Journal of Epidemiology and Community Health最新文献

Background: Childhood infection might be associated with adverse child development and neurocognitive outcomes, but the results have been inconsistent.

Methods: Two population-based record-linkage cohorts of all singleton children born at term in New South Wales, Australia, from 2001 to 2014, were set up and followed up to 2019 for developmental outcome (N=276 454) and school performance (N=644 291). The primary outcome was developmentally high risk (DHR) at age 4-6 years and numeracy and reading below the national minimum standard at age 7-9 years. Cox regression was used to assess the association of childhood infection ascertained from hospital records with each outcome adjusting for maternal, birth and child characteristics, and sensitivity analyses were conducted assessing E-values and sibling analysis for discordant exposure.

Results: A higher proportion of children with an infection-related hospitalisation were DHR (10.9% vs 8.7%) and had numeracy (3.7% vs 2.7%) and reading results (4.3% vs 3.1%) below the national minimum standard, compared with those without infection-related hospitalisation. In the multivariable analysis, children with infection-related hospitalisation were more likely to be DHR (adjusted HR 1.12, 95% CI 1.08 to 1.15) and have numeracy (adjusted HR 1.22, 95% CI 1.18 to 1.26) and reading results (adjusted HR 1.16, 95% CI 1.12 to 1.20) below the national minimum standard. However, these results may be impacted by unmeasured confounding, based on E-values of 1.48-1.74, and minimal association with education outcome was found in the sibling analysis.

Conclusions: Infection-related hospitalisation was modestly associated with adverse child development and school performance, but the association may be explained by shared familial factors, particularly in those with most socioeconomic disadvantages.

Background: Migrants use less mental health services compared with non-migrant populations, but there is very little information on the use of long-term psychotherapy among migrants. Finnish register data allow for studying the whole migrant population in Finland and collecting data on all publicly supported rehabilitative psychotherapy.

Methods: This study is based on a sample of migrants (n=185 605) and Finnish-born controls (n=185 605). Participants who had received reimbursements for rehabilitative psychotherapy during 2007-2020 were identified from a register maintained by the Social Insurance Institution of Finland. Cox regression analysis was used to study the effect of migrant status on the time until the start of therapy. Multinomial logistic regression was used to study the association between migrant status and the number of psychotherapy sessions.

Results: Finnish-born participants received psychotherapy more often (n=7258) than migrants (n=1516). The adjusted HR for initiating psychotherapy among migrants compared with Finnish-born individuals was 0.27 (95% CI 0.25 to 0.28). Migrants from sub-Saharan Africa and Asia and recently arrived migrants were least likely to receive psychotherapy. Migrants were more likely to receive short treatment periods than Finnish-born controls.

Conclusion: Lower use of rehabilitative psychotherapy among migrant population in Finland is not likely to reflect lower need for treatment. More efforts are needed to promote equal access to psychotherapy.

Background: Many studies have demonstrated that pregnant women living in rural areas are more likely to experience domestic violence (DV). Systematic reviews on the prevalence and risk factors of DV among pregnant women have been conducted mainly in urban areas. Thus, there has been no determination of the global prevalence of DV among rural pregnant women. The objective of this study is to assess the prevalence and types of DV among rural pregnant women globally using systematic review and meta-analysis.

Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis expanded checklist for 2020 was employed. The Condition-Context-Population framework was used to determine the inclusion criteria. Fifteen studies met the inclusion criteria. The PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature and Scopus databases were searched for published articles through January 2023. Pooled prevalence and types of DV in rural pregnant women were assessed using the random effect model.

Results: DV against rural pregnant women was prevalent at 33.4% (95% CI 20.8 to 47.9%). Psychological violence was the most common with a prevalence of 34.2%, followed by physical violence (14.1%) and sexual violence (13.5%).

Conclusion: One-third of pregnant women in rural areas are victims of DV. In rural pregnant women, the prevalence of DV is higher than overall global estimates. Policymakers, healthcare professionals and researchers must prioritise assessment and prevention of DV against pregnant women who reside in rural areas.

Background: This study investigates the association between frailty and mortality in Eastern European populations, which remains largely unexplored compared with Western Europe. The aim is to assess the risk of all-cause and cardiovascular mortality associated with varying levels of frailty.

Methods: A prospective multicentre cohort study was conducted, involving random population samples from the Czech Republic, Poland and Lithuania. The baseline survey (2002-2005) included 26 746 individuals aged 45-69 years, with an average follow-up of 13 years. Frailty was measured using a Comprehensive Geriatric Assessment (CGA)-based Frailty Index (FI), calculating the number of deficits in each domain. Cox proportional regression models and inverse probability weighting (IPW) were employed to account for risk factor differences among the frailty groups: robust, prefrail, mild, moderate and severe.

Results: The study included 14 287 people, among whom 891 were frail, with a total of 2402 deaths.Compared with non-frail persons, those with mild (IPW HR 2.06, 95% CI 1.60 to 2.66) and severe (IPW HR 2.71, 95% CI 1.45 to 5.07) frailty had more than twofold elevated risk of all-cause mortality. For cardiovascular mortality, the corresponding HRs were (IPW HR 3.05, 95% CI 2.14 to 4.35) and (IPW HR 3.88, 95% CI 1.95 to 7.74). Men exhibited a higher mortality risk at all frailty levels only in unweighted analysis. Country-specific differences were not significant.

Conclusions: A CGA-based FI is an independent predictor of all-cause and cardiovascular mortality, with even mild frailty increasing the risk. Implementing frailty assessments can improve health risk prediction in older adults from Eastern Europe.

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.

Introduction: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) represent significant public health challenges, linked to an elevated risk of cardiovascular disease (CVD) and influenced by socioeconomic disparities. This longitudinal study investigates the interplay between socioeconomic position (SEP), measured as educational level, CKD/ESRD and CVD using the syndemic framework.

Methods: We used data from the Piedmont Longitudinal Study to establish CKD and ESRD cohorts and to identify incident CVD between January 2013 and December 2017. The educational level was retrieved from census data. We applied an accelerated failure time model to explore the relationships between CKD/ESRD, CVD and educational level with all-cause mortality and emergency room (ER) acuity.

Results: The CKD cohort included 44 220 individuals, with 12 341 deaths and 15 440 ER admissions. The ESRD cohort included 4021 subjects, experiencing 1303 deaths and 1640 ER admissions. After adjusting for confounders, the combination of CKD, low educational level and incident CVD was associated with increased all-cause mortality (time ratios (TR) 0.07, 95% CI 0.05 to 0.08) and ER acuity (TR 0.16, 95% CI 0.14 to 0.17) compared with those with higher education. Instead, patients with ESRD with incident CVD and high educational level had the highest increase in mortality (TR 0.08, 95% CI 0.05 to 0.14) and ER acuity (TR 0.20, 95% CI 0.1 to 0.30).

Conclusions: Patients with CKD with low educational levels and incident CVD may represent a 'syndemic', associated with higher mortality and ER acuity. Our study highlights a potential link between these conditions and socioeconomic disparities, suggesting the need for multifaceted approaches.

Background: While prior literature has documented the impact of housing quality on health, the long-lasting effects of poor housing conditions in adolescence on adult health remain understudied. This study employs an outcome-wide longitudinal approach to estimate the association between poor housing conditions in adolescence and a set of health outcomes in adulthood.

Methods: Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a large-scale, nationally representative sample of US adolescents, were used. This study analysed 15 health outcomes encompassing physical and mental/cognitive health, and health behaviours. The Bonferroni correction was applied to adjust the significance level of multiple testing of the associations.

Results: After applying the Bonferroni correction, poor housing conditions in adolescence were associated with seven adult health outcomes. These conditions were particularly strongly and robustly linked to mental health issues, including depression, suicidal ideation and perceived stress. Additionally, poor housing conditions were related to physical health outcomes such as cardiovascular disease risk and self-rated health, as well as health behaviours such as smoking and unhealthy eating behaviour.

Conclusion: Poor housing conditions during adolescence can act as an early risk factor for adult health, particularly mental health. These findings support the adoption of a life course approach and strengthen the case for housing interventions aimed at improving health outcomes.

Background: Athletes who have a history of participation in contact sports appear to subsequently experience elevated rates of neurodegenerative diseases such as dementia but have a lower incidence of cardiovascular disease and selected cancers. We quantified the occurrence of little-examined cardiometabolic and mental health outcomes, plus associated lifestyle factors, in a group of former contact sports athletes and a general population sample.

Methods: In this cohort study, male former elite athletes active between 1920 and 1965 in soccer (N=303), boxing (N=281), and wrestling (N=318) were recruited using sports yearbooks and the administrative records of sports associations. A population control group was identified using data from a compulsory medical examination (N=1712). All study members were linked to hospital registers (1970-2015) and a self-completion questionnaire was circulated in 1985.

Results: Across 12 health outcomes, the general pattern of association was null. On the few occasions when statistically significant differences did occur, there were in fact more favourable health characteristics and behaviours in former athletes. For instance, in comparison to population controls, we found a lower prevalence of ever having smoked cigarettes in all contact sports groups (range in odds ratios (95% confidence intervals) of 0.32 (0.21, 0.48) to 0.52 (0.36, 0.75)).

Conclusion: In this study, male retired contact sports athletes had similar cardiometabolic and mental health profiles to those of population controls.