Journal of Epidemiology and Community Health最新文献

Background: Inequalities in colorectal cancer (CRC) staging and outcomes exist across numerous sociodemographic axes. Early-stage CRC diagnosis is important for treatment success and survival. In this study, we investigate inequalities in CRC staging using registry data for 186 713 first-time CRC cancer diagnoses from 2013 to 2019 in England.

Methods: We employ the novel Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) approach to National Cancer Registry data. We investigate inequalities in CRC staging (early vs advanced stage) via a logistic MAIHDA. We examine a range of intersectional inequalities in CRC staging, across different age, ethnicity, gender and area-level deprivation groups.

Results: Just over half of the staged cancers in the sample were diagnosed at advanced stage (62%). Results demonstrate notable inequalities in the risk of advanced CRC staging, with a gap of 17 percentage points between the strata with the lowest and highest predicted probability of advanced stage CRC diagnosis. These inequalities exist between age groups, ethnicity and deprivation level, with no evidence of gender-related inequalities when other variables are controlled. However, unexpectedly, we find these inequalities to be almost entirely additive in nature.

Conclusions: These results suggest substantial inequalities in advanced stage CRC diagnosis exist, but that these are driven largely by universal processes of inequality, rather than disadvantages associated with single intersectional strata beyond an additive layering of disadvantage. Policy tools to encourage prompt screening engagement and symptom awareness campaigns in pre-screening age groups may benefit from considering the groups most disadvantaged by that additive layering.

Background: Theatre interventions such as psychodrama are increasingly being used to help individuals with mental health conditions. Previous findings provided mixed results on the impact of theatre interventions for reducing psychological symptoms. Given the growing use of theatre interventions, it is important to investigate their impact on specific mental health conditions. This systematic review and meta-analysis aims to examine the impact of theatre interventions on mental health outcomes and suicidality.

Methods: The review was prospectively registered on The International Prospective Register of Systematic Reviews (CRD42021212666), and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for reporting. Embase, ProQuest Central, PsycInfo, PubMed and Scopus were searched. All English-language studies examining the impact of theatre interventions and on mental health outcomes and/or suicidality were included.

Results: In total, 42 papers met the inclusion criteria. Of these, 21 studies were included in meta-analyses that found significant reductions in standardised mean change using raw score standardisation symptoms of anxiety (k=10; -0.45 (95% CI -0.71 to -0.19)) depression (k=16; -0.79 (95% CI -1.07 to -0.51)) and post-traumatic stress disorder (k=6; -0.82 (95% CI -1.21 to -0.42)) among adult participants of theatre intervention studies. Results from studies excluded from meta-analyses indicated that theatre interventions helped reduce symptoms of schizophrenia and psychosis for adults and lowered the risk of suicidal ideation and suicide attempt among adolescents. Most studies had a high/serious risk or some concerns about bias.

Conclusion: Theatre interventions may be useful to help reduce symptoms of mental health conditions. Further high-quality research is necessary to build on the existing evidence and to assess both the short- and long-term impacts of theatre interventions on mental health outcomes.

Background: The Swedish Targeted Health Dialogue (THD) is a widely implemented, individual-focused intervention involving screening and health counselling for mid-life individuals. Previous research has shown somewhat mixed results; therefore, this study aims to provide rigorous evidence on the population-level impact of the THD programme on ischaemic heart disease (IHD) in Sweden.

Methods: This study used the number of recorded county-specific IHD events and mortality among 40-69-year-olds between 1987 and 2023 in Sweden to estimate the effect of the THD programme. Six out of 21 counties had implemented THD fully during the study period. These six counties were used to evaluate the effect of the programme by estimating the change in IHD incidence trend post implementation compared with controls where the programme was not implemented at that specific time. This intervention effect was estimated using generalised multilevel controlled interrupted time-series models.

Results: In men, the intervention showed no statistically significant effect on IHD events compared with the controls, with an estimated increased annual rate of 0.1% (95% CI -0.1% to 0.2%). In women, a similar non-significant increase in incidence rate of 0.2% (95% CI -0.1% to 0.5%) per year was observed in the intervention counties. These figures can be contrasted with an annual linear reduction of 3.2% in IHD incidence among men and 1.5% among women. Similar results were attained regarding IHD mortality.

Conclusion: These findings do not support evidence for any beneficial population effect of the THD programme on future IHD. Hence, revisiting the fundamental concern on the effectiveness of the programme is pertinent.

Introduction: Prior studies have observed associations between poverty measured at single or across diffuse periods of the life course and cognitive function measured in later life. Few studies examine the relationship between cumulative poverty exposure and midlife cognition or address confounding of this relationship by early-life cognitive ability.

Methods: To estimate the effect of cumulative poverty with midlife cognitive function, we analysed data from National Longitudinal Survey of Youth 1979 participants with ≥3 family income measures over a 20-year period (1990-2010) who completed the modified Telephone Interview for Cognitive Status when ~48 years of age (N=2923). We defined participants' cumulative poverty status by the proportion of their family income measures <200% of the Federal Poverty Limit: 0 (never), <1/3 but >0 (sometimes), ≥1/3 but less than all (often) and all (always). Armed Forces Qualification Test score defined early-life cognitive ability. We used linear regression models to examine the association between cumulative poverty and sample-standardised z-scores for memory, attention and global cognitive function.

Results: Overall, 37.9% of participants were never, 26.6% were sometimes, 27.5% were often and 8.0% were always in poverty. In fully adjusted models and relative to participants never in poverty, those often (beta: -0.13; 95% CI -0.23 to -0.04) and always (beta: -0.37; 95% CI -0.53 to -0.22) in poverty had lower z-scores for midlife global cognitive function. Likewise, their z-scores were lower for midlife memory function.

Conclusions: Longer durations of poverty exposure may be more detrimental for midlife cognition. This relationship was not fully explained by early-life cognitive ability.

Background: Future economic transitions have the potential to replicate historical patterns of deindustrialisation. It is important to understand the health consequences of deindustrialisation to help us prevent the long-term health legacies we see in postindustrial communities. This paper presents the case of mental health on the Welsh coalfields as an example of how these health legacies can manifest.

Methods: Data on 180 462 respondents to the Welsh Health Survey between 2003 and 2015 and 57 331 respondents to the National Survey for Wales between 2016 and 2023 were linked to spatial data on historical coal mining activity at the middle super output area level. Linear mixed-effects models were fitted to self-reported mental health and well-being measures as a function of local mining extent, both overall and as a function of generational cohort and sex.

Results: An association between mining extent and mental health was found in both datasets, with residents of areas with greater mining extent reporting worse mental health. This association was strongest in generations who lived through the decline of the mining industry. There was a stronger association for women than men in the older Welsh Health Survey, but moderation by gender was not replicated in the newer National Survey for Wales.

Conclusion: The study underscores the enduring mental health legacy of deindustrialisation and how it is patterned by geography, generation and sex. The health consequences should be an important consideration for industrial policy and attempts to mitigate the effects of future deindustrialisation.

Background: Problematic gaming is a known risk factor for adolescent well-being. Yet, socioeconomic factors that might contribute to problematic gaming in adolescence have not been fully explored. This study examined the association between relative deprivation, defined as an individual's financial gap relative to their classmates, and problematic gaming in a representative sample of Italian adolescents.

Methods: We analysed data on family material assets and self-reported symptoms of problematic gaming from 58 881 participants in the 2021/2022 Italian Health Behaviour in school-aged children study. Relative deprivation was measured using the Yitzhaki index, with classmates as a social reference group. Associations with problematic gaming were tested using a two-level multiple logistic regression model while accounting for the effects of economic, sociodemographic and psychological factors.

Results: Adolescents reporting higher relative deprivation were eight times more likely to be classified as problematic gamers compared with their better-off peers, after controlling for individual and class-level deprivation, and self-efficacy beliefs. Males, younger adolescents and adolescents with lower self-efficacy were more at risk of being problematic gamers.

Conclusion: The current study expands the existing literature on the detrimental impact of inequalities on adolescent behaviours by highlighting the association between relative deprivation and problematic gaming. Policymakers are advised to implement measures to reduce inequalities and mitigate maladaptive gaming patterns among adolescents.

Background: Chronically absent students miss learning opportunities at school, and as a result, may suffer academically and socially. Student absenteeism is rising across the USA, with 14%-30% of K-12 students being chronically absent (missing ≥10% of school days) each year. In 2012, Michigan started Pathways to Potential (P2P)-placing caseworkers in public schools to address the material needs of students that interfere with attendance. In this study, we evaluated the effect of P2P on chronic absenteeism in public schools across Michigan.

Methods: Our quasi-experimental study included 160 Michigan K-12 public schools that began implementing P2P between 2012 and 2016. We evaluated the effect of P2P on chronic absenteeism using administrative data for academic years 2008-2009 through 2018-2019. We used a staggered interrupted time series (ITS) analysis, first modelling a simple ITS for each school, and then pooling effect estimates using random effects meta-analysis. We estimated meta-regressions to investigate heterogeneous treatment effects.

Results: Results suggest P2P reduced chronic absenteeism rates by 7.88% (incidence rate ratio=0.92 (95% CI 0.88 to 0.96)), preventing 21 students from being chronically absent per school per year (95% CI 17.52 to 24.95). There was significant heterogeneity, with greater effects for schools that received a higher P2P dose, were in the eastern region of the state, had wealthier student bodies, and were less racially diverse.

Conclusion: This school-based intervention represents a feasible and effective programme for preventing chronic absenteeism. Further standardising the programme, while ensuring P2P can address diverse needs, may produce more consistent results across schools.

Background: Spousal caregiving is linked to increased symptoms of poor mental health among older people. Less is known about the effects of physical health conditions with different progression and level of impairment on spousal mental health among younger people.

Methods: Using Finnish total population register data, we identified 106 673 partnered individuals aged 30-70, newly diagnosed in 2000-2015 with progressive conditions with increasing impairment (Parkinson's disease, multiple sclerosis, dementia), acute conditions with sudden impairment (stroke) and acute conditions without cognitive impairment (myocardial infarction, prostate cancer, female breast cancer), and employed event-study difference-in-difference models to assess short-term and long-term effects on spouses' 6-month probability of psychotropic medication purchases (Anatomical Therapeutic Chemical (ATC) codes N05B, N05C and N06A) by type of health condition.

Results: Incident stroke had a sudden effect on spousal psychotropic medication purchase probability (2.1 percentage points increase among female and 1.4 percentage points increase among male spouses). Effect size attenuated thereafter, although more slowly among female spouses, yet remained over 1 percentage point in the long term. Smaller (about 0.7 percentage points among female and 0.5 percentage points among male spouses), but also persistent, effect was observed following the diagnosis of acute conditions without cognitive impairments. For progressive conditions, little changes occurred around the time of diagnosis.

Conclusions: Acute onset of physical illness may have sudden and persistent adverse impact on spousal mental health in midlife even when prognosis is good and expectations for spousal care are likely to be limited.

Aims: Electronic nicotine delivery system (ENDS) use by youth remains a significant public health concern. Perceived risk is an important predictor of adolescent ENDS use. While state policies have been shown to affect ENDS use, and perceived risk is inversely associated with use, whether policies shape adolescent risk perceptions remains less well studied.

Methods: We used longitudinal (2013-2019) US adolescent data from the Population Assessment of Tobacco and Health study-a population-based sample of adolescents enrolled between ages 12 and 17-and state policy data for ENDS and tobacco policies. Hybrid within-person and between-person panel models estimated associations of policies with three outcomes: perceived harms of ENDS, perceived risk of addiction and perceived risk of ENDS compared with smoking.

Results: Within-person findings revealed that ENDS purchase age restrictions were associated with increased odds of reporting categories of greater perceived harm (OR=1.65), perceived risk of addiction (OR=1.14) and risk relative to smoking (OR=1.60). Similarly, smoking bans were associated with perceived harm (OR=1.33), perceived risk of addiction (OR=1.21) and risk relative to smoking (OR=1.36). Between-person models indicated that ENDS excise taxes and purchase age restrictions, as well as smoking bans, were associated with all three perceived risk outcomes.

Conclusions: Implementing smoking bans, excise taxes and purchase age restrictions may present an avenue to heighten perceived risk among youth. As such, policies may enhance prevention of initiation and improve interventions for youth who vape. Further, as greater duration of exposure to policies is associated with increased risk perceptions, maintaining consistently strong policies is important.