Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 36.924
Filtrar
Más filtros

Intervalo de año de publicación
1.
J Prev Alzheimers Dis ; 11(5): 1406-1409, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39350387

RESUMEN

Cognitive resilience has emerged as a mechanism that may help explain individual differences in cognitive function associated with aging and/or pathology. It is unknown whether an association exists between family income level and cognitive resilience. We performed a cross-sectional study to estimate the relationship between family income level and high cognitive resilience using the National Health and Nutrition Examination Survey (NHANES) among older adults (age≥60). Logistic regression was used to estimate the association between income level and high cognitive resilience adjusted for other factors. Accounting for differences in education, occupation, and health status, older adults in the highest income category were twice as likely compared to those with very low income to have high cognitive resilience (OR: 1.90, 95% CI: 1.05,3.43). A doseresponse was apparent between income category and high cognitive resilience. The finding that income, above and beyond that of known factors, affects cognitive function is important for future public health strategies that aim to prevent or delay cognitive impairment.


Asunto(s)
Cognición , Renta , Resiliencia Psicológica , Humanos , Estudios Transversales , Masculino , Femenino , Renta/estadística & datos numéricos , Anciano , Estados Unidos/epidemiología , Persona de Mediana Edad , Encuestas Nutricionales , Anciano de 80 o más Años
2.
BMC Public Health ; 24(1): 2678, 2024 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-39350210

RESUMEN

BACKGROUND: National health systems have different strengths and resilience levels. During the COVID-19 pandemic, resources often had to be reallocated and this impacted the availability of healthcare services in many countries. To date there have been few quantitative contemporary studies of inequalities in access to healthcare within and between countries. In this study, we aim to compare inequality within and between 16 economically diverse countries. METHODS: Online surveys were conducted on 22 150 adults in 16 countries across six continents in 2022. Quota sampling and post-stratification weighting was used to obtain an age, gender, geographically, and educationally representative sample. The study assesses the differences in challenges in access to healthcare during the pandemic (for GP, surgical/clinical and digital GP services) using country-specific expanded health-needs-adjusted Erreygers' concentration indices and compares these values between countries using a Spearman's rank correlation coefficient. RESULTS: Results show wide variation in income-related challenges in access within countries for different types of care. For example, Erreygers' concentration index for digital services in Colombia exhibited highly regressive inequality at 0·17, compared to Japan with an index of -0·15. Inequalities between countries were also evident, with Spearman rank coefficients of -0·69 and -0·65 (p-values of 0·003 and 0·006) for digital and surgical access, indicating that lower income countries had greater inequality in healthcare access challenges. CONCLUSION: During the pandemic, inequalities in challenges to accessing healthcare were greatest in low and middle-income countries. Digital technologies offer a reasonable means to address some of this inequality if adequate support is provided and accessible digital infrastructure exists.


Asunto(s)
COVID-19 , Accesibilidad a los Servicios de Salud , Humanos , COVID-19/epidemiología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Estudios Transversales , Masculino , Femenino , Adulto , Persona de Mediana Edad , Disparidades en Atención de Salud , Renta/estadística & datos numéricos , Factores Socioeconómicos , Adulto Joven , Pandemias , Anciano , Adolescente , SARS-CoV-2
3.
Am J Otolaryngol ; 45(1): 104077, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39382965

RESUMEN

This study examines how patient demographics impact pediatric sensorineural hearing loss (SNHL) prevalence using the 2016 Kids' Inpatient Database (KID). By analyzing age, gender, race, income, insurance, and region, the study provides insights for early intervention and diagnosis. Multivariate regression analysis reveals associations between these factors and SNHL occurrence. OBJECTIVE: This study aims to assess the influence of patient demographics on pediatric SNHL prevalence, offering guidance for early detection and intervention strategies. STUDY DESIGN: Using 2016 KID data, this retrospective analysis investigates how patient factors like age, gender, race, income, insurance, and region relate to SNHL prevalence. Multivariate regression is employed to control for potential confounders. METHODS: Data from 6,266,285 patient discharges, including 9997 hearing loss cases, are analyzed. SNHL prevalence is calculated, and demographic variables are examined. Weighted odds ratios and multivariate regression are used to assess associations. RESULTS: The study finds an overall SNHL prevalence of 101.67 cases per 100,000 discharges in 2016. Non-Hispanic White patients show the highest prevalence. Black patients are more likely to be diagnosed, while Hispanic patients are less likely. Multivariate analysis highlights race, income, insurance, region, age, and sex as significant confounders. CONCLUSION: This study underscores the impact of patient demographics on pediatric SNHL prevalence. Factors like race, income, insurance, and region play a role. These findings aid in risk assessment, early identification, and tailored interventions. Further research can uncover socioeconomic disparities and underlying mechanisms.


Asunto(s)
Bases de Datos Factuales , Pérdida Auditiva Sensorineural , Pacientes Internos , Humanos , Pérdida Auditiva Sensorineural/epidemiología , Pérdida Auditiva Sensorineural/diagnóstico , Masculino , Femenino , Niño , Preescolar , Estudios Retrospectivos , Adolescente , Lactante , Prevalencia , Estados Unidos/epidemiología , Pacientes Internos/estadística & datos numéricos , Factores de Edad , Factores Sexuales , Recién Nacido , Análisis Multivariante , Renta/estadística & datos numéricos
4.
Clin Transl Med ; 14(10): e70032, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39360669

RESUMEN

BACKGROUND: Structural income inequality - the uneven income distribution across regions or countries - could affect brain structure and function, beyond individual differences. However, the impact of structural income inequality on the brain dynamics and the roles of demographics and cognition in these associations remains unexplored. METHODS: Here, we assessed the impact of structural income inequality, as measured by the Gini coefficient on multiple EEG metrics, while considering the subject-level effects of demographic (age, sex, education) and cognitive factors. Resting-state EEG signals were collected from a diverse sample (countries = 10; healthy individuals = 1394 from Argentina, Brazil, Colombia, Chile, Cuba, Greece, Ireland, Italy, Turkey and United Kingdom). Complexity (fractal dimension, permutation entropy, Wiener entropy, spectral structure variability), power spectral and aperiodic components (1/f slope, knee, offset), as well as graph-theoretic measures were analysed. FINDINGS: Despite variability in samples, data collection methods, and EEG acquisition parameters, structural inequality systematically predicted electrophysiological brain dynamics, proving to be a more crucial determinant of brain dynamics than individual-level factors. Complexity and aperiodic activity metrics captured better the effects of structural inequality on brain function. Following inequality, age and cognition emerged as the most influential predictors. The overall results provided convergent multimodal metrics of biologic embedding of structural income inequality characterised by less complex signals, increased random asynchronous neural activity, and reduced alpha and beta power, particularly over temporoposterior regions. CONCLUSION: These findings might challenge conventional neuroscience approaches that tend to overemphasise the influence of individual-level factors, while neglecting structural factors. Results pave the way for neuroscience-informed public policies aimed at tackling structural inequalities in diverse populations.


Asunto(s)
Encéfalo , Electroencefalografía , Humanos , Masculino , Femenino , Encéfalo/fisiología , Adulto , Electroencefalografía/métodos , Electroencefalografía/estadística & datos numéricos , Persona de Mediana Edad , Factores Socioeconómicos , Adulto Joven , Cognición/fisiología , Renta/estadística & datos numéricos , Anciano
5.
BMC Womens Health ; 24(1): 557, 2024 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-39385272

RESUMEN

The struggle women face in balancing work and family roles is a significant factor contributing to the decline in their fertility intentions. Therefore, work-family conflict serves as a crucial determinant influencing women's fertility intentions. This study aims to explore the internal mechanism between work-family conflict and the fertility intentions of Chinese women, using data obtained from 334 questionnaires. Data analysis was conducted using Mplus 8.0. The following conclusions were drawn: (1) There is a negative correlation between work-family conflict and women's fertility intentions. (2) Fertility attitudes play a mediating role in the relationship between work-family conflict and women's fertility intentions. (3) The relationship between work-family conflict and women's fertility intentions is moderated by income class. (4) The relationship between work-family conflict and women's fertility intentions is moderated by women's child-rearing burden. The findings of this study provide a foundation for governments at all levels to formulate population policies.


Asunto(s)
Fertilidad , Intención , Humanos , Femenino , Adulto , China , Encuestas y Cuestionarios , Crianza del Niño/psicología , Renta/estadística & datos numéricos , Adulto Joven , Conflicto Psicológico , Actitud , Pueblos del Este de Asia
6.
Sci Rep ; 14(1): 25021, 2024 10 23.
Artículo en Inglés | MEDLINE | ID: mdl-39443533

RESUMEN

Despite the significant impact of the COVID-19 pandemic on various factors related to adolescent mental health problems such as stress, sadness, suicidal ideation, and suicide attempts, research on this topic has been insufficient to date. This study is based on the Korean Youth Risk Behavior Web-based Survey from 2006 to 2022. We analyzed the mental health problems of adolescents based on questionnaires with medical interviews, within five income groups and compared them with several risk factors. A total of 1,138,804 participants were included in this study, with a mean age (SD) of 15.01 (0.75) years. Of these, 587,256 were male (51.57%). In 2022, the recent period from the study, the weighted prevalence of stress in highest income group was 40.07% (95% CI, 38.67-41.48), sadness was 28.15% (26.82-29.48), suicidal ideation was 13.92% (12.87-14.97), and suicide attempts was 3.42% (2.90-3.93) while the weighted prevalence of stress in lowest income group was 62.77% (59.42-66.13), sadness was 46.83% (43.32-50.34), suicidal ideation was 31.70% (28.44-34.96), and suicide attempts was 10.45% (8.46-12.45). Lower income groups showed a higher proportion with several risk factors. Overall proportion had decreased until the onset of the pandemic. However, a significant increase has been found during the COVID-19 pandemic. Our study showed an association between household income level and the prevalence of mental illness in adolescents. Furthermore, the COVID-19 pandemic has exacerbated mental illness among adolescents from low household income level, underscoring the necessity for heightened public attention and measures targeted at this demographic.


Asunto(s)
COVID-19 , Renta , Salud Mental , Ideación Suicida , Intento de Suicidio , Humanos , Adolescente , COVID-19/epidemiología , COVID-19/psicología , República de Corea/epidemiología , Masculino , Femenino , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Intento de Suicidio/tendencias , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios , Estrés Psicológico/epidemiología , SARS-CoV-2/aislamiento & purificación , Trastornos Mentales/epidemiología , Pandemias
7.
Inquiry ; 61: 469580241290145, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39415354

RESUMEN

As housing prices in China continue to escalate and the limitations of the "personal unlimited liability system" for housing loans become more evident, the financial stress on families has significantly increased. This stress not only impacts the physical and mental health of family members but also results in rising health care costs. This paper presents empirical research examining how housing stress influences changes in household health care costs through a panel data analysis. The study is based on the China Family Panel Study (CFPS) database and employs a panel two-way fixed effect model alongside a mediating effect model to examine the impact of housing stress, family income, and health status on health care costs. The findings reveal a significant positive correlation between housing stress and health care costs; specifically, for every 1% point increase in housing stress, health care costs rise by 0.141. Robustness tests and propensity score matching (PSM) further validate these findings, even after addressing endogeneity issues. Mediation effect analysis indicates that for every 1% point increase in housing stress, household disposable income decreases by 1.749, and health status declines by 0.468, thereby increasing household health care costs. Heterogeneity analysis demonstrates that housing stress has a more pronounced impact on health care costs among western, eastern, urban, and rental households. The government should implement various measures, such as promoting a "personal limited liability system" mortgage policy, reducing housing prices, and ensuring equal rights to rent and purchase, to alleviate housing stress, enhance family income, and improve residents' health status. These actions would contribute to the promotion of both the housing market and medical care, supporting the sustainable development of the health care sector and ultimately improving long-term social welfare.


Asunto(s)
Costos de la Atención en Salud , Vivienda , Humanos , Vivienda/economía , China , Costos de la Atención en Salud/estadística & datos numéricos , Femenino , Masculino , Renta/estadística & datos numéricos , Estado de Salud , Persona de Mediana Edad , Adulto , Estrés Financiero , Factores Socioeconómicos
8.
Sci Rep ; 14(1): 24732, 2024 10 21.
Artículo en Inglés | MEDLINE | ID: mdl-39433792

RESUMEN

The increasing frequency and intensity of heat waves due to climate change and urbanization have caused serious public health problems, especially in urban areas in which the heat effects are amplified by dense infrastructure and limited green space. This study examined the impact of heatwaves on vulnerable populations in Korean cities, focusing on how age, income, and disability are associated with higher health risks. In our study, we analyzed healthcare big data from 2010 to 2022 for seven major Korean cities. We employed a distributed lag non-linear model to assess the relationship between heat exposure and health outcomes, allowing us to quantify the compounded vulnerabilities due to socioeconomic and physical factors. The results showed that the association of compounded vulnerability was more pronounced in patients hospitalized through the emergency room, a severe health outcome, than in patients with mild health outcome such as outpatient visits for heat-related illnesses. The association of compounded vulnerability was particularly evident in the elderly population. These findings suggest the need for tailored heatwave preparedness strategies for vulnerable groups, contributing to the broader discourse on climate adaptation and public health resilience.


Asunto(s)
Poblaciones Vulnerables , Humanos , Anciano , Persona de Mediana Edad , República de Corea , Femenino , Masculino , Adulto , Renta , Personas con Discapacidad , Adulto Joven , Adolescente , Cambio Climático , Factores de Edad , Ciudades , Calor , Niño , Anciano de 80 o más Años , Preescolar
9.
Health Aff (Millwood) ; 43(10): 1455-1463, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39374453

RESUMEN

This study examined the equity implications of high-deductible health plans within the context of racial and ethnic wealth disparities. Using restricted data from the Medical Expenditure Panel Survey, we evaluated the net worth (in 2011-18) and financial assets (in 2011-16) of families with private insurance and those in high-deductible health plans with and without an associated health savings account. Our results represent, to our knowledge, the first estimates of racial and ethnic wealth disparities within these populations. Results show that White households consistently held significantly more wealth than did Black and Hispanic households across income levels. In the lowest income quartile, White privately insured families had more than 350 percent more in financial assets than their Black counterparts. Low-income Black and Hispanic families with high-deductible health plans but no savings accounts had median financial assets ($2,200 and $2,000, respectively) that were well below the average family coverage deductible. Study findings highlight the role of systemic racial wealth disparities, beyond that of income, to establish a unique pathway whereby high deductibles can exacerbate health care inequities.


Asunto(s)
Deducibles y Coseguros , Etnicidad , Seguro de Salud , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Negro o Afroamericano , Deducibles y Coseguros/economía , Gastos en Salud/estadística & datos numéricos , Disparidades en Atención de Salud/economía , Disparidades en Atención de Salud/etnología , Hispánicos o Latinos , Renta/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Seguro de Salud/economía , Grupos Raciales , Factores Socioeconómicos , Estados Unidos , Blanco
10.
Clin Cardiol ; 47(10): e70036, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39429221

RESUMEN

INTRODUCTION: Both low family income and subclinical myocardial injury (SCMI) are risk factors for cardiovascular disease (CVD) mortality. However, the impact of their joint association on CVD mortality is unclear. METHODS: This analysis from the third National Health and Nutrition Examination Survey included 6805 participants (age 59.1 ± 13.4 years, 52.3% women, and 49.8% White) free of CVD at baseline. Family income was assessed using the poverty-income ratio (PIR) and categorized into low (PIR < 1), middle (PIR = 1-4), and high (PIR > 4) income. A validated ECG-based cardiac infarction injury score (CIIS) ≥ 10 was considered positive for SCMI. CVD mortality was determined using the National Death Index. Cox-proportional hazard analysis was used to evaluate the associations of family income and SCMI, separately and jointly, with CVD mortality. RESULTS: A total of 1782 (26.2%) participants had SCMI at baseline. During a median follow-up of 18.2 years, 856 (12.6%) events of CVD mortality occurred. In separate multivariable Cox models, SCMI (vs. no SCMI) and middle- and low-income (vs. high-income) were each associated with a higher risk of CVD mortality (HR [95% CI]: 1.34 [1.16-1.54], 1.44 [1.16-1.78], and 1.59 [1.22-2.07], respectively). Compared to high-income participants without SCMI, those with low-income and SCMI had an increased risk of CVD mortality (HR [95% CI]: 2.17 [1.53-3.08]). The multiplicative interaction between PIR and SCMI was not significant (p = 0.054). CONCLUSION: Lower family income and SCMI are associated with CVD mortality, and their concomitant presence is associated with the highest risk. Family income and SCMI may help in the individualized assessment of CVD risk.


Asunto(s)
Renta , Encuestas Nutricionales , Humanos , Femenino , Masculino , Persona de Mediana Edad , Renta/estadística & datos numéricos , Estados Unidos/epidemiología , Medición de Riesgo/métodos , Factores de Riesgo , Anciano , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/epidemiología , Enfermedades Asintomáticas , Factores de Tiempo , Electrocardiografía , Pronóstico , Modelos de Riesgos Proporcionales , Pobreza
11.
COPD ; 21(1): 2413712, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-39392247

RESUMEN

Chronic Obstructive Pulmonary Disease (COPD) is a complex and heterogeneous condition. Exposure to tobacco smoke and air pollutants are key risk factors for COPD development; however, other risk factors include race/ethnicity, sex of adults, a history of asthma, occupational exposures, and chronic respiratory infections. Data for the current study were from the 2022 Behavioral Risk Factor Surveillance Survey. Chi-squares and multinomial logistic regression analyses, adjusted with the survey's sampling weight, were used to examine how critical health indicators impacted a COPD diagnosis. Participants (N = 311,175) were adults aged 45 years and older. Adjusted multinomial regression analyses showed adults who reported asthma, current and former smoking, poor physical health, depression, less physical activity, and fatigue were more likely to report COPD. Those with COPD were more likely to be male than female. Moreover, those with COPD reported higher rates of health insurance coverage, and yet had lower income and more financial difficulty affording a doctor for health services. In a follow up regression analysis, examining racial differences in COPD for participants, American Indian adults had a higher odds of reporting COPD than the "other" race groups. Because COPD remains a leading cause of death and disability in the U.S., and racial disparities persist in respiratory outcomes, continuing to identify risk factors for vulnerable groups could assist health program planners with development of successful health messaging.


Asunto(s)
Sistema de Vigilancia de Factor de Riesgo Conductual , Enfermedad Pulmonar Obstructiva Crónica , Fumar , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Asma/epidemiología , Depresión/epidemiología , Ejercicio Físico , Estado de Salud , Renta , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Modelos Logísticos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Factores de Riesgo , Factores Sexuales , Fumar/epidemiología , Fumar/efectos adversos , Estados Unidos/epidemiología , Indígenas Norteamericanos
12.
PLoS One ; 19(10): e0307947, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39453965

RESUMEN

Consumption is crucial to individual well-being and national economic development. This study investigates whether high-speed rail (HSR) influences consumption expenditure (CE) and consumption structure (CS) of urban and rural Chinese citizens. Using panel data from 2003 to 2019 and econometric models, this study finds that: (1) HSR significantly increases CE for both urban and rural residents, promotes CS upgrades in rural areas, but inhibits CS upgrades in urban areas. These results remain robust after extensive testing. (2) HSR's impact on urban consumption is relatively focused and singular, whereas its effect on rural consumption is dispersed and extensive. Additionally, the impact of HSR on consumption exhibited significant delays and regional characteristics. (3) Mediation analysis reveals that HSR significantly enhances urban and rural CE and facilitates rural CS upgrades through market, price, and income effects. However, it also triggers housing price increases, impeding urban CS upgrades. This study provides important references for the government to optimize transportation infrastructure investments, promote balanced economic development between urban and rural areas, and enhance residents' well-being.


Asunto(s)
Vías Férreas , Población Rural , Población Urbana , China , Humanos , Desarrollo Económico , Renta , Femenino
13.
PLoS One ; 19(10): e0306180, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39454115

RESUMEN

This study examines the effects of relative household income on individual well-being, mental health, and physical health in Germany. Consistent with previous studies, we document a dip in the distribution of households in which the wife out-earns the husband. Using a regression discontinuity design, we show that husbands in couples in which the wife earns just more exhibit lower satisfaction with life, work, and health, and report worse physical health. Women in these couples report lower satisfaction with life and health, and worse mental health. Results on life, work, and health satisfaction among women are more pronounced in West Germany, consistent with previous evidence of gender norm differences between East and West Germany.


Asunto(s)
Composición Familiar , Renta , Satisfacción Personal , Humanos , Femenino , Alemania , Masculino , Adulto , Salud Mental/estadística & datos numéricos , Persona de Mediana Edad , Esposos/psicología , Estado de Salud , Factores Sexuales
14.
J Headache Pain ; 25(1): 164, 2024 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-39354353

RESUMEN

BACKGROUND: Headache disorders are among the most prevalent neurological disorders worldwide. However, whether groups differing in socioeconomic position (SEP) are disproportionately affected by headache disorders has not yet been adequately clarified. Our aim was to analyse (1) the headache prevalence by socioeconomic position (SEP) and (2) the attack frequency by SEP in a German population-based adult sample. METHODS: Cross-sectional data from a random general population were used. The sample included N = 2,189 participants aged ≥ 18 years. SEP was measured using net equivalised income (NEI) and education. A binary logistic regression model tested the effect of SEP in predicting the prevalence of headache in general. Ordinal logistic regressions were modeled to predict the effect of SEP on the likelihood of attack frequency. Attack frequency was categorized in low frequency episodic headache (LFEH: 0-3 days per month), moderate frequency episodic headache (MFEH: 4-14 days per month) and chronic headache (CH: ≥ 15 days per month). RESULTS: Of the 2,189 participants, 891 reported headache in the last six months. Neither income nor education was associated with headache prevalence. However, significant differences between income groups were found for attack frequency. Compared to participants with NEI > 150%, those with NEI < 60% were 5.21 times more likely (95%CI 2.03, 13.36) to experience higher headache frequency, and those with NEI between 60 and 150% were 2.29 times more likely (95%CI 1.02, 5.11), with adjustments made for a set of potential confounders, including depressive symptoms. CONCLUSIONS: To reduce headache attacks, it is essential to address both low- and middle-income groups affected by headaches. Universal public health prevention campaigns are particularly appropriate.


Asunto(s)
Cefalea , Renta , Autoinforme , Humanos , Alemania/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Estudios Transversales , Prevalencia , Renta/estadística & datos numéricos , Cefalea/epidemiología , Anciano , Adulto Joven , Adolescente , Factores Socioeconómicos , Trastornos de Cefalalgia/epidemiología
15.
Int J Epidemiol ; 53(6)2024 Oct 13.
Artículo en Inglés | MEDLINE | ID: mdl-39396253

RESUMEN

INTRODUCTION: Despite poor agreement, neighbourhood income is used as a proxy for household income, due to a lack of data availability. We quantified misclassification between household and neighbourhood income and demonstrate quantitative bias analysis (QBA) in scenarios where only neighbourhood income is available in assessing income inequalities on colorectal cancer mortality. METHODS: This was a retrospective study of adults with colorectal cancer diagnosed 2006-14 from Statistics Canada's Canadian Census Health and Environment Cohort. Neighbourhood income quintiles from Statistics Canada were used. Census household income quintiles were used to determine bias parameters and confirm results of the QBA. We calculated positive and negative predictive values using multinomial models, adjusting for age, sex and rural residence. Probabilistic QBA was conducted to explore the implication of exposure misclassification when estimating the effect of income on 5-year mortality. RESULTS: We found poor agreement between neighbourhood and household income: positive predictive values ranged from 21% to 37%. The bias-adjusted risk of neighbourhood income on 5-year mortality was similar to the risk of mortality by household income. The bias-adjusted relative risk of the lowest income quintile compared with the highest was 1.42 [95% simulation interval (SI) 1.32-1.53] compared with 1.46 [95% confidence interval (CI) 1.39-1.54] for household income and 1.18 (95% CI 1.12-1.24) for neighbourhood income. CONCLUSION: QBA can be used to estimate adjusted effects of neighbourhood income on mortality which represent household income. The predictive values from our study can be applied to similar cohorts with only neighbourhood income to estimate the effects of household income on cancer mortality.


Asunto(s)
Sesgo , Neoplasias Colorrectales , Renta , Humanos , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/epidemiología , Femenino , Masculino , Renta/estadística & datos numéricos , Persona de Mediana Edad , Canadá/epidemiología , Anciano , Estudios Retrospectivos , Características del Vecindario , Adulto , Características de la Residencia , Anciano de 80 o más Años
16.
BMC Public Health ; 24(1): 2780, 2024 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-39394083

RESUMEN

BACKGROUND: The literature shows that social support is an important factor influencing health behaviors. This study aimed to explore the relationships and intrinsic pathways of social support, loneliness, economic income, and health behaviors among older adults during the Corona Virus Disease 2019 (COVID-19) pandemic, and to provide a theoretical basis for the implementation of health behaviors interventions for older adults. METHODS: A cluster-random-sampling survey was adopted within two towns in Dongguan, China. Demographic characteristics, social support, loneliness, economic income and health behaviors were measured. The Social Support Appraisals scale (SS-A), the ULS-8 Loneliness Scale, and the Self-rated abilities for health practice scale (SRAHPS) were used to measure social support, loneliness, and health behaviors in older adults, respectively. A moderated mediation model was built to examine the relationships among social support, loneliness, economic income, and health behaviors using the SPSS PROCESS 4.0 macro. We conducted bootstrapping of regression estimates with 5000 samples and a 95% confidence interval. RESULTS: 621 older adults completed the questionnaire. Most of the participants were female, accounting for 75.0%, and the average age was 81.11 years (SD = 8.11). The median (interquartile range) of the participants' average monthly economic income was 800 (500-1000)RMB. The results of the mediation analysis showed that loneliness partly mediated the relationship between social support and health behaviors (B = 0.024, 95%CI: 0.007, 0.042), with the mediating effect accounting for 4.56% of the total effect. The moderation mediation analysis revealed a positive moderating role of economic income in the relationship between social support and loneliness (B = 0.114, 95%CI: 0.054, 0.174). Specifically, the relationship between social support and loneliness was found to be weaker for older adults with a high economic income compared to those with a lower economic income. CONCLUSION: The provision of enhanced social support and the alleviation of loneliness among older adults during an epidemic can facilitate the development of healthy behaviours, particularly among those who are economically disadvantaged.


Asunto(s)
COVID-19 , Conductas Relacionadas con la Salud , Renta , Soledad , Apoyo Social , Humanos , COVID-19/psicología , COVID-19/epidemiología , China/epidemiología , Masculino , Soledad/psicología , Femenino , Anciano , Anciano de 80 o más Años , Renta/estadística & datos numéricos , Encuestas y Cuestionarios , Análisis de Mediación , Pandemias
17.
Lancet Psychiatry ; 11(11): 890-898, 2024 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-39419562

RESUMEN

BACKGROUND: Research, mainly conducted in Europe and North America, has shown an inequitable burden of internalising mental health problems among adolescents from poorer households. We investigated whether these mental health inequalities differ across a diverse range of countries and multiple measures of economic circumstances. METHODS: In this longitudinal observational cohort study, we analysed data from studies conducted in eight countries (Australia, Ethiopia, India, Mexico, Peru, South Africa, the UK, and Viet Nam) across five global regions. All studies had self-reported measures of internalising symptoms using a validated scale at two timepoints in adolescence; a measure of household income, household consumption expenditure, or subjective wealth; and data collected between 2000 and 2019. Household income (measured in four countries), consumption expenditure (six countries), and adolescents' subjective assessment of household wealth (five countries) were measured in mid-adolescence (14-17 years). The primary outcome (internalising symptoms, characterised by negative mood, affect, and anxiety) was measured later in adolescence between age 17 and 19 years. Analyses were linear regression models with adjustment. Effect estimates were added to random-effects meta-analyses to aid understanding of cross-country differences. FINDINGS: The overall pooled sample of eight studies featured 18 910 adolescents (9568 [50·6%] female and 9342 [49·4%] male). Household income had a small or null association with adolescents' internalising symptoms. Heterogeneity (I2 statistic) was 71·04%, falling to 39·71% after adjusting for baseline symptoms. Household consumption expenditure had a stronger association with internalising symptoms (decreases of 0·075 SD in Peru [95% CI -0·136 to -0·013], 0·034 SD in South Africa [-0·061 to -0·006], and 0·141 SD in Viet Nam [-0·202 to -0·081] as household consumption expenditure doubled). The I2 statistic was 74·24%, remaining similar at 74·83% after adjusting for baseline symptoms. Adolescents' subjective wealth was associated with internalising symptoms in four of the five countries where it was measured. The I2 statistic was 57·09% and remained similar after adjusting for baseline symptoms (53·25%). We found evidence for cross-country differences in economic inequalities in adolescents' internalising symptoms, most prominently for inequalities according to household consumption expenditure. Subjective wealth explained greater variance in symptoms compared with the objective measures. INTERPRETATION: Our study suggests that economic inequalities in adolescents' mental health are prevalent in many but not all countries and vary by the economic measure considered. Variation in the magnitude of inequalities suggests that the wider context within countries plays an important role in the development of these inequalities. FUNDING: Wellcome Trust.


Asunto(s)
Factores Socioeconómicos , Humanos , Adolescente , Masculino , Femenino , Estudios Longitudinales , Reino Unido/epidemiología , México/epidemiología , Sudáfrica/epidemiología , Perú/epidemiología , Australia/epidemiología , India/epidemiología , Etiopía/epidemiología , Vietnam/epidemiología , Adulto Joven , Renta/estadística & datos numéricos , Disparidades en el Estado de Salud , Ansiedad/epidemiología
18.
Clin Oral Investig ; 28(11): 601, 2024 Oct 18.
Artículo en Inglés | MEDLINE | ID: mdl-39419851

RESUMEN

OBJECTIVES: The aim of this study was to detect trends and related factors in the functional dentition (FD) in 65- to 74-year-olds in Guangdong, China, while also assessing trends in education and income inequality factors. MATERIALS AND METHODS: Three large-scale cross-sectional National Oral Health Surveys (NOHS), specifically NOHS II in 1995, NOHS III in 2005, and NOHS IV in 2015, were included. Post hoc stratification was weighted for 1038 participants aged 65 to 74years. Retaining teeth ≥ 20 teeth and retaining < 20 teeth was defined as functional dentition (FD) and nonfunctional dentition (NFD), respectively. Logistic regression models were established to assess related factors. Slope index of inequality (SII) and relative index of inequality (RII) were used to analyze inequality. RESULTS: From NOHS II to IV, the FD proportion increased from 42.8 to 71.9%. Years of NOH, with caries, with periodontal pocket, high educational level, high income level, female, and those who had dental visits were associated with FD preservation. The education-related SII decreased from 0.44 to 0.20, and the income-related SII increased from 0.13 to 0.16. CONCLUSIONS: The FD proportion among 65- to 74-year-olds improved from 1995 to 2015. Years of NOHS, with caries, with periodontal pocket, high education level, and high income level were associated with higher FD proportion. Female and those who had dental visits were associated lower FD proportion. Social inequalities in FD persisted, especially economic-related inequalities. Public health policy support and respective interventions should be applied to increase FD retention.


Asunto(s)
Encuestas de Salud Bucal , Pérdida de Diente , Humanos , Estudios Transversales , China/epidemiología , Anciano , Femenino , Masculino , Pérdida de Diente/epidemiología , Factores de Riesgo , Escolaridad , Renta/estadística & datos numéricos , Factores Socioeconómicos
19.
Health Aff (Millwood) ; 43(10): 1410-1419, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39374462

RESUMEN

Little is known about how long it takes for new medicines to reach countries with different income levels. We analyzed data, sourced from IQVIA, on the timing of new drug launches in seventy-five low-, middle-, and high-income markets from 1982 to 2024. The sample captured the majority of essential medicines (as designated by the World Health Organization in the twenty-third Model List of Essential Medicines) that first came into medical use anywhere globally from 1982 onward. Kaplan-Meier estimates were used to quantify delays in launches across countries. Our analysis comprised 119 medicines with 6,871 observed launches. Nearly three-quarters (74 percent) of first launches occurred in just eight countries (in order of the most first launches, the US, the Netherlands, Sweden, Switzerland, the United Kingdom, France, Germany, and Japan). From the first launch globally, the median time to availability was 2.7 years for high-income countries, 4.5 years for upper-middle-income countries, 6.9 years for lower-middle-income countries, and 8.0 years for low-income countries. The gap between richer (high- and upper-middle-income) and poorer (lower-middle- and low-income) countries remained largely unchanged over time. Strategies to address the disparities highlighted by this analysis are urgently needed.


Asunto(s)
Países en Desarrollo , Medicamentos Esenciales , Accesibilidad a los Servicios de Salud , Medicamentos Esenciales/provisión & distribución , Medicamentos Esenciales/economía , Humanos , Factores de Tiempo , Renta , Organización Mundial de la Salud
20.
PLoS One ; 19(10): e0311815, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39383152

RESUMEN

Cancer patients often grapple with substantial out-of-pocket (OOP) expenses and productivity loss, with the ramifications being particularly crucial for lower-income households. This study aims to estimate OOP costs incurred by cancer patients, assess their productivity loss, and analyse the financial coping mechanisms employed by individuals within the lower-income bracket. The study employed face-to-face interviews among cancer patients aged 40 years and above, currently undergoing treatment, and belonging to the lower-income group. Participants were recruited from six public cancer referral hospitals. OOP expenses, encompassing medical and non-medical costs, along with productivity loss, were measured. A generalized linear model was applied to identify potential OOP determinants. Additionally, the coping mechanisms employed by individuals to finance their cancer OOP expenses were also determined. Among the 430 participants recruited, predominantly female (63.5%), and aged 60 or older (53.9%). The annual mean total cancer costs per patient were US$ 2,398.28 (±2,168.74), including 15% for medical costs US$ 350.95 (±560.24), 34% for non-medical costs US$820.24 (±818.24), and 51% for productivity loss costs US$1,227.09 (±1,809.09). Transportation, nutritional supplements, outpatient treatment, and medical supplies were notable cost contributors to total OOP expenditures. Ethnicity (ß = 1.44; 95%CI = 1.15-1.79), household income (ß = 1.40; 95%CI = 1.10-1.78), annual outpatient visits (ß = 1.00; 95%CI = 1.00-1.01), age (ß = 0.74; 95%CI = 0.56-0.98), and employment status (ß = 0.54; 95%CI = 0.72-1.34) were identified as significant predictors of OOP costs among cancer patients. Notably, 91% of participants relied on household salaries and savings, while 15% resorted to interest-free borrowing, 11% sold possessions, and 0.5% borrowed with interest to finance their expenses. This study offers crucial insights into the economic impact of cancer on individuals and their families, providing policymakers with valuable information to tackle challenges faced in their journey. Despite substantial public healthcare subsidies, the study revealed that cancer costs can remain a potential barrier to accessing essential treatment. Therefore, there is a need for reinforced system-level infrastructure to facilitate targeted financial navigation services.


Asunto(s)
Gastos en Salud , Neoplasias , Humanos , Femenino , Masculino , Persona de Mediana Edad , Neoplasias/economía , Neoplasias/terapia , Neoplasias/psicología , Gastos en Salud/estadística & datos numéricos , Malasia , Anciano , Adulto , Adaptación Psicológica , Pobreza , Costo de Enfermedad , Renta , Eficiencia , Habilidades de Afrontamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA