Journal of Epidemiology and Community Health最新文献

Background: Deprived communities, migrants and ethnic minorities were disproportionately affected by COVID-19 and may, therefore, be at a higher risk of post-COVID condition (PCC). This analysis, using data from the Virus Watch study, investigates how deprivation, migration status and ethnic minority status influence PCC risk in both the full cohort (all regardless of infection status) and those with a confirmed COVID-19 infection.

Methods: A subset of participants from Virus Watch, a prospective community cohort study in England, were included. We used logistic regression to compare the predicted probability of developing PCC in both full and infected cohorts among different deprivation levels, migration and ethnic minority status categories by sex-at-birth during pre-Omicron and Omicron periods, adjusting for sociodemographic covariates.

Results: During the pre-Omicron period, PCC probability increased with deprivation levels, especially in females (most deprived: 7.8%, 95% CI 4.6% to 11.0%; least deprived: 3.5%, 2.5%-4.5%). Migrant and ethnic minority males had a higher likelihood of PCC than their respective counterparts, particularly in the full cohort for migrants (6.3%, 1.8%-10.8%) and the previously infected cohort for ethnic minorities (38.8%, 21.2%-56.4%). However, these disparities were less pronounced in females. In the Omicron period, these differential probabilities were also less evident.

Conclusion: Our findings suggest that greater PCC probability among these populations is driven by increased infection risk and postinfection determinants. This underscores the need for policies and interventions to reduce infection risk and affordable and easily available healthcare services for those with PCC.

The reduction of health inequalities has been a priority of researchers, decision-makers and practitioners for many years. Advances in causal mediation analysis offer great promise for identifying intervention targets and inferring how policy actions might alter health inequalities. However, these methods are sometimes presented in a manner that is not accessible to the wider community of health researchers. Causal mediation methods also have a range of limitations and assumptions that have implications for their application and the interpretation of results. In this paper, we consider three types of questions that can be used to guide policy actions to reduce health inequalities, addressed using causal mediation methods: (1) which mediating pathways offer most promise for the reduction of health inequalities and should be the focus of further, more indepth analysis? 2) In the face of two competing pathways, which one is most likely to lead to a narrowing of health inequalities? 3) What would be the impact of a hypothetical intervention on one specific mediating pathway when implemented under different scenarios? Focusing on early years' health, we use real life examples of the application of causal mediation methods to address these three types of question. In doing so, we discuss the relative strengths and limitations of these methods and introduce key mediation concepts relevant to health inequalities researchers.

Background: Adverse childhood experiences (ACEs) are linked to poor health and social outcomes, with growing interest in their intergenerational effects. Socioeconomic context strongly shapes both exposure to ACEs and their transmission across generations, yet is often under-represented in research. While many studies have explored how ACEs affect adult health, the impact of parental ACEs on children's healthcare utilisation has not yet been systematically reviewed.

Methods: We systematically reviewed studies examining associations between parental ACEs or related adversity and children's use of preventive, primary or secondary healthcare. We searched PubMed, Embase and PsycINFO databases up to December 2024. Title and abstract screening were conducted using an AI-assisted screening tool called Active Learning for Systematic Reviews. Study quality was assessed across design, participant selection, measurement and analysis. Findings were synthesised narratively and visualised with harvest plots, grouped by healthcare level and exposure type.

Results: Out of 8494 records, 15 studies were included. Designs, populations, ACE measures and outcome definitions were heterogeneous. No consistent associations were found in preventive or primary care domains. In secondary care, 11 of 12 analyses found a positive or no association; four high-quality studies showed increased use of emergency, inpatient or psychiatric services among children of parents with ACEs. Methodological variability limited comparability between studies, particularly in ACE definitions.

Conclusions: Parental ACEs may contribute to increased use of secondary healthcare in offspring, though evidence across care levels remains inconclusive. Future studies should aim for more consistent measurement of ACEs and standardised outcome definitions to clarify intergenerational effects on healthcare utilisation.

Background: Socioeconomic status (SES) is a potentially important upstream determinant of late-life cognitive health, but a review which captures the dynamic influence of SES across the life-course is lacking. We conducted a systematic review of studies reporting associations between life-course SES and dementia/late-life cognitive decline.

Methods: On 21 February 2024, we searched Medline, Embase, PsycINFO, CINAHL, British Education Index, Web of Science, Scopus and Advanced Google for studies related to life-course SES and dementia. We included studies employing trajectory or mediation analysis that measured dementia/cognitive decline as outcomes. Two researchers independently screened articles and assessed risk of bias. Results were synthesised narratively and in Harvest plots.

Results: We included 18 out of 6040 studies screened (n=7 trajectory studies, n=8 mediation studies, n=3 both). Most (13/23) trajectory analyses reported that stable low SES and downward social mobility, relative to stable high SES/upward mobility, were linked to higher dementia and/or cognitive decline risk. Half (5/10) of the mediation analyses reported full mediation of adulthood SES on the association between childhood SES and dementia/cognitive decline, and 4/10 reported partial mediation. Overall, study quality was moderate.

Conclusion: SES has a dynamic life-course association with dementia risk. Increases in dementia risk are compounded by sustained life-course disadvantage. Policies to address socioeconomic disadvantage across the life-course are needed to address this upstream determinant of dementia.

Prospero registration number: CRD42024505975.

Background: Genomic information is transforming public health and personalised medicine by identifying genetic and environmental contributors to disease. However, Hispanic populations remain under-represented in global genomic datasets, limiting the relevance of findings for groups such as the Mexican population. The oriGen project, launched by Tecnológico de Monterrey, aims to address this disparity by establishing a nationally representative cohort of 100 000 Mexican adults. The project integrates clinical, lifestyle and genomic data to enable the study of gene-environment interactions, disease susceptibility and health disparities in Mexico and Latin America.

Methods: oriGen is a prospective, population-based biobank recruiting participants from 18 metropolitan areas across 19 Mexican states using probabilistic, stratified, multistage sampling based on national statistical frameworks. Data collection includes electronic questionnaires, anthropometric measurements, vital signs and biological samples for biochemical analysis and genomic sequencing. Whole-genome and whole-exome sequencing are conducted in collaboration with national and international partners.

Results: As of April 2025, 83 764 individuals (61% female) have been enrolled. The cohort slightly over-represents older adults and women. Baseline data show a high prevalence of obesity (40%), elevated blood pressure (mean 127.4/81.7 mm Hg) and elevated blood glucose (mean 133.3 mg/dL). Initial genomic analyses (n=1318) indicate an average admixture of 61.8% Native American, 32.4% European and 5.1% African ancestry, with regional variation.

Conclusion: oriGen represents one of the most comprehensive genomic epidemiology efforts in Mexico, offering a valuable resource for advancing equitable precision medicine and public health research in under-represented populations.