Browsing by Subject "DISPARITIES"

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  • Sever, Mehmet Sukru; Jager, Kitty J.; Vanholder, Raymond; Stengel, Benedicte; Harambat, Jerome; Finne, Patrik; Tesar, Vladimir; Barbullushi, Myftar; Bumblyte, Inga A.; Zakharova, Elena; Spasovski, Goce; Resic, Halima; Wiecek, Andrzej; Blankestijn, Peter J.; Bruchfeld, Annette; Cozzolino, Mario; Goumenos, Dimitris; Soler, Maria Jose; Rychlik, Ivan; Stevens, Kate; Wanner, Christoph; Zoccali, Carmine; Massy, Ziad A. (2021)
    Chronic kidney disease (CKD) is a major health problem because of its high prevalence, associated complications and high treatment costs. Several aspects of CKD differ significantly in the Eastern European nephrology community compared with Western Europe because of different geographic, socio-economic, infrastructure, cultural and educational features. The two most frequent aetiologies of CKD, DM and hypertension, and many other predisposing factors, are more frequent in the Eastern region, resulting in more prevalent CKD Stages 3-5. Interventions may minimize the potential drawbacks of the high prevalence of CKD in Eastern Europe, which include several options at various stages of the disease, such as raising public, medical personnel and healthcare authorities awareness; early detection by screening high-risk populations; preventing progression and CKD-related complications by training health professionals and patients; promoting transplantation or home dialysis as the preferred modality; disseminating and implementing guidelines and guided therapy and encouraging/supporting country-specific observational research as well as international collaborative projects. Specific ways to significantly impact CKD-related problems in every region of Europe through education, science and networking are collaboration with non-nephrology European societies who have a common interest in CKD and its associated complications, representation through an advisory role within nephrology via national nephrology societies, contributing to the training of local nephrologists and stimulating patient-oriented research. The latter is mandatory to identify country-specific kidney disease-related priorities. Active involvement of patients in this research via collaboration with the European Kidney Patient Federation or national patient federations is imperative to ensure that projects reflect specific patient needs.
  • Kaltiala-Heino, Riittakerttu; Lindberg, Nina; Fröjd, Sari; Haravuori, Henna; Marttunen, Mauri (2019)
    Purpose: To explore whether sexual harassment experiences are more common among adolescents reporting romantic and erotic interests in the same sex and both sexes, when sociodemographic and mental health confounding are controlled for, and whether the associations are similar in both sexes and in different phases of adolescence. Methods: A cross-sectional survey among a nationally representative dataset of 25,147 boys and 25,257 girls in comprehensive school, and 33,231 boys and 36,765 girls in upper secondary education. Self-reports of experiences of sexual harassment, and emotional (depression) and behavioral (delinquency) symptoms were used. Results: All associations between sexual minority status and harassment diminished clearly when mental disorder dimensions were controlled for. In the comprehensive school sample (mean age 15.4 years), sexual harassment experiences were 4-7-fold more common among boys, and 1.5-3-fold among girls, with same-sex/both-sexes interest, compared to those interested exclusively in the opposite sex. In the upper secondary education sample (mean age 17.4 years), among boys, sexual harassment was reported 3-6-fold more commonly by those not exclusively heterosexually interested. Among older girls, a slight increase in sexual harassment experiences was seen among those interested in both sexes. Conclusions: Sexual harassment experiences are associated with sexual minority status, particularly among boys. Confounding by mental disorders needs to be accounted for when studying sexual minority status and sexual harassment.
  • Wisgrill, Lukas; Fyhrquist, Nanna; Ndika, Joseph; Paalanen, Laura; Berger, Angelika; Laatikainen, Tiina; Karisola, Piia; Haahtela, Tari; Alenius, Harri (2022)
    Background In allergic patients, clinical symptoms caused by pollen remind of symptoms triggered by viral respiratory infections, which are also the main cause of asthmatic exacerbations. In patients sensitized to birch pollen, Bet v 1 is the major symptom-causing allergen. Immune mechanisms driving Bet v 1-related responses of human blood cells have not been fully characterized. Objective To characterize the immune response to Bet v 1 in peripheral blood in patients allergic to birch pollen. Methods The peripheral blood mononuclear cells of birch-allergic (n = 24) and non-allergic (n = 47) adolescents were stimulated ex-vivo followed by transcriptomic profiling. Systems-biology approaches were employed to decipher disease-relevant gene networks and deconvolution of associated cell populations. Results Solely in birch-allergic patients, co-expression analysis revealed activation of networks of innate immunity and antiviral signalling as the immediate response to Bet v 1 stimulation. Toll-like receptors and signal transducer transcription were the main drivers of gene expression patterns. Macrophages and dendritic cells were the main cell subsets responding to Bet v 1. Conclusions and clinical relevance In birch-pollen-allergic patients, the activated innate immune networks seem to be, in part, the same as those activated during viral infections. This tendency of the immune system to read pollens as viruses may provide new insight to allergy prevention and treatment.
  • Fan, Yuxin; Wang, Leishen; Liu, Huikun; Zhang, Shuang; Tian, Huiguang; Shen, Yun; Tuomilehto, Jaakko; Yu, Zhijie; Yang, Xilin; Hu, Gang; Liu, Ming (2020)
    Introduction To evaluate the single association of postpartum beta-cell dysfunction and insulin resistance (IR), as well as different combinations of postpartum beta-cell dysfunction, IR, obesity, and a history of gestational diabetes mellitus (GDM) with postpartum type 2 diabetes risk. Research design and methods The study included 1263 women with prior GDM and 705 women without GDM. Homeostatic model assessment was used to estimate homeostatic model assessment of beta-cell secretory function (HOMA-%beta) and homeostatic model assessment of insulin resistance (HOMA-IR). Results Multivariable-adjusted ORs of diabetes across quartiles of HOMA-%beta and HOMA-IR were 1.00, 1.46, 2.15, and 6.25 (p(trend) Conclusions beta-cell dysfunction or IR was significantly associated with postpartum diabetes. IR and beta-cell dysfunction, together with obesity and a history of GDM, had the highest ORs of postpartum diabetes risk.
  • Ruokolainen, Lasse; Parkkola, Anna; Karkman, Antti; Sinkko, Hanna; Peet, Aleksandr; Hämäläinen, Anu-Maaria; von Hertzen, Leena; Tillmann, Vallo; Koski, Katriina; Virtanen, Suvi M.; Niemelä, Onni; Haahtela, Tari; Knip, Mikael (2020)
    Background Allergic diseases are more common in Finland than in Estonia, which-according to the biodiversity hypothesis-could relate to differences in early microbial exposures. Methods We aimed at defining possible microbial perturbations preceding early atopic sensitization. Stool, nasal and skin samples of 6-month-old DIABIMMUNE study participants with HLA susceptibility to type 1 diabetes were collected. We compared microbiotas of sensitized (determined by specific IgE results at 18 months of age) and unsensitized Estonian and Finnish children. Results Sensitization was differentially targeted between populations, as egg-specific and birch pollen-specific IgE was more common in Finland. Microbial diversity and community composition also differed; the genusAcinetobacterwas more abundant in Estonian skin and nasal samples. Particularly, the strain-level profile ofAcinetobacter lwoffiiwas more diverse in Estonian samples. Early microbiota was not generally associated with later sensitization. Microbial composition tended to differ between children with or without IgE-related sensitization, but only in Finland. While land-use pattern (ie green areas vs. urban landscapes around the children's homes) was not associated with microbiota as a whole, it associated with the composition of the genusAcinetobacter. Breastfeeding affected gut microbial composition and seemed to protect from sensitization. Conclusions In accordance with the biodiversity hypothesis, our results support disparate early exposure to environmental microbes between Finnish and Estonian children and suggest a significant role of the genusAcinetobacterin the allergy gap between the two populations. The significance of the observed differences for later allergic sensitization remains open.
  • Morales, Juliana; Malles, Aaron; Kimble, Marrell; de la Vega, Pura Rodriguez; Castro, Grettel; Nieder, Alan M.; Barengo, Noel C. (2019)
    Background: Scientific evidence on the effect of health insurance on racial disparities in urinary bladder cancer patients' survival is scant. The objective of our study was to determine whether insurance status modifies the association between race and bladder cancer specific survival during 2007-2015. Methods: The 2015 database of the cancer surveillance program of the National Cancer Institute (n = 39,587) was used. The independent variable was race (White, Black and Asian Pacific Islanders (API)), the main outcome was cancer specific survival. Health insurance was divided into uninsured, any Medicaid and insured. An adjusted model with an interaction term for race and insurance status was computed. Unadjusted and adjusted Cox regression analysis were applied. Results: Health insurance was a statistically significant effect modifier of the association between race and survival. Whereas, API had a lower hazard of death among the patients with Medicaid insurance (HR 0.67; 95% CI 0.48-0.94 compared with White patients, no differences in survival was found between Black and White urinary bladder carcinoma patients (HR 1.24; 95% CI 0.95-1.61). This may be due a lack of power. Among the insured study participants, Blacks were 1.46 times more likely than Whites to die of bladder cancer during the 5-year follow-up (95% CI 1.30-1.64). Conclusions: While race is accepted as a poor prognostic factor in the mortality from bladder cancer, insurance status can help to explain some of the survival differences across races.
  • Oura, Petteri (2022)
    Background: Deaths due to medical care appear common. Individuals with low socioeconomic position seem to be at a higher risk for sustaining a medical adverse event and premature death. This time series analysis aimed to assess educational gradients behind adverse event deaths in the US over the period 2010–2019. Methods: Publicly available mortality and census data were retrieved from official sources. The data included age, sex, educational attainment, and underlying cause of death. Adverse event deaths were identified by ICD-10 codes Y40—Y84 and Y88. Four education categories were created in accordance with the International Standard Classification of Education 2011 coding scheme [No high school or General Educational Development (GED); High school or GED; Some college; Bachelor's degeree or higher]. To capture also highly educated individuals, the analysis was delimited to ≥30-year-olds. Age-adjusted mortality rates (AMRs) were compared between education categories by means of mortality plots and linear mixed models. Results: A total of 25,897,334 certified deaths occurred among ≥30-year-olds during the study period. The underlying cause of death was an adverse event in a rarity of cases (0.12%, n = 31,997). Individuals with Bachelor's degeree or higher had the lowest adverse event AMRs (6.1–12.4 per million per year), followed by the Some college category (9.6–18.6), the High school or GED category (17.1–35.4), and finally the No high school or GED category (20.0–36.0). AMRs showed a gradual increase as education level decreased (p ≤ 0.001 against those with Bachelor's degeree or higher). Moreover, the temporal increase in adverse event AMRs was more pronounced among individuals with low than high education; the contrasts between categories were greatest toward the end of the study period. Conclusion: The findings of this study suggest that the widening socioeconomic gradients in mortality extend also to fatal adverse events. Future studies should aim to analyze whether access to care, severity of the condition at presentation, quality of care, and social determinants of health may drive the gradients.
  • American Joint Committee on Cancer Ophthalmic Oncology Task Force; Tomar, AS; Finger, PT; Gallie, B; Kivelä, Tero T.; Mallipatna, A; Zhang, CY; Zhao, JY; Wilson, MW; Brenna, RC; Burges, M; Kim, J; Khetan, V; Ganesan, S; Yarovoy, A; Yarovaya, V; Kotova, E; Yousef, YA; Nummi, Kalle; Ushakova, TL; Yugay, OV; Polyakov, VG; Ramirez-Ortiz, MA; Esparza-Aguiar, E; Chantada, G; Schaiquevich, P; Fandino, A; Yam, JC; Lau, WW; Lam, CP; Sharwood, P; Moorthy, S; Long, QB; Essuman, VA; Renner, LA; Semenova, E; Catala, J; Correa-Llano, G; Carreras, E (2021)
    Purpose: To compare metastasis-related mortality, local treatment failure, and globe salvage after retinoblastoma in countries with different national income levels. Design: International, multicenter, registry-based retrospective case series. Participants: Two thousand one hundred ninety patients, 18 ophthalmic oncology centers, and 13 countries on 6 continents. Methods: Multicenter registry-based data were pooled from retinoblastoma patients enrolled between January 2001 and December 2013. Adequate data to allow American Joint Committee on Cancer staging, eighth edition, and analysis for the level, as defined by the 2017 United Nations World Population Prospects, and included high-income countries (HICs), upper middle-income countries (UMICs), and lower middle-income countries (LMICs). Patient survival was estimated with the Kaplan-Meier method. Logistic and Cox proportional hazards regression models were used to determine associations between national income and treatment outcomes. Main Outcome Measures: Metastasis-related mortality and local treatment failure (defined as use of secondary enucleation or external beam radiation therapy). Results: Most (60%) study patients resided in UMICs and LMICs. The global median age at diagnosis was 17.0 months and higher in UMICs (20.0 months) and LMICs (20.0 months) than HICs (14.0 months; P < 0.001). Patients in UMICs and LMICs reported higher rates of disease-specific metastasis-related mortality and local treatment failure. As compared with HICs, metastasis-related mortality was 10.3-fold higher for UMICs and 9.3-fold higher for LMICs, and the risk for local treatment failure was 2.2-fold and 1.6-fold higher, respectively (all P < 0.001). Conclusions: This international, multicenter, registry-based analysis of retinoblastoma management revealed that lower national income levels were associated with significantly higher rates of metastasis-related mortality, local treatment failure, and lower globe salvage. (C) 2020 by the American Academy of Ophthalmology.
  • Loi, Silvia; Pitkänen, Joonas; Moustgaard, Heta; Myrskylä, Mikko; Martikainen, Pekka (2021)
    Although the children of first-generation immigrants tend to have better health than the native population, the health advantage of the children of immigrant families deteriorates over generations. It is, however, poorly understood where on the generational health assimilation spectrum children with one immigrant and one native parent (i.e., exogamous families) lie, to what extent family resources explain health assimilation, and whether the process of assimilation varies across health conditions. We seek to extend our understanding of the process of health assimilation by analyzing the physical and mental health of immigrant generations, assessing the role of exoga-mous family arrangements, and testing the contributions of family material and social resources to children’s outcomes. We use register-based longitudinal data on all children residing in Finland, born in 1986–2000, and alive in 2000; these data are free of report-ing bias and loss to follow-up. We estimate the risk of receiving inpatient and outpatient care for somatic conditions, psychopathological disorders, and injuries by immigrant generation status. Our results show evidence of a negative health assimilation process, with both first-and second-generation immigrant children having a higher prevalence of physical problems and particularly mental health problems than native children that is only partially explained by family resources. We find that the children of exogamous families are at especially high risk of developing psychopathological disorders. These results provide strong support for the hypothesis that children of exogamous families constitute a specific health risk group and that the impact on children’s health of family social and material resources seems to be secondary to other unobserved factors.
  • Tanaka, Hirokazu; Nusselder, Wilma J.; Bopp, Matthias; Bronnum-Hansen, Henrik; Kalediene, Ramune; Lee, Jung Su; Leinsalu, Mall; Martikainen, Pekka; Menvielle, Gwenn; Kobayashi, Yasuki; Mackenbach, Johan P. (2019)
    Background We compared mortality inequalities by occupational class in Japan and South Korea with those in European countries, in order to determine whether patterns are similar. Methods National register-based data from Japan, South Korea and eight European countries (Finland, Denmark, England/Wales, France, Switzerland, Italy (Turin), Estonia, Lithuania) covering the period between 1990 and 2015 were collected and harmonised. We calculated age-standardised all-cause and cause-specific mortality among men aged 35-64 by occupational class and measured the magnitude of inequality with rate differences, rate ratios and the average inter-group difference. Results Clear gradients in mortality were found in all European countries throughout the study period: manual workers had 1.6-2.5 times higher mortality than upper non-manual workers. However, in the most recent time-period, upper non-manual workers had higher mortality than manual workers in Japan and South Korea. This pattern emerged as a result of a rise in mortality among the upper non-manual group in Japan during the late 1990s, and in South Korea during the late 2000s, due to rising mortality from cancer and external causes (including suicide), in addition to strong mortality declines among lower non-manual and manual workers. Conclusion Patterns of mortality by occupational class are remarkably different between European countries and Japan and South Korea. The recently observed patterns in the latter two countries may be related to a larger impact on the higher occupational classes of the economic crisis of the late 1990s and the late 2000s, respectively, and show that a high socioeconomic position does not guarantee better health.
  • Andersen, Heidi; Kankaanranta, Hannu; Tuomisto, Leena E.; Piirilä, Päivi; Sovijärvi, Anssi; Langhammer, Arnulf; Backman, Helena; Lundbäck, Bo; Rönmark, Eva; Lehtimäki, Lauri; Ilmarinen, Pinja (2021)
    Multimorbidity is an emerging public health priority. This study aims to assess the role of lifestyle and socioeconomic status in the prevalence of multimorbidity and chronic diseases by using two language groups that are part of the same genetic subgroup but differ by daily habits. We conducted a cross-sectional survey in 2016 with randomly selected population sample with 4173 responders (52.3%) aged 20-69 years in Western Finland. We included 3864 Finnish participants with Swedish (28.1%) or Finnish (71.9%) as a native language. We used a questionnaire to assess participants' chronic diseases and lifestyle. We determined multimorbidity as a disease count >= 2. Finnish speakers were more likely to have a diagnosis of COPD, heart failure, diabetes, reflux disease, chronic kidney failure, and painful conditions than Swedish speakers. The prevalence of multimorbidity was higher for Finnish speakers in the age group of 60-69 years (41.0% vs. 32.0%, p = 0.018) than Swedish speakers. A higher proportion of Finnish speakers smoked, were obese, inactive, and had lower socioeconomic status compared to Swedish speakers. All these factors, in addition to age and female sex, were significant risk factors for multimorbidity. Prevalence of multimorbidity was different in two language groups living in the same area and was associated with differences in lifestyle factors such as smoking, physical inactivity and obesity.
  • Wesołowska, Karolina; Elovainio, Marko; Komulainen, Kaisla; Hietapakka, Laura; Heponiemi, Tarja (2020)
    Abstract Aim To examine: 1) whether nativity status was associated with workplace discrimination, 2) whether this association was mediated through psychosocial work characteristics (job strain, job demands and job control) among registered female nurses. Design Cross-sectional survey with a self-report questionnaire was conducted. Methods A random sample of 610 native Registered Nurses and a total sample of 188 foreign-born Registered Nurses working in Finland were used. Data were collected between September - November of 2017 and analyzed using a counterfactual approach in the causal mediation framework. Results After adjusting for several potential confounders, foreign-born nurses scored higher on workplace discrimination than native nurses. Approximately 20% of the association between nativity status and workplace discrimination was mediated through job control. Job demands and job strain were unlikely to mediate this association. Conclusion The study provides further evidence that migrant status is associated with a higher risk of workplace discrimination among nurses. Lower levels of control over one's own job may partly contribute to the higher risk of workplace discrimination in foreign-born women nurses. Impact Our study addresses the relationship between nativity status and workplace discrimination among female nurses and its mediating factors. The findings suggest that health care organization leaders need to be aware of the increased risk of workplace discrimination among migrant nurses. Moreover, health care organizations need to consider psychosocial work characteristics, including job control, in the efforts aimed to prevent and reduce discrimination against their foreign-born employees.
  • Lagström, Hanna; Halonen, Jaana I.; Kawachi, Ichiro; Stenholm, Sari; Pentti, Jaana; Suominen, Sakari; Kivimäki, Mika; Vahtera, Jussi (2019)
    Neighborhood socioeconomic status (SES) is associated with dietary habits among the residents, but few studies have examined this association separately among long-term residents and movers. We calculated cumulative neighborhood SES score weighted by residential time in each address over 6 years for non-movers (n = 7704) and movers (n = 8818) using national grid database. Increase in average neighborhood SES was associated with higher adherence to dietary recommendations in both groups. Among the movers, an upward trajectory from low to high neighborhood SES was also associated with better adherence. Our findings suggest high SES areas might offer healthier food environments than low SES areas.
  • Pekkala, Johanna; Blomgren, Jenni; Pietilainen, Olli; Lahelma, Eero; Rahkonen, Ossi (2017)
    Objectives Sickness absence is consistently higher in lower occupational classes, but attempts to analyse changes over time in socioeconomic differences are scarce. We examined trends in medically certified sickness absence by occupational class in Finland from 1996 to 2013 and assessed the magnitude and changes in absolute and relative occupational class differences. Design Population-based, repeated cross-sectional study. Setting A 70% random sample of Finns aged between 25 and 63 years in the years 1996-2013. Participants The study focused on 25-to 63 year-old female (n between 572 246 and 690 925) and male (n between 525 698 and 644 425) upper and lower nonmanual and manual workers. Disability and old age pensioners, students, the unemployed, entrepreneurs and farmers were excluded. The analyses covered 2 160 084 persons, that is, 77% of the random sample. For primary and secondary outcome measures, we examined yearly prevalence of over 10 working days long sickness absence by occupational class. The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were used to assess the magnitude and changes in occupational class differences. Results Compared with mid-1990s, sickness absence prevalence was slightly lower in 2013 in all occupational classes except for female lower non-manual workers. Hierarchical occupational class differences in sickness absence were found. Absolute differences (SII) peaked in 2005 in both women (0.12, 95% CI 0.12 to 0.13) and men (0.15, 95% CI 0.14 to 0.15) but reached the previous level in women by 2009 and decreased modestly in men until 2013. Relative differences narrowed over time (p Conclusions Sickness absence prevalence is currently slightly lower in almost all occupational classes than in the mid-1990s, but occupational class differences have remained large. Ill health and poor working conditions especially in the lower occupational classes should be targeted in order to reduce sickness absence and to achieve longer working lives.
  • Sahrakorpi, Niina; Koivusalo, Saila B.; Eriksson, Johan G.; Kautiainen, Hannu; Stach-Lempinen, Beata; Roine, Risto P. (2017)
    Objectives To assess the associations of perceived financial satisfaction and health-related quality of life (HRQoL) and depressive symptoms in an unselected pregnant population in early pregnancy. Methods 750 consecutive pregnant women attending the first communal ultrasound examination before gestational week 14 were invited to participate. Questionnaires assessing HRQoL (15D), depressive symptoms (Edinburgh Depression Scale, EPDS), medical, obstetric, and socioeconomic status were handed out. The participants were divided into three groups according to their satisfaction with their financial status, (unsatisfied, somewhat satisfied, and satisfied). Main outcome measures were 15D and EPDS-scores and dimensions of HRQoL. Results 325 (43,3%) questionnaires were returned. The mean 15D-score for HRQoL was 0,926 (SD 0,056). The financially unsatisfied women had lower HRQoL than women in more satisfied groups (0.906, 0.923 and 0.931, p = 0.012). The result remained significant, even after adjusting for age and education(p = 0.032). The unsatisfied women had a higher mean body mass index (BMI) (25.4, 24.4 and 23.2 kg/m(2), p for linearity = 0.002), were more often smokers, (13 vs. 4 and 3%, p = 0.029), and had experienced at least one abortion (18, 14 and 7%, p = 0.017). Dimensions of depression, distress and sleep explained the differences between the groups. 27% of unsatisfied women scored EPDS ae10 points suggesting increased risk of depression. Conclusions Financial satisfaction in early pregnancy associates with HRQoL and risk of perinatal depressive symptoms. Unsatisfied women more often have risk factors for unfavourable pregnancy outcomes which may influence the later health and wellbeing of the mother and child.
  • Di Girolamo, Chiara; Nusselder, Wilma J.; Bopp, Matthias; Bronnum-Hansen, Henrik; Costa, Giuseppe; Kovacs, Katalin; Leinsalu, Mall; Martikainen, Pekka; Pacelli, Barbara; Valverde, Jose Rubio; Mackenbach, Johan P. (2020)
    Objective To assess whether recent declines in cardiovascular mortality have benefited all socioeconomic groups equally and whether these declines have narrowed or widened inequalities in cardiovascular mortality in Europe. Methods In this prospective registry-based study, we determined changes in cardiovascular mortality between the 1990s and the early 2010s in 12 European populations by gender, educational level and occupational class. In order to quantify changes in the magnitude of differences in mortality, we calculated both ratio measures of relative inequalities and difference measures of absolute inequalities. Results Cardiovascular mortality has declined rapidly among lower and higher socioeconomic groups. Relative declines (%) were faster among higher socioeconomic groups; absolute declines (deaths per 100 000 person-years) were almost uniformly larger among lower socioeconomic groups. Therefore, although relative inequalities increased over time, absolute inequalities often declined substantially on all measures used. Similar trends were seen for ischaemic heart disease and cerebrovascular disease mortality separately. Best performer was England and Wales, which combined large declines in cardiovascular mortality with large reductions in absolute inequalities and stability in relative inequalities in both genders. In the early 2010s, inequalities in cardiovascular mortality were smallest in Southern Europe, of intermediate magnitude in Northern and Western Europe and largest in Central-Eastern European and Baltic countries. Conclusions Lower socioeconomic groups have experienced remarkable declines in cardiovascular mortality rates over the last 25 years, and trends in inequalities can be qualified as favourable overall. Nevertheless, further reducing inequalities remains an important challenge for European health systems and policies.
  • Manderbacka, Kristiina; Arffman, Martti; Lumme, Sonja; Lehikoinen, Markku; Winell, Klas; Keskimaki, Ilmo (2016)
    Objectives: Diabetes requires continuous medical care including prevention of acute complications and risk reduction for long-term complications. Diabetic complications impose a substantial burden on public health and care delivery. We examined trends in regional differences in hospitalisations due to diabetes-related complications among the total diabetes population in Finland. Research design: A longitudinal register-based cohort study 1996-2011 among a total population with diabetes in Finland. Participants: All persons with diabetes identified from several administrative registers in Finland in 1964-2011 and alive on 1 January 1996. Outcome measures: We examined hospitalisations due to diabetes-related short-term and long-term complications, uncomplicated diabetes, myocardial infarction, stroke, lower extremity amputation and end-stage renal disease (ESRD). We calculated annual age-adjusted rates per 10 000 person years and the systematic component of variation. Multilevel models were used for studying time trends in regional variation. Results: There was a steep decline in complication-related hospitalisation rates during the study period. The decline was relatively small in ESRD (30%), whereas rates of hospitalisations for short-term and long-term complications as well as uncomplicated diabetes diminished by about 80%. The overall correlation between hospital district intercepts and slopes in time was -0.72 (p Conclusions: Our study suggests that the prevention of complications among persons with diabetes has improved in Finland between 1996 and 2011. The results further suggest that the prevention of complications has become more uniform throughout the country.
  • Garcia-Velázquez, Regina; Komulainen, Kaisla; Gluschkoff, Kia; Airaksinen, Jaakko; Määttänen, Ilmari; Rosenström, Tom Henrik; Jokela, Markus (2021)
    Objective: Individuals with low socioeconomic status have higher rates of depression, but it is unknown whether the socioeconomically disadvantaged also have more disabling depressive symptoms. We examined (1) the associations of three indicators of socioeconomic status with depression-related severe role impairment, and (2) whether socioeconomic factors moderate the association between individual depression symptoms and depression-related severe role impairment. Methods: We used data from the National Survey on Drug Use and Health (NSDUH). Depressive symptoms, role impairment and socioeconomic indicators (poverty, participation in workforce, educational attainment) were self-reported by participants. The analytic sample consisted of participants who screened positive for a depressive episode during past 12 months (n = 32 661). We used survey-weighted logistic models to examine the associations of depressive symptoms with severe role impairment and the modifying effects of socioeconomic indicators. Results: The association between depression symptom count and severe role impairment was stronger among those not in workforce (OR = 1.12[1.02-1.23]). The association between specific depression symptoms and severe role impairment was stronger for conditions of poverty (fatigue, OR = 2.97 [1.54-5.73]; and anhedonia, OR = 1.93[1.13-3.30]), workforce non-participation (inability to concentrate/indecisiveness, OR = 1.54 [1.12-2.12]), and lower educational attainment (anhedonia, OR = 0.77 [0.59-0.99]). Feelings of worthlessness was the only symptom with independent associations for all socioeconomic groups (adjusted OR = 1.91 [1.35-2.70]). Conclusion: Depression was more frequent and also more disabling for socioeconomically disadvantaged groups, especially when assessed with workforce participation. Additionally, some specific symptoms showed socioeconomic differences. Our findings highlight the need to prioritize population groups with more severe impairment associated with depressive symptoms.
  • Garcia-Velázquez, Regina; Komulainen, Kaisla; Gluschkoff, Kia; Airaksinen, Jaakko; Määttänen, Ilmari; Rosenström, Tom Henrik; Jokela, Markus (2021)
    Objective: Individuals with low socioeconomic status have higher rates of depression, but it is unknown whether the socioeconomically disadvantaged also have more disabling depressive symptoms. We examined (1) the associations of three indicators of socioeconomic status with depression-related severe role impairment, and (2) whether socioeconomic factors moderate the association between individual depression symptoms and depression-related severe role impairment. Methods: We used data from the National Survey on Drug Use and Health (NSDUH). Depressive symptoms, role impairment and socioeconomic indicators (poverty, participation in workforce, educational attainment) were self-reported by participants. The analytic sample consisted of participants who screened positive for a depressive episode during past 12 months (n = 32 661). We used survey-weighted logistic models to examine the associations of depressive symptoms with severe role impairment and the modifying effects of socioeconomic indicators. Results: The association between depression symptom count and severe role impairment was stronger among those not in workforce (OR = 1.12[1.02-1.23]). The association between specific depression symptoms and severe role impairment was stronger for conditions of poverty (fatigue, OR = 2.97 [1.54-5.73]; and anhedonia, OR = 1.93[1.13-3.30]), workforce non-participation (inability to concentrate/indecisiveness, OR = 1.54 [1.12-2.12]), and lower educational attainment (anhedonia, OR = 0.77 [0.59-0.99]). Feelings of worthlessness was the only symptom with independent associations for all socioeconomic groups (adjusted OR = 1.91 [1.35-2.70]). Conclusion: Depression was more frequent and also more disabling for socioeconomically disadvantaged groups, especially when assessed with workforce participation. Additionally, some specific symptoms showed socioeconomic differences. Our findings highlight the need to prioritize population groups with more severe impairment associated with depressive symptoms.
  • Manyanga, Taru; Tremblay, Mark S.; Chaput, Jean-Philippe; Katzmarzyk, Peter T.; Fogelholm, Mikael; Hu, Gang; Kuriyan, Rebecca; Kurpad, Anura; Lambert, Estelle V.; Maher, Carol; Maia, Jose; Matsudo, Victor; Olds, Timothy; Onywera, Vincent; Sarmiento, Olga L.; Standage, Martyn; Tudor-Locke, Catrine; Zhao, Pei; Mikkila, Vera; Broyles, Stephanie T.; ISCOLE Res Grp (2017)
    Background: Although 'unhealthy' diet is a well-known risk factor for non-communicable diseases, its relationship with socio-economic status (SES) has not been fully investigated. Moreover, the available research has largely been conducted in countries at high levels of human development. This is the first study to examine relationships among dietary patterns and SES of children from countries spanning a wide range of human development. Methods: This was a multinational cross-sectional study among 9-11 year-old children (n = 6808) from urban/peri-urban sites across 12 countries. Self-reported food frequency questionnaires were used to determine the children's dietary patterns. Principal Components Analysis was employed to create two component scores representing 'unhealthy' and 'healthy' dietary patterns. Multilevel models accounting for clustering at the school and site level were used to examine the relationships among dietary patterns and SES. Results: The mean age of participants in this study (53.7% girls) was 10.4 years. Largest proportions of total variance in dietary patterns occurred at the individual, site, and school levels (individual, school, site: 62.8%; 10.8%; 26.4% for unhealthy diet pattern (UDP) and 88.9%; 3.7%; 7.4%) for healthy diet pattern (HDP) respectively. There were significant negative 'unhealthy' diet-SES gradients in 7 countries and positive 'healthy' diet-SES gradients in 5. Within country diet-SES gradients did not significantly differ by HDI. Compared to participants in the highest SES groups, unhealthy diet pattern scores were significantly higher among those in the lowest within-country SES groups in 8 countries: odds ratios for Australia (2.69; 95% CI: 1.33-5.42), Canada (4.09; 95% CI: 2.02-8.27), Finland (2.82; 95% CI: 1.27-6.22), USA (4.31; 95% CI: 2.20-8.45), Portugal (2.09; 95% CI: 1.06-4.11), South Africa (2.77; 95% CI: 1.22-6.28), India (1.88; 95% CI: 1.12-3.15) and Kenya (3.35; 95% CI: 1.91-5.87). Conclusions: This study provides evidence of diet-SES gradients across all levels of human development and that lower within-country SES is strongly related to unhealthy dietary patterns. Consistency in within-country diet-SES gradients suggest that interventions and public health strategies aimed at improving dietary patterns among children may be similarly employed globally. However, future studies should seek to replicate these findings in more representative samples extended to more rural representation.