Journal of Epidemiology and Community Health最新文献

Background: Housing affordability stress is a significant determinant of psychological health among young adults in urban settings. However, prior studies often rely on a single indicator, limiting understanding of how objective financial burdens and subjective experiences of affordability stress relate to depressive symptoms and suicidal ideation. This study addresses these gaps by jointly examining objective and subjective housing affordability stress.

Methods: We used longitudinal data from the Seoul Young Adult Panel Study (2021-2024), comprising 5155 individuals and 13 735 person-wave observations. Objective housing affordability stress was defined as allocating 30% or more of total household expenditures to housing, while subjective affordability stress captured self-reported difficulty paying housing-related expenses. Individual fixed-effects regression models were estimated to examine within-person associations between housing affordability stress and depressive symptoms and suicidal ideation.

Results: Both objective and subjective housing affordability stress were significantly associated with higher depressive symptoms and increased likelihood of suicidal ideation. Subjective affordability stress showed a stronger association with depressive symptoms than objective measures. When the two measures were considered jointly, individuals experiencing both objective and subjective affordability stress had the highest levels of depressive symptoms and suicidal ideation, indicating an additive effect of dual affordability stress.

Conclusions: Objective and subjective measures of housing affordability stress capture distinct yet complementary dimensions of housing-related hardship and identify different at-risk groups. A joint measurement approach provides a more comprehensive assessment of housing-related psychological health risks among urban young adults than reliance on a single indicator.

Background: Health-related economic inactivity in England has risen, with more working-age adults claiming disability and incapacity benefits. The 2016 Welfare Reform and Work Act reduced weekly payments for Employment and Support Allowance recipients deemed capable of some work from April 2017, potentially affecting poverty, mental health and employment among people with long-term conditions (LTCs). Evidence on its causal impact is limited.

Data and methods: Using UK Household Longitudinal Survey data (2010-2019), we evaluated the reform's impact on working-age individuals with LTCs. Triple-difference and difference-in-differences models assessed transitions in employment, poverty risk (income <40% median) and incident poor mental health (defined as SF-12 Mental Component Score ≤45.6 among those without prior poor mental health), controlling for age, gender, children and education.

Results: The 2017 reform was associated with a 5.5 percentage point increase in poverty risk among individuals with LTCs leaving employment (95% CI 1.4% to 9.6%, p=0.008) and an 8.9 percentage point increase in the incidence of poor mental health in this group (95% CI 1.1% to 16.7%, p=0.025). No significant effects on transitions into or out of employment were observed at the 95% confidence level.Applying these estimates to national employment figures suggests that the reform may have resulted in approximately 37254 additional people entering severe poverty and 60117 additional cases of poor mental health annually.

Conclusions: These findings suggest that reductions in disability-related benefits may exacerbate financial and mental health vulnerability among affected individuals but not affect employment. This highlights the need for policy measures that balance fiscal objectives with social protection.

Background: Allostatic load (AL) is the physiological burden of stress, and it is suggested to be a mediator between socioeconomic position and health. The aim of this article was to study life-course trajectories in levels of AL by employing data collected over three decades (1994-2019) to compare sex and socioeconomic groups in the adult Norwegian population.

Methods: Harmonised data from the following Norwegian health studies were used: the Trøndelag Health Study, the Tromsø Study, the Age 40 Program and CONOR. In total, 264 824 participants aged 30-79 years contributed with 346 312 health examinations. A combined AL score was calculated as the number of biomarkers in the worst quartile among the following eight variables: systolic blood pressure, diastolic blood pressure, resting heart rate, triglycerides, total cholesterol, high-density lipoprotein cholesterol, body mass index and waist-hip ratio. High-sensitivity C reactive protein and glycated haemoglobin were included in sensitivity analyses for a subset of participants. Life-course trajectories were analysed by using a linear mixed model. A shared-parameter model was employed to evaluate attrition caused by death.

Results: Participants with primary education had higher AL compared with secondary and tertiary educated people in all age groups. Men had higher AL than women throughout the life-course. Overall, AL increased with age but levelled off at higher ages among women and decreased at higher ages among men.

Conclusions: We found significant socioeconomic inequalities and sex differences in AL throughout the life-course. This highlights a potential for improvement in public health by effective treatment and public health measures to reduce AL inequities.

Background: Bridging capital (ie, friendships across socioeconomic strata) increases upward economic mobility, yet its role in shaping health outcomes remains poorly understood. Evidence appears especially limited for low-income communities and populations experiencing disproportionate health risks. We examine the association between economic connectivity, a type of bridging capital, and perinatal health disparities. We used a recently released zip code level measure of bridging capital derived from Facebook data on more than 70 million US adults to examine the associations between social connectedness and fetal and infant death in California (8 million births; 2005 to 2021).

Methods: We used generalised estimating equations to test the association between the z-scored economic connectivity and the odds of fetal death and infant death. We used information on median household income in each zip code to focus on mothers residing in the lowest quartile neighbourhoods of income. We also examined non-Hispanic (NH) black mothers in low-income neighbourhoods given that they experience persistently elevated risks of perinatal mortality.

Results: We found strong protective associations (p<0.001) between bridging capital and fetal and infant death among residents of low-income areas (OR: 0.75, 95% CI 0.70 to 0.80 ; OR: 0.82, 95% CI 0.82 to 0.94). We also found strong protective associations when restricting to NH black persons only for fetal death (OR: 0.81, 95% CI 0.71 to 0.93) and infant death (OR: 0.79, 95% CI 0.70 to 0.90).

Conclusion: Cross-class social connections may play an important but underexamined role in promoting maternal and infant health, particularly within disadvantaged communities.

Background: Socioeconomic inequalities in mortality persist across welfare systems. Income, a key determinant of material resources and long-term security, is rarely measured at the individual level in epidemiological studies due to data limitations. This study addresses this gap by combining individual-level income and mortality data in Italy, focusing on the elderly, for whom income may be a more sensitive socioeconomic indicator than education.

Methods: A nationwide retrospective cohort study was conducted on residents aged ≥65 years (n=12.8 million), as of 31 December 2018. Individual income for 2018 was obtained from administrative tax and social security data and integrated with 2019 mortality using national population registers. Mortality Rate Ratios (MRRs) with 95% CIs were estimated using negative binomial regression models, both age-adjusted and fully adjusted for marital status, education and geographic area. Analyses were stratified by sex.

Results: A clear income gradient in mortality was observed. Excess mortality gradually decreased across ascending income groups. In fully adjusted models, individuals in the lowest income class had significantly higher mortality than those in the highest (MRR=1.65, 95% CI 1.61 to 1.70 in men; MRR=1.47, 95% CI 1.43 to 1.50 in women). Education and marital status also influenced mortality, while geographic differences were minimal.

Conclusions: In Italy, substantial income-related inequalities in mortality persist among the older population, showing that socioeconomic disparities remain marked even with broad access to healthcare. Individual-level income is a key predictor of mortality and should be prioritised in addressing health inequalities in ageing societies, as it better reflects material conditions relevant to health than educational attainment.

Introduction: Accounting for missing data by imputing or weighting conditional on covariates relies on the variable with missingness being observed at least some of the time for all unique covariate values. This requirement is referred to as positivity, and positivity violations can result in bias. Here, we review a novel approach to addressing positivity violations in the context of systolic blood pressure.

Methods: To illustrate the proposed approach, we estimate the mean systolic blood pressure among children and adolescents aged 2-17 years old in the USA using data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). As blood pressure was not measured for those aged 2-7, there exists a positivity violation by design. Using a recently proposed synthesis of statistical and mathematical models, we integrate external information with NHANES to address our motivating question.

Results: With the synthesis model, the estimated mean systolic blood pressure was 100.5 (95% CI 99.9 to 101.0), which is notably lower than either a complete-case analysis or extrapolation from a statistical model. The synthesis results were supported by a diagnostic comparing the performance of the mathematical model in the positive region.

Discussion: Positivity violations pose a threat to quantitative medical research, and standard approaches to addressing non-positivity rely on restrictive untestable assumptions. Using a synthesis model, like the one detailed here, offers a viable alternative.

Background: Adverse childhood experiences (ACEs) are traumatic events that occur before a child reaches the age of 15 with long-term health consequences, economic costs and intergenerational challenges for society. This study investigated the association between ACEs and cardiometabolic risk (cardiovascular disease (CVD), diabetes, hypertension and obesity) in adulthood.

Methods: We used data from the Survey on Health, Well-Being and Ageing (SABE)-Colombia (n=18 044 adults aged >65). Exposures were defined as single and cumulative ACEs score. Logistic regression, adjusted for demographics and socioeconomic position, was used to investigate associations.

Results: 41.3% reported at least one ACE and 4.2% reported four or more. Associations between individual ACEs and outcomes differed by gender. In women, exposure to all ACEs, except childhood migration, was associated with increased odds of CVD, for example, emotional abuse (OR=1.69 (95% CI 1.32 to 2.13)) and poor childhood health status (OR=1.64 (95% CI 1.39 to 1.91)). Among men, these associations were much weaker and often non-statistically significant, except childhood migration that showed increased odds of CVD (OR=1.55 (95% CI 1.09 to 2.15), diabetes (OR=1.55 (95% CI 1.11 to 2.14)) and hypertension (OR=1.40 (95% CI 1.07 to 1.83) in adulthood). A significant association was observed between cumulative ACEs score and odds of CVD, diabetes and hypertension in both men and women. This pattern was not observed for obesity.

Conclusion: The long-term health consequences of ACEs differ by gender. Longitudinal studies are needed to establish causality and identify mediators. Public health interventions should adopt gender-sensitive, holistic approaches integrating biological, environmental, social and behavioural dimensions, and prioritise early-life interventions to address long-term health inequalities.

Background: Little is known about the association between direct pollen exposure and cognitive performance. The aim of our study is to investigate the effect of pollen exposure on performance in the Finnish matriculation examination.

Methods: The study was conducted among students who participated in the national high school matriculation examinations in the metropolitan area of Helsinki and Turku in southern Finland between 2006 and 2020. Daily regional pollen counts of alder and hazel were monitored throughout the study period as part of the Finnish pollen monitoring network. Extensive data on matriculation examination results were retrieved from Statistics Finland, and air pollution and weather data from the Finnish Meteorological Institute. A fixed effect regression analysis was used to identify the effect of pollen exposure (as independent variables) on matriculation examination results (as dependent variable) controlling for student-semester fixed effects, pollutants and precipitation.

Results: The regression coefficients indicated that on average an increase of 10 pollen grains in alder and hazel reduced the matriculation examination score by 0.0034 (p<0.01) and 0.0144 (p<0.05) standard deviations (SDs), respectively. Increasing pollen exposure per additional unit (an increase of 10 pollen grains) especially dropped examination scores in mathematical subjects among males (alder -0.0118 (p<0.001) and hazel -0.0328 (p<0.05) SDs). The association between alder pollen exposure (low, moderate and abundant) and examination scores was inversely U-shaped.

Conclusion: Exposure to pollen can hinder a student's performance in the matriculation exam, which strongly determines the future opportunities and emphasises early initiation of medication.

Background: Early cardiovascular disease risk detection opportunities are limited in men, whereas gestational diabetes, gestational hypertension and preeclampsia are risk indicators in women. We hypothesised adverse pregnancy outcomes also signal risk in fathers, due to shared environments and behaviours.

Methods: Our retrospective cohort study included fathers whose female partners had at least two singleton deliveries between April 1990 and December 2012. We examined population-based data up to April 2019 from Quebec province, Canada (health administrative databases, birth, stillbirth and death registries). The primary exposure was cumulative gestational diabetes, gestational hypertension and preeclampsia occurrences across two pregnancies. Outcomes were new diagnoses of diabetes, hypertension and cardiovascular disease in fathers, analysed using Cox proportional hazards models.

Results: Among 415 730 fathers, 17 065 developed diabetes, 44 315 developed hypertension and 9695 experienced a cardiovascular disease event over more than a decade. Compared with no gestational diabetes or gestational hypertension/preeclampsia occurrences in partners, the hazards of diabetes in fathers increased by 21% with a single occurrence (HR 1.21, 95% CI 1.16 to 1.26), 40% with two (HR 1.40, 95% CI 1.30 to 1.50) and 84% with three or more (HR 1.84, 95% CI 1.54 to 2.21). Corresponding increases in hypertension hazards were 11% (HR 1.11, 95% CI 1.08 to 1.14), 17% (HR 1.17, 95% CI 1.12 to 1.23) and 39% (HR 1.39, 95% CI 1.22 to 1.58), respectively. Cardiovascular disease hazards increased by 15% with two or more occurrences (HR 1.15, 95% CI 1.04 to 1.27).

Conclusion: More maternal adverse pregnancy outcomes lead to greater paternal cardiometabolic disease hazards. Partner pregnancy history may help identify at-risk men to support early prevention.

Background: Telehealth has become a critical tool for improving access to care among populations facing physical barriers to in-person care. However, its potential role in delivering care to adults with social barriers remains underexplored. We examined whether adults with loneliness or social isolation are more likely to use telehealth care versus in-person care compared to adults without loneliness or social isolation.

Methods: This cross-sectional study analysed data for US adults in the 2021 Medical Expenditure Panel Survey. Loneliness and social isolation were measured using the UCLA Loneliness Scale and the Berkman-Syme Social Network Index. Three indicators of healthcare utilisation were used as outcomes: in-person care only, telehealth care only and a combination of both.

Results: Among adults experiencing loneliness and social isolation, the likelihood of using only in-person care was lower by 4.1 (95% CI -6.1 to -2.1) and 2.8 (95% CI -5 to -0.6) percentage points. In contrast, the likelihood of using only telehealth care was higher by 2.6 (1.1-4.2) and 5.4 (3.9-6.9). The likelihood of using both in-person and telehealth care was also higher by 2.3 (0.7-3.9) and 5.2 (3.7-6.7), but telehealth was used more frequently than in-person care. Furthermore, telehealth utilisation for mental health services was higher among adults experiencing loneliness or social isolation.

Conclusion: Compared with adults who are not lonely or socially isolated, adults experiencing loneliness and social isolation are more likely to use telehealth and less likely to use in-person care. Telehealth may serve as a viable alternative for individuals facing social challenges in accessing in-person services.