.

Background: In 2014, a bushfire ignited the Hazelwood coalmine in regional Victoria, Australia, shrouding nearby communities in smoke for 6 weeks. In this study, we examined whether survival decreased among people with cancer in smoke-exposed areas.

Methods: We identified cancers diagnosed between January 2009 and February 2014, the start of the coalmine fire, from the Victorian Cancer Registry. Tumours were grouped by location as well as subtypes for breast and lung cancers. Smoke exposure was determined by the daily average of PM_2.5 per 10 µg/m³ attributable to the mine fire at Statistical Area level 2. Survival effects were analysed using a Cox proportional hazards frailty model.

Results: There was no detectable effect of fire-related PM_2.5 on overall cancer survival. There was weak evidence that fire-related PM_2.5 exposure reduced survival among women with breast cancer (HR: 1.18, 95% CI 1.00 to 1.38 per 10 µg/m³ of PM_2.5). No other effects were detectable.

Conclusion: We found limited evidence that smoke from the Hazelwood coal mine fire reduced survival among people living with cancer. The association with reduced survival among women with breast cancer may be a chance finding. However, this does not rule out an effect and further analyses should follow when more data become available or following other similar disasters.

Background: Deaths of despair - suicide, drug overdose and chronic liver disease mortality - are major contributors to premature mortality in the USA, disproportionately affecting individuals with low socioeconomic status (SES). The mechanisms underlying these disparities, particularly the roles of psychological distress and alcohol use, remain insufficiently understood. We assessed associations of SES, alcohol use and psychological distress with deaths of despair, along with the mediating roles of alcohol use and psychological distress in the SES-deaths of despair association in men and women.

Methods: We linked US National Health Interview Survey data (1997-2018) to mortality records until 31 December 2019 by following 3 11 508 women and 2 42 463 men for 10.5 years. Using counterfactual-based inverse probability-weighted marginal structural models, we decomposed the total effect of SES (education, income) into direct and indirect effects through psychological distress (Kessler-6) and alcohol use (daily consumption). Analyses were sex-stratified and adjusted for marital status, race and ethnicity and survey year.

Results: Severe psychological distress and high alcohol use were each associated with over a threefold increased risk of death of despair. In men, psychological distress and alcohol use mediated up to 16% and 14% of the SES-deaths of despair relationship, respectively. In women, psychological distress mediated up to 20% of the association, while alcohol use did not mediate the relationship.

Conclusion: Low SES, psychological distress and alcohol use are key risk factors for deaths of despair. Intervention targeting mental health and alcohol use, especially through SES-specific and sex-specific approaches, may help reduce inequalities in these preventable causes of death.

Background: Bullying involvement (victim or perpetrator role) in childhood is linked to later suicidality. However, findings are inconsistent, and sex may be a moderator. We investigated whether childhood bullying involvement was associated with suicidality in adolescence, and whether this association varied by sex.

Methods: Childhood bullying involvement was collected from self-reports of children and parents during the 11-year follow-up of the Danish National Birth Cohorts (DNBC). Data on suicidal ideation (SI) and suicide attempts (SA) from the 18-year follow-up were supplemented with hospital records of SA from the National Patient Register. Associations were estimated using multinomial logistic regressions, while inverse probability weighting accounted for socioeconomic-related selection bias.

Results: 11 705 boys and 17 292 girls were included. Adolescent boys exposed to bullying had increased risks of SI (adjusted relative risk ratio (aRRR): 1.6; 95% CI: 1.4 to 1.8) and SA (aRRR: 2.8; 95% CI: 2.0 to 3.8), while no increased risk was found among those who were perpetrators of bullying vs non-involved peers. Girl victims had increased risks (aRRR) of SI and SA of 1.6 (95% CI: 1.5 to 1.7) and 2.9 (95% CI: 2.5 to 3.5), respectively. Girl perpetrators had an increased risk of SA (aRRR: 2.3; 95% CI: 1.5 to 3.6). Sex significantly moderated the association between perpetration role and suicidality.

Conclusion: Childhood bullying was associated with a higher risk of suicidality during adolescence. Girl, but not boy, perpetrators had increased risk of SI and SA. These findings emphasise the importance of preventive interventions targeting bullying in childhood and its long-term effects, including possible differences in policies for boys and girls.