Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century.

AIMS/HYPOTHESIS: The aim of this study was to determine and quantify socioeconomic position (SEP) inequalities in diabetes mellitus in different areas of Europe, at the turn of the century, for men and women. METHODS: We analysed data from ten representative national health surveys and 13 mortality registers. For national health surveys the dependent variable was the presence of diabetes by self-report and for mortality registers it was death from diabetes. Educational level (SEP), age and sex were independent variables, and age-adjusted prevalence ratios (PRs) and risk ratios (RRs) were calculated. RESULTS: In the overall study population, low SEP was related to a higher prevalence of diabetes, for example men who attained a level of education equivalent to lower secondary school or less had a PR of 1.6 (95% CI 1.4-1.9) compared with those who attained tertiary level education, whereas the corresponding value in women was 2.2 (95% CI 1.9-2.7). Moreover, in all countries, having a disadvantaged SEP is related to a higher rate of mortality from diabetes and a linear relationship is observed. Eastern European countries have higher relative inequalities in mortality by SEP. According to our data, the RR of dying from diabetes for women with low a SEP is 3.4 (95% CI 2.6-4.6), while in men it is 2.0 (95% CI 1.7-2.4). CONCLUSIONS/INTERPRETATION: In Europe, educational attainment and diabetes are inversely related, in terms of both morbidity and mortality rates. This underlines the importance of targeting interventions towards low SEP groups. Access and use of healthcare services by people with diabetes also need to be improved.

Effect of nationwide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries.

BACKGROUND: Recently a scale was introduced to quantify the implementation of tobacco control policies at country level. Our study used this scale to examine the potential impact of these policies on quit ratios in European countries. Special attention was given to smoking cessation among lower educational groups. METHODS: Cross-sectional data were derived from national health surveys from 18 European countries. In the analyses we distinguished between country, sex, two age groups (25-39 and 40-59 years) and educational level. Age-standardised quit ratios were calculated as total former-smokers divided by total ever-smokers. In regression analyses we explored the correlation between national quit ratios and the national score on the Tobacco Control Scale (TCS). RESULTS: Quit ratios were especially high (>45%) in Sweden, England, The Netherlands, Belgium and France and relatively low (<30%) in Lithuania and Latvia. Higher educated smokers were more likely to have quit smoking than lower educated smokers in all age-sex groups in all countries. National score on the tobacco control scale was positively associated with quit ratios in all age-sex groups. The association of quit ratios with score on TCS did not show consistent differences between high and low education. Of all tobacco control policies of which the TCS is constructed, price policies showed the strongest association with quit ratios, followed by an advertising ban. CONCLUSION: Countries with more developed tobacco control policies have higher quit ratios than countries with less developed tobacco control policies. High and low educated smokers benefit about equally from the nationwide tobacco control policies.

Neural tube defects in the Czech Republic during 1961-1999: incidences, prenatal diagnosis and prevalences according to maternal age.

We set out to present the incidences of the neural tube defects (anencephaly, spina bifida and encephalocele) and to document maternal age distribution and the influence of the prenatal diagnostics on incidences in neonates. We also analysed maternal age as a risk factor for the defects studied. This was a retrospective epidemiological study of neural tube defects using data from the population-based register of congenital malformations in the Czech Republic over the 1961-99 period. The total number of neural tube defects detected both pre- and postnatally was 4696 in this period (anencephaly 1857, spina bifida 2420 and encephalocele 419 cases). In this period, a significant decrease (due to improved prenatal diagnostic efficiency) in the above-mentioned defects occurred in the Czech Republic. No statistically significant correlation between any of the particular defects and the maternal age was revealed. However, neural tube defects as a whole show some correlation, the probability of these defects occurring being higher than expected in 15- and 32-year-old mothers. By application of the two-sided 95% CI, statistically significant correlation was found in 15-, 35- and 39-year cohorts; in other age-groups above the age of 32 years this correlation was neither confirmed nor rejected. In this study, maternal age as a risk factor for the origin of neural tube defects has not been statistically confirmed. However, probability estimate makes this correlation possible. Statistical methods in use reveal the risk for these defects (regarding their relative incidences) only in maternal age groups of 15, 35 and 39 years.

Mortality differentials in the Czech Republic during the post-1989 socio-political transformation.

The Czech Republic, together with Slovakia and Poland, forms a region within Central-Eastern Europe in which the values of life expectancy at birth have been increasing during the period of transformation. However, the tempo of mortality reduction has differed spatially within the territory of the Czech Republic, as have other outcomes of the transformation process. This paper discussed possible socio-economic explanations of regional differences in the tempos of mortality change between 1990/91 and 1995/96. Standardized mortality rates for males aged 0-64 years specified for the three most frequent causes of death were examined by means of the regression and correlation analysis.

[Occurrence of cleft defects of the central nervous system in the Czech Republic 1961-1999. Incidence, prenatal diagnosis and prevalence based on maternal age]. / Výskyt rozstepových vad centrálního nervového systému v Ceské republice v období 1961-1999. Incidence, prenatální diagnostika a prevalence podle veku matky.

OBJECTIVE OF STUDY: Presentation of the incidence of neural tube defects (anencephaly, spina bifida, encephalocele) in the Czech Republic in 1961 to 1999. Analysis of the prevalence of these defects in different groups by maternal age. TYPE OF STUDY: Retrospective demographic-epidemiological study. METHOD: Epidemiological analysis of the incidence of neural tube defects diagnosed prenatally and postnatally in the Czech Republic in 1961-1999. Mathematical and statistical analysis of these defects by maternal age, the method of 95% confidence probability interval was used. Data from the nationwide register of inborn defects were used assembled in the Institute of Health Information and Statistics of the Czech Republic and data on the prenatal diagnosis from different departments of medical genetics. RESULTS: In the Czech Republic in 1961-1999 4629 cases of neural tube defects were recorded. This number comprised 1812 cases of anencephaly, 2420 cases of spina bifida and 397 cases of encephalocele. Of this total number of notified defects 386 cases of anencephaly were diagnosed prenatally and pregnancy was terminated. In spina bifida thus 261 pregnancies were terminated prematurely, in encephalocele 67 cases. CONCLUSION: A significant reduction of the incidence of anencephaly, spina bifida and encephalocele in the Czech Republic was found during the last decade of the investigation period (1961-1999). This decline is most probably due to advances of primary and secondary prevention. When evaluating maternal age as one of the risk factors for the development of neural tube defects, this risk was neither unequivocally confirmed nor ruled out.

[Quality of atmosphere and mortality level: selected towns of the Czech Republic, daily values, 1992]. / Kvalita ovzdusi a uroven umrtnosti: vybrana mesta Ceske Republiky, denni hodnoty za rok 1992.

PIP: "The study issued from four indicators of the state of atmosphere (average daily concentrations of sulphurous and nitrogen oxides, dusty aerosol, average daily temperature) and numbers of deaths per day classified by living place, sex and age of deceased persons [after] elimination of death due to [other] causes and accidents....[The] study results acknowledge the assumption that pollution of the atmosphere is not the decisive cause of higher intensity of mortality." (EXCERPT)^ieng

Relationship between environment quality and mortality in Czechoslovakia.

"Our paper concentrates on a regional analysis of the relationship between living environment and public health.... We utilized the collected data concerning the relationship between environment and public health and worked out an application of these data to be implemented in Czechoslovakia (CSFR)....Czechoslovakia's extremely disturbed areas usually correspond to regions with high mortality rates. However, the relationship between the two phenomena is not explicit because these ¿disrupted' areas also have different ethnic and social structures. The education standards of their populations are usually lower, in addition to other adverse characteristics which can be described as socio-pathological." (SUMMARY IN CZE)

[Typology of districts in the Czech Socialist Republic by causes of death]. / Typologie okresu CSR podle pricin umrti.

PIP: This article builds on a series of previously published analyses of regional mortality differentials in Czechoslovakia and focuses on the structure of causes of death. The data concern the period 1980-1984 and are presented separately for males and females for the 75 districts of the Czech part of the country. (SUMMARY IN ENG AND RUS)^ieng