Journal of Epidemiology and Community Health

Journal Information
ISSN / EISSN: 0143005X / 14702738
Published by: BMJ
Total articles ≅ 11,670

Latest articles in this journal

Qiguo Lian, Ruili Li, , Qiru Su
Published: 30 November 2022
by BMJ
Journal of Epidemiology and Community Health; https://doi.org/10.1136/jech-2022-219547

Abstract:
Background Although adolescents are generally healthy, subjective health complaints (SHC) are common in this age group, especially in adolescent girls. We explored the association between early menarche and the frequency of psychosomatic symptoms and how this association varies between countries. Methods Our sample included 298 000 adolescent girls from 2002, 2006, 2010 and 2014 cycles of the Health Behaviour in School-aged Children (HBSC) study in 41 European and North American countries. School surveys measured the frequency of eight psychosomatic symptoms in the past 6 months. Early maturation was defined as self-reported age at menarche below 11 years. Using logistic regression, we estimated adjusted ORs (aORs) and 95% CIsof experiencing each psychosomatic symptom at least more than once a week and experiencing two or more symptoms at least more than once a week. Results Early menarche occurred in 4.73% of the sample and was positively related to headache, stomachache, backache, feeling low, irritability or bad temper, feeling nervous, difficulties in sleeping, feeling dizzy and two or more of these symptoms, respectively (all p values<0.001). The interactions between early menarche and survey circle were non-significant. Changing the age criterion to 12 years did not affect the results. The associations between early menarche and psychosomatic symptoms were robust across the HBSC-participating counties with two age criteria. Conclusions Early menarche positively relates to various psychosomatic symptoms in European and North American adolescent girls. Our findings suggest that early-maturing girls may need early supportive interventions.
, Cathrine Juel Lau, Michael Davidsen, Ola Ekholm, Anne Illemann Christensen
Published: 29 November 2022
by BMJ
Journal of Epidemiology and Community Health; https://doi.org/10.1136/jech-2022-219944

Abstract:
Background Agreement may be low when comparing self-reported diseases in health surveys with registry data. The aim of the present study was to examine the agreement between seven self-reported diseases among a representative sample of Danish adults aged ≥16 years and data from medical records. Moreover, possible associations with sociodemographic variables were examined. Methods Nationally representative data on self-reported current or previous diabetes, asthma, rheumatoid arthritis, osteoporosis, myocardial infarction, stroke and cancer, respectively, were derived from the Danish National Health Survey in 2017 (N=183 372). Individual-level data were linked to data on the same diseases from medical records in registries. Logistic regression models were used to explore potential associations between sociodemographic variables and total agreement. Results For all included diseases, specificity was >92% and sensitivity varied between 66% (cancer) and 95% (diabetes). Negative predictive value (NPV) was >96% for all diseases and positive predictive value (PPV) varied between 13% (rheumatoid arthritis) and 90% (cancer). Total agreement varied between 91% (asthma) and 99% (diabetes), whereas the kappa value was lowest for rheumatoid arthritis (0.21) and highest for diabetes (0.88). Sociodemographic variables were demonstrated to be significantly associated with total agreement for all diseases, with sex, age and educational level exhibiting the strongest associations. However, the directions of the associations were inconsistent across diseases. Conclusion Overall, self-reported data were accurate in identifying individuals without the specific disease (ie, specificity and NPV). However, sensitivity, PPV and kappa varied greatly between diseases. These findings should be considered when interpreting similar results from surveys.
Finn Sigglekow, Nick Wilson, Tony Blakely
Published: 28 November 2022
by BMJ
Journal of Epidemiology and Community Health; https://doi.org/10.1136/jech-2021-218255

Abstract:
Objective: To estimate the income loss from having two or more diseases, over and above the independent and separate effects of having a single disease.Methods: We used linked health income data from 2006–2007 to 2015–2016 for 25–64 years, for the entire New Zealand population. Fixed effects OLS regression was used to estimate within-individual income loss for diseases separately, and to estimate if having two or more diseases together resulted in reduced (subadditive) or additional (superadditive) income impacts (relative to adding together the income impacts for each disease when experienced singly).Results: Of the 169 comorbidity pairs for both sexes, 28 (17%) had a statistically significant superadditive (n=14) or subadditive (n=14) effect of having two diseases. The combined total income gain from deleting all diseases and comorbidities was US$2.269 billion (95% CI US$$2.125 to US$2.389 billion), or a 3.61% (95% CI 3.38% to 3.80%) increase in income. Of this, 8.8% or US$200 million (95% CI US$193 to US$207 million) was attributable to a tendency for comorbidity interactions to increase income loss more than expected for common disease pairings.Conclusions: This national longitudinal study found that disease is associated with income loss, but most of this impact is due to the distinct and independent impact of separate diseases. Nevertheless, there was a tendency for two or more diseases to disproportionately increase income loss more than the summed impacts of each of these diseases if experienced singly.
, Tanja Aj Houweling, Pauline W Jansen, Nil Horoz, J. Marieke Buil, Pol Ac van Lier, Frank J van Lenthe
Published: 25 November 2022
by BMJ
Journal of Epidemiology and Community Health; https://doi.org/10.1136/jech-2022-219548

Abstract:
Background Stressful family conditions may contribute to inequalities in child development because they are more common among disadvantaged groups (ie, differential exposure) and/or because their negative effects are stronger among disadvantaged groups (ie, differential impact/susceptibility). We used counterfactual mediation analysis to investigate to what extent stressful family conditions contribute to inequalities in child development via differential exposure and susceptibility. Methods We used data from the Generation R Study, a population-based birth cohort in the Netherlands (n=6842). Mother’s education was used as the exposure. Developmental outcomes, measured at age 13 years, were emotional and behavioural problems (Youth Self-Report), cognitive development (Wechsler Intelligence Scale for Children) and secondary education entry level. Financial and social stress at age 9 years were the putative mediators. Results Differential exposure to financial stress caused a 0.07 (95% CI −0.12 to −0.01) SD worse emotional and behavioural problem -score, a 0.05 (95% CI −0.08 to −0.02) SD lower intelligence score and a 0.05 (95% CI −0.05 to −0.01) SD lower secondary educational level, respectively, among children of less-educated mothers compared with children of more-educated mothers. This corresponds to a relative contribution of 54%, 9% and 6% of the total effect of mother’s education on these outcomes, respectively. Estimates for differential exposure to social stress, and differential susceptibility to financial or social stress, were much less pronounced. Conclusion Among children of less-educated mothers, higher exposure to financial stress in the family substantially contributes to inequalities in socioemotional development, but less so for cognitive development and educational attainment.
Andrea Dalecká, Hynek Pikhart, Anna Bartošková, Naděžda Čapková, Martin Bobák
Published: 22 November 2022
by BMJ
Journal of Epidemiology and Community Health; https://doi.org/10.1136/jech-2022-219412

Abstract:
Background Numerous studies reported higher levels of mental health issues during the COVID-19 pandemic but only a minority used repeated measurements. We investigated change in depressive symptoms in the Czech ageing cohort and the impact of pre-existing and COVID-19-related stressors. Methods We used data on 2853 participants (mean age 73.4 years) from the Czech part of the prospective Health, Alcohol and Psychosocial factors In Eastern Europe cohort that participated in postal questionnaire surveys before (September 2017–June 2018) and during the pandemic (October 2020–April 2021). Participants reported their depressive symptoms using the Centre for Epidemiological Studies-Depression Scale including 10 (CESD-10) tool. A principal component analysis (PCA) was used to create representative components of the pandemic-related stressors. The impact of the stressors on change in depressive symptoms was tested using multivariable linear regression, after adjustment for age and potential confounders. Results Three patterns of the pandemic-related stressors (‘financial stressors’, ‘social and perception stressors’ and ‘death and hospitalisation stressors’) were extracted from the PCA. The mean CESD-10 score increased from 4.90 to 5.37 (p<0.001). In fully adjusted models, significantly larger increases in depression score were reported by older people (β=0.052; p=0.006), those with poor self-rated health (β=0.170; p<0.001), those who experienced death or hospitalisation of a close person (β=0.064; p<0.001), social deprivation (β=0.057; p<0.001), delays in healthcare (β=0.048; p=0.005) and those who suffered from COVID-19 (β=0.045; p=0.008). Conclusion This study confirms an increase in depressive symptoms in older persons during the pandemic and identified several pandemic-related risk factors suggesting that public health policies should address this vulnerable group by adopting the preventing strategies.
, Michel Grignon, Marisa Young,
Published: 16 November 2022
by BMJ
Journal of Epidemiology and Community Health; https://doi.org/10.1136/jech-2022-219545

Abstract:
Background It has been shown that the high cost of housing can be detrimental to individual health. However, it is unknown (1) whether high housing costs pose a threat to population health and (2) whether and how social policies moderate the link between housing cost burden and mortality. This study aims to reduce these knowledge gaps. Methods Country-level panel data from Organisation for Economic Co-operation and Development (OECD) countries are used. Housing cost to income ratio and age-standardised mortality were obtained from the OECD database. Fixed effects models were conducted to estimate the extent to which the housing cost to income ratio was associated with preventable mortality, treatable mortality, and suicides. In order to assess the moderating effects of social and housing policies, different types of social spending per capita as well as housing policies were taken into account. Results Housing cost to income ratio was significantly associated with preventable mortality, treatable mortality, and suicide during the post-global financial crisis (2009–2017) but not during the pre-global financial crisis (2000–2008). Social spending on pensions and unemployment benefits decreased the levels of mortality rate associated with housing cost burden. In countries with higher levels of social housing stock, the link between housing cost burden and mortality was attenuated. Similar patterns were examined for countries with rent control. Conclusion Our findings suggest that housing cost burden can be related to population health. Future studies should examine the role of protective measures that alleviate health problems caused by housing cost burden.
, Claire L Cleland, John Busby, Glenna Nightingale, Frank Kee, , Paul Kelly, Michael P Kelly, Karen Milton, Kelly Kokka, et al.
Published: 15 November 2022
by BMJ
Journal of Epidemiology and Community Health; https://doi.org/10.1136/jech-2022-219729

Abstract:
Background Evidence regarding the effectiveness of 20 miles per hour (mph) speed limit interventions is limited, and rarely have long-term outcomes been assessed. We investigate the effect of a 20 mph speed limit intervention on road traffic collisions, casualties, speed and volume at 1 and 3 years post-implementation. Methods An observational, repeated cross-sectional design was implemented, using routinely collected data for road traffic collisions, casualties, speed and volume. We evaluated difference-in-differences in collisions and casualties (intervention vs control) across three different time series and traffic speed and volume pre-implementation, at 1 and 3 years post-implementation. Results Small reductions in road traffic collisions were observed at year 1 (3%; p=0.82) and year 3 post-implementation (15%; p=0.31) at the intervention site. Difference-in-differences analyses showed no statistically significant differences between the intervention and control sites over time for road traffic collisions. There were 16% (p=0.18) and 22% (p=0.06) reductions in casualty rates at years 1 and 3 post-implementation, respectively, at the intervention site. Results showed little change in mean traffic speed at year 1 (0.2 mph, 95% CI −0.3 to 2.4, p=0.14) and year 3 post-implementation (0.8, 95% CI −1.5 to 2.5, p=0.17). For traffic volume, a decrease in 57 vehicles per week was observed at year 1 (95% CI –162 to −14, p<0.00) and 71 vehicles at year 3 (95% CI −213 to 1, p=0.05) post-implementation. Conclusion A 20 mph speed limit intervention implemented at city centre scale had little impact on long-term outcomes including road traffic collisions, casualties and speed, except for a reduction in traffic volume. Policymakers considering implementing 20 mph speed limit interventions should consider the fidelity, context and scale of implementation.
, , David Henry McKelly, Robin Wood, Sabine Hermans
Published: 15 November 2022
by BMJ
Journal of Epidemiology and Community Health; https://doi.org/10.1136/jech-2022-219622

Abstract:
Background Individuals with a history of tuberculosis (TB) disease are at higher risk of developing a subsequent episode than those without. Considering the role of social and environmental factors in tuberculosis, we assessed neighbourhood-level risk factors associated with recurrent tuberculosis in Cape Town, South Africa. Methods This cohort consisted of patients who completed treatment for their first drug-sensitive TB episode between 2003 and 2015. Addresses were geocoded at neighbourhood level. Data on neighbourhood-level factors were obtained from the Census 2011 (household size, population density) and the City of Cape Town (Socio-Economic Index). Neighbourhood-level TB burden was calculated annually by dividing the number of notified TB episodes by the population in that neighbourhood. Multilevel survival analysis was performed with the outcome recurrent TB, defined as a second episode of TB, and controlling for individual-level risk factors (age, gender and time since first episode in years). Follow-up ended at the second episode, or on 31 December 2015, whichever came first. Results The study included 173 421 patients from 700 neighbourhoods. Higher Socio-Economic Index was associated with a lower risk of recurrence compared with average Socio-Economic Index. An increased risk was found for higher household size and TB burden, with an increase of 20% for every additional person in mean household size and 10% for every additional TB episode/100 inhabitants. No association was found with population density. Conclusion Recurrent TB was associated with increased household size and TB burden at neighbourhood level. These findings could be used to target TB screening activities.
Kirstin Leslie, Beth Findlay, Theresa Ryan, Leonardo I Green, Ciaran Harvey, Alice E Whettlock, Jen Bishop, , April Went, Lesley Wallace, et al.
Published: 8 November 2022
by BMJ
Journal of Epidemiology and Community Health; https://doi.org/10.1136/jech-2022-219367

Abstract:
Background The early COVID-19 pandemic in Scotland—defined as the era before widespread access to vaccination and monoclonal antibody treatment—can be characterised into three distinct waves: March–July 2020, July 2020–April 2021 and May–August 2021. Each wave was met with various societal restrictions in an effort to reduce disease transmission and associated morbidity and mortality. Understanding the epidemiology of infections during these waves can provide valuable insights into future pandemic planning. Methods Scottish RT-PCR testing data reported up until 8 August 2021, the day prior to most restrictions being lifted in Scotland, were included. Demographic characteristics including age, sex and social deprivation associated with transmission, morbidity and mortality were compared across waves. A case–control analysis for each wave was then modelled to further compare risk factors associated with death over time. Results Of the 349 904 reported cases, there were 18 099, 197 251 and 134 554 in waves 1, 2 and 3, respectively. Hospitalisations, intensive care unit admissions and deaths appeared highest in wave 2, though risk factors associated with COVID-19 death remained similar across the waves. Higher deprivation and certain comorbidities were associated with higher deaths in all waves. Conclusions Despite the higher number of cases reported in waves 2 and 3, case fatality rates were lower: likely a combination of improved detection of infections in younger age groups, introduction of social measures and vaccination. Higher social deprivation and comorbidities resulted in higher deaths for all waves.
, Clara Llorens-Serrano, , , Salvador Moncada,
Published: 7 November 2022
by BMJ
Journal of Epidemiology and Community Health; https://doi.org/10.1136/jech-2022-219523

Abstract:
Background Studying the working population’s mental health in times of crisis (such as the 2008 recession or the COVID-19 pandemic) is very relevant. This study aims to assess the prevalence of poor mental health among the Spanish salaried population, according to the labour market inequality axes (2005–2021). Methods Repeated cross-sectional study by comparing different surveys from 2005, 2010, 2016 and 2021 on workers residing in Spain who had been working in a salaried job during the week preceding the survey. n=7197 (2005), n=4985 (2010), n=1807 (2016) and n=18 870 (2021). Outcome variable: poor mental health (Mental Health Inventory of the 36-item Short Form Health Survey scale). Explanatory variables: gender, age, occupational class and type of contract. Prevalence of poor mental health was estimated for each year by means of logistic regression models with robust clustered SEs, stratifying by the explanatory variables. Additionally, prevalence ratios (PR) were estimated by means of robust Poisson regression models to assess differences between the explanatory variables’ categories. All analyses were weighted to address unrepresentativeness. Results Poor mental health significantly increased in 2021 (55.92%), compared with the previous years of study (15%–17.72%). Additionally, pattern changes were identified on inequality axes in 2021, with better mental health status among older workers (oldest group PR: 0.76; 95% CI 0.71 to 0.8) and permanent workers (PR: 0.9; 95% CI 0.85 to 0.94). Conclusion This study shows a steep worsening of mental health among the salaried population in 2021 compared with previous periods. In 2021, health inequalities have apparently narrowed, although not by improving the disadvantaged groups’ mental health but by worsening the typically advantaged groups’ mental health.
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