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1.
Int J Equity Health ; 20(1): 258, 2021 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-34922557

RESUMO

BACKGROUND: Belgium was one of the countries that was struck hard by COVID-19. Initially, the belief was that we were 'all in it together'. Emerging evidence showed however that deprived socioeconomic groups suffered disproportionally. Yet, few studies are available for Belgium. The main question addressed in this paper is whether excess mortality during the first COVID-19 wave followed a social gradient and whether the classic mortality gradient was reproduced. METHODS: We used nationwide individually linked data from the Belgian National Register and the Census 2011. Age-standardized all-cause mortality rates were calculated during the first COVID-19 wave in weeks 11-20 in 2020 and compared with the rates during weeks 11-20 in 2015-2019 to calculate absolute and relative excess mortality by socioeconomic and -demographic characteristics. For both periods, relative inequalities in total mortality between socioeconomic and -demographic groups were calculated using Poisson regression. Analyses were stratified by age, gender and care home residence. RESULTS: Excess mortality during the first COVID-19 wave was high in collective households, with care homes hit extremely hard by the pandemic. The social patterning of excess mortality was rather inconsistent and deviated from the usual gradient, mainly through higher mortality excesses among higher socioeconomic groups classes in specific age-sex groups. Overall, the first COVID-19 wave did not change the social patterning of mortality, however. Differences in relative inequalities between both periods were generally small and insignificant, except by household living arrangement. CONCLUSION: The social patterning during the first COVID-19 wave was exceptional as excess mortality did not follow the classic lines of higher mortality in lower classes and patterns were not always consistent. Relative mortality inequalities did not change substantially during the first COVID-19 wave compared to the reference period.


Assuntos
COVID-19 , Bélgica/epidemiologia , Humanos , Lactente , Mortalidade , Pandemias , Características de Residência , SARS-CoV-2 , Fatores Socioeconômicos
2.
SSM Popul Health ; 15: 100879, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34355057

RESUMO

Background: Understanding public health risk perceptions is essential in efficient environmental health management. In the light of the negative impact of air pollution on health and the direct and indirect mediation of this impact through risk perceptions, it is crucial to better understand the lay perceptions of air pollution. Since qualitative research methods are well suited for this aim, the central objective of this study is to present a review of qualitative research articles in the field of environmental epidemiology that investigate health risk perceptions of ambient air pollution since the 2000s. Methods: We followed the PRISMA-guidelines which resulted in a selection of 20 scientific articles published in peer-reviewed academic journals that used qualitative research methods and reported on health risk perceptions about ambient air pollution. Results: Qualitative research in the field of environmental epidemiology is still scarce. Most of the studies included in the review were based on face-to-face interviews and focus group discussions; a minority used a mixed-method approach. Interesting contributions were made with respect to both the perception of exposure to air pollution and the perception of the health effect associated with air pollution. Conclusions: The review suggests that data generated through qualitative research might complement the traditionally quantitative field of environmental epidemiology. Mixed method multidisciplinary research is likely to provide a more holistic explanation of environmental health patterns observed through quantitative research. These explanations are key in managing environmental health and in developing successful prevention, mitigation and communication strategies. Implementing qualitative research methods contribute to the field of environmental epidemiology as it i) allows for triangulation of findings; ii) generates nuanced findings and new research questions; iii) triggers in-depth understandings of quantitatively identified patterns; iv) leads to additional surprising and/or multifaceted responses; v) enhances relationships between researcher and respondent; vi) increases the awareness of important context-dependent dynamics or interactions that may generate biases and vii) grasps the local, contextual, situational and cultural elements that interact with health risk perceptions.

3.
Health Place ; 70: 102603, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34166885

RESUMO

This study examines the associations between residential urban green spaces (UGS) and self-perceived health and natural cause mortality, applying an intersectional approach across gender, education and migrant background. We used data from the 2001 Belgian census linked to register data on emigration and mortality for the period 2001-2014, including 571,558 individuals aged 16-80 residing in Brussels (80% response rate). Residential UGS were assessed with the Normalized Difference Vegetation Index (NDVI) within a 300 m buffer from the residential address and perceived neighbourhood greenness. Multilevel logistic and Cox proportional hazards regression models were conducted to estimate associations between UGS and poor self-perceived health at baseline and natural cause mortality during follow-up. Residential UGS were inversely associated with both outcomes, but there were differences between groups. The strongest beneficial associations among women were found in the lower educated, regardless of their migrant background. For men the strongest association was found in those with tertiary education and Belgian origin. No significant beneficial associations were found in men originating from low and middle-income countries. Applying an intersectionality approach is crucial to understand health inequalities related to UGS exposure. Further research in different geographical contexts is needed to contrast our findings.


Assuntos
Censos , Parques Recreativos , Estudos de Coortes , Feminino , Nível de Saúde , Humanos , Masculino , Características de Residência , Fatores Socioeconômicos
4.
SSM Popul Health ; 14: 100797, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33997246

RESUMO

Introduction: Belgium has noted a significant excess mortality during the first COVID-19 wave. Research in other countries has shown that people with migrant origin are disproportionally affected. Belgium has an ethnically diverse and increasingly ageing population and is therefore particularly apt to study differential mortality by migrant group during this first wave of COVID-19. Data and methods: We used nationwide individually-linked data from the Belgian National Register providing sociodemographic indicators and mortality; and the administrative census of 2011 providing indicators of socioeconomic position. Age-standardized all-cause mortality rates (ASMRs) were calculated during the first COVID-19 wave (weeks 11-20 in 2020) and compared with ASMRs during weeks 11-20 in 2019 to calculate excess mortality by migrant origin, age and gender. For both years, relative inequalities were calculated by migrant group using Poisson regression, with and without adjustment for sociodemographic and socioeconomic indicators. Results: Among the middle-aged, ASMRs revealed increased mortality in all origin groups, with significant excess mortality for Belgians and Sub-Saharan African men. At old age, excess mortality up to 60% was observed for all groups. In relative terms, most male elderly migrant groups showed higher mortality than natives, as opposed to 2019 and to women. Adding the control variables decreased this excess mortality. Discussion: This study underlined important inequalities in overall and excess mortality in specific migrant communities, especially in men. Tailor-made policy measures and communication strategies should be set-up taking into account the particular risks to which groups are exposed.

5.
Cancers (Basel) ; 13(5)2021 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-33668089

RESUMO

Background: Socio-economic position is associated with cancer incidence, but the direction and magnitude of this relationship differs across cancer types, geographical regions, and socio-economic parameters. In this nationwide cohort study, we evaluated the association between different individual-level socio-economic and -demographic factors, cancer incidence, and stage at diagnosis in Belgium. Methods: The 2001 census was linked to the nationwide Belgian Cancer Registry for cancer diagnoses between 2004 and 2013. Socio-economic parameters included education level, household composition, and housing conditions. Incidence rate ratios were assessed through Poisson regression models. Stage-specific analyses were conducted through logistic regression models. Results: Deprived groups showed higher risks for lung cancer and head and neck cancers, whereas an inverse relation was observed for malignant melanoma and female breast cancer. Typically, associations were more pronounced in men than in women. A lower socio-economic position was associated with reduced chances of being diagnosed with known or early stage at diagnosis; the strongest disparities were found for male lung cancer and female breast cancer. Conclusions: This study identified population groups at increased risk of cancer and unknown or advanced stage at diagnosis in Belgium. Further investigation is needed to build a comprehensive picture of socio-economic inequality in cancer incidence.

6.
Cancer Epidemiol Biomarkers Prev ; 30(1): 45-52, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33082205

RESUMO

BACKGROUND: Socioeconomic status (SES) is an important factor in cancer survival; however, results are heterogeneous and linked to characteristics of the study population and health care system. This population-based cohort study evaluates the association between individual-level socioeconomic and demographic factors and cancer survival for the first time in Belgium. METHODS: From the Belgian Cancer Registry, we identified 109,591 patients diagnosed between 2006 and 2013 with one of eight common cancer types. Information on treatment, socioeconomic parameters, and vital status were retrieved from multiple data sources and linked using a unique personal identification number. The outcome was 5-year observed survival. Associations between survival and socioeconomic and demographic factors were assessed using multivariable Cox proportional-hazard regression models. RESULTS: Lower income, unemployment, and living alone were all associated with worse cancer survival. These associations were most pronounced for certain lifestyle-related cancer types (e.g., head and neck cancers) and those with good to moderate prognosis (e.g., colorectal and female breast cancer). CONCLUSIONS: These results indicate that, despite a comprehensive and nationwide health insurance program in which equity in rights and access to health care are pursued, SES is associated with disparities in cancer survival in Belgium. IMPACT: This population-based study with individual-level socioeconomic information of more than 100,000 patients with cancer identifies patient groups that may be at highest risk for socioeconomic disparities in cancer survival. Reasons behind the observed disparities are multiple and complex and should be further examined. Health policy interventions should consider the observed deprivation gap to plan targeted actions.


Assuntos
Disparidades nos Níveis de Saúde , Neoplasias/mortalidade , Fatores Socioeconômicos , Adulto , Idoso , Bélgica/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Modelos de Riscos Proporcionais , Sistema de Registros
7.
Scand J Work Environ Health ; 47(2): 108-116, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33146399

RESUMO

Objectives Evidence is growing that non-standard employment is associated with adverse health. However, little is known about the relationship between different non-standard employment arrangements and subsequent all-cause and cause-specific mortality. Using population-wide data, the present study investigated this link. Methods Data was derived from the 2001 Belgian census and a 13-year-long follow-up. The analyses comprised 1 454 033 healthy and disability-free employees aged 30-59 years at baseline. Cox regressions were fitted to analyze the mortality risks of those in non-standard employment forms (temporary agency, seasonal, fixed-term, causal work and employment program) compared to permanent employees. Results Several groups of workers in non-standard employment arrangements in 2001 exhibited a higher mortality risk relative to permanent employees during the follow-up after adjusting for socio-economic and work-related factors. This was especially the case among men. The relative mortality disadvantage was particularly elevated for male temporary agency workers. External causes of death played an important role in this association. Conclusions A mortality gradient between the core and outer periphery of the Belgian labor market has been observed. This study also shows that the excess risk of death, previously attributed to non-permanent employment as a whole, hides inequalities between specific forms of non-standard work (eg, temporary agency, seasonal, fixed-term employment).

8.
PLoS One ; 14(5): e0216145, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048926

RESUMO

BACKGROUND: Life expectancy increased in industrialized countries, but inequalities in health and mortality by socioeconomic position (SEP) still persist. Several studies have documented educational inequalities, yet the association between health and employment status remains unclear. However, this is an important issue considering the instability of the labour market and the fact that unemployment now also touches 'non-traditional groups' (e.g. the high-educated). This study will 1) probe into the association between unemployment and cause-specific mortality; 2) look into the possible protective effect of sociodemographic variables; 3) assess the association between unemployment, SEP, gender and cause-specific mortality. MATERIAL AND METHODS: Individually linked data of the Belgian census (2001) and Register data on emigration and cause-specific mortality during 2001-2011 are used. The study population contains the Belgian population eligible for employment at census, based on age (25-59 years) and being in good health. Both absolute and relative measures of all-cause and cause-specific mortality by employment status have been calculated, stratified by gender and adjusted for sociodemographic and socioeconomic indicators. RESULTS: Unemployed men and women were at a higher risk for all-cause and cause-specific mortality compared with their employed counterparts. The excess mortality among unemployed Belgians was particularly high for endocrine and digestive diseases, mental disorders, and falls, and more pronounced among men than among women. Other indicators of SEP did only slightly decrease the mortality disadvantage of being unemployed. DISCUSSION: The findings stress the need for actions to ameliorate the health status of unemployed people, especially for the most vulnerable groups in society.


Assuntos
Expectativa de Vida/etnologia , Fatores Sociológicos , Desemprego/tendências , Adulto , Bélgica/epidemiologia , Causas de Morte/tendências , Feminino , Identidade de Gênero , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Ocupações/tendências , Meio Social , Fatores Socioeconômicos
9.
Arch Public Health ; 77: 6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30815257

RESUMO

Background: Reducing socio-economic health inequalities is a public health priority, necessitating careful monitoring that should take into account changes in the population composition. We analyzed the evolution of educational inequalities in life expectancy and disability-free life expectancy at age 25 (LE25 and DFLE25) in Belgium between 2001 and 2011. Methods: The 2001 and 2011 census data were linked with the national register data for a five-year mortality follow up. Disability prevalence estimates from the health interview surveys (2001 to 2013) were used to compute DFLE according to Sullivan's method. LE25 and DFLE25 were computed by educational level (EL). Absolute differentials of LE25 and DFLE25 were calculated for each EL and for each period, as well as composite inequality indices (CII) of population-level impact of inequality. Changes over the 10-year period were then calculated for each inequality index. Results: The LE25 increased in all ELs and both genders, except in the lowest EL for women. The increase was larger in the highest EL, leading in 2011 to 6.07 and 4.58 years for the low-versus-high LE25 gaps respectively in men and women, compared to 5.19 and 3.76 in 2001, namely 17 and 22% increases. The upwards shift of the EL distribution led to a limited 7% increase of the CII among men but no change in women.The substantial increase of the DFLE25 in males with high EL (+ 4.5 years) and the decrease of the DFLE25 in women with low EL, results in a substantial increase of all considered DFLE25 inequality measures in both genders. In 2011, DFLE25 gaps were respectively 10.4 and 13.5 years in males and females compared to 6.51 and 9.30 in 2001, representing increases of 61 and 44% for the gaps, and 72 and 20% for the CII. Conclusion: The LE25 increased in all ELs, but at a higher pace in highly educated, leading to an increase in the LE25 gaps in both genders. After accounting for the upwards shift of the educational distribution, the population-level inequality index increased only for men. The DFLE25 increased only in highly educated men, and decreased in low educated women, leading to large increases of inequalities in both genders. A general plan to tackle health inequality should be set up, with particular efforts to improve the health of the low educated women.

10.
PLoS One ; 13(2): e0192526, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29420646

RESUMO

Because of compositional effects (more highly educated unemployed) and differences in the vulnerability towards the health consequences of unemployment (i.e. disappointment paradox hypothesis and/or status inconsistency for highly educated unemployed), it is argued that indicators of educational attainment need to be included when investigating the social norm of unemployment. Data from the 2001 census linked to register data from 2001-2011 are used, selecting all Belgian employed and unemployed between 30 and 59-year-old at time of the census. Poisson multilevel modelling was used to account for clustering of respondents within sub-districts. For individuals with low education levels, the relative difference in mortality rate ratios between the unemployed and employed is smallest in those regions where aggregate unemployment levels are high. For highly educated, this social norm effect was not found. This study suggest that the social norm effect is stronger for workers with low education levels, while highly educated workers suffer from disappointment and status inconsistency.


Assuntos
Escolaridade , Emprego , Mortalidade , Normas Sociais , Adulto , Bélgica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Distribuição de Poisson , Desemprego
11.
Int J Cancer ; 142(1): 23-35, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-28877332

RESUMO

Our study explores the association between individual and neighborhood socioeconomic position (SEP) and all-cancer and site-specific cancer mortality. Data on all Belgian residents are retrieved from a population-based dataset constructed from the 2001 census linked to register data on emigration and mortality for 2001-2011. The study population contains all men and women aged 40 years or older during follow-up. Individual SEP is measured using education, employment status and housing conditions. Neighborhood SEP is measured by a deprivation index (in quintiles). Directly age-standardized mortality rates and multilevel Poisson models are used to estimate the association between individual SEP and neighborhood deprivation and mortality from all-cancer and cancer of the lung, colon and rectum, pancreas, prostate and female breast. The potential confounding role of population density is assessed using multilevel models as well. Our findings show an increase in mortality from all-cancer and site-specific cancer by decreasing level of individual SEP for both men and women. In addition, individuals living in highly deprived neighborhoods experience significantly higher mortality from all-cancer, lung cancer, pancreatic cancer and female colorectal cancer after controlling for individual SEP. Male colorectal and prostate cancer and female breast cancer are not associated with neighborhood deprivation. Population density acts as a confounder for female lung cancer only. Our study indicates that deprivation at both the individual and neighborhood level is associated with all-cancer mortality and mortality from several cancer sites. More research into the role of life-style related and clinical factors is necessary to gain more insight into causal pathway.


Assuntos
Neoplasias/mortalidade , Densidade Demográfica , Fatores Socioeconômicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bélgica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multinível
12.
BMJ Open ; 7(11): e015216, 2017 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-29133313

RESUMO

OBJECTIVE: This study probes into site-specific cancer mortality inequalities by employment and occupational group among Belgians, adjusted for other indicators of socioeconomic (SE) position. DESIGN: This cohort study is based on record linkage between the Belgian censuses of 1991 and 2001 and register data on emigration and mortality for 01/10/2001 to 31/12/2011. SETTING: Belgium. PARTICIPANTS: The study population contains all Belgians within the economically active age (25-65 years) at the census of 1991. OUTCOME MEASURES: Both absolute and relative measures were calculated. First, age-standardised mortality rates have been calculated, directly standardised to the Belgian population. Second, mortality rate ratios were calculated using Poisson's regression, adjusted for education, housing conditions, attained age, region and migrant background. RESULTS: This study highlights inequalities in site-specific cancer mortality, both related to being employed or not and to the occupational group of the employed population. Unemployed men and women show consistently higher overall and site-specific cancer mortality compared with the employed group. Also within the employed group, inequalities are observed by occupational group. Generally manual workers and service and sales workers have higher site-specific cancer mortality rates compared with white-collar workers and agricultural and fishery workers. These inequalities are manifest for almost all preventable cancer sites, especially those cancer sites related to alcohol and smoking such as cancers of the lung, oesophagus and head and neck. Overall, occupational inequalities were less pronounced among women compared with men. CONCLUSIONS: Important SE inequalities in site-specific cancer mortality were observed by employment and occupational group. Ensuring financial security for the unemployed is a key issue in this regard. Future studies could also take a look at other working regimes, for instance temporary employment or part-time employment and their relation to health.


Assuntos
Emprego/estatística & dados numéricos , Neoplasias/economia , Neoplasias/mortalidade , Ocupações/estatística & dados numéricos , Adulto , Idoso , Bélgica/epidemiologia , Censos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos
13.
Arch Public Health ; 75: 44, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29046785

RESUMO

BACKGROUND: In Belgium, socio-economic inequalities in mortality have long been described at country-level. As Belgium is a federal state with many responsibilities in health policies being transferred to the regional levels, regional breakdown of health indicators is becoming increasingly relevant for policy-makers, as a tool for planning and evaluation. We analyzed the educational disparities by region for all-cause and cause-specific premature mortality in the Belgian population. METHODS: Residents with Belgian nationality at birth registered in the census 2001 aged 25-64 were included, and followed up for 10 years though a linkage with the cause-of-death database. The role of 3 socio-economic variables (education, employment and housing) in explaining the regional mortality difference was explored through a Poisson regression. Age-standardised mortality rates (ASMRs) by educational level (EL), rate differences (RD), rate ratios (RR), and population attributable fractions (PAF) were computed in the 3 regions of Belgium and compared with pairwise regional ratios. The global PAFs were also decomposed into the main causes of death. RESULTS: Regional health gaps are observed within each EL, with ASMRs in Brussels and Wallonia exceeding those of Flanders by about 50% in males and 40% in females among Belgian. Individual SE variables only explained up to half of the regional differences. Educational inequalities were also larger in Brussels and Wallonia than in Flanders, with RDs ratios reaching 1.8 and 1.6 for Brussels versus Flanders, and Wallonia versus Flanders respectively; regional ratios in relative inequalities (RRs and PAFs) were smaller. This pattern was observed for all-cause and most specific causes of premature mortality. Ranking the cause-specific PAFs revealed a higher health impact of inequalities in causes combining high mortality rate and relative inequality, with lung cancer and ischemic heart disease on top for all regions and both sexes. The ranking showed few regional differences. CONCLUSIONS: For the first time in Belgium, educational inequalities were studied by region. Among the Belgian, educational inequalities were higher in Brussels, followed by Wallonia and Flanders. The region-specific PAF decomposition, leading to a ranking of causes according to their population-level impact on overall inequality, is useful for regional policy-making processes.

14.
Arch Public Health ; 75: 55, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28852501

RESUMO

BACKGROUND: This study focuses on the health impact of the labour market position, since recent research indicates that exposure to both unemployment and precarious employment causes serious harm to people's health and well-being. An overview of general and mental health associations of different labour market positions in Belgium is provided. A distinction is made between employment and unemployment and in addition between different types of jobs among the employed, taking into account the quality of employment. Given the fact that precarious labour market positions tend to coincide with a precarious social environment, the latter is taken into consideration by including the composition and material living conditions of the household and the presence of social support. METHODS: Belgian data from the 1st Generations and Gender Survey are used. A Latent Class Cluster Analysis is performed to construct a typology of labour market positions that includes four different types of waged employment: standard jobs, instrumental jobs, precarious jobs and portfolio jobs, as well as self-employment and unemployment. Then, binary logistic regression analyses are performed in order to relate this typology to health, controlling for household situation and social support. Two health outcomes are included: self-perceived general health (good versus fair/bad) and self-rated mental health (good versus bad, based on 7 items from the Center for Epidemiologic Studies Depression Scale). RESULTS: Two labour market positions are consistently related to poor general and mental health in Belgium: unemployment and the precarious job type. The rather small gap in general and mental health between both labour market positions emphasises the importance of employment quality for the health and well-being of individuals in waged employment. Controlling for the household level context and social support illustrates that part of the reported health associations can be explained by the precarious social environment of individuals in unfavourable labour market positions. CONCLUSIONS: The results from this study confirm that the labour market position and social environment of individuals are important health determinants in Belgium.

15.
BMC Cancer ; 17(1): 470, 2017 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-28679369

RESUMO

BACKGROUND: According to the "fundamental cause" theory, emerging knowledge on health-enhancing behaviours and technologies results in health disparities. This study aims to assess (trends in) educational inequalities in site-specific cancer mortality in Belgian men in the 1990s and the 2000s using this framework. METHODS: Data were derived from record linkage between the Belgian censuses of 1991 and 2001 and register data on mortality. The study population comprised all Belgian men aged 50-79 years during follow-up. Both absolute and relative inequality measures have been calculated. RESULTS: Despite an overall downward trend in cancer mortality, educational differences are observed for the majority of cancer sites in the 2000s. Generally, inequalities are largest for mortality from preventable cancers. Trends over time in inequalities are rather stable compared with the 1990s. CONCLUSIONS: Educational differences in site-specific cancer mortality persist in the 2000s in Belgium, mainly for cancers related to behavioural change and medical interventions. Policy efforts focussing on behavioural change and healthcare utilization remain crucial in order to tackle these increasing inequalities.


Assuntos
Escolaridade , Educação em Saúde , Neoplasias/epidemiologia , Idoso , Bélgica/epidemiologia , Causas de Morte , História do Século XX , História do Século XXI , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Neoplasias/história , Neoplasias/mortalidade , Neoplasias/patologia , Vigilância da População , Fatores Sexuais , Fatores Socioeconômicos
16.
Cancer Causes Control ; 28(8): 829-840, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28677024

RESUMO

PURPOSE: According to the "fundamental cause theory", emerging knowledge on health-enhancing behaviours and technologies results in persisting and even widening health disparities, favouring the higher socioeconomic groups. This study aims to assess (trends in) socioeconomic inequalities in site-specific cancer mortality in Belgian women. METHODS: Data were derived from record linkage between the Belgian census and register data on mortality for 1991-1997 and 2001-2008 for all Belgian female inhabitants aged 50-79 years. Both absolute and relative inequalities by education and housing conditions were calculated. RESULTS: The results revealed persisting socioeconomic inequalities in total and site-specific cancer mortality. As expected, these inequalities were larger for the more preventable cancer sites. Generally, socioeconomic inequalities remained quite stable between the 1990s and the 2000s, although for some preventable cancer sites (e.g., uterus and oesophagus) a significant increase in inequality was observed. CONCLUSIONS: These persisting socioeconomic inequalities are likely due to differences in exposure to risk factors and unhealthy behaviours, and access and utilization of healthcare across the social strata. Since equality in health should be a priority for a fair public health policy, efforts to reduce inequalities in risk behaviours and access and use of health care should remain high on the agenda.


Assuntos
Neoplasias/mortalidade , Idoso , Bélgica/epidemiologia , Feminino , Comportamentos Relacionados com a Saúde , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos
17.
J Epidemiol Community Health ; 71(4): 371-380, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27885048

RESUMO

BACKGROUND: Reducing socioeconomic inequalities in mortality, a key public health objective may be supported by a careful monitoring and assessment of the contributions of specific causes of death to the global inequality. METHODS: The 1991 and 2001 Belgian censuses were linked with cause-of-death data, each yielding a study population of over 5 million individuals aged 25-64, followed up for 5 years. Age-standardised mortality rates (ASMR) were computed by educational level (EL) and cause. Inequalities were measured through rate differences (RDs), rate ratios (RRs) and population attributable fractions (PAFs). We analysed changes in educational inequalities between the 1990s and the 2000s, and decomposed the PAF into the main causes of death. RESULTS: All-cause and avoidable ASMR decreased in all ELs and both sexes. Lung cancer, ischaemic heart disease (IHD), chronic obstructive pulmonary disease (COPD) and suicide in men, and IHD, stroke, lung cancer and COPD in women had the highest impact on population mortality. RDs decreased in men but increased in women. RRs and PAFs increased in both sexes, albeit more in women. In men, the impact of lung cancer and COPD inequalities on population mortality decreased while that of suicide and IHD increased. In women, the impact of all causes except IHD increased. CONCLUSION: Absolute inequalities decreased in men while increasing in women; relative inequalities increased in both sexes. The PAFs decomposition revealed that targeting mortality inequalities from lung cancer, IHD, COPD in both sexes, suicide in men and stroke in women would have the largest impact at population level.


Assuntos
Escolaridade , Disparidades nos Níveis de Saúde , Mortalidade Prematura/tendências , Adulto , Fatores Etários , Bélgica , Doenças Cardiovasculares/mortalidade , Causas de Morte/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
18.
Oral Oncol ; 61: 76-82, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27688108

RESUMO

OBJECTIVE: The aim of this study is to assess to what extent individual and area-level socioeconomic position (SEP) are associated to head and neck cancer (HNC) mortality and to what extent they contribute to regional variation in HNC mortality in Belgium. MATERIALS AND METHODS: Data on men aged 40-64 are collected from a population based dataset based on the 2001 Belgian census linked to register data on emigration and mortality for 2001-2011. Individual SEP is measured using education, employment status and housing conditions. Deprivation at municipal level is measured by a deprivation index. Absolute mortality differences are estimated by age standardised mortality rates. Multilevel Poisson models are used to estimate the association and interaction between HNC mortality and individual and area-level SEP, and to estimate the regional variation in HNC mortality. RESULTS: HNC mortality rates are significantly higher for men with a low SEP and men living in deprived areas. Cross-level interactions indicate that the association between individual SEP and HNC mortality is conditional on area deprivation. HNC mortality in deprived areas is especially high among high-SEP men. As a result, social disparities appear to be smaller in more deprived areas. Regional variation in HNC mortality was significant. Population composition partially explains this regional variation, while area deprivation and cross-level interactions explains little. CONCLUSION: Both individual and area-level deprivation are important determinants of HNC mortality. Underlying trends in incidence and survival, and risk factors, such as alcohol and tobacco use, should be explored further.


Assuntos
Neoplasias de Cabeça e Pescoço/mortalidade , Fatores Socioeconômicos , Bélgica/epidemiologia , Estudos de Coortes , Humanos
19.
BMC Public Health ; 16: 493, 2016 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-27287541

RESUMO

BACKGROUND: Ample studies have observed an adverse association between individual socioeconomic position (SEP) and lung cancer mortality. Moreover, the presence of a partner has shown to be a crucial determinant of health. Yet, few studies have assessed whether partner's SEP affects health in addition to individual SEP. This paper will study whether own SEP (education), partner's SEP (partner's education) and own and partner's SEP combined (housing conditions), are associated with lung cancer mortality in Belgium. METHODS: Data consist of the Belgian 2001 census linked to register data on cause-specific mortality for 2001-2011. The study population includes all married or cohabiting Belgian inhabitants aged 40-84 years. Age-standardized lung cancer mortality rates (direct standardization) and mortality rate ratios (Poisson regression) were computed for the different SEP groups. RESULTS: In men, we observed a clear inverse association between all SEP indicators (own and partner's education, and housing conditions) and lung cancer mortality. Men benefit from having a higher educated partner in terms of lower lung cancer mortality rates. These observations hold for both middle-aged and older men. For women, the picture is less uniform. In middle-aged and older women, housing conditions is inversely associated with lung cancer mortality. As for partner's education, for middle-aged women, the association is rather weak whereas for older women, there is no such association. Whereas the educational level of middle-aged women is inversely associated with lung cancer mortality, in older women this association disappears in the fully adjusted model. CONCLUSIONS: Both men and women benefit from being in a relationship with a high-educated partner. It seems that for men, the educational level of their partner is of great importance while for women the housing conditions is more substantial. Both research and policy interventions should allow for the family level as well.


Assuntos
Características da Família , Neoplasias Pulmonares/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Bélgica/epidemiologia , Censos , Feminino , Humanos , Neoplasias Pulmonares/prevenção & controle , Masculino , Casamento , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos
20.
Arch Public Health ; 74: 22, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27280020

RESUMO

BACKGROUND: Country averages for health outcomes hide important within-country variations. This paper probes into the geographic Belgian pattern of all-cause mortality and wishes to investigate the contribution of individual and area socio-economic characteristics to geographic mortality differences in men aged 45-64 during the period 2001-2011. METHODS: Data originate from a linkage between the Belgian census of 2001 and register data on mortality and emigration during the period 2001-2011. Mortality rate ratios (MRRs) are estimated for districts and sub-districts compared to the Belgian average mortality level using Poisson regression modelling. Individual socio-economic position (SEP) indicators are added to examine the impact of these characteristics on the observed geographic pattern. In order to scrutinize the contribution of area-level socio-economic characteristics, random intercepts Poisson modelling is performed with predictors at the individual and the sub-district level. Random intercepts and slopes models are fitted to explore variability of individual-level SEP effects. RESULTS: All-cause MRRs for middle-aged Belgian men are higher in the geographic areas of the Walloon region and the Brussels-Capital Region (BCR) compared to those in the Flemish region. The highest MRRs are observed in the inner city of the BCR and in several Walloon cities. Their disadvantage can partially be explained by the lower individual SEP of men living in these areas. Similarly, the relatively low MRRs observed in the districts of Halle-Vilvoorde, Arlon and Virton can be related to the higher individual SEP. Among the area-level characteristics, both the percentage of men employed and the percentage of labourers in a sub-district have a protective effect on the individual MRR, regardless of individual SEP. Variability in individual-level SEP effects is limited. CONCLUSIONS: Individual SEP partly explains the observed mortality gap in Belgium for some areas. The percentage of men employed and the percentage of labourers in a sub-district have an additional effect on the individual MRR aside from that of individual SEP. However, these socio-economic factors cannot explain all of the observed differences. Other mechanisms such as public health policy, cultural habits and environmental influences contribute to the observed geographic pattern in all-cause mortality among middle-aged men.

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