Journal of Epidemiology and Community Health最新文献

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.

Background: Food insecurity poses a substantial threat to mental health. However, there is limited understanding of how food-insecure adults experience mental health challenges and access necessary health services. We examined the association of food insecurity with mental health status, mental health service utilisation and general healthcare utilisation among US adults.

Methods: A retrospective longitudinal cohort study was conducted to analyse data from 9906 US adults participating in the 2016-2017 Medical Expenditure Panel Survey. Outcomes included mental health status, mental health service utilisation and general healthcare utilisation. The primary independent variable was food insecurity measured using the 10-item Food Security Survey Module. Two separate models were used: A lagged-dependent model and a fixed-effect model.

Results: The lagged dependent model showed that food insecurity in 1 year was associated with a higher likelihood of reporting mental health symptoms based on the Patient Health Questionnaire and the Kessler 6 Psychological Distress Scale (3.5 percentage points (95% CI: 1.3 to 5.8)) and self-reported poor mental health (5.8 percentage points (2.9 to 8.7)) in the subsequent year. However, compared with food-secure adults, food-insecure adults were no more likely to have outpatient mental health visits, specialty mental health visits or psychotropic medication fills. Moreover, food-insecure adults were 4.1 (1.2 to 7.0) percentage points more likely to have an emergency room visit than food-secure adults. These findings were consistent with the fixed-effect model.

Conclusion: Food insecurity is associated with worse mental health. However, food-insecure adults may not access adequate mental health services and instead rely on emergency room visits.

Background: Although the mental health burden of diabetes has received substantial attention, there is limited evidence on whether the risk of suicide-a severe consequence of mental health problems-increases among individuals with diabetes. Therefore, this study investigated the association between diabetes and suicide in Japan.

Methods: This nationwide longitudinal cohort study included adults aged 18-74 years, who were enrolled in the Japan Health Insurance Association's health insurance programme between 2015 and 2022. Individuals newly diagnosed with diabetes were matched in a 1:1 ratio with those without diabetes, based on age and sex. We employed multivariable Cox proportional hazard models to estimate the hazard ratios for suicide in relation to the diagnosis of diabetes, adjusting for potential confounders, such as sociodemographic characteristics, history of psychiatric disorders, physical measurements, health behaviours and laboratory data.

Results: Among 4 210 272 individuals in the matched-pair cohort, we observed 337 deaths by suicide among those with diabetes and 250 deaths by suicide among those without diabetes. After conditioning on potential confounders, diabetes diagnosis was linked to an increased risk of suicide (HR (95% CI) = 1.25 (1.06 to 1.47)). The association tended to be larger among those aged younger than 40 years and among women (among those aged 18-39 years, HR=1.69 (95% CI 1.05 to 2.73); among women, HR=1.56 (95% CI 0.92 to 2.64)).

Conclusion: Diabetes diagnosis may increase suicide risk among the working-age population, even after conditioning on potential confounders. Our findings underscore the importance of psychosocial support following a diagnosis.

Background: Child mental health has become an increasingly important issue in the UK, especially in the context of significant welfare reforms. Universal Credit (UC) has introduced substantial changes to the UK's social security system, significantly impacting low-income families. Our aim was to assess the effects of UC's introduction on children's mental health for families eligible for UC versus a comparable non-eligible sample.

Methods: Using Understanding Society data from 5806 observations of 4582 children (aged 5 or 8 years) in Great Britain between 2012 and 2018, we created two groups: children whose parents were eligible for UC (intervention group) and children whose parents were ineligible for UC (comparison group). Child mental health was assessed using a parent-reported Strengths and Difficulties Questionnaire. The OR and percentage point change in the prevalence of children experiencing mental health difficulties between the intervention group and the comparison group following the introduction of UC were analysed. We also investigated whether the utilisation of childcare services and changes in household income were mechanisms by which UC impacted children's mental health.

Results: Logistic regression results demonstrated that the prevalence of mental health problems among eligible children whose parents were unemployed increased by an OR of 2.18 (95% CI 1.14 to 4.18), equivalent to an 8-percentage point increase (95% CI 1 to 14 percentage points) following the introduction of UC, relative to the comparison group. Exploring potential mechanisms, we found neither reduced household income nor increased use of childcare services, which served as a proxy for reduced time spent with parents, significantly influenced children's mental health.

Conclusions: UC has led to an increase in mental health problems among recipient children, particularly for children in larger families and those aged 8. Policymakers should carefully evaluate the potential health consequences for specific demographics when introducing new welfare policies.

Background: Material disadvantage is associated with poor health, but commonly available area-based metrics provide a poor proxy for it. We investigate if a measure of material disadvantage could be constructed from UK primary care electronic health records.

Methods: Using data from Clinical Practice Research Datalink Aurum (May 2022) linked to the 2019 English Index of Multiple Deprivation (IMD), we sought to (1) identify codes that signified material disadvantage, (2) aggregate these codes into a binary measure of material disadvantage and (3) compare the proportion of people with this binary measure against IMD quintiles for validation purposes.

Results: We identified 491 codes related to benefits, employment, housing, income, environment, neglect, support services and transport. Participants with one or more of these codes were defined as being materially disadvantaged. Among 30,897,729 research-acceptable patients aged ≥18 with complete data, only 6.1% (n=1,894,225) were classified as disadvantaged using our binary measure, whereas 42.2% (n=13,038,085) belonged to the two most deprived IMD quintiles.

Conclusion: Data in a major primary care research database do not currently contain a useful measure of individual-level material disadvantage. This represents an omission of one of the most important health determinants. Consideration should be given to creating codes for use by primary care practitioners.

Background: Research has long documented the increased emergency department usage by persons who are homeless compared with their housed counterparts, as well as an increased prevalence of infectious diseases. However, there is a gap in knowledge regarding the comparative treatment that persons who are homeless receive. This study seeks to describe this potential difference in treatment, including diagnostic services tested, procedures performed and medications prescribed.

Methods: This study used a retrospective, cohort study design to analyse data from the 2007-2010 United States National Hospital Ambulatory Medical Care Survey database, specifically looking at the emergency department subset. Complex sample logistic regression analysis was used to compare variables, including diagnostic services, procedures and medication classes prescribed between homeless and private residence individuals seeking emergency department treatment for infectious diseases. Findings were then adjusted for potential confounding variables.

Results: Compared with private residence individuals, persons who are homeless and presenting with an infectious disease were more likely (adjusted OR: 10.99, CI 1.08 to 111.40, p<0.05) to receive sutures or staples and less likely (adjusted OR: 0.29, CI 0.10 to 0.87, p<0.05) to be provided medications when presenting with an infectious disease in US emergency departments. Significant differences were also detected in prescribing habits of multiple anti-infective medication classes.

Conclusion: This study detected a significant difference in suturing/stapling and medication prescribing patterns for persons who are homeless with an infectious disease in US emergency departments. While some findings can likely be explained by the prevalence of specific infectious organisms in homeless populations, other findings would benefit from further research.

Background: Prescribing is the most common intervention made by healthcare professionals. Our study aimed to compare prescribing between general practitioner (GP) practices with the highest and lowest levels of deprivation.

Methods: The deprivation level of each GP practice was determined using data from the income domain of the Welsh Index of Multiple Deprivation and individual patient postcodes. We compared prescribing data between the highest and lowest deprivation quintiles for selected groups of medicines. The prescribing measures used were selected as the most appropriate to the specific medicine group being considered. Data were analysed across the period of April 2018-March 2023.

Results: For the medicine groups of statins, hypnotics and anxiolytics, and antidepressants, there was a statistically significantly higher level of prescribing in the highest deprivation quintile. For anticoagulants, there was no significant difference in prescribing between the different quintiles. For hormone replacement therapy, there was a significantly higher level of prescribing in the quintile of lowest deprivation.

Conclusion: Our study shows variation in the prescribing of different medicine groups between the highest and lowest deprivation quintiles in Wales. Further investigation into this variation is required.

Background: The purpose of this study was to examine the association between racial and economic segregation and diabetes mortality among US counties from 2016 to 2020.

Methods: We conducted a cross-sectional ecological study that combined county-level diabetes mortality data from the National Vital Statistics System and sociodemographic information drawn from the 2016-2020 American Community Survey (n=2380 counties in the USA). Racialized economic segregation was measured using the Index Concentration at the Extremes (ICE) for income (ICE_income), race (ICE_race) and combined income and race (ICE_combined). ICE measures were categorised into quintiles, Q1 representing the highest concentration and Q5 the lowest concentration of low-income, non-Hispanic (NH) black and low-income NH black households, respectively. Diabetes was ascertained as the underlying cause of death. County-level covariates included the percentage of people aged ≥65 years, metropolitan designation and population size. Multilevel Poisson regression was used to estimate the adjusted mean mortality rate and adjusted risk ratios (aRR) comparing Q1 and Q5.

Results: Adjusted mean diabetes mortality rate was consistently greater in counties with higher concentrations of low-income (ICE_income) and low-income NH black households (ICE_combined). Compared with counties with the lowest concentration (Q1), counties with the highest concentration (Q5) of low-income (aRR 1.96; 95% CI 1.81 to 2.11 for ICE_income), NH black (aRR 1.32; 95% CI 1.18 to 1.47 for ICE_race) and low-income NH black households (aRR 1.70; 95% CI 1.56 to 1.84 for ICE_combined) had greater diabetes mortality.

Conclusion: Racial and economic segregation is associated with diabetes mortality across US counties.

During the last decade, a multitude of epidemiological studies with different designs have been published assessing the association between the use of digital media and psychological well-being, including the incidence of mental disorders and suicidal behaviours. Particularly, available research has very often focused on smartphone use in teenagers, with highly addictive potential, coining the term 'problematic smartphone use' and developing specific scales to measure the addictive or problematic use of smartphones. Available studies, despite some methodological limitations and gaps in knowledge, suggest that higher screen time is associated with impaired psychological well-being, lower self-esteem, higher levels of body dissatisfaction, higher incidence of eating disorders, poorer sleeping outcomes and higher odds of depressive symptoms in adolescents. Moreover, a significant association has also been found between screen time and higher suicide risk. Finally, problematic pornography has been shown to be highly prevalent and it is a strong cause of concern to many public health departments and national governments because it might be eventually associated with aggressive sexual behaviours.