Pre-pregnancy body mass index, gestational weight gain and adverse birth outcomes: some evidence from Italy.

BACKGROUND: Overweight and obese women present an increased risk of poor maternal and child health outcomes. The aim of this paper is to analyze the joint effects of pre-pregnancy body mass index and inadequate gestational weight gain on birth weight and gestational age in an Italian sample of pregnant women. METHODS: Data were obtained from a sample of about 2,000 pregnant women at the University Teaching Hospital of Perugia University (Italy) in 2013. We used the revised classification proposed by Institute of Medicine to identify gestational weight gains considered as appropriate. Logistic regression models were used to estimate the adjusted odds-ratios of women belonging to any BMI class different from normal (used as the reference category) and of women who increased their weight by an amount smaller or greater than normal, controlling for a large set of observable confounders. RESULTS: Higher probability of low birth weight was associated with both obesity (OR = 1.9124, s.e. = 0.526) and less than normal weight gains (OR = 2.3614, s.e. = 0.388). The probability of fetal macrosomia was found to be positively associated with more than normal weight increases (OR = 2.6232, s.e. = 0.465). Pre-term deliveries were associated with less than normal gestational weight gains (OR 1.7338, s.e. = 0.320). CONCLUSION: Overweight and obesity represent a big issue for public health. In particular, weight management during pregnancy and pre-pregnancy could determine negative health outcomes in newborns. In our study we found that inadequate weight variations during pregnancy, according to the Classification of the Institute of Medicine, negatively influence health conditions at birth. Stronger initiatives, especially in terms of midwifery, nurse training and informative policies should be adopted by policy makers.

Health and income inequalities in Europe: What is the role of circumstances?

Equality of opportunity theories distinguish between inequalities due to individual effort and those due to external circumstances. Recent research has shown that half of the variability in income of World population was determined by country of birth and income distribution. Since health and income are generally strictly related, the aim of this paper is to estimate how much variability in income and health is determined by external circumstances. We use data from the Survey of Health, Ageing and Retirement (SHARE) and the English Longitudinal Survey on Ageing (ELSA), two comparable multidisciplinary surveys that provide micro-level data on health and financial resources among the elderly for a large number of European countries. Our baseline estimation shows that about 20% of the variability in income is explained by current country-specific circumstances, while health outcomes range from 12% using BMI to 19% using self-rated health. By including early-life circumstances, the explained variability increases almost 20 percentage points for income and for self-rated health but less for other health outcomes. Finally, by controlling for endogeneity issues linked with effort, our estimates indicate that circumstances better explain variability in health outcomes. Results are robust to some tests, and the implications of these findings are discussed.

Economic Evaluation of the effect of Quitting Smoking on Weight Gains: Evidence from the United Kingdom.

OBJECTIVE: This article estimated the causal effect of quitting smoking on body weight gains in the United Kingdom to evaluate whether savings in health costs deriving from smoking prevention and its related diseases are greater than the costs associated with increased obesity. METHODS: We used a longitudinal data set extracted from two waves (2004-2006) of the British Household Panel Survey, which includes information on smoking and a large number of sociodemographic variables. We modeled the effect of quitting smoking on body weight accounting for heterogeneous responses from individuals belonging to different clinical classes of body mass index (BMI) (i.e., overweight and obese individuals). National Health Service costs associated with smoking were then used to implement a cost-benefit analysis, comparing the advantages of smoking reductions with the costs associated with increased obesity. RESULTS: The BMI was found to increase by 0.26 points for quitters compared with those who continued to smoke. The estimated BMI increase was larger for overweight (0.49 points) and obese (0.76 points) people. This result does not change when different control groups are examined. From an economic perspective, the National Health Service cost reductions attributable to quitting smoking were £156.81 million whereas the lost benefit for unintended increases in body weight was £24.07 million. CONCLUSIONS: This article found that the health benefits associated with quitting smoking are greater than the costs associated with increased overweight and obesity.

Impact of immigration on burden of tuberculosis in Umbria: a low-incidence Italian region with high immigrants rates.

INTRODUCTION: In Italy, Tubercolosis (TB) has increasingly become a disease for specific population subgroups such as immigrants. The objective of this paper is to describe the trend in TB incidence from 1999 to 2008 in Umbria: a low-incidence Italian region with high immigrants rates. METHODS: Data were obtained from the Regional Information System for Infectious Diseases. Using a linear regressions model we estimated trends for number of cases and incidence rates; with a logistic regression model we estimated the effect of a set of covariates on the probability of being affected by TB. RESULT: 590 TB cases were reported of whom 254 (43%) were foreign. In 2008 39.7 new cases per 100.000 were registered among foreign-born subjects. TB incidence among Italians was 3.8/100.000 Italians. But a linear regression analysis showed a statistically significant decreasing trend in the notification rate among foreign-born people (coef: -7.32, r2:0.57, p < 0.05). The probability to be affected by extra-pulmonary is significantly larger in foreign patients (OR = 0.72, CI = 0.48-1.07). Foreign unskilled workers report a higher probability to be affected by TB (OR = 19.05, CI = 6.01-60.4). DISCUSSION: Increasing immigration rates may affect TB epidemiology. The analysis of incidence trends is an important toolfor monitoring tuberculosis disease control and to identify specific sub-group at risk.

Food prices and overweight patterns in Italy.

In this paper, we examine the role of relative food prices in determining the recent increase in body weight in Italy. Cross-price elasticities of unhealthy and healthy foods estimated by a demand system provide a consistent framework to evaluate substitution effects, when a close association is assumed between unhealthy (healthy) foods and more (less) energy-dense foods. We used a dataset constructed from a series of cross-sections of the Italian Household Budget Survey (1997-2005) to obtain the variables of the demand system, which accounts for regional price variability. The relative increase in healthy food prices was found to produce nontrivial elasticities of substitution towards higher relative consumption of unhealthy foods, with effects on weight outcomes. In addition, these changes were unevenly distributed among individuals and were particularly significant for those who were poorer and had less education.