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1.
Artigo em Inglês | MEDLINE | ID: mdl-34806803

RESUMO

OBJECTIVE: To examine income-related inequalities in access to dental services from 1975 to 2018. In Norway, dental care services for adults are privately financed. This may lead to income-related inequalities in access. In the early 1970s, that is, at the beginning of the study period, there were marked inequalities in access to dental services according to personal income. However, from the beginning of the 1970s, there has been a large increase in gross national income per capita in Norway as a result of the growth of the oil and gas industry. This increase in income also meant that people with a low income in 1975 had a rise in their level of income. According to the law of diminishing utility, an increase in income leads to higher consumption of dental services for people with a low level of income compared to people with a high level of income. The study hypothesis is that the inequalities in access to dental services that existed in 1975 became less over time. METHODS: Statistics Norway collected samples of cross-sectional health survey data for the following years: 1975, 1985, 1995, 2002, 2008, 2012 and 2018. For each sample, individuals 21 years and older were drawn randomly from the non-institutionalized adult population using a two-stage stratified cluster sample technique. Inequalities were measured using the concentration index. The dependent variable was the use of dental services during the last year, and the key independent variable was equivalized household income. RESULTS: The concentration index for inequalities in use of dental services according to income decreased from 0.10 (95% CI = 0.09, 0.11) in 1975 to 0.04 (95% CI = 0.03, 0.05) in 2018. The decrease was particularly large from 2002 to 2012. This was a period with a large growth in gross national income. CONCLUSION: People with a low income had a marked increase in their purchasing power from 1975 to 2018. This coincided with an increase in demand for dental care for this low-income group.

2.
Health Econ ; 30(12): 2974-2994, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34498332

RESUMO

We examined the impact of primary care physician density on perinatal health outcomes in Norway. From 1992 and onwards, primary care physicians who chose to work in selected remote municipalities were given an annual reduction in their student loan. This reduction, combined with increased supply of physicians, led to an increase in the density of primary care physicians in these selected municipalities. Our register-based population study showed that this increase in physician density significantly improved perinatal health in terms of fewer fetal deaths and increased birth weight. The richness of the data allowed us to perform several robustness tests.

3.
BMC Med ; 19(1): 152, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34193123

RESUMO

BACKGROUND: Disparities in health by adult income are well documented, but we know less about the childhood origins of health inequalities, and it remains unclear how the shape of the gradient varies across health conditions. This study examined the association between parental income in childhood and several measures of morbidity in adulthood. METHODS: We used administrative data on seven complete Norwegian birth cohorts born in 1967-1973 (N = 429,886) to estimate the association between parental income from birth to age 18, obtained from tax records available from 1967, linked with administrative registries on health. Health measures, observed between ages 39 and 43, were taken from registry data on consultations at primary health care services based on diagnostic codes from the International Classification of Primary Care (ICPC-2) and hospitalizations and outpatient specialist consultations registered in the National Patient Registry (ICD-10). RESULTS: Low parental income during childhood was associated with a higher risk of being diagnosed with several chronic and pain-related disorders, as well as hospitalization, but not overall primary health care use. Absolute differences were largest for disorders related to musculoskeletal pain, injuries, and depression (7-9 percentage point difference). There were also differences for chronic disorders such as hypertension (8%, CI 7.9-8.5 versus 4%, CI 4.1-4.7) and diabetes (3.2%, CI 3.0-3.4 versus 1.4%, CI 1.2-1.6). There was no difference in consultations related to respiratory disorders (20.9%, CI 20.4-21.5 versus 19.7%, CI 19.2-20.3). Childhood characteristics (parental education, low birth weight, and parental marital status) and own adult characteristics (education and income) explained a large share of the association. CONCLUSIONS: Children growing up at the bottom of the parental income distribution, compared to children in the top of the income distribution, had a two- to threefold increase in somatic and psychological disorders measured in adulthood. This shows that health inequalities by socioeconomic family background persist in a Scandinavian welfare-state context with universal access to health care.


Assuntos
Renda , Transtornos Mentais , Adolescente , Adulto , Criança , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Pais , Pobreza , Fatores Socioeconômicos
4.
Int J Epidemiol ; 50(5): 1615-1627, 2021 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-33975355

RESUMO

BACKGROUND: Children with low-income parents have a higher risk of mental disorders, although it is unclear whether other parental characteristics or genetic confounding explain these associations and whether it is true for all mental disorders. METHODS: In this registry-based study of all children in Norway (n = 1 354 393) aged 5-17 years from 2008 to 2016, we examined whether parental income was associated with childhood diagnoses of mental disorders identified through national registries from primary healthcare, hospitalizations and specialist outpatient services. RESULTS: There were substantial differences in mental disorders by parental income, except for eating disorders in girls. In the bottom 1% of parental income, 16.9% [95% confidence interval (CI): 15.6, 18.3] of boys had a mental disorder compared with 4.1% (95% CI: 3.3, 4.8) in the top 1%. Among girls, there were 14.2% (95% CI: 12.9, 15.5) in the lowest, compared with 3.2% (95% CI: 2.5, 3.9) in the highest parental-income percentile. Differences were mainly attributable to attention-deficit hyperactivity disorder in boys and anxiety and depression in girls. There were more mental disorders in children whose parents had mental disorders or low education, or lived in separate households. Still, parental income remained associated with children's mental disorders after accounting for parents' mental disorders and other factors, and associations were also present among adopted children. CONCLUSIONS: Mental disorders were 3- to 4-fold more prevalent in children with parents in the lowest compared with the highest income percentiles. Parents' own mental disorders, other socio-demographic factors and genetic confounding did not fully explain these associations.

5.
Drug Alcohol Rev ; 40(3): 431-442, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33210443

RESUMO

INTRODUCTION AND AIMS: The gender difference in alcohol use seems to have narrowed in the Nordic countries, but it is not clear to what extent this may have affected differences in levels of harm. We compared gender differences in all-cause and cause-specific alcohol-attributed disease burden, as measured by disability-adjusted life-years (DALY), in four Nordic countries in 2000-2017, to find out if gender gaps in DALYs had narrowed. DESIGN AND METHODS: Alcohol-attributed disease burden by DALYs per 100 000 population with 95% uncertainty intervals were extracted from the Global Burden of Disease database. RESULTS: In 2017, all-cause DALYs in males varied between 2531 in Finland and 976 in Norway, and in females between 620 in Denmark and 270 in Norway. Finland had the largest gender differences and Norway the smallest, closely followed by Sweden. During 2000-2017, absolute gender differences in all-cause DALYs declined by 31% in Denmark, 26% in Finland, 19% in Sweden and 18% in Norway. In Finland, this was driven by a larger relative decline in males than females; in Norway, it was due to increased burden in females. In Denmark, the burden in females declined slightly more than in males, in relative terms, while in Sweden the relative decline was similar in males and females. DISCUSSION AND CONCLUSIONS: The gender gaps in harm narrowed to a different extent in the Nordic countries, with the differences driven by different conditions. Findings are informative about how inequality, policy and sociocultural differences affect levels of harm by gender.


Assuntos
Efeitos Psicossociais da Doença , Carga Global da Doença , Feminino , Finlândia , Humanos , Masculino , Fatores de Risco , Países Escandinavos e Nórdicos , Fatores Sexuais
6.
JACC Heart Fail ; 8(11): 917-927, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33039444

RESUMO

OBJECTIVES: This study explored the association between socioeconomic position (SEP) and long-term mortality following first heart failure (HF) hospitalization. BACKGROUND: It is not clear to what extent education and income-individually or combined-influence mortality among patients with HF. METHODS: This study included 49,895 patients, age 35+ years, with a first HF hospitalization in Norway during 2000 to 2014 and followed them until death or December 31, 2014. The association between education, income, and mortality was explored using Cox regression models, stratified by sex and age group (35 to 69 years and 70+ years). RESULTS: Compared with patients with primary education, those with tertiary education had lower mortality (adjusted hazard ratio [HR]: 0.89; 95% confidence interval [CI]: 0.78 to 0.99 in younger men; HR: 0.57; 95% CI: 0.43 to 0.75 in younger women; HR: 0.90; 95% CI: 0.84 to 0.97 in older men, and HR: 0.87; 95% CI: 0.81 to 0.93 in older women). After adjusting for educational differences, younger and older men and younger women in the highest income quintile had lower mortality compared with those in the lowest income quintile (HR: 0.63; 95% CI: 0.55 to 0.72; HR: 0.78; 95% CI: 0.63 to 0.96, and HR: 0.91; 95% CI: 0.86 to 0.97, respectively). The association between income and mortality was almost linear. No association between income and mortality was observed in older women. CONCLUSIONS: Despite the well-organized universal health care system in Norway, education and income were independently associated with mortality in patients with HF in a clear sex- and age group-specific pattern.


Assuntos
Insuficiência Cardíaca/economia , Hospitalização/estatística & dados numéricos , Assistência de Saúde Universal , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Fatores de Risco , Fatores Socioeconômicos , Taxa de Sobrevida/tendências
8.
BMC Health Serv Res ; 19(1): 696, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615572

RESUMO

BACKGROUND: Overweight and obesity is a major global public health challenge, and understanding the implications for healthcare systems is essential for policy planning. Past studies have typically found positive associations between obesity and healthcare utilization, but these studies have not taken into consideration that obesity is also associated with early mortality. We examined associations between body mass index (BMI, reported as kg/m2) and healthcare utilization with and without taking BMI-specific survival into consideration. METHODS: We used nationally representative data on 33 882 adults collected between 2002 and 2015. We computed BMI- and age-specific primary and secondary care utilization and multiplied the estimated values with gender-, age-, and BMI-specific probabilities of surviving to each age. Then, we summed the average BMI-specific utilization between 18 and 85 years. RESULTS: During a survival-adjusted lifetime, males with normal weight (BMI: 18.5-24.9) had, on average, 167 primary care, and 77 secondary care contacts. In comparison, males with overweight (BMI: 25.0-29.9), category I obesity (BMI: 30.0-34.9), and category II/III obesity (BMI ≥35.0) had 11%, 41%, and 102% more primary care, and 14%, 29%, and 78% more secondary care contacts, respectively. Females with normal weight had, on average, 210 primary care contacts and 91 secondary care contacts. Females with overweight, category I obesity, and category II/III obesity had 20%, 34%, and 81% more primary care contacts, and 26%, 16%, and 16% more secondary care contacts, respectively. CONCLUSION: The positive association between BMI and healthcare utilization was reduced, but not offset, when BMI-specific survival was taken into consideration. Our findings underpin previous research and suggest that interventions to offset the increasing prevalence of overweight, and especially obesity, are warranted.


Assuntos
Índice de Massa Corporal , Sobrepeso/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Atenção à Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Obesidade/mortalidade , Obesidade/terapia , Sobrepeso/mortalidade , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Distribuição por Sexo , Adulto Jovem
9.
JAMA ; 321(19): 1916-1925, 2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-31083722

RESUMO

Importance: Examining causes of death and making comparisons across countries may increase understanding of the income-related differences in life expectancy. Objectives: To describe income-related differences in life expectancy and causes of death in Norway and to compare those differences with US estimates. Design and Setting: A registry-based study including all Norwegian residents aged at least 40 years from 2005 to 2015. Exposures: Household income adjusted for household size. Main Outcomes and Measures: Life expectancy at 40 years of age and cause-specific mortality. Results: In total, 3 041 828 persons contributed 25 805 277 person-years and 441 768 deaths during the study period (mean [SD] age, 59.3 years [13.6]; mean [SD] number of household members per person, 2.5 [1.3]). Life expectancy was highest for women with income in the top 1% (86.4 years [95% CI, 85.7-87.1]) which was 8.4 years (95% CI, 7.2-9.6) longer than women with income in the lowest 1%. Men with the lowest 1% income had the lowest life expectancy (70.6 years [95% CI, 69.6-71.6]), which was 13.8 years (95% CI, 12.3-15.2) less than men with the top 1% income. From 2005 to 2015, the differences in life expectancy by income increased, largely attributable to deaths from cardiovascular disease, cancers, chronic obstructive pulmonary disease, and dementia in older age groups and substance use deaths and suicides in younger age groups. Over the same period, life expectancy for women in the highest income quartile increased 3.2 years (95% CI, 2.7-3.7), while life expectancy for women in the lowest income quartile decreased 0.4 years (95% CI, -1.0 to 0.2). For men, life expectancy increased 3.1 years (95% CI, 2.5-3.7) in the highest income quartile and 0.9 years (95% CI, 0.2-1.6) in the lowest income quartile. Differences in life expectancy by income levels in Norway were similar to differences observed in the United States, except that life expectancy was higher in Norway in the lower to middle part of the income distribution in both men and women. Conclusions and Relevance: In Norway, there were substantial and increasing gaps in life expectancy by income level from 2005 to 2015. The largest differences in life expectancy between Norway and United States were for individuals in the lower to middle part of the income distribution.


Assuntos
Renda , Expectativa de Vida , Mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Feminino , Humanos , Expectativa de Vida/tendências , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Noruega/epidemiologia , Sistema de Registros , Estados Unidos/epidemiologia
10.
BMJ ; 364: l1042, 2019 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-30957776

RESUMO

OBJECTIVE: To investigate the shape of the causal relation between body mass index (BMI) and mortality. DESIGN: Linear and non-linear mendelian randomisation analyses. SETTING: Nord-Trøndelag Health (HUNT) Study (Norway) and UK Biobank (United Kingdom). PARTICIPANTS: Middle to early late aged participants of European descent: 56 150 from the HUNT Study and 366 385 from UK Biobank. MAIN OUTCOME MEASURES: All cause and cause specific (cardiovascular, cancer, and non-cardiovascular non-cancer) mortality. RESULTS: 12 015 and 10 344 participants died during a median of 18.5 and 7.0 years of follow-up in the HUNT Study and UK Biobank, respectively. Linear mendelian randomisation analyses indicated an overall positive association between genetically predicted BMI and the risk of all cause mortality. An increase of 1 unit in genetically predicted BMI led to a 5% (95% confidence interval 1% to 8%) higher risk of mortality in overweight participants (BMI 25.0-29.9) and a 9% (4% to 14%) higher risk of mortality in obese participants (BMI ≥30.0) but a 34% (16% to 48%) lower risk in underweight (BMI <18.5) and a 14% (-1% to 27%) lower risk in low normal weight participants (BMI 18.5-19.9). Non-linear mendelian randomisation indicated a J shaped relation between genetically predicted BMI and the risk of all cause mortality, with the lowest risk at a BMI of around 22-25 for the overall sample. Subgroup analyses by smoking status, however, suggested an always-increasing relation of BMI with mortality in never smokers and a J shaped relation in ever smokers. CONCLUSIONS: The previously observed J shaped relation between BMI and risk of all cause mortality appears to have a causal basis, but subgroup analyses by smoking status revealed that the BMI-mortality relation is likely comprised of at least two distinct curves, rather than one J shaped relation. An increased risk of mortality for being underweight was only evident in ever smokers.


Assuntos
Índice de Massa Corporal , Causas de Morte , Adulto , Idoso , Doenças Cardiovasculares/mortalidade , Feminino , Humanos , Masculino , Análise da Randomização Mendeliana , Pessoa de Meia-Idade , Neoplasias/mortalidade , Noruega/epidemiologia , Obesidade/mortalidade , Fatores de Risco , Distribuição por Sexo , Magreza/mortalidade , Reino Unido/epidemiologia
11.
Tidsskr Nor Laegeforen ; 138(15)2018 10 02.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-30277038

RESUMO

BAKGRUNN: For å kunne møte helseutfordringer i befolkningen trenger vi oversikt over befolkningens helsetilstand. I Norge har vi tradisjonelt hatt god oversikt over dødsårsaker, men vi vet mindre om byrden fra tilstander som medfører sykelighet, såkalt ikke-dødelig helsetap. Vårt mål var å beskrive den totale sykdomsbyrden i Norge i 2016, utviklingen de siste ti årene samt kjønnsforskjeller i sykdomsbyrde. MATERIALE OG METODE: Vi brukte resultater fra det globale sykdomsbyrdeprosjektet Global Burden of Diseases, Injuries and Risk Factors Study (GBD), som kvantifiserer ikke-dødelig helsetap slik at det kan måles på samme skala som dødelighet i form av tapte leveår. Summen av tapte leveår og ikke-dødelig helsetap gir sykdomsbyrdemålet helsetapsjusterte leveår (DALY). RESULTATER: Ikke-smittsomme sykdommer som hjerte- og karsykdom, kreft, kronisk obstruktiv lungesykdom og demens var viktige årsaker til tapte leveår hos begge kjønn i Norge i 2016. Ikke-dødelig helsetap utgjorde 52 % av sykdomsbyrden målt i helsetapsjusterte leveår. Spesielt muskel- og skjelettsykdommer, psykiske lidelser og ruslidelser var viktige. De siste ti årene har sykdomsbyrden (i aldersjusterte rater) sunket for mange tilstander som medfører tapte leveår, men ikke for tilstander som gir ikke-dødelig helsetap. FORTOLKNING: Ikke-dødelig helsetap utgjør en stor og økende andel av sykdomsbyrden i den norske befolkningen, noe som vil gi nye utfordringer for helsevesenet.


Assuntos
Efeitos Psicossociais da Doença , Carga Global da Doença , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Criança , Pré-Escolar , Demência/economia , Demência/epidemiologia , Feminino , Humanos , Lactente , Expectativa de Vida , Masculino , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Mortalidade , Doenças Musculoesqueléticas/economia , Doenças Musculoesqueléticas/epidemiologia , Neoplasias/economia , Neoplasias/epidemiologia , Noruega/epidemiologia , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Distribuição por Sexo , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Ferimentos e Lesões/economia , Ferimentos e Lesões/epidemiologia
12.
Sci Rep ; 8(1): 11499, 2018 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-30065250

RESUMO

The article aims to describe the association between midlife body mass index (BMI) and cardiovascular disease (CVD)- and all-cause mortality, and to use early adulthood BMI as an instrumental variable for midlife BMI, in order to obtain an estimate less distorted by midlife confounders and reverse causality. Data from Norwegian health surveys (1974-2003) (midlife BMI, smoking, blood pressure, total cholesterol, heart rate), Military Conscription Records, National Tuberculosis Screenings (early adulthood BMI), National Educational Registry and Cause of Death Registry were linked. Participants with data on BMI in early adulthood and midlife were included (n = 148.886). Hazard Ratio (HR) for CVD mortality was higher in men with midlife obesity relative to normal weight (HR = 1.46(95% CI 1.25, 1.70). For all-cause mortality, HR was higher in those with obesity or underweight in midlife relative to normal weight (Men:HR = 1.19(95% CI 1.09, 1.29), HR = 2.49(95% CI 1.81, 3.43) Women:HR = 1.33(95% CI 1.13, 1.56), HR = 1.61(95% CI 1.22, 2.13)). In instrumental variable analyses, increased BMI became more strongly associated with CVD and all-cause mortality, and the increased risk of all-cause mortality among the underweight attenuated.


Assuntos
Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Obesidade/complicações , Obesidade/mortalidade , Magreza/complicações , Magreza/mortalidade , Adulto , Índice de Massa Corporal , Causas de Morte , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Modelos de Riscos Proporcionais , Sistema de Registros , Fatores de Risco
13.
BMJ Glob Health ; 3(1): e000528, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29515915

RESUMO

Background: Per capita allocation of overall development assistance has been shown to be biased towards countries with lower population size, meaning funders tend to provide proportionally less development assistance to countries with large populations. Individuals that happen to be part of large populations therefore tend to receive less assistance. However, no study has investigated whether this is also true regarding development assistance for health. We examined whether this so-called 'small-country bias' exists in the health aid sector. Methods: We analysed the effect of a country's population size on the receipt of development assistance for health per capita (in 2015 US$) among 143 countries over the period 1990-2014. Explanatory variables shown to be associated with receipt of development assistance for health were included: gross domestic product per capita, burden of disease, under-5 mortality rate, maternal mortality ratio, vaccination coverage (diphtheria, tetanus and pertussis) and fertility rate. We used the within-between regression analysis, popularised by Mundluck, as well as a number of robustness tests, including ordinary least squares, random-effects and fixed-effects regressions. Results: Our results suggest there exists significant negative effect of population size on the amount of development assistance for health per capita countries received. According to the within-between estimator, a 1% larger population size is associated with a 0.4% lower per capita development assistance for health between countries (-0.37, 95% CI -0.45 to -0.28), and 2.3% lower per capita development assistance for health within countries (-2.29, 95% CI -3.86 to -0.72). Conclusions: Our findings support the hypothesis that small-country bias exists within international health aid, as has been previously documented for aid in general. In a rapidly changing landscape of global health and development, the inclusion of population size in allocation decisions should be challenged on the basis of equitable access to healthcare and health aid effectiveness.

14.
Health Serv Res ; 53(3): 1621-1643, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28516496

RESUMO

OBJECTIVE: To test the impact of obesity on health and health care use in children, by the use of various methods to account for reverse causality and omitted variables. DATA SOURCES/STUDY SETTING: Fifteen rounds of the Health Survey for England (1998-2013), which is representative of children and adolescents in England. STUDY DESIGN: We use three methods to account for reverse causality and omitted variables in the relationship between BMI and health/health service use: regression with individual, parent, and household control variables; sibling fixed effects; and instrumental variables based on genetic variation in weight. DATA COLLECTION/EXTRACTION METHODS: We include all children and adolescents aged 4-18 years old. PRINCIPAL FINDINGS: We find that obesity has a statistically significant and negative impact on self-rated health and a positive impact on health service use in girls, boys, younger children (aged 4-12), and adolescents (aged 13-18). The findings are comparable in each model in both boys and girls. CONCLUSIONS: Using econometric methods, we have mitigated several confounding factors affecting the impact of obesity in childhood on health and health service use. Our findings suggest that obesity has severe consequences for health and health service use even among children.


Assuntos
Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Obesidade Pediátrica/epidemiologia , Adolescente , Fatores Etários , Índice de Massa Corporal , Criança , Pré-Escolar , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Modelos Econométricos , Fatores Sexuais , Fatores Socioeconômicos
15.
Health Econ Rev ; 7(1): 18, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28508169

RESUMO

There is evidence to suggest that high birth weight increases subsequent BMI. However, little attention has been paid to variations in this impact between population groups. This study investigates the relationship between high birth weight and subsequent obesity, and whether or not this relationship varies by household income. Data was taken from fourteen rounds of the Health Survey for England (between 2000-2014; N = 31,043) for children aged 2-16. We regressed obesity in childhood against birth weight, accounting for interactions between birth weight and household income, using sibling-fixed effects models. High birth weight was associated with increased risk of subsequent obesity. This association was significantly more pronounced in children from low-income families, compared with children from high-income families. A 1 kg increase in birth weight increased the probability of obesity by 7% in the lowest income tertile and 4% in the highest income tertile. This suggests that early socioeconomic deprivation compound the effect of high birth weight on obesity.

16.
Health Policy ; 121(6): 691-698, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28461038

RESUMO

We explore the correlation between disease specific estimates of economic losses and the burden of disease. This is based on data for Norway in 2013 from the Global Burden of Disease (GBD) project and the Norwegian Directorate of Health. The diagnostic categories were equivalent to the ICD-10 chapters. Mental disorders topped the list of the costliest conditions in Norway in 2013, and musculoskeletal disorders caused the highest production loss, while neoplasms caused the greatest burden in terms of DALYs. There was a positive and significant association between economic losses and burden of disease. Neoplasms, circulatory diseases, mental and musculoskeletal disorders all contributed to large health care expenditures. Non-fatal conditions with a high prevalence in working populations, like musculoskeletal and mental disorders, caused the largest production loss, while fatal conditions such as neoplasms and circulatory disease did not, since they occur mostly at old age. The magnitude of the production loss varied with the estimation method. The estimations presented in this study did not include reductions in future consumption, by net-recipients, due to premature deaths. Non-fatal diseases are thus even more burdensome, relative to fatal diseases, than the production loss in this study suggests. Hence, ignoring production losses may underestimate the economic losses from chronic diseases in countries with an epidemiological profile similar to Norway.


Assuntos
Efeitos Psicossociais da Doença , Pessoas com Deficiência/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Emprego/economia , Humanos , Mortalidade , Noruega/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida
17.
Eur J Health Econ ; 18(6): 787-799, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27730443

RESUMO

Body mass index (BMI) is an imperfect measure of body fat. Recent studies provide evidence in favor of replacing BMI with waist circumference (WC). Hence, I investigated whether or not the association between fat mass and employment status vary by anthropometric measures. I used 15 rounds of the Health Survey for England (1998-2013), which has measures of employment status in addition to measured height, weight, and WC. WC and BMI were entered as continuous variables and obesity as binary variables defined using both WC and BMI. I used multivariate models controlling for a set of covariates. The association of WC with employment was of greater magnitude than the association between BMI and employment. I reran the analysis using conventional instrumental variables methods. The IV models showed significant impacts of obesity on employment; however, they were not more pronounced when WC was used to measure obesity, compared to BMI. This means that, in the IV models, the impact of fat mass on employment did not depend on the measure of fat mass.


Assuntos
Índice de Massa Corporal , Emprego/estatística & dados numéricos , Obesidade/diagnóstico , Obesidade/epidemiologia , Circunferência da Cintura , Adulto , Fatores Etários , Pesos e Medidas Corporais , Inglaterra , Características da Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fatores Sexuais , Fatores Socioeconômicos
18.
Econ Hum Biol ; 22: 117-125, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27054482

RESUMO

Earlier literature has usually modelled the impact of obesity on employment status as a binary choice (employed, yes/no). I provide new evidence on the impact of obesity on employment status by treating the dependent variable as a as a multinomial choice variable. Using data from a representative English survey, with measured height and weight on parents and children, I define employment status as one of four: working; looking for paid work; permanently not working due to disability; and, looking after home or family. I use a multinomial logit model controlling for a set of covariates. I also run instrumental variable models, instrumenting for Body Mass Index (BMI) based on genetic variation in weight. I find that BMI and obesity significantly increase the probability of "not working due to disability". The results for the other employment outcomes are less clear. My findings also indicate that BMI affects employment through its effect on health. Factors other than health may be less important in explaining the impact of BMI/obesity on employment.


Assuntos
Índice de Massa Corporal , Pessoas com Deficiência/estatística & dados numéricos , Emprego/estatística & dados numéricos , Obesidade/epidemiologia , Estatura , Peso Corporal , Feminino , Humanos , Masculino , Pais , Distribuição por Sexo , Fatores Socioeconômicos
19.
SSM Popul Health ; 2: 333-340, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29349151

RESUMO

We explore if the geographic variation in excess body-mass in Norway can be explained by socioeconomic status, as this has consequences for public policy. The analysis was based on individual height and weight for 198,311 Norwegian youth in 2011, 2012 and 2013, stemming from a compulsory screening for military service, which covers the whole population aged seventeen. These data were merged with municipality-level socioeconomic status (SES) variables and we estimated both ecological models and two-level models with a random term at the municipality level. Overweight was negatively associated with income, education and occupation at municipality level. Furthermore, the municipality-level variance in overweight was reduced by 57% in females and 40% in males, when SES factors were taken into account. This suggests that successful interventions aimed at reducing socioeconomic variation in overweight will also contribute to reducing the geographic variation in overweight, especially in females.

20.
Tidsskr Nor Laegeforen ; 135(21): 1949-53, 2015 Nov 17.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-26577321

RESUMO

BACKGROUND: The quality of the data in the Cause of Death Registry is crucial to produce reliable statistics on causes of death. The Cancer Registry of Norway uses data from the Norwegian Patient Register to request information from hospitals regarding patients registered with cancer in the patient registry, but not in the cancer registry. We wanted to investigate whether data from the Norwegian Patient Register can also be used to advantage in the Cause of Death Registry. MATERIAL AND METHOD: Data from the Cause of Death Registry on deaths that occurred during the period 2009 ­ 2011 (N = 124,098) were collated with data on contact with somatic hospitals and psychiatric institutions during the last year of life, retrieved from the Norwegian Patient Register. Causes of death were grouped in the same way as in standard statistics on causes of death. RESULTS: Out of 124,098 deaths, altogether 34.9% occurred in somatic hospitals. A total of 80.9% of all deceased had been admitted to a somatic hospital and/or had attended an outpatient consultation during their last year of life. The proportion with hospital contact was highest for those whose cause of death was cancer. In cases of unknown/unspecified cause of death, more than half also had contact with hospitals, but the majority of these were registered with only outpatient consultations. Altogether 5.4% of all deceased had been admitted to and/or had an outpatient consultation in a psychiatric institution during their last year of life. For those whose cause of death was suicide, this proportion amounted to 41.8%. INTERPRETATION: In case of incomplete information on the cause of death, data from the Norwegian Patient Register can supply valuable information on where the patient has been treated, thus enabling the Cause of Death Registry to contact the hospitals in question. However, any potential benefit is restricted by the fact that deceased persons with unknown/unspecified causes of death had less frequently been admitted to hospital during their last year of life.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Causas de Morte , Hospitalização/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Noruega/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde , Sistema de Registros , Suicídio/estatística & dados numéricos
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