RESUMO
BACKGROUND: Most older adults wish to remain in their homes and communities as they age. Despite this widespread preference, disparities in health outcomes and access to healthcare and social support may create inequities in the ability to age in place. Our objectives were to synthesise evidence of social inequity in ageing in place among older adults using an intersectional lens and to evaluate the methods used to define and measure inequities. METHODS: We conducted a mixed studies systematic review. We searched MEDLINE, EMBASE, PsycINFO, CINAHL and AgeLine for quantitative or qualitative literature that examined social inequities in ageing in place among adults aged 65 and older in Organisation for Economic Co-operation and Development (OECD) member countries. Results of included studies were synthesised using qualitative content analysis guided by the PROGRESS-Plus framework. RESULTS: Of 4874 identified records, 55 studies were included. Rural residents, racial/ethnic minorities, immigrants and those with higher socioeconomic position and greater social resources are more likely to age in place. Women and those with higher educational attainment appear less likely to age in place. The influence of socioeconomic position, education and social resources differs by gender and race/ethnicity, indicating intersectional effects across social dimensions. CONCLUSIONS: Social dimensions influence the ability to age in place in OECD settings, likely due to health inequalities across the lifespan, disparities in access to healthcare and support services, and different preferences regarding ageing in place. Our results can inform the development of policies and programmes to equitably support ageing in place in diverse populations.
Assuntos
Vida Independente , Fatores Socioeconômicos , Humanos , Idoso , Feminino , Masculino , Envelhecimento/psicologia , Fatores Etários , Idoso de 80 Anos ou mais , Apoio Social , Disparidades em Assistência à Saúde , Determinantes Sociais da Saúde , Disparidades nos Níveis de Saúde , Países DesenvolvidosRESUMO
BACKGROUND AND OBJECTIVES: People aged 65 and older, deemed most "vulnerable" by public health, were targeted by the coronavirus disease 2019 protection measures, which sought to minimize physical contact and social activities. Older adults living alone were particularly affected by these measures. However, such measures meant to protect the older population may not have necessarily reflected older adults' individual prioritization choices. This study therefore aimed to understand how protecting oneself over the virus was considered in the prioritization of other health and social needs of older adults living alone during the pandemic. RESEARCH DESIGN AND METHODS: This study adopted a qualitative design. A total of 17 semistructured interviews were conducted between May 2021 and June 2022 with older adults living alone. All interviews were audio-recorded and transcribed verbatim. A reflexive thematic analysis as defined by Braun and Clarke was performed. RESULTS: Our analysis showed 2 forms of prioritization across 2 themes. This first theme focused on participants who reported prioritizing protecting themselves over the virus by limiting in-person contact and activities. The second theme showed that although several participants reported that protecting themselves over the virus was important to them, the prioritization of this need was not shared by all and, in some cases, evolved over the course of the pandemic. DISCUSSION AND IMPLICATIONS: Our study demonstrated heterogeneity in the prioritization of older adults needs. Future public health recommendations should consider these variations in the needs and priorities of older adults when determining public health measures.
Assuntos
COVID-19 , Pesquisa Qualitativa , SARS-CoV-2 , Humanos , Idoso , COVID-19/prevenção & controle , COVID-19/epidemiologia , COVID-19/psicologia , Feminino , Masculino , Idoso de 80 Anos ou mais , Vida Independente/psicologiaRESUMO
AIM: Persons living with dementia are a heterogeneous population with complex needs whose healthcare use varies widely. This study aimed to identify the healthcare use profiles in a cohort of persons with incident dementia, and to describe their characteristics. METHODS: This is a retrospective cohort study of health administrative data in Quebec (Canada). The study population included persons who: (i) had an incident dementia diagnosis between 1 April 2015 and 31 March 2016; (ii) were aged ≥65 years and living in the community at the time of diagnosis. We carried out a latent class analysis to identify subgroups of healthcare users. The final number of groups was chosen based on clinical interpretation and statistical indicators. RESULTS: The study cohort consisted of 15 584 individuals with incident dementia. Four profiles of healthcare users were identified: (i) Low Users (36.4%), composed of individuals with minimal healthcare use and fewer comorbidities; (ii) Ambulatory Care-Centric Users (27.5%), mainly composed of men with the highest probability of visiting cognition specialists; (iii) High Acute Hospital Users (23.6%), comprised of individuals mainly diagnosed during hospitalization, with higher comorbidities and mortality rate; and (iv) Long-Term Care Destined Users (12.5%), who showed the highest proportion of antipsychotics prescriptions and delayed hospitalization discharge. CONCLUSIONS: We identified four distinct subgroups of healthcare users within a population of persons living with dementia, providing a valuable context for the development of interventions tailored to specific needs within this diverse population. Geriatr Gerontol Int 2024; 24: 789-796.
Assuntos
Demência , Humanos , Demência/epidemiologia , Masculino , Feminino , Idoso , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Quebeque/epidemiologia , Estudos de Coortes , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricosRESUMO
BACKGROUND: Scholars recommend providing migrants living with HIV (MLWH) with free treatment, rapidly, once linked to care to optimize their HIV-related experiences and health outcomes. Quantitative evaluations of patient-reported measures for MLWH in such models are necessary to explore the viability of these recommendations. METHODS: Within a 96-week prospective cohort study at a multidisciplinary HIV clinic, participants received bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) for free and rapidly following care linkage. Eight patient-reported measures were administered at weeks 4, 24, and 48: (1) mMOS-SS to measure perceived social support; (2) IA-RSS to measure internalized stigma; (3) K6 to measure psychological distress; (4) PROMIS to measure self-efficacy with treatment taking; (5) G-MISS to measure perceived compliance with clinicians' treatment plans; (6) HIVTSQ to measure treatment satisfaction; (7) CARE to measure perceived provider empathy; and (8) PRPCC to measure perceived clinician cultural competence. Linear mixed modelling with bootstrapping was conducted to identify significant differences by sociodemographics and time. RESULTS: Across weeks 4, 24, and 48, results suggest that MLWH enrolled in this study experienced moderate levels of social support; elevated levels of HIV-related stigma; moderate levels of distress; high self-efficacy with daily medication self-management; great compliance with clinicians' treatment plans; high treatment satisfaction; high perceived empathy; and high perceived cultural competence. Experience of social support (i.e., mMOS-SS scores) differed significantly by birth region. Experience of HIV-related stigma (i.e., IA-RSS scores) differed significantly by birth region, age, and language. Experience of distress (i.e., K6 scores) differed significantly by sexual orientation. Experience of treatment satisfaction (i.e., HIVTSQ scores) differed significantly by birth region and age. No significant differences were identified by time for any measure. CONCLUSION: Overall, participants expressed positive experiences around treatment and care, alongside comparably lower perceptions of social support, internalized stigma, and distress, potentially underscoring a need to embed targeted, well-funded, and accessible mental health support within HIV care models.
Assuntos
Fármacos Anti-HIV , Infecções por HIV , Medidas de Resultados Relatados pelo Paciente , Estigma Social , Migrantes , Humanos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Masculino , Feminino , Adulto , Estudos Prospectivos , Fármacos Anti-HIV/uso terapêutico , Pessoa de Meia-Idade , Apoio Social , Compostos Heterocíclicos de 4 ou mais Anéis/uso terapêutico , Tenofovir/uso terapêutico , Emtricitabina/uso terapêutico , Piperazinas/uso terapêutico , Adesão à Medicação , Piridonas/uso terapêutico , Combinação de Medicamentos , Satisfação do Paciente , Adulto Jovem , Autoeficácia , Amidas , Compostos Heterocíclicos com 3 AnéisRESUMO
AIM: To develop a typology of care trajectories (CTs) 1 year before and after a first dementia diagnosis in individuals aged ≥65 years, with prevalent schizophrenia or bipolar disorder. METHODS: This was a longitudinal, retrospective cohort study using health administrative data (1996-2016) from Quebec (Canada). We selected patients aged ≥65 years with an incident diagnosis of dementia between 1 January 2014 and 31 December 2016, and a diagnosis of schizophrenia and/or or bipolar disorder. A CT typology was generated by a multidimensional state sequence analysis based on the "6 W" model of CTs. Three dimensions were considered: the care setting ("where"), the reason for consultation ("why") and the specialty of care providers ("which"). RESULTS: In total, 3868 patients were categorized into seven distinct types of CTs, with varying patterns of healthcare use and comorbidities. Healthcare use differed in terms of intensity, but also in its distribution around the diagnosis. For instance, whereas one group showed low healthcare use, healthcare use abruptly increased or decreased after the diagnosis in other groups, or was equally distributed. Other significant differences between CTs included mortality rates and use of long-term care after the diagnosis. Most patients (67%) received their first dementia diagnosis during hospitalization. CONCLUSIONS: Our innovative approach provides a unique insight into the complex healthcare patterns of people living with serious mental illness and dementia, and provides an avenue to support data-driven decision-making by highlighting fragility areas in allocating care resources. Geriatr Gerontol Int 2024; 24: 577-586.
Assuntos
Demência , Humanos , Demência/diagnóstico , Demência/epidemiologia , Masculino , Feminino , Idoso , Estudos Retrospectivos , Quebeque/epidemiologia , Idoso de 80 Anos ou mais , Estudos Longitudinais , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Hospitalização/estatística & dados numéricos , Estudos de CoortesRESUMO
Background: Rural persons with dementia face medical services gaps. This study compares the health service utilization of rural and urban community-dwelling individuals with incident dementia. Methods: This study used a repeated annual cross-sectional cohort design spanning a period from 2000 to 2019 analyzing age-adjusted rates for 20 indicators of service use and mortality one year after diagnosis in Quebec administrative databases. Results: Of 237,259 persons, 20.1% were rural. Most rural persons had more emergency department visits and hospitalizations, shorter stays, less alternate level of care and fewer family physicians' and cognition specialists' visits. All groups had similar long-term care and mortality rates. Conclusion: Policy implications of these disparities are discussed.
Assuntos
Demência , População Rural , População Urbana , Humanos , Demência/epidemiologia , Demência/terapia , Quebeque/epidemiologia , Feminino , Masculino , Idoso , Estudos Transversais , População Rural/estatística & dados numéricos , Idoso de 80 Anos ou mais , População Urbana/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos de Coortes , Hospitalização/estatística & dados numéricosRESUMO
Objectives: Describe sex differences in healthcare utilization and mortality in persons with new dementia in Quebec, Canada. Methods: We conducted a repeated cohort study from 2000 to 2017 using health administrative databases. Community-dwelling persons aged 65+ with a new diagnosis of dementia were included. We measured 23 indicators of healthcare use across five care settings: ambulatory care, pharmacological care, acute hospital care, long-term care, and mortality. Clinically meaningful sex differences in age-standardized rates were determined graphically through expert consultations. Results: Women with dementia had higher rates of ambulatory care and pharmacological care, while men with dementia had higher acute hospital care, admission to long-term care, and mortality. There was no meaningful difference in visits to cognition specialists, antipsychotic prescriptions, and hospital death. Discussion: Men and women with dementia demonstrate differences in healthcare utilization and mortality. Addressing these differences will inform decision-makers, care providers and researchers and guide more equitable policy and interventions in dementia care.
RESUMO
OBJECTIVE: Multidisciplinary care with free, rapid, and on-site bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) dispensation may improve health outcomes among migrants living with HIV. However, models for rapid B/F/TAF initiation are not well studied among migrants living with HIV, and an understanding of how social determinants of health (SDH) may affect HIV-related health outcomes for migrants enrolled in such care models is limited. METHODS: Within a 96-week pilot feasibility prospective cohort study at a multidisciplinary HIV clinic, participants received free B/F/TAF rapidly after care linkage. The effects of SDH (i.e., birth region, sexual orientation, living status, education, employment, French proficiency, health coverage, use of a public health facility outside our clinic for free blood tests, and time in Canada) and other covariates (i.e., age, sex) on median time to antiretroviral therapy (ART) initiation and HIV viral undetectability from care linkage were calculated via survival analyses. RESULTS: Thirty-five migrants were enrolled in this study. Median time to ART initiation and HIV undetectability was 5 days (range 0-50) and 57 days (range 5-365), respectively. Those who took significantly longer to initiate ART were aged <35 years, identified as heterosexual, had less than university-level education, or were unemployed. No factor was found to significantly affect time to undetectability. CONCLUSION: Despite the provision of free B/F/TAF, several SDH were linked to delays in ART initiation. However, once initiated and engaged, migrants living with HIV reached HIV undetectability efficiently. Findings provide preliminary support for adopting this care model with migrants living with HIV and suggest that SDH should be considered when designing clinical interventions for more equitable outcomes.
Assuntos
Emtricitabina , Infecções por HIV , Determinantes Sociais da Saúde , Tenofovir , Migrantes , Humanos , Infecções por HIV/tratamento farmacológico , Feminino , Masculino , Adulto , Estudos Prospectivos , Migrantes/estatística & dados numéricos , Tenofovir/uso terapêutico , Emtricitabina/uso terapêutico , Projetos Piloto , Pessoa de Meia-Idade , Alanina/uso terapêutico , Alanina/análogos & derivados , Compostos Heterocíclicos de 4 ou mais Anéis/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Fármacos Anti-HIV/uso terapêutico , Tempo para o Tratamento , Combinação de Medicamentos , Carga Viral , Estudos de Viabilidade , Adulto Jovem , Canadá , Amidas , Piperazinas , PiridonasRESUMO
Financial wellbeing in retirement is contingent on realizations of financial expectations developed earlier in life and may differ substantially by gender. People's standard of living in retirement is tied to stability in work and income trajectories during working years along with retirement benefits and savings. Women have a greater overall income disadvantage relative to men, including reduced life course labor force exposure that may restrict retirement savings and benefits. Using the Canadian Longitudinal and International Study of Adults (LISA) and 20 years of linked tax record data (N = 2,353), we explore the association between instability in work and income histories and lower perceived retirement standard of living (PRSOL), net of retirement benefits, for women and men in Canada. Results show that for women, life course effects shaping PRSOL are driven by cumulative disability exposure and bouts of social assistance. For men, PRSOL is influenced more by cumulative unemployment. Although retirement benefits do not offset histories of work and income instability for either gender, income assistance is protective for women in retirement while personal investments are protective for men. Overall, our findings suggest that despite Canada's relatively generous pension program in later life, life course instability in work and income have persisting, gendered effects on financial wellbeing in retirement that underscore financial and health disadvantage for women across the life course.
Assuntos
Renda , Aposentadoria , Humanos , Aposentadoria/economia , Aposentadoria/psicologia , Feminino , Masculino , Canadá , Pessoa de Meia-Idade , Renda/estatística & dados numéricos , Estudos Longitudinais , Idoso , Fatores Sexuais , Pensões/estatística & dados numéricos , Emprego/estatística & dados numéricos , Emprego/psicologiaRESUMO
BACKGROUND: Work-related stressors and work-family conflict are important social determinants of mental health. While the impact of these stressors on parents' mental health is well documented, we know comparatively less about their impact on children's mental health. Furthermore, though the COVID-19 pandemic has significantly altered these stressors, particularly with the increase in teleworking, major knowledge gaps persist regarding the association between parents' stressors and perceived parental concern for their children's mental health during the COVID-19 pandemic. Based on the stress contagion perspective, this study tests (1) the mediating role of parents' depressive symptoms with parental concern for their children's mental health, and (2) whether these associations vary depending on whether parents had the opportunity to engage in telework. METHODS: A path analysis was performed from a cross-sectional analytic sample of 780 employed parents in the province of Quebec (Canada). The same model was then stratified by teleworking opportunity. The model's indirect associations were obtained by the bootstrap bias-corrected method with 1,000 replications. RESULTS: The results show that the stressors of work-to-family conflict, increased difficulties in work-family balance since the COVID-19 pandemic, irregular schedules, low esteem derived from work, and job insecurity were all indirectly associated with an increase in parental concern for their children's mental health through increased parents' depressive symptoms. However, some associations differ depending on teleworking status. The indirect associations involving increased difficulties in work-family balance since the COVID-19 pandemic as well as irregular work schedules were observed only in the teleworking group. CONCLUSIONS: This study fills a gap in research on the association between the work-family interface and parental concern for their children's mental health during the COVID-19 pandemic. It highlights the importance of concerted and cohesive action between child health policies and those regarding work and work-family balance to prevent work-related psychosocial risks, particularly considering the post pandemic expanded and persistent reliance on teleworking.
Assuntos
COVID-19 , Saúde Mental , Criança , Humanos , Estudos Transversais , Conflito Familiar , Depressão/epidemiologia , Depressão/psicologia , Pandemias , COVID-19/epidemiologia , Pais/psicologiaRESUMO
BACKGROUND: The Laval-ROSA Transilab is a living lab that aims to support the Laval Integrated Health and Social Services Centres (Quebec, Canada) in consolidating the Quebec Alzheimer Plan. It aims to improve care transitions between different settings (Family Medicine Groups, home care, and community services) and as such improve the care of people living with dementia and their care partners. Four transition-oriented innovations are targeted. Two are already underway and will be co-evaluated: A) training of primary care professionals on dementia and interprofessional collaboration; B) early referral process to community services. Two will be co-developed and co-evaluated: C) developing a structured communication strategy around the dementia diagnosis disclosure; D) designation of a care navigator from the time of dementia diagnosis. The objectives are to: 1) co-develop a dashboard for monitoring transitions; 2) co-develop and 3) co-evaluate the four targeted innovations on transitions. In addition, we will 4) co-evaluate the impact and implementation process of the entire Laval-ROSA Transilab transformation, 5) support its sustainability, and 6) transfer it to other health organizations. METHODS: Multi-methods living lab approach based on the principles of a learning health system. Living labs are open innovation systems that integrate research co-creation and knowledge exchange in real-life settings. Learning health systems centers care improvement on developing the organization's capacity to learn from their practices. We will conduct two learning cycles (data to knowledge, knowledge to practice, and practice to data) and involve various partners. We will use multiple data sources, including health administrative databases, electronic health records data, surveys, semi-structured interviews, focus groups, and observations. DISCUSSION: Through its structuring actions, the Laval-ROSA Transilab will benefit people living with dementia, their care partners, and healthcare professionals. Its strategies will support sustainability and will thus allow for improvements throughout the care continuum so that people can receive the right services, at the right time, in the right place, and from the right staff.
Assuntos
Demência , Rosa , Humanos , Canadá , Quebeque , Serviço Social , Demência/terapiaRESUMO
Comprehensive primary healthcare for patients with complex care needs requires connections to other health services, social services and community supports. This descriptive comparative policy research program used publicly available documents and informant interviews to examine progress toward integrated comprehensive care through the lens of services needed by children and youth (0-25 years) and community-dwelling older adults (≥ 65 years) with high functional health needs. This article describes five projects. The following three findings emerged across all the projects: Canada indeed has multiple health systems; numerous integrated service delivery solutions are being trialled and most focus on medical services; and it is an ongoing challenge for ministries of health to engage physicians and physician associations in integration.
Assuntos
Política de Saúde , Serviço Social , Criança , Adolescente , Humanos , Idoso , CanadáRESUMO
This paper describes how health and social services are governed and organized across Canada for two patient groups. Governance configurations and governance proximity between primary care and priority health and social services varied markedly between provinces. While the need for integrated service delivery has been made a clear priority during the COVID-19 pandemic, the potential of Canada's healthcare systems has not yet translated into coordinated and integrated care for health services, much less for health and social services. It is time to act on the policy recommendations from commissioned reports over the past two decades that focus on comprehensive, community-based care.
Assuntos
COVID-19 , Pandemias , Humanos , COVID-19/epidemiologia , Atenção à Saúde , Canadá , Serviço SocialRESUMO
Introduction: From a larger study examining policy and program information on how Canadian provinces integrate care services, this study aimed to create "priority lists" of 10-15 services that are "absolutely needed" for care integration. Methodology: A diverse group of over 50 Canadian stakeholders participated in virtual consensus-building using the nominal group technique and a modified e-Delphi method to identify services that focused on two different groups: children and youth with high functional health needs and older adults in functional decline. Results: Three lists - containing services, processes and infrastructure elements - emerged: one per tracer condition group and a consolidated list. The latter identified the following five services as top priority for primary care integration: mental health and addictions services; home care; transition between urgent-emergency-acute care; medication reconciliation in community pharmacies; and respite care. No single social service was a clear priority, but those that mitigate material deprivation emerged within the top 10. Discussion: This humble pan-Canadian study shows that priority services in health and social services are neither well integrated nor connected to primary care. It also suggests that effective policy strategizing for primary care integration for those with complex care needs may require thinking beyond the logic of services - given their siloed organization.
Assuntos
Serviços Médicos de Emergência , Criança , Adolescente , Humanos , Idoso , Canadá , ConsensoRESUMO
The First Ministers Health Accords of 2001 through 2003 (Health Canada 2006) launched the renewal of primary care toward more comprehensive care delivery models. We scanned government websites in the 10 Canadian provinces to assess how comprehensive and integrated renewal models were for health and social services in 2018. More comprehensive primary care delivery models were the norm in five out of 10 provinces. The policy approaches were: (1) expanding traditional family practice; (2) creating primary care networks; and (3) increasing the number of community health centres, which provide the broadest range of health and social care. Integration initiatives were limited to medical services. Additional financial and policy investments will be required to meet the comprehensive needs of patients with complex health and social needs at a system level.
Assuntos
Atenção à Saúde , Atenção Primária à Saúde , Humanos , CanadáRESUMO
BACKGROUND: Respite care is one of the most frequently requested support services by family caregivers. Yet, too often, respite care services are inaccessible, due in part to families' lack of knowledge regarding available services and a lack of service flexibility. Information and communication technologies (ICTs) may help to improve the flexibility of services available and families' knowledge of such services. However, an understanding of the use of ICTs and research in this area is lacking. OBJECTIVE: The objective of this study was to provide a comprehensive overview of the academic literature on ICTs for supporting the provision of respite care services. METHODS: A scoping review study was conducted. Six library databases were systematically searched for relevant literature. Key data were extracted into a summary chart. Text and quantitative data were coded using descriptive qualitative content analysis techniques, and the results were collated and summarized into a comprehensive narrative. RESULTS: A total of 23 papers describing 15 unique ICT programs exploring the potential of ICTs to support respite care services met the inclusion criteria. ICTs supported the provision of respite care by facilitating information-sharing with families and providers, recruiting and training respite care providers, and coordinating services. Key design considerations for developing respite care ICTs were trustworthiness and participatory design methods. Implementation considerations included designing for complementarity with existing services, assessing the appropriate timing for introducing the ICT-based services, and ensuring adequate promotion strategies to raise awareness about the services. CONCLUSIONS: There is limited but promising research on the potential of ICTs to support the provision of respite care services. Further research should be conducted to advance the results of this review, ultimately aiming to build ICTs that can improve the quality of, and access to, respite care services.
RESUMO
BACKGROUND: Road safety policies (RSPs) have emerged worldwide. Yet, while an important group of RSPs have been regarded as necessary to reduce traffic crashes and their consequences, the impact of others remain inconclusive. To advance knowledge on this debate, this article focuses on the potential effects of two RSPs: i) road safety agencies (RSAs) and ii) health systems (HS). METHODS AND DATA SOURCES: Cross-sectional longitudinal data corresponding to 146 countries from 1994 to 2012 are analyzed using regression models to account for the endogeneity of RSA formation, including instrumental variable and fixed effects designs. A global dataset compiling information from multiple sources, including the World Bank, and the World Health Organization is built. RESULTS: RSAs are associated with a decrease of traffic injuries in the long-term. This trend is observed in Organisation for Economic Co-operation and Development (OECD) countries only. Potential data reporting differences between countries could not be accounted for, and therefore it is unclear whether the observation for non-OECD countries is due to an actual difference or due to these reporting differences. HSs decrease traffic fatalities by 5% (95% Confidence interval (CI) 3% to 7%). Across (OECD) countries, HS is not associated with traffic injury variation. CONCLUSION: While some authors have theorised that RSA institutions may fail to reduce either traffic injuries or fatalities, our work however captured a long-term effect in RSAs performance when targeting traffic injury outcomes. That well-developed HSs have been effective in decreasing traffic fatalities, and ineffective in decreasing injuries, is consistent with the overall function that this type of policies fulfils. Results call for revisiting the specific mechanisms which explain why RSAs and HSs seem effective in decreasing different traffic outcomes.
Assuntos
Acidentes de Trânsito , Ferimentos e Lesões , Humanos , Acidentes de Trânsito/prevenção & controle , Estudos Transversais , Organização Mundial da Saúde , Políticas , Organização para a Cooperação e Desenvolvimento Econômico , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controleRESUMO
BACKGROUND: Striking geographic variations in prostate cancer incidence suggest an aetiological role for spatially-distributed factors. We assessed whether neighbourhood social deprivation, which can reflect limited social contacts, unfavourable lifestyle and environmental exposures, is associated with prostate cancer risk. METHODS: In 2005-2012, we recruited 1931 incident prostate cancer cases and 1994 controls in a case-control study in Montreal, Canada. Lifetime residential addresses were linked to an area-based social deprivation index around recruitment (2006) and about 10 years earlier (1996). Logistic regression estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Men residing in areas characterised by greater social deprivation had elevated prostate cancer risks (ORs of 1.54 and 1.60 for recent and past exposures, respectively; highest vs lowest quintiles), independently from area- and individual-level confounders and screening patterns. The increase in risk with recent high social deprivation was particularly elevated for high-grade prostate cancer at diagnosis (OR 1.87, 95% CI 1.32-2.64). Associations were more pronounced for neighbourhoods with higher proportions of separated/divorced or widowed individuals in the past, and with higher percentages of residents living alone recently. CONCLUSIONS: These novel findings, suggesting that neighbourhood-level social deprivation increases the risk of prostate cancer, point out to potential targeted public health interventions.
Assuntos
Exposição Ambiental , Neoplasias da Próstata , Masculino , Humanos , Estudos de Casos e Controles , Canadá , Privação Social , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/etiologia , Características de Residência , Fatores SocioeconômicosRESUMO
Social isolation has been linked to a poorer prostate cancer prognosis. Little is known about how it could also influence its incidence. We investigated the association between family structure and living arrangements as potential indicators of social isolation, and prostate cancer risk, globally and according to disease aggressiveness. Data from the Prostate Cancer & Environment Study (PROtEuS), a case-control population-based study conducted between 2005 and 2012 in Montreal, Canada, were used. The study population comprised 1931 incident cases of prostate cancer, aged ≤75 years, and 1994 age-matched (±5 years) population controls. In-person interviews collected information on family composition and living arrangements recently and at age 40. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for potential confounders. Single men had an increased risk of high-grade prostate cancer at diagnosis (OR 1.80; 95% CI 1.29-2.51), compared to men currently married or with a partner. Having at least one daughter was associated with a lower risk of aggressive cancer (OR 0.76; 95% CI 0.61-0.96) while no association was found with having son(s). An inverse dose-response relationship was observed between the number of people living with the subject 2 years before diagnosis/interview and prostate cancer risk (p-trend<0.001). These results suggest a protective role of a rich personal environment on the risk of developing prostate cancer. As several of the associations studied here are novel, replication is required.