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1.
BMC Med ; 14(1): 145, 2016 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-27733163

RESUMO

BACKGROUND: Some recent research has suggested that health-related behaviours, such as smoking, might explain much of the socio-economic inequalities in coronary heart disease (CHD) risk. In a large prospective study of UK women, we investigated the associations between education and area deprivation and CHD risk and assessed the contributions of smoking, alcohol consumption, physical activity and body mass index (BMI) to these inequalities. METHODS: After excluding women with heart disease, stroke or cancer at recruitment, 1,202,983 women aged 56 years (SD 5 years) on average, were followed for first coronary event (hospital admission or death) and for CHD mortality. Relative risks of CHD were estimated by Cox regression, and the extent to which any association could be accounted for by smoking, alcohol, physical inactivity, and BMI was assessed by calculating the percentage reduction in the relevant likelihood-ratio (LR) statistic after adjustment for these factors, separately and together. RESULTS: A total of 71,897 women had a first CHD event (hospital admission or death) and 6032 died from CHD during 12 years follow-up. In analyses adjusted by age, birth cohort and region of residence only, lower levels of education and greater deprivation were associated with higher risks of CHD (P heterogeneity < 0.0001 for each); associations for education were found within every level of deprivation and for deprivation were found within every level of education. Smoking, alcohol consumption, physical inactivity and BMI accounted for most of the associations (adjustment for all four factors together reduced the LR statistics for education and for deprivation by 76 % and 71 %, respectively, for first CHD event; and by 87 % and 79 %, respectively, for CHD mortality). Of these four factors, adjustment for smoking resulted in the largest reduction in the LR statistic. Given the large reduction in the predictive values of education and deprivation after adjustment for only four health-related behavioural factors recorded just at recruitment, residual confounding might plausibly account for the remaining associations. CONCLUSIONS: Most of the association between CHD risk and education and area deprivation in UK women is accounted for by health-related behaviours, particularly by smoking and to a lesser extent by alcohol consumption, physical inactivity and BMI.


Assuntos
Doença das Coronárias/epidemiologia , Comportamentos Relacionados com a Saúde , Estilo de Vida Saudável , Adulto , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Exercício Físico , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fumar/efeitos adversos , Fatores Socioeconômicos , Reino Unido/epidemiologia
2.
Health Stat Q ; (42): 22-39, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19562908

RESUMO

Current health inequality targets include the goal of reducing the differential in infant mortality between social groups. This article reports on a multivariate analysis of risk factors for infant mortality, with specific focus on deprivation and socio-economic status. Data on all singleton live births in England and Wales in 2005-06 were used, and deprivation quintile (Carstairs index) was assigned to each birth using postcode at birth registration. Deprivation had a strong independent effect on infant mortality, risk of death tending to increase with increasing levels of deprivation. The strength of this relationship depended, however, on whether the babies were low birthweight, preterm or small-for-gestational-age. Trends of increasing mortality risk with increasing deprivation were strongest in the postneonatal period. Uniquely, this article reports the number and proportion of all infant deaths which would potentially be avoided if all levels of deprivation were reduced to that of the least deprived group. It estimates that one quarter of all infant deaths would potentially be avoided if deprivation levels were reduced in this way.


Assuntos
Mortalidade Infantil/tendências , Classe Social , Inglaterra/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Análise Multivariada , Sistema de Registros , País de Gales/epidemiologia
3.
Health Stat Q ; (37): 15-23, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18351024

RESUMO

This paper investigates the quality of information in the National Health Service (NHS) Numbers for Babies (NN4B) dataset and provides statistics on gestational age at birth in relation to live/stillbirth status, multiple birth status, age of mother, babies' sex, and birthweight. Gestational age information is not recorded at the registration of live births and the NN4B system provides the opportunity to access this information for all live and stillbirths in England and Wales. All NN4B records for babies born in England and Wales in 2005 were used in this analysis. Data quality was generally good although some aspects need further investigation. The gestational age data are credible, consistent with other U.K. data sources, and the statistics by maternal age, multiplicity and sex are as expected. These data, previously unavailable for England and Wales as a whole, provide a reference against which to monitor trends in preterm births and can inform the planning of neonatal care provision. NN4B is a powerful new data source which can extend


Assuntos
Idade Gestacional , Nascido Vivo/epidemiologia , Programas Nacionais de Saúde/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Natimorto/epidemiologia , Adolescente , Adulto , Coeficiente de Natalidade , Peso ao Nascer , Inglaterra/epidemiologia , Feminino , Humanos , Recém-Nascido , Programas Nacionais de Saúde/normas , Gravidez , Estatísticas Vitais , País de Gales/epidemiologia
4.
Health Stat Q ; (39): 22-31, 34-55, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18810886

RESUMO

Low birthweight babies and babies born preterm are at increased risk of morbidity and mortality in the first year of life, as well as in the longer-term. Since information on ethnic group is not recorded at birth registration in England and Wales, it has not been possible to produce routine statistics on birthweight or gestational age by ethnic group. A new system, introduced in 2002, for allocating NHS numbers at birth (NN4B) provided the opportunity to obtain ethnic group information. The NN4B record includes information on the ethnic group of the baby classified according to the 2001 Census categories. This paper presents the first analyses of ethnic differences in birthweight and gestational age at birth for England and Wales as a whole. Utilising NN4B records linked with birth registration records for all births occurring in England and Wales in 2005, birthweight and gestational age distributions, including the percentages low birthweight and preterm, are compared between ethnic groups. The paper also examines how parental socio-demographic circumstances vary by ethnic group.


Assuntos
Peso ao Nascer , Idade Gestacional , Resultado da Gravidez/etnologia , Adolescente , Adulto , Inglaterra/epidemiologia , Etnicidade , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Estado Civil , Idade Materna , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez/epidemiologia , Fatores Socioeconômicos , País de Gales/epidemiologia , Adulto Jovem
5.
Int J Epidemiol ; 36(6): 1285-91, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17898027

RESUMO

BACKGROUND: Socio-economic inequalities in health within countries are a key public health issue. It is important that we can effectively make international comparisons of the level of inequalities and assess trends over time. We investigate how the results of such comparisons can differ depending on whether inequality is quantified using the rate ratio or rate difference. METHODS: We examine levels and trends in inequality in under-five mortality using data from 22 low/lower-middle income countries [Africa (11), Latin America/Caribbean (5), Asia (6)], each with two Demographic and Health Surveys between 1991 and 2001. Within-country inequalities are quantified using the rate ratio and rate difference. RESULTS: Ranking countries by their level of inequality at one point in time differed, sometimes substantially, according to whether the rate ratio or difference was used (Spearman's rank correlation = 0.49). Similarly, ranking countries according to the magnitude and direction of change in inequality over time depended on the measure used. Importantly from a policy perspective, in five countries the direction of change was in the opposite direction (increase vs decline in inequality) when using the ratio compared with the difference measure. CONCLUSIONS: The results of comparisons of the magnitude of health inequalities between countries and over time depend upon whether the rate ratio or rate difference is used. When statements are made comparing the size of inequalities it should be made completely clear whether these are measured on an absolute or relative scale. If the substantive conclusions differ according to the measure used this should be clearly stated. In this situation emphasis should only be given to results based on one summary measure if this can be clearly and explicitly justified in the context.


Assuntos
Interpretação Estatística de Dados , Demografia , Saúde Global , Nível de Saúde , Pré-Escolar , Estudos Transversais , Indicadores Básicos de Saúde , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Mortalidade/tendências , Fatores Socioeconômicos
6.
Br J Gen Pract ; 57(538): 404-6, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17504593

RESUMO

It is important that women know that the risk of breast cancer increases with age. Women's knowledge of the increased risk will help to inform their health-seeking behaviour. This study shows that over 50% of women wrongly believe that the risk does not vary with age. Only 1% are correctly informed, believing that the oldest group of women are at the greatest risk of breast cancer. Those working in primary care need to be aware of this lack of knowledge when patients consult.


Assuntos
Envelhecimento , Neoplasias da Mama/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto/métodos , Adulto , Fatores Etários , Idoso , Atitude Frente a Saúde , Medicina de Família e Comunidade , Feminino , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Fatores de Risco
7.
Health Stat Q ; (33): 25-33, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17373380

RESUMO

Information about gestational age is important but is not available for live births from registration data. It is, however, collected in NHS Numbers for Babies (NN4B) records. This project investigates the feasibility of linking NN4B data for births in the First quarter of 2005 with birth registration records. Overall 99.8 per cent of NN4B records linked with a registration record. Accuracy of linkage was questioned in 0.9 per cent. Live/stillbirth and multiple birth status were each differently classified in approximately 1 per 1,000 records. Discordance rates for other individual data items ranged from 0.3 per cent for date of birth to 12.9 per cent for postcode. Although needing further investigation, these results justify extending the linkage to the remainder of births in 2005. Linkage would be improved by retaining NHS numbers on stillbirth registration records and avoiding manual transfer of NHS numbers.


Assuntos
Declaração de Nascimento , Bases de Dados Factuais , Idade Gestacional , Medicina Estatal/organização & administração , Peso ao Nascer , Inglaterra/epidemiologia , Feminino , Humanos , Nascido Vivo/epidemiologia , Masculino , Idade Materna , Reprodutibilidade dos Testes , Natimorto/epidemiologia , País de Gales/epidemiologia
8.
Health Stat Q ; (35): 13-27, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17894197

RESUMO

Gestational age is highly correlated with birth outcomes including birthweight and infant mortality. Since gestational age is not recorded at the registration of live births in England and Wales, it has not been possible to produce routine statistics on gestation-specific infant mortality rates. A new system, introduced in 2002, for allocating NHS numbers at birth (NN4B) provided the opportunity to obtain gestational age information. NN4B records have been linked with birth registration data for all births occurring in 2005, and further linked with registration records for deaths in the first year of life. Thus, for the first time, we produce gestation-specific infant mortality rates for England and Wales as a whole, including in relation to birthweight, multiplicity, age of mother, marital status/registration type, and the National Statistics Socio-Economic Classification.


Assuntos
Idade Gestacional , Mortalidade Infantil/tendências , Peso ao Nascer , Inglaterra/epidemiologia , Humanos , Recém-Nascido , Medicina Estatal , Estatísticas Vitais , País de Gales/epidemiologia
9.
Diabetes Care ; 29(12): 2694-700, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17130207

RESUMO

OBJECTIVE: The metabolic syndrome is more common in socially disadvantaged groups. Inequalities in household wealth are currently widening and may contribute to the increasing prevalence of the metabolic syndrome. RESEARCH DESIGN AND METHODS: This was a cross-sectional analysis of 1,509 women and 4,090 men (aged 45.2-68.9 years) of an occupational cohort study of 20 civil service departments located in London, U.K. Components of the metabolic syndrome were measured in 1997-1999 and defined using a modified World Health Organization definition. RESULTS: Own income, household income, and wealth were each strongly and inversely associated with the metabolic syndrome in both sexes (P(trend) < 0.001). Within each group of household wealth, the prevalence of the metabolic syndrome was higher in men than in women. Sex differences became smaller with decreasing household wealth, with the prevalence of the metabolic syndrome rising from 12.0 and 5.7% in the wealthiest men and women, respectively, to corresponding values of 23.6 and 20.1% in the poorest group. The odds ratio (95% CI) associated with each decrease of one category in household wealth was 1.25 (1.03-1.50) in men and 1.69 (1.18-2.41) in women, adjusting for age, household members, occupational grade, education, father's social class, personal and household income, ethnic group, smoking, alcohol intake, diet, and physical activity. CONCLUSIONS: Household wealth, a measure of assets accumulated over decades and generations, is strongly and inversely associated with the metabolic syndrome. Future research should explore the potential mechanisms by which wealth inequalities are associated with the metabolic syndrome.


Assuntos
Renda , Síndrome Metabólica/epidemiologia , Fatores Socioeconômicos , Adulto , Feminino , Comportamentos Relacionados com a Saúde , Nível de Saúde , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Pobreza , Prevalência
10.
Indian J Soc Psychiatry ; 31(1): 55-66, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-28856341

RESUMO

BACKGROUND/OBJECTIVES: Migration is suspected to increase the risk for psychological distress for those who enter a new cultural environment. We investigated the association between sociodemographic characteristics, premigratory and migratory factors and psychological distress in rural-to-urban migrants just after migration and after resettlement. METHODS: Data from the cross-sectional sib-pair designed Indian Migration Study (IMS, 2005-2007) were used. The analysis focused on 2112 participants aged ≥18 years from the total IMS sample (n = 7067) who reported being migrant. Psychological distress was assessed based on the responses of the 7-questions in a five-point scale, where the respondents were asked to report about their feelings now and also asked to recall these feelings when they first migrated. The associations were analyzed using multiple logistic regression models. RESULTS: High prevalence of psychological distress was found just after migration (7.3%; 95% confidence interval [CI]: 6.2-8.4) than after settlement (4.7%; 95% CI: 3.8-5.6). Push factors as a reason behind migration and not being able to adjust in the new environment were the main correlates of psychological distress among both the male and female migrants, just after migration. CONCLUSIONS: Rural-urban migration is a major phenomenon in India and given the impact of premigratory and migratory related stressors on mental health, early intervention could prevent the development of psychological distress among the migrants.

12.
Br J Gen Pract ; 52(481): 658-60, 2002 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12171226

RESUMO

An analysis was undertaken of consultation rates in 226 UK general practices contributing to the General Practice Research Database. Over the period 1992-1998 the mean age-standard-ised consultation rate per person year at risk was 3.85 (3.01 for males and 4.71 for females). In contrast with younger ages, consultation rates among those aged 65years and over showed an upward trend over the seven-year period. Consultation rates were higher in areas of low population density as compared with higher density areas.


Assuntos
Bases de Dados Factuais , Medicina de Família e Comunidade/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Medicina de Família e Comunidade/tendências , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Reino Unido/epidemiologia
14.
PLoS One ; 9(1): e86043, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24465859

RESUMO

BACKGROUND: Hypertension is a major contributing factor to the current epidemic of cardiovascular disease in India. Small studies suggest high, and increasing, prevalence especially in urban areas, with poor detection and management, but national data has been lacking. The aim of the current study was to use nationally-representative survey data to examine socio-demographic inequalities in the prevalence, diagnosis and management of hypertension in Indian adults. METHODS: Using data on self-reported diagnosis and treatment, and blood pressure measurement, collected from 12,198 respondents aged 18+ in the 2007 WHO Study on Global Ageing and Adult Health in India, factors associated with prevalence, diagnosis and treatment of hypertension were investigated. RESULTS: 22% men and 26% women had hypertension; prevalence increased steeply with body mass index (<18.5 kg/m(2): 18% men, 21% women; 25-29.9 kg/m(2): 35% men, 35% women), was higher in the least poor vs. poorest (men: odds ratio (95%CI) 1.82 (1.20 to 2.76); women: 1.40 (1.08 to 1.81)), urban vs. rural men (1.64 (1.19 to 2.25)), and men recently vs. never using alcohol (1.96 (1.40 to 2.76)). Over half the hypertension in women, and 70% in men, was undetected with particularly poor detection rates in young urban men, and in poorer households. Two-thirds of men and women with detected hypertension were treated. Two-thirds of women treated had their hypertension controlled, irrespective of urban/rural setting or wealth. Adequate blood pressure control was sub-optimal in urban men. CONCLUSION: Hypertension is very common in India, even among underweight adults and those of lower socioeconomic position. Improved detection is needed to reduce the burden of disease attributable to hypertension. Levels of treatment and control are relatively good, particularly in women, although urban men require more careful attention.


Assuntos
Disparidades em Assistência à Saúde , Hipertensão/epidemiologia , Adolescente , Adulto , Idoso , Monitoramento Epidemiológico , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/terapia , Índia/epidemiologia , Masculino , Prevalência , População Rural , Distribuição por Sexo , Fatores Socioeconômicos , População Urbana , Adulto Jovem
16.
J Epidemiol Community Health ; 66(6): 544-51, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21118952

RESUMO

BACKGROUND: The mean birth weight of offspring of Bangladeshi, Indian and Pakistani women tends to be among the lowest of any ethnic groups regardless of country of residence. However, it is unclear whether the mean birth weight of South Asian offspring born in England and Wales is higher among those whose mothers were themselves born in England and Wales compared to those whose mothers were born in the Indian sub-continent. METHODS: We used cross-sectional data from a unique linkage of routine records for the whole of England and Wales (2005-2006, n=861 654) to estimate mean birth weights of the live singleton offspring of Bangladeshi, Indian, Pakistani or White British ethnicity according to whether maternal place of birth was England and Wales or the Indian sub-continent. RESULTS: Offspring of women born in the Indian sub-continent were slightly heavier at birth than offspring of South Asian women born in England and Wales even after adjustment for gestational age, maternal age and parity (Bangladeshi 28 g, 95% CI 10 to 46; Indian 31 g, 95% CI 20 to 42; Pakistani 21 g, 95% CI 12 to 29). CONCLUSIONS: There is no indication that the mean birth weight of South Asian offspring of women born in England and Wales is higher than the mean birth weight of those whose mothers were born in the Indian sub-continent. This suggests a shared physiological tendency for down-regulation of fetal growth transmissible across generations. Within the UK, there is unlikely to be any appreciable increase in mean birth weight of South Asian babies over the next few decades.


Assuntos
Aculturação , Recém-Nascido de Baixo Peso , Características de Residência , Adulto , Ásia/etnologia , Estudos Transversais , Inglaterra , Feminino , Humanos , Recém-Nascido , Estado Nutricional , Gravidez , Complicações na Gravidez/etnologia , Fumar/efeitos adversos , Medicina Estatal , País de Gales , Adulto Jovem
17.
J Med Screen ; 18(2): 96-102, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21852703

RESUMO

OBJECTIVE: To assess the feasibility and acceptability of randomizing the phased introduction of the extension of the invited age range in the National Health Service (NHS) Breast Screening Programme in England from 50-70 to 47-73 years. SETTING: Six volunteer breast screening units (BSUs) in England. METHODS: Cluster-randomized trial of invitation versus no invitation for breast screening. STUDY PARTICIPANTS: women aged 47-49 and 71-73 years in screening batches randomized between 1 June 2009 and 31 May 2010. OUTCOMES: workload, screening uptake among women invited, self-referrals among women not invited, and screening outcomes among women invited. RESULTS: A total of 312 screening batches (clusters) were randomized including 60,708 women. Screening uptake was 63% in women aged 47-49 and 62% in women aged 71-73. Those who attended screening in the younger age group were more likely to be recalled for assessment than older attendees (7.5% vs. 3.0%) but less likely to be diagnosed with breast cancer (0.5% vs. 1.1%). Among women not invited, 0.2% of those aged 47-49 and 6.8% of those aged 71-73 self-referred for screening. Despite the extra workload BSUs largely coped although there was some slippage in round lengths and other targets. CONCLUSION: No major problems of feasibility or acceptability of randomization were found. This pilot study has informed the randomized phasing-in of the age extension across the whole of England.


Assuntos
Neoplasias da Mama/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Idoso , Inglaterra , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto
18.
BMJ ; 338: b2025, 2009 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-19531549

RESUMO

OBJECTIVE: To investigate the relation between women's reported use of breast and cervical screening and sociodemographic characteristics. DESIGN: Cross sectional multipurpose survey. SETTING: Private households, Great Britain. Population 3185 women aged 40-74 interviewed in the National Statistics Omnibus Survey 2005-7. MAIN OUTCOME MEASURES: Ever had a mammogram, ever had a cervical smear, and, for each, timing of most recent screen. RESULTS: 91% (95% confidence interval 90% to 92%) of women aged 40-74 years reported ever having had a cervical smear, and 93% (92% to 94%) of those aged 53-74 years reported ever having had a mammogram; 3% (2% to 4%) of women aged 53-74 years had never had either breast or cervical screening. Women were significantly more likely to have had a mammogram if they lived in households with cars (compared with no car: one car, odds ratio 1.67, 95% confidence interval 1.06 to 2.62; two or more cars, odds ratio 2.65, 1.34 to 5.26), and in owner occupied housing (compared with rented housing: own with mortgage, odds ratio 2.12, 1.12 to 4.00; own outright, odds ratio 2.19, 1.39 to 3.43), but no significant differences by ethnicity, education, occupation, or region were found. For cervical screening, ethnicity was the most important predictor; white British women were significantly more likely to have had a cervical smear than were women of other ethnicity (odds ratio 2.20, 1.41 to 3.42). Uptake of cervical screening was greater among more educated women but was not significantly associated with cars, housing tenure, or region. CONCLUSIONS: Most (84%) eligible women report having had both breast and cervical screening, but 3% report never having had either. Some inequalities exist in the reported use of screening, which differ by screening type; indicators of wealth were important for breast screening and ethnicity for cervical screening. The routine collection within general practice of additional sociodemographic information would aid monitoring of inequalities in screening coverage and inform policies to correct them.


Assuntos
Neoplasias da Mama/prevenção & controle , Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Distribuição por Idade , Idoso , Detecção Precoce de Câncer , Métodos Epidemiológicos , Feminino , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Esfregaço Vaginal/estatística & dados numéricos
19.
Trop Med Int Health ; 11(8): 1218-27, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16903885

RESUMO

OBJECTIVES: To identify the socioeconomic and geographical groups in which the recent under-5 mortality increase observed in several African countries was most pronounced, and to explore the contribution of a number of proximate determinants of under-5 mortality. METHODS: Time trends in under-5 mortality were assessed with Cox Proportional Hazards regression analysis, using Demographic and Health Surveys data for Burkina Faso, Cameroon, Côte d'lvoire, Kenya and Zimbabwe for the late 1980s - 1990s. We tested for differences in time trends between socioeconomic and rural/urban subgroups, and described the inequalities in time trends in living conditions, malnutrition and health care use. RESULTS: Under-5 mortality increased substantially (ranging from 25% to 71% in 10 years) within the five countries. In Kenya, the increase was the largest among children born to less educated mothers (test for difference between educational groups: P = 0.074) and in rural areas (P = 0.090). In Cameroon, the increase was the largest among the higher educated (P = 0.013), and in Zimbabwe among the higher educated (P = 0.098) and in urban areas (P = 0.093). For Burkina Faso and Côte d'Ivoire, we did not observe statistically significant differences between educational and rural/urban subgroups. The decline in skilled delivery attendance in Zimbabwe and Kenya was similar among the less and higher educated. The decline in immunization coverage during the mid-1990s in Zimbabwe was the largest in the group with the highest mortality increase, but in Kenya it was as large among the less and higher educated. Whereas in Kenya the increase in malnutrition was the largest in the group with the highest mortality increase, this was not the case in Zimbabwe. CONCLUSIONS: The recent increase in under-5 mortality in some African countries was highly concentrated in specific population subgroups. Exactly which groups were most affected was highly variable. It cannot be assumed that lower socioeconomic groups are always most vulnerable. Strategies to halt the under-5 mortality increase should be based on disaggregate information for individual countries.


Assuntos
Mortalidade Infantil/tendências , África Subsaariana/epidemiologia , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Escolaridade , Inquéritos Epidemiológicos , Humanos , Imunização/tendências , Lactente , Transtornos da Nutrição do Lactente/epidemiologia , Modelos de Riscos Proporcionais , Características de Residência , Saúde da População Rural , Fatores Socioeconômicos , Saúde da População Urbana
20.
Bull World Health Organ ; 83(3): 202-9, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15798844

RESUMO

OBJECTIVE: We sought to investigate to what extent worldwide improvements in mortality over the past 50 years have been accompanied by convergence in the mortality experience of the world's population. METHODS: We have adopted a novel approach to the objective measurement of global mortality convergence. The global mortality distribution at a point in time is quantified using a dispersion measure of mortality (DMM). Trends in the DMM indicate global mortality convergence and divergence. The analysis uses United Nations data for 1950-2000 for all 152 countries with populations of at least 1 million in 2000 (99.7% of the world's population in 2000). FINDINGS: The DMM for life expectancy at birth declined until the late 1980s but has since increased, signalling a shift from global convergence to divergence in life expectancy at birth. In contrast, the DMM for infant mortality indicates continued convergence since 1950. CONCLUSION: The switch in the late 1980s from the global convergence of life expectancy at birth to divergence indicates that progress in reducing mortality differences between many populations is now more than offset by the scale of reversals in adult mortality in others. Global progress needs to be judged on whether mortality convergence can be re-established and indeed accelerated.


Assuntos
Saúde Global , Expectativa de Vida/tendências , Mortalidade/tendências , Indicadores Básicos de Saúde , Humanos , Fatores de Tempo
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