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1.
Spat Spatiotemporal Epidemiol ; 41: 100501, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35691639

RESUMO

OBJECTIVES: Smoking-related mortality varies over different social, environmental, and policy contexts. However, spatial patterns, examined at a small area level, have been seldom considered. Therefore, the study provides a detailed analysis of socio-spatial inequalities in premature mortality related to smoking in the contemporary Czech adult population. DESIGN, SETTINGS, AND METHODS: We conducted a population-based, cross-sectional study to investigate the spatial pattern of the age-adjusted smoking-related mortality across Czechia. The spatial inequalities, as measured at the municipality level, were investigated using geostatistical modeling techniques. The ecological regression of the local mortality risk on socioeconomic composition of municipalities was also conducted. The target population was defined as permanent adult residents of Czechia aged 25-64 years in the period of 2011-2015. RESULTS: Among both sexes, a significant spatial gradient in the South-East (lower relative risk) - North-West (higher relative risk) axis was detected. The local mortality risk was significantly related to the level of relative deprivation of the municipalities (a composite index comprised from unemployment rate and level of education): adjusted RR among males (for an increase by 1 SD): 1.21 [95% CI: 1.158-1.256], p < 0.001; adjusted RR among females (for an increase by 1 SD): 1.14 [95% CI: 1.090-1.186], p < 0.001. Mortality among males was approximately twice as high as opposed to females. Regarding the spatial inequalities of the phenomena, however, only rather minor sex-specific patterns were identified. Contrasted to males, mortality among females was unrelated to unemployment rates. CONCLUSIONS: Consistent spatial patterns of the premature mortality were identified. The mortality risk was significantly related to socioeconomic composition of the Czech municipalities. The higher the level of local deprivation, the higher the local mortality risk. The results of the study can be found beneficial for planning of both socially and spatially integrated public health policy.


Assuntos
Mortalidade Prematura , Fumar , Adulto , Causas de Morte , Estudos Transversais , República Tcheca/epidemiologia , Feminino , Humanos , Masculino , Mortalidade , Sistema de Registros , Fatores de Risco , Análise de Pequenas Áreas , Fatores Socioeconômicos
2.
J R Soc Interface ; 19(191): 20220094, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35673858

RESUMO

Gaussian processes (GPs), implemented through multivariate Gaussian distributions for a finite collection of data, are the most popular approach in small-area spatial statistical modelling. In this context, they are used to encode correlation structures over space and can generalize well in interpolation tasks. Despite their flexibility, off-the-shelf GPs present serious computational challenges which limit their scalability and practical usefulness in applied settings. Here, we propose a novel, deep generative modelling approach to tackle this challenge, termed PriorVAE: for a particular spatial setting, we approximate a class of GP priors through prior sampling and subsequent fitting of a variational autoencoder (VAE). Given a trained VAE, the resultant decoder allows spatial inference to become incredibly efficient due to the low dimensional, independently distributed latent Gaussian space representation of the VAE. Once trained, inference using the VAE decoder replaces the GP within a Bayesian sampling framework. This approach provides tractable and easy-to-implement means of approximately encoding spatial priors and facilitates efficient statistical inference. We demonstrate the utility of our VAE two-stage approach on Bayesian, small-area estimation tasks.


Assuntos
Análise de Pequenas Áreas , Análise Espacial , Teorema de Bayes , Humanos
3.
BMC Med Res Methodol ; 22(1): 129, 2022 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-35501713

RESUMO

BACKGROUND: The increased availability of data on health outcomes and risk factors collected at fine geographical resolution is one of the main reasons for the rising popularity of epidemiological analyses conducted at small-area level. However, this rich data setting poses important methodological issues related to modelling complexities and computational demands, as well as the linkage and harmonisation of data collected at different geographical levels. METHODS: This tutorial illustrated the extension of the case time series design, originally proposed for individual-level analyses on short-term associations with time-varying exposures, for applications using data aggregated over small geographical areas. The case time series design embeds the longitudinal structure of time series data within the self-matched framework of case-only methods, offering a flexible and highly adaptable analytical tool. The methodology is well suited for modelling complex temporal relationships, and it provides an efficient computational scheme for large datasets including longitudinal measurements collected at a fine geographical level. RESULTS: The application of the case time series for small-area analyses is demonstrated using a real-data case study to assess the mortality risks associated with high temperature in the summers of 2006 and 2013 in London, UK. The example makes use of information on individual deaths, temperature, and socio-economic characteristics collected at different geographical levels. The tutorial describes the various steps of the analysis, namely the definition of the case time series structure and the linkage of the data, as well as the estimation of the risk associations and the assessment of vulnerability differences. R code and data are made available to fully reproduce the results and the graphical descriptions. CONCLUSIONS: The extension of the case time series for small-area analysis offers a valuable analytical tool that combines modelling flexibility and computational efficiency. The increasing availability of data collected at fine geographical scales provides opportunities for its application to address a wide range of epidemiological questions.


Assuntos
Meio Ambiente , Humanos , Londres , Análise de Pequenas Áreas , Fatores de Tempo
4.
Matern Child Nutr ; 18(3): e13369, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35488416

RESUMO

The states and districts are the primary focal points for policy formulation and programme intervention in India. The within-districts variation of key health indicators is not well understood and consequently underemphasised. This study aims to partition geographic variation in low birthweight (LBW) and small birth size (SBS) in India and geovisualize the distribution of small area estimates. Applying a four-level logistic regression model to the latest round of the National Family Health Survey (2015-2016) covering 640 districts within 36 states and union territories of India, the variance partitioning coefficient and precision-weighted prevalence of LBW (<2.5 kg) and SBS (mother's self-report) were estimated. For each outcome, the spatial distribution by districts of mean prevalence and small area variation (as measured by standard deviation) and the correlation between them were computed. Of the total valid sample, 17.6% (out of 193,345 children) had LBW and 12.4% (out of 253,213 children) had SBS. The small areas contributed the highest share of total geographic variance in LBW (52%) and SBS (78%). The variance of LBW attributed to small areas was unevenly distributed across the regions of India. While a strong correlation between district-wide percent and within-district standard deviation was identified in both LBW (r = 0.88) and SBS (r = 0.87), they were not necessarily concentrated in the aspirational districts. We find the necessity of precise policy attention specifically to the small areas in the districts of India with a high prevalence of LBW and SBS in programme formulation and intervention that may be beneficial to improve childbirth outcomes.


Assuntos
Recém-Nascido de Baixo Peso , Parto , Peso ao Nascer , Criança , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Modelos Logísticos , Gravidez , Análise de Pequenas Áreas
5.
PLoS Med ; 18(11): e1003850, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34762663

RESUMO

BACKGROUND: Body-mass index (BMI) and blood pressure (BP) levels are rising in sub-Saharan African cities, particularly among women. However, there is very limited information on how much they vary within cities, which could inform targeted and equitable health policies. Our study aimed to analyse spatial variations in BMI and BP for adult women at the small area level in the city of Accra, Ghana. METHODS AND FINDINGS: We combined a representative survey of adult women's health in Accra, Ghana (2008 to 2009) with a 10% random sample of the national census (2010). We applied a hierarchical model with a spatial term to estimate the associations of BMI and systolic blood pressure (SBP) and diastolic blood pressure (DBP) with demographic, socioeconomic, behavioural, and environmental factors. We then used the model to estimate BMI and BP for all women in the census in Accra and calculated mean BMI, SBP, and DBP for each enumeration area (EA). BMI and/or BP were positively associated with age, ethnicity (Ga), being currently married, and religion (Muslim) as their 95% credible intervals (95% CrIs) did not include zero, while BP was also negatively associated with literacy and physical activity. BMI and BP had opposite associations with socioeconomic status (SES) and alcohol consumption. In 2010, 26% of women aged 18 and older had obesity (BMI ≥ 30 kg/m2), and 21% had uncontrolled hypertension (SBP ≥ 140 and/or DBP ≥ 90 mm Hg). The differences in mean BMI and BP between EAs at the 10th and 90th percentiles were 2.7 kg/m2 (BMI) and in BP 7.9 mm Hg (SBP) and 4.8 mm Hg (DBP). BMI was generally higher in the more affluent eastern parts of Accra, and BP was higher in the western part of the city. A limitation of our study was that the 2010 census dataset used for predicting small area variations is potentially outdated; the results should be updated when the next census data are available, to the contemporary population, and changes over time should be evaluated. CONCLUSIONS: We observed that variation of BMI and BP across neighbourhoods within Accra was almost as large as variation across countries among women globally. Localised measures are needed to address this unequal public health challenge in Accra.


Assuntos
Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Censos , Inquéritos Epidemiológicos , Análise de Pequenas Áreas , Análise Espacial , Adulto , Teorema de Bayes , Comportamento , Diástole/fisiologia , Feminino , Geografia , Gana/epidemiologia , Humanos , Fatores Socioeconômicos , Sístole/fisiologia
6.
Int J Equity Health ; 20(1): 216, 2021 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-34579732

RESUMO

BACKGROUND: The small-area deprivation indices are varied across countries due to different social context and data availability. Due to lack of chronic disease-related social deprivation index (SDI) in Hong Kong, China, this study aimed to develop a new SDI and examine its association with cancer mortality. METHODS: A total of 14 socio-economic variables of 154 large Tertiary Planning Unit groups (LTPUGs) in Hong Kong were obtained from 2016 population by-census. LTPUG-specific all-cause and chronic condition-related mortality and chronic condition inpatient episodes were calculated as health outcomes. Association of socio-economic variables with health outcomes was estimated for variable selection. Candidates for SDI were constructed with selected socio-economic variables and tested for criterion validity using health outcomes. Ecological association between the selected SDI and cancer mortality were examined using zero-inflated negative binomial regression. RESULTS: A chronic disease-related SDI constructed by six area-level socio-economic variables was selected based on its criterion validity with health outcomes in Hong Kong. It was found that social deprivation was associated with higher cancer mortality during 2011-2016 (most deprived areas: incidence relative risk [IRR] = 1.40, 95% confidence interval [CI]: 1.27-1.55; second most deprived areas: IRR = 1.34, 95%CI: 1.21-1.48; least deprived areas as reference), and the cancer mortality gap became larger in more recent years. Excess cancer death related to social deprivation was found to have increased through 2011-2016. CONCLUSIONS: Our newly developed SDI is a valid and routinely available measurement of social deprivation in small areas and is useful in resource allocation and policy-making for public health purpose in communities. There is a potential large improvement in cancer mortality by offering relevant policies and interventions to reduce health-related deprivation. Further studies can be done to design strategies to reduce the expanding health inequalities between more and less deprived areas.


Assuntos
Disparidades nos Níveis de Saúde , Neoplasias , Áreas de Pobreza , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Indicadores Básicos de Saúde , Hong Kong/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Neoplasias/mortalidade , Análise de Pequenas Áreas , Adulto Jovem
7.
Spat Spatiotemporal Epidemiol ; 38: 100433, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353525

RESUMO

Timely monitoring of incidence risks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and associated deaths at small-area level is essential to inform containment strategies. We analysed the spatiotemporal epidemiology of the SARSCoV- 2 pandemic at district level in Germany to develop a tool for disease monitoring. We used a Bayesian spatiotemporal model to estimate the district-specific risk ratios (RR) of SARS-CoV-2 incidence and the posterior probability (PP) for exceedance of RR thresholds 1, 2 or 3. Of 220 districts (55% of 401 districts) showing a RR > 1, 188 (47%) exceed the RR threshold with sufficient certainty (PP ≥ 80%) to be considered at high risk. 47 districts show very high (RR > 2, PP ≥ 80%) and 15 extremely high (RR > 3, PP ≥ 80%) risks. The spatial approach for monitoring the risk of SARS-CoV-2 provides an informative basis for local policy planning.


Assuntos
COVID-19/epidemiologia , Pandemias , SARS-CoV-2 , COVID-19/mortalidade , Alemanha/epidemiologia , Humanos , Incidência , Análise de Pequenas Áreas
8.
Osteoporos Int ; 32(12): 2515-2524, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34156489

RESUMO

Regional variation in procedure use often reflects the uncertainty about the risks and benefit of procedures. In Switzerland, regional variation in vertebroplasty and balloon kyphoplasty rates was high, although the variation declined between 2013 and 2018. Substantial parts of the variation remained unexplained, and likely signal unequal access and differing physician opinion. PURPOSE: To assess trends and regional variation in percutaneous vertebroplasty (VP) and balloon kyphoplasty (BKP) use across Switzerland. METHODS: We conducted a population-based analysis using patient discharge data from all Swiss acute care hospitals for 2013-2018. We calculated age/sex-standardized mean procedure rates and measures of variation across VP/BKP-specific hospital areas (HSAs). We assessed the influence of potential determinants of variation using multilevel regression models with incremental adjustment for demographics, cultural/socioeconomic, health, and supply factors. RESULTS: We analyzed 7855 discharges with VP/BKP from 31 HSAs. The mean age/sex-standardized procedure rate increased from 16 to 20/100,000 persons from 2013 to 2018. While the variation in procedure rates across HSAs declined, the overall variation remained high (systematic component of variation from 56.8 to 6.9 from 2013 to 2018). Determinants explained 52% of the variation. CONCLUSIONS: VP/BKP procedure rates increased and regional variation across Switzerland declined but remained at a high level. A substantial part of the regional variation remained unexplained by potential determinants of variation.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Humanos , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/cirurgia , Análise de Pequenas Áreas , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/cirurgia , Suíça/epidemiologia , Resultado do Tratamento
9.
Am J Epidemiol ; 190(12): 2618-2629, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34132329

RESUMO

Local-level childhood overweight and obesity data are often used to implement and evaluate community programs, as well as allocate resources to combat overweight and obesity. The most current substate estimates of US childhood obesity use data collected in 2007. Using a spatial multilevel model and the 2016 National Survey of Children's Health, we estimated childhood overweight and obesity prevalence rates at the Census regional division, state, and county levels using small-area estimation with poststratification. A sample of 24,162 children aged 10-17 years was used to estimate a national overweight and obesity rate of 30.7% (95% confidence interval: 27.0%, 34.9%). There was substantial county-to-county variability (range, 7.0% to 80.9%), with 31 out of 3,143 counties having an overweight and obesity rate significantly different from the national rate. Estimates from counties located in the Pacific region had higher uncertainty than other regions, driven by a higher proportion of underrepresented sociodemographic groups. Child-level overweight and obesity was related to race/ethnicity, sex, parental highest education (P < 0.01 for all), county-level walkability (P = 0.03), and urban/rural designation (P = 0.02). Overweight and obesity remains a vital issue for US youth, with substantial area-level variability. The additional uncertainty for underrepresented groups shows surveys need to better target diverse samples.


Assuntos
Sobrepeso/epidemiologia , Obesidade Pediátrica/epidemiologia , Adolescente , Criança , Feminino , Humanos , Masculino , Análise Multinível , Características de Residência , Análise de Pequenas Áreas , Fatores Sociodemográficos , Estados Unidos/epidemiologia
10.
Public Health ; 194: 182-184, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33962094

RESUMO

OBJECTIVES: The objective of the study is to compare excess mortality (EM) patterns and spatial correlation between the first and second wave of the pandemic in Lombardy, the Italian region that paid an extremely high COVID-19-related mortality toll in March and April 2020. STUDY DESIGN: We conducted a longitudinal study using municipality-level mortality data. METHODS: We investigated the patterns and spatial correlation of EM of men aged ≥75 years during the first two pandemic waves (March-April 2020 vs November 2020) of COVID-19, using the mortality data released by the Italian National Institute of Statistics. EM was estimated at the municipality level to accurately detect the critical areas within the region. RESULTS: The areas that were mostly hit during the first wave of COVID-19 were generally spared by the second wave: EM of men aged ≥75 years in the municipality of Bergamo plummeted from +472% in March and April to -13% in November, and in Cremona the variation was from +344% to -19%. Conversely, in November 2020 EM was higher in some areas that had been protected in the first wave of the pandemic. Spatial correlation widely corroborates these findings, as large sections of the hot spots of EM detected in the first wave of the pandemic changed into cold spots in the second wave, and vice versa. CONCLUSIONS: Our results reveal the specular distribution of EM between the first and second wave of the pandemic, which may entail the consequences of social distancing measures and individual behaviors, local management strategies, 'harvesting' of the frailer population and, possibly, acquired immune protection. In conclusion, our findings support the need for continuous monitoring and analysis of mortality data using detailed spatial resolution.


Assuntos
COVID-19/mortalidade , Pandemias , Idoso , COVID-19/epidemiologia , Cidades/epidemiologia , Humanos , Itália/epidemiologia , Estudos Longitudinais , Masculino , Mortalidade/tendências , Análise de Pequenas Áreas , Análise Espacial
11.
Environ Health ; 20(1): 59, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985498

RESUMO

BACKGROUND: Noise pollution is increasingly recognised as a public health hazard, yet limited evidence is available from low- and middle-income countries (LMIC), particularly for specific sources. Here, we investigated the association between day-night average (Ldn) aircraft noise and the risk of death due to cardiovascular disease (CVD), stroke and coronary heart disease (CHD) at small-area level around São Paulo's Congonhas airport, Brazil during the period 2011-2016. METHODS: We selected 3259 census tracts across 16 districts partially or entirely exposed to ≥50 dB aircraft noise levels around the Congonhas airport, using pre-modelled 5 dB Ldn noise  bands (≤50 dB to > 65 dB). We estimated the average noise exposure per census tract using area-weighting. Age, sex and calendar year-specific death counts for CVD, stroke and CHD were calculated by census tract, according to the residential address at time of death. We fitted Poisson regression models to quantify the risk associated with aircraft noise exposure, adjusting for age, sex, calendar year and area-level covariates including socioeconomic development, ethnicity, smoking and road traffic related noise and air pollution. RESULTS: After accounting for all covariates, areas exposed to the highest levels of noise (> 65 dB) showed a relative risk (RR) for CVD and CHD of 1.06 (95% CI: 0.94; 1.20) and 1.11 (95%CI: 0.96; 1.27), respectively, compared to those exposed to reference noise levels (≤50 dB). The RR for stroke ranged between 1.05 (95%CI: 0.95;1.16) and 0.91 (95%CI: 0.78;1.11) for all the noise levels assessed. We found a statistically significant positive trend for CVD and CHD mortality risk with increasing levels of noise (p = 0.043 and p = 0.005, respectively). No significant linear trend was found for stroke. Risk estimates were generally higher after excluding road traffic density, suggesting that road traffic air and noise pollution are potentially important confounders. CONCLUSIONS: This study provides some evidence that aircraft noise is associated with increased risk of CVD and CHD mortality in a middle-income setting. More research is needed to validate these results in other LMIC settings and to further explore the influence of residual confounding and ecological bias. Remarkably, 60% of the study population living near the Congonhas airport (~ 1.5 million) were exposed to aircraft noise levels > 50 dB, well above those recommended by the WHO (45 dB), highlighting the need for public health interventions.


Assuntos
Doenças Cardiovasculares/mortalidade , Ruído dos Transportes/efeitos adversos , Acidente Vascular Cerebral/mortalidade , Aeronaves , Aeroportos , Brasil/epidemiologia , Feminino , Humanos , Masculino , Fatores de Risco , Análise de Pequenas Áreas
12.
Can J Public Health ; 112(4): 773-781, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33844239

RESUMO

OBJECTIVES: The objective of this study was to examine the presence of small-area-level effects on children's dental caries in Alberta, Canada, where dental public health programming is targeted in nature, based on an area-level measure of socio-economic circumstances. METHODS: This cross-sectional study included data on tooth decay (from an intra-oral examination conducted by dental hygienists at school) and socio-demographic and behavioural information (from a parent questionnaire) from 5677 grade 1 and 2 schoolchildren attending schools in public or Catholic school systems in Calgary and Edmonton in 2013/2014. Area-level socio-economic circumstances were quantified using the Pampalon Material Deprivation Index derived from census data, applied to the dissemination area (DA) of the child's school. The outcome variable was presence (vs. absence) of tooth decay (cavitation). Data were analyzed using multilevel modeling with two levels: individual level (level 1) and school dissemination area (DA) (level 2). RESULTS: We observed a small but statistically significant area-level effect on children's caries experience, above and beyond individual-level characteristics. CONCLUSION: Study findings are relevant to dental public health programming in Alberta and other jurisdictions that use targeted strategies. Multilevel interventions, including universal approaches, are necessary to reduce inequities in children's dental caries.


RéSUMé: OBJECTIFS: Examiner la présence d'effets de petite région sur les caries dentaires des enfants en Alberta, au Canada, où les programmes publics de santé dentaire sont ciblés de nature, d'après un indicateur régional de la situation socioéconomique. MéTHODE: Cette étude transversale a inclus des données sur la carie dentaire (venant d'un examen intra-buccal mené par des hygiénistes dentaires dans les écoles) et des informations sociodémographiques et comportementales (venant d'un questionnaire auprès des parents) concernant 5 677 enfants d'âge scolaire de 1e et de 2e année fréquentant les écoles du système public ou du système catholique de Calgary et d'Edmonton en 2013-2014. La situation socioéconomique régionale a été chiffrée à l'aide de l'indice de défavorisation matérielle de Pampalon dérivé des données du Recensement, lesquelles ont été appliquées à l'aire de diffusion (AD) des écoles des enfants. Le résultat a été la présence (c. l'absence) de carie dentaire (cavitation). Les données ont été analysées par modélisation multiniveaux selon deux niveaux : la personne (niveau 1) et l'AD de l'école (niveau 2). RéSULTATS: Nous avons observé un effet régional léger mais significatif sur l'expérience de caries des enfants, au-delà des caractéristiques individuelles. CONCLUSION: Les constatations de l'étude sont pertinentes pour les programmes de santé dentaire en Alberta et dans d'autres administrations qui utilisent des stratégies ciblées. Des interventions multiniveaux, y compris des approches universelles, sont nécessaires pour réduire les iniquités dans les caries dentaires des enfants.


Assuntos
Cárie Dentária , Alberta/epidemiologia , Criança , Estudos Transversais , Cárie Dentária/epidemiologia , Feminino , Humanos , Masculino , Análise Multinível , Instituições Acadêmicas , Análise de Pequenas Áreas
13.
Euro Surveill ; 26(17)2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33928902

RESUMO

BackgroundAlthough measles is endemic throughout the World Health Organization European Region, few studies have analysed socioeconomic inequalities and spatiotemporal variations in the disease's incidence.AimTo study the association between socioeconomic deprivation and measles incidence in Germany, while considering relevant demographic, spatial and temporal factors.MethodsWe conducted a longitudinal small-area analysis using nationally representative linked data in 401 districts (2001-2017). We used spatiotemporal Bayesian regression models to assess the potential effect of area deprivation on measles incidence, adjusted for demographic and geographical factors, as well as spatial and temporal effects. We estimated risk ratios (RR) for deprivation quintiles (Q1-Q5), and district-specific adjusted relative risks (ARR) to assess the area-level risk profile of measles in Germany.ResultsThe risk of measles incidence in areas with lowest deprivation quintile (Q1) was 1.58 times higher (95% credible interval (CrI): 1.32-2.00) than in those with highest deprivation (Q5). Areas with medium-low (Q2), medium (Q3) and medium-high deprivation (Q4) had higher adjusted risks of measles relative to areas with highest deprivation (Q5) (RR: 1.23, 95%CrI: 0.99-1.51; 1.05, 95%CrI: 0.87-1.26 and 1.23, 95%CrI: 1.05-1.43, respectively). We identified 54 districts at medium-high risk for measles (ARR > 2) in Germany, of which 22 were at high risk (ARR > 3).ConclusionSocioeconomic deprivation in Germany, one of Europe's most populated countries, is inversely associated with measles incidence. This association persists after demographic and spatiotemporal factors are considered. The social, spatial and temporal patterns of elevated risk require targeted public health action and policy to address the complexity underlying measles epidemiology.


Assuntos
Sarampo , Teorema de Bayes , Alemanha/epidemiologia , Humanos , Incidência , Sarampo/epidemiologia , Análise de Pequenas Áreas , Fatores Socioeconômicos
14.
Int J Cancer ; 149(3): 561-572, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-33751564

RESUMO

Socioeconomic inequalities in cancer survival have been reported in various countries but it is uncertain to what extent they persist in countries with relatively comprehensive health insurance coverage such as Germany. We investigated the association between area-based socioeconomic deprivation on municipality level and cancer survival for 25 cancer sites in Germany. We used data from seven population-based cancer registries (covering 32 million inhabitants). Patients diagnosed in 1998 to 2014 with one of 25 most common cancer sites were included. Area-based socioeconomic deprivation was assessed using the categorized German Index of Multiple Deprivation (GIMD) on municipality level. We estimated 3-month, 1-year, 5-year and 5-year conditional on 1-year age-standardized relative survival using period approach for 2012 to 2014. Trend analyses were conducted for periods between 2003-2005 and 2012-2014. Model-based period analysis was used to calculate relative excess risks (RER) adjusted for age and stage. In total, 2 333 547 cases were included. For all cancers combined, 5-year survival rates by GIMD quintile were 61.6% in Q1 (least deprived), 61.2% in Q2, 60.4% in Q3, 59.9% in Q4 and 59.0% in Q5 (most deprived). For most cancer sites, the most deprived quintile had lower 5-year survival compared to the least deprived quintile even after adjusting for stage (all cancer sites combined, RER 1.16, 95% confidence interval 1.14-1.19). For some cancer sites, this association was stronger during short-term follow-up. Trend analyses showed improved survival from earlier to recent periods but persisting deprivation differences. The underlying reasons for these persisting survival inequalities and strategies to overcome them should be further investigated.


Assuntos
Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Neoplasias/mortalidade , Sistema de Registros/estatística & dados numéricos , Análise de Pequenas Áreas , Fatores Socioeconômicos , Idoso , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Masculino , Neoplasias/economia , Neoplasias/epidemiologia , Prognóstico , Fatores de Risco , Taxa de Sobrevida
15.
Cancer Epidemiol ; 72: 101910, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33735659

RESUMO

BACKGROUND: A previous investigation of the occurrence of childhood acute leukemia around the Belgian nuclear sites has shown positive associations around one nuclear site (Mol-Dessel). In the following years, the Belgian Cancer Registry has made data available at the smallest administrative unit for which demographic information exists in Belgium, i.e. the statistical sector. This offers the advantage to reduce the potential misclassification due to large geographical scales. METHODS: The current study performed for the period 2006-2016 uses Poisson models to investigate (i) the incidence of childhood acute leukemia within 20 km around the four Belgian nuclear sites, (ii) exposure-response relationships between cancer incidence and surrogate exposures from the nuclear sites (distance, wind direction frequency and exposure by hypothetical radioactive discharges taking into account historical meteorological conditions). All analyses are carried out at statistical sector level. RESULTS: Higher incidence rate ratios were found for children <15 years (7 cases, RR = 3.01, 95% CI: 1.43;6.35) and children <5 years (< 5 cases, RR = 3.62, 95% CI: 1.35;9.74) living less than 5 km from the site of Mol-Dessel. In addition, there was an indication for positive exposure-response relationships with the different types of surrogate exposures. CONCLUSION: Results confirm an increased incidence of acute childhood leukemia around Mol-Dessel, but the number of cases remains very small. Random variation cannot be excluded and the ecological design does not allow concluding on causality. These findings emphasize the need for more in-depth research into the risk factors of childhood leukemia, for a better understanding of the etiology of this disease.


Assuntos
Leucemia/epidemiologia , Centrais Nucleares/estatística & dados numéricos , Adolescente , Bélgica/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Sistema de Registros , Análise de Pequenas Áreas
16.
Value Health ; 24(2): 188-195, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33518025

RESUMO

OBJECTIVES: To measure access to opioid treatment programs (OTPs) and office-based buprenorphine treatment (OBBTs) at the smallest geographic unit for which the Census Bureau publishes demographic and socioeconomic data (ie, block group) and to explore disparities in access to treatment across the rural-urban and area deprivation continua across the United States. METHODS: Access to OTPs and OBBTs at the block group in 2019 was quantified using an innovative 2-step floating catchment area technique that accounts for the supply of treatment facilities relative to the population size, proximity of facilities relative to the location of population in block groups, and time as a barrier within catchments. Block groups were stratified into tertiles based on the rural-urban continuum codes (metropolitan, micropolitan, small town, or rural) and area deprivation index (least-deprived, middle-deprived, most-deprived). The Integrated Nested Laplace Approximation approach was used for statistical analysis. RESULTS: Across the United States, 3329 block groups corresponding to 2 915 949 adults lacked access to OTPs within a 2-hour drive of their community and 130 block groups corresponding to 86 605 adults did not have access to OBBTs. Disparities in access to treatment were observed across the urban-rural and area deprivation continua including (1) lowest mean access score to OBBTs were found among most-deprived small towns, and (2) lower mean access score to OTPs were found among micropolitan and small towns. CONCLUSIONS: The results of this study revealed disparities in access to medication-assisted treatment. The findings call for creative initiatives and local and regional policies to develop to mitigate access problems.


Assuntos
Buprenorfina/uso terapêutico , Acesso aos Serviços de Saúde/estatística & dados numéricos , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Buprenorfina/administração & dosagem , Estudos Transversais , Acesso aos Serviços de Saúde/economia , Humanos , Antagonistas de Entorpecentes/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Características de Residência , População Rural/estatística & dados numéricos , Análise de Pequenas Áreas , Fatores Socioeconômicos , Estados Unidos , População Urbana/estatística & dados numéricos
17.
PLoS One ; 16(2): e0246253, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33539391

RESUMO

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting about 1.6% of the population in England. Novel oral anticoagulants (NOACs) are approved AF treatments that reduce stroke risk. In this study, we estimate the equality in individual NOAC prescriptions with high spatial resolution in Clinical Commissioning Groups (CCGs) across England from 2014 to 2019. METHODS: A Bayesian spatio-temporal model will be used to estimate and predict the individual NOAC prescription trend on 'prescription data' as an indicator of health services utilisation, using a small area analysis methodology. The main dataset in this study is the "Practice Level Prescribing in England," which contains four individual NOACs prescribed by all registered GP practices in England. We will use the defined daily dose (DDD) equivalent methodology, as recommended by the World Health Organization (WHO), to compare across space and time. Four licensed NOACs datasets will be summed per 1,000 patients at the CCG-level over time. We will also adjust for CCG-level covariates, such as demographic data, Multiple Deprivation Index, and rural-urban classification. We aim to employ the extended BYM2 model (space-time model) using the RStan package. DISCUSSION: This study suggests a new statistical modelling approach to link prescription and socioeconomic data to model pharmacoepidemiologic data. Quantifying space and time differences will allow for the evaluation of inequalities in the prescription of NOACs. The methodology will help develop geographically targeted public health interventions, campaigns, audits, or guidelines to improve areas of low prescription. This approach can be used for other medications, especially those used for chronic diseases that must be monitored over time.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Inibidores do Fator Xa/farmacologia , Anticoagulantes/uso terapêutico , Teorema de Bayes , Bases de Dados Factuais , Atenção à Saúde/estatística & dados numéricos , Inglaterra/epidemiologia , Inibidores do Fator Xa/administração & dosagem , Humanos , Modelos Estatísticos , Padrões de Prática Médica/estatística & dados numéricos , Prescrições/estatística & dados numéricos , Análise de Pequenas Áreas , Acidente Vascular Cerebral/tratamento farmacológico , Varfarina/uso terapêutico
18.
Econ Hum Biol ; 41: 100988, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33636583

RESUMO

In the U.S. in early 2020, heterogenous and incomplete county-scale data on COVID-19 hindered effective interventions in the pandemic. While numbers of deaths can be used to estimate actual number of infections after a time lag, counties with low death counts early on have considerable uncertainty about true numbers of cases in the future. Here we show that supplementing county-scale mortality statistics with socioeconomic data helps estimate true numbers of COVID-19 infections in low-data counties, and hence provide an early warning of future concern. We fit a LASSO negative binomial regression to select a parsimonious set of five predictive variables from thirty-one county-level covariates. Of these, population density, public transportation use, voting patterns and % African-American population are most predictive of higher COVID-19 death rates. To test the model, we show that counties identified as under-estimating COVID-19 on an early date (April 17) have relatively higher deaths later (July 1) in the pandemic.


Assuntos
Afro-Americanos/estatística & dados numéricos , COVID-19/epidemiologia , Fatores Socioeconômicos , COVID-19/mortalidade , Humanos , Pandemias , SARS-CoV-2 , Análise de Pequenas Áreas , Estados Unidos/epidemiologia
19.
Psychiatr Serv ; 72(4): 384-390, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33530729

RESUMO

OBJECTIVE: To identify geographic variation in mental health service use in the Department of Veterans Affairs (VA), the authors constructed utilization-based VA mental health service areas (MHSAs) for outpatient treatment and mental health referral regions (MHRRs) for residential and acute inpatient treatment. METHODS: MHSAs are empirically derived geographic groupings of one or more counties containing one or more VA outpatient mental health clinics. For each county within an MHSA, patients received most of their VA-provided outpatient mental health care within that MHSA. MHSAs were aggregated into MHRRs according to where VA users in each MHSA received most of their residential and acute inpatient mental health care. Attribution loyalty was evaluated with the localization index-the fraction of VA users living in each geographic area who used their designated MHSA and MHRR facility. Variation in outpatient mental health visits and in acute inpatient and residential mental health stays was determined for the 2008-2018 period. RESULTS: A total of 441 MHSAs were aggregated to 115 MHRRs (representing 3,909,080 patients with 52,372,303 outpatient mental health visits). The mean±SD localization index was 59.3%±16.4% for MHSAs and 67.8%±12.7% for MHRRs. Adjusted outpatient mental health visits varied from a mean of 0.88 per year in the lowest quintile of MHSAs to 3.14 in the highest. Combined residential and acute inpatient days varied from 0.29 to 1.79 between the lowest and highest quintiles. CONCLUSIONS: MHSAs and MHRRs validly represented mental health utilization patterns in the VA and displayed considerable variation in mental health service provision across different locations.


Assuntos
Serviços de Saúde Mental , Veteranos , Hospitais de Veteranos , Humanos , Análise de Pequenas Áreas , Estados Unidos , United States Department of Veterans Affairs
20.
Ann Epidemiol ; 55: 27-33, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33285260

RESUMO

PURPOSE: Research examining the association between crime and health outcomes has been hampered by a lack of reliable small-area (e.g., census tract or census block group) crime data. Our objective is to assess the accuracy of synthetically estimated crime indices for use in health research by using preterm birth as a case study. METHODS: We used violent crime data reported by 47 law enforcement agencies in 15 counties in Atlanta, Georgia and compared them with commercially estimated crime rates from the same year to assess (1) how two measures of crime were correlated and (2) if the associations between violent crime rate indices and preterm birth (PTB) varied as a function of the source of crime index. To assess the association between violent crime and PTB, we used multilevel logistic regression and controlled for potential individual- and neighborhood-level confounders. RESULTS: Violent crime, both estimated and observed, was positively correlated with poverty, neighborhood proportion Black, and neighborhood deprivation index; however, the association was stronger using estimated rates as compared with observed crime rates. The association between living in a high violent crime neighborhood and PTB was only consistent for white women across the two crime indices after covariate adjustment. For Black women, the association between living in a high violent crime neighborhood and PTB is systematically underestimated across all models when the estimated crime rate is used. CONCLUSIONS: There is evidence that model-estimated crime rates are not reliable proxies for crime in an urban area even when appropriate confounders are adjusted for.


Assuntos
Crime , Modelos Estatísticos , Adolescente , Adulto , Crime/estatística & dados numéricos , Feminino , Georgia/epidemiologia , Humanos , Recém-Nascido , Observação , Gravidez , Nascimento Prematuro/epidemiologia , Reprodutibilidade dos Testes , Análise de Pequenas Áreas , Adulto Jovem
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