Journal of Epidemiology and Community Health最新文献

Background: While C-section (CS) deliveries exhibit significant socioeconomic inequalities in low- and middle-income countries (LMICs), the extent and underlying drivers of these inequalities remain poorly understood. This study assesses these inequalities and identifies key contributing factors.

Methods: The most recent nationally representative samples of live births (n=652 539) from the Demographic and Health Surveys, conducted between 2014 and 2024 in 44 LMICs, were used to calculate the CS delivery rates. The Wagstaff (WI) and Erreygers (EI) indices were used to measure the relative and absolute socioeconomic inequalities in CS delivery. Meta-regression analyses were performed to identify the proximate determinants of the observed socioeconomic inequalities in CS delivery across the selected LMICs.

Results: CS delivery rates varied across LMICs, with a median of 6.25% (IQR=16.18). The WI and EI indicated that CS deliveries were concentrated among high socioeconomic backgrounds, with only one country exhibiting no inequality. The pooled estimates (WI: 0.32, 95% CI 0.28 to 0.36 and EI: 0.11, 95% CI 0.09 to 0.14) further demonstrate the concentration of CS among the rich in LMICs. Meta-regression analyses indicated that inequalities in education and antenatal care were significantly and positively associated with the concentration of CS deliveries among wealthier women.

Conclusion: CS delivery concentration among wealthier women remains a health concern in LMICs. Given the positive link between higher education and antenatal care with CS deliveries, country-specific policies promoting health education and targeted messaging during antenatal care visits on the adverse health effects of unnecessary CS deliveries may help reduce socioeconomic inequalities in CS delivery.

Background: Layoffs may affect the health of those who lose their jobs as well as those who remain employed. Existing studies have found that remaining employed through layoffs is associated with poorer mental health in the short term, but the implications for long-term outcomes such as mortality remain unclear.

Methods: We estimated adjusted HRs for all-cause and cause-specific mortality associated with layoff intensity while employed among white men, non-white men and women in a cohort of 9761 autoworkers who worked at one of three plants in Michigan between the years 1950 and 1980. We defined layoff intensity as the number of layoff months endured while employed divided by duration of employment. We identified layoff months as those in which the percentage of the workforce leaving employment was 1.96 SD above the predicted value from an autoregressive integrated moving average model.

Results: We found statistically significant associations among non-white men but not women or white men. Relative to layoff intensity below the first quartile, the adjusted HR associated with layoff intensity between the first and second quartiles was 1.35 (95% CI 1.05 to 1.74) for all-cause mortality among non-white men. The adjusted HRs associated with layoff intensity between the second and third quartiles were 1.85 (95% CI 1.08 to 3.17) and 2.41 (95% CI 1.00 to 5.84) for death due to all cancers and lung cancer, respectively.

Conclusion: Layoffs endured while employed may lead to early mortality among non-white male employees. Reducing workforce instability may reduce racial disparities in health.

Background: Most minority populations in Europe generally exhibit lower childhood vaccine uptake compared with the general population. Improving uptake in these populations requires contextually tailored interventions. We conducted a realist review to identify interventions effective at improving measles, mumps and rubella (MMR) and human papillomavirus (HPV) vaccine uptake among underserved communities.

Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane and ProQuest for English language publications from 2005 to 2022. Following title and abstract screening, full texts were assessed for relevance. Grey literature and reference lists were also examined. Data extraction and analysis were performed independently by two reviewers. Programme theories were generated from included articles and data extraction focusing on context-mechanism-outcome configurations.

Results: Of 1942 screened titles, 87 studies underwent full-text review of which 34 met inclusion criteria. 10 primary intervention categories were identified: parental and youth education; clinical outreach; data infrastructure/quality improvement; health provider training; school-based education; digital technology for patients; cash incentives; home visits; comic books; community leaders' education; and consent policy changes. Analysis highlighting contextual factors enabling or hindering each intervention category's success was conducted.

Conclusions: Multicomponent strategies proved the most effective, with strongest evidence supporting home visits, parental and youth education, school-based programmes, data infrastructure and quality improvement and healthcare provider training. Moderate evidence supported reminders/recall strategies, comic books and consent policy changes, while digital technology for patients and cash incentives showed limited effectiveness. Importantly, there is no one-size-fits-all solution. Policymakers and practitioners should tailor and adapt interventions to the unique cultural, social and economic contexts of each group to ensure success.

Prospero registration number: CRD42021268068.

Background: Many studies have detected a negative relationship between income inequality and general measures of health. However, data limitations have prevented a full understanding of whose health is impacted and in what ways.

Methods: In this study, we combined area-level census data with individual-level health claims data to estimate the cross-sectional association between county-level income inequality and healthcare utilisation across a range of member characteristics.

Results: We found that a 1 SD increase in the Gini coefficient was associated with about 5% higher medical and pharmacy costs and a 0.2 percentage-point increase in the probability of a hospital visit within the year. Income inequality was associated with higher medical costs primarily among adults with commercial insurance, more emergency department visits among children and Medicaid members, and more hospital visits among older adults, including Medicare members. By examining diagnoses attached to claims, we found that income inequality was associated with detrimental impacts on mental health, as indicated by higher spending for anxiety and depression and more emergency department visits for substance-use disorders.

Conclusions: Income inequality was associated with worse health across a wide range of members by age, income and insurance type, and can be considered as a risk factor by policymakers and health systems.

Background: Falls can repeatedly occur as people age, which leads to injury, disability and mortality in older adults. Sleep duration may be a modifiable factor, but longitudinal evidence on its association with recurrent falls is limited.

Methods: We analysed data from two prospective cohorts: the China Health and Retirement Longitudinal Study (CHARLS) and the English Longitudinal Study of Ageing (ELSA). Baseline self-reported sleep duration was classified as short (<6 hours), normal (6-10 hours) and long (>10 hours). Fall status was assessed in each follow-up wave and analysed as recurrent events. HRs and 95% CIs were estimated using Andersen-Gill models. Non-linear associations were explored using restricted cubic splines (RCS).

Results: A total of 11 603 participants from CHARLS and 8083 from ELSA were included. During median follow-ups of 9.0 years and 9.1 years, 7783 and 6472 recurrent falls were reported, respectively. Compared with normal sleep, short sleep was associated with higher fall risk (CHARLS: HR 1.127, 95% CI 1.066 to 1.191; ELSA: HR 1.115, 95% CI 1.041 to 1.195). Long sleep also showed increased risk (CHARLS: HR 1.293, 95% CI 1.020 to 1.640; ELSA: HR 1.413, 95% CI 1.027 to 1.946). RCS analysis revealed non-linear relationships, with the lowest risk observed at 7-8 hours.

Conclusion: Both short and long sleep durations are associated with increased risk of recurrent falls in adults aged 50 and above. A sleep duration of 7-8 hours appears to represent the lowest risk. Sleep-focused interventions may be a valuable strategy for fall prevention in public health and geriatric care.

Background: During preconception counselling, pregnant women who smoke are advised to quit smoking. While the adverse effects of paternal smoking on pregnancy and perinatal outcomes have been increasingly recognised, the health benefits of paternal smoking cessation prior to conception remain understudied.

Methods: The current study involved non-smoking reproductive-aged Chinese women who participated two times in the National Free Prepregnancy Checkups Project during 2010-2018. A total of 158 986 pregnancies were included, with husbands reporting smoking at the preconception examination stage during their first participation. The primary exposure was paternal smoking cessation before pregnancy. And the primary outcome was spontaneous abortion (SAB) recorded in the second participation. Inverse-probability-weighted (IPW) logistic regression was used to estimate ORs and their 95% CIs of SAB with paternal smoking cessation before pregnancy. Instrumental variable (IV) analyses were further used to estimate the association.

Results: Compared with continued paternal smoking, paternal smoking cessation before pregnancy was associated with a reduced risk of SAB (IPW-adjusted OR 0.86 (95% CI 0.81 to 0.91); IV-estimated OR 0.79 (95% CI 0.76 to 0.82)). Additionally, a decrease in paternal smoking was also associated with a lower risk of SAB. Notably, the risk of SAB was still higher than that of those without paternal smoking in IV analysis (OR 1.21 (95% CI 1.26 to 1.32)).

Conclusions: Paternal smoking cessation prior to conception is linked to a reduced risk of SAB. However, the risk of SAB among women with paternal smoking cessation was still higher than that among those without paternal smoking. Preconception counselling should advise fathers who smoke to quit.

Background: Suicide is a leading cause of death among young adults in South Korea. We investigated the association between triglyceride-glucose (TyG) index and suicide mortality in young adults.

Methods: This nationwide study analysed data from 6 667 138 individuals aged 20-39 using the National Health Insurance Database. Participants were grouped into TyG index quartiles. The primary outcome was suicide mortality.

Results: During a median follow-up duration of 10.7 years, 41 004 (0.6%) suicidal deaths occurred. The cumulative event rates for suicide mortality were highest among participants in TyG index quartile 4. Multivariable Cox analysis showed significant increases in the risks of suicide mortality in participants with TyG index quartile 4 compared with those in the low quartiles (adjusted HR 1.17, 95% CI 1.11 to 1.23, vs quartile 1; adjusted HR 1.15, 95% CI 1.10 to 1.20, vs quartile 1-3). The association between the TyG index and the risks of suicide mortality was positive and quasi-linear. Subgroup analysis showed a consistent trend of increasing HRs for suicide mortality with higher TyG index quartiles, with significant interactions between TyG index, sex and depression.

Conclusion: TyG index can be useful in identifying young individuals at an increased risk of suicide mortality.

Background: Cold weather remains a serious health threat in the UK and elsewhere, particularly for older adults. The Winter Fuel Payment has been a key government strategy to mitigate health risks linked to cold homes in the UK, but recent policy shifts have raised questions about whether income-based eligibility criteria effectively identify those most at risk.

Methods: We analysed cold-related mortality in adults aged ≥75 across 324 local authority districts in England (2007-2019) using distributed lag non-linear models in a spatial Bayesian framework. Multivariate meta-regression was used to evaluate modification of cold effects by deprivation, income-based pension credit uptake, home energy efficiency and fuel poverty.

Results: Areas in the highest quartile of fuel poverty had significantly greater cold-related mortality risk than those in the lowest quartile, with a 15.3% versus 13.1% increase in mortality risk at the first compared with the 50th percentile of wintertime temperature, ie, an absolute difference of 2.2% (p<0.001). This effect was stronger than the corresponding differences for energy efficiency (1.7%, p=0.04), income as indicated by pension credit uptake (0.6%, p=0.39) and deprivation-based measures, for which differences were minimal. Overall, an estimated 17% of cold-related deaths among people aged ≥75 were attributable to fuel poverty.

Conclusion: Fuel poverty, an indicator designed to capture both low-income and housing energy efficiency, is a stronger predictor of cold-related mortality than income (as indicated by pension credit update) or deprivation-based indicators alone. Winter energy support schemes should consider fuel poverty metrics in their targeting to more effectively reduce health risks associated with cold homes and improve equity.