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Ribeiro, Ana Isabel, Alexandra Mayer, Ana Miranda, and Maria de Fátima De Pina. "The Portuguese Version of the European Deprivation Index: An Instrument to Study Health Inequalities." Acta Médica Portuguesa 30, no. 1 (January 31, 2017): 17. http://dx.doi.org/10.20344/amp.7387.
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Introduction: Tackling socioeconomic health inequalities is a big public health challenge and ecological deprivation indexes are essential instruments to monitor and understand them. In Portugal, no standard ecological deprivation index exists, contrasting with other countries. We aimed to describe the construction of the Portuguese version of a transnational deprivation index, European Deprivation Index.Material and Methods: The European Deprivation Index was developed under the Townsend theorization of deprivation. Using data from the European Union - Statistics on Income and Living Conditions Survey, we obtained an indicator of individual deprivation. This indicator became the gold-standard variable, based on what we selected the variables at aggregate level (census) to be included in the European Deprivation Index, a total of eight. The European Deprivation Index was produced for the smallest area unit possible (n = 16 094, mean/area = 643 inhabitants) and resulted from the weighted sum of the previous variables. It was then classified into quintiles.Results: The first quintile (least deprived) comprised 20.9% national population and the fifth quintile (most deprived) 18.0%. The European Deprivation Index showed a clear geographic pattern – most deprived areas concentrated in the South and in the inner North and Centre of the country, and the least deprived areas in the coastal areas of North and Centre and in the Algarve.Discussion: The development of the European Deprivation Index was grounded on a solid theoretical framework, individual and aggregate variables, and on a longitudinal Europe-wide survey allowing its replication over the time and in any European country.Conclusion: Hopefully, the European Deprivation Index will start being employed by those interested in better understand health inequalities not only in Portugal but across Europe.
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Zadnik, Vesna, Elodie Guillaume, Katarina Lokar, Tina Žagar, Maja Primic Žakelj, Guy Launoy, and Ludivine Launay. "Slovenian version of the european deprivation index at municipal level." Slovenian Journal of Public Health 57, no. 2 (April 12, 2018): 47–54. http://dx.doi.org/10.2478/sjph-2018-0007.
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Abstract Introduction Ecological deprivation indices belong to essential instruments for monitoring and understanding health inequalities. Our aim was to develop the SI-EDI, a newly derived European Deprivation Index for Slovenia. We intend to provide researchers and policy-makers in our country with a relevant tool for measuring and reducing the socioeconomic inequalities in health, and even at a broader level. Methods Data from the European survey on Income and Living Conditions and Slovenian national census for the year 2011 were used in the SI-EDI construction. The concept of relative deprivation was used where deprivation refers to unmet need(s), which is caused by lack of all kinds of resources, not only material. The SI-EDI was constructed for 210 Slovenian municipalities. Its geographical distribution was compared to the distribution of two existing deprivation scores previously applied in health inequality research in Slovenia. Results There were 36% of adults recognized as deprived in Slovenia in 2011. SI-EDI was calculated using 10 census variables that were associated with individual deprivation. A clear east-to-west gradient was detected with the most deprived municipalities in the eastern part of the country. The two existing deprivation scores correlate significantly with the SI-EDI. Conclusions A new deprivation index, the SI-EDI, is grounded on the internationally established scientific concept, can be replicated over time and, crucially, provides an account of the socioeconomic and cultural particularities of the Slovenian population. The SI-EDI could be used by the stakeholders and the governmental and nongovernmental sectors in Slovenia, with the goal of better understanding health inequalities in Slovenia.
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Vercelli, Marina, Roberto Lillini, Fabrizio Stracci, Valerio Brunori, Alessio Gili, Fortunato Bianconi, Francesco La Rosa, Alberto Izzotti, Elodie Guillaume, and Guy Launoy. "Cancer Mortality and Deprivation: Comparison Among the Performances of the European Deprivation Index, the Italian Deprivation Index and Local Socio-Health Deprivation Indices." Social Indicators Research 151, no. 2 (June 5, 2020): 599–620. http://dx.doi.org/10.1007/s11205-020-02396-7.
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Rabanal, Kjersti Stormark, Haakon Eduard Meyer, Romana Pylypchuk, Suneela Mehta, Randi Marie Selmer, and Rodney T. Jackson. "Performance of a Framingham cardiovascular risk model among Indians and Europeans in New Zealand and the role of body mass index and social deprivation." Open Heart 5, no. 2 (July 2018): e000821. http://dx.doi.org/10.1136/openhrt-2018-000821.
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ObjectivesTo evaluate a Framingham 5-year cardiovascular disease (CVD) risk score in Indians and Europeans in New Zealand, and determine whether body mass index (BMI) and socioeconomic deprivation were independent predictors of CVD risk.MethodsWe included Indians and Europeans, aged 30–74 years without prior CVD undergoing risk assessment in New Zealand primary care during 2002–2015 (n=256 446). Risk profiles included standard Framingham predictors (age, sex, systolic blood pressure, total cholesterol/high-density lipoprotein ratio, smoking and diabetes) and were linked with national CVD hospitalisations and mortality datasets. Discrimination was measured by the area under the receiver operating characteristics curve (AUC) and calibration examined graphically. We used Cox regression to study the impact of BMI and deprivation on the risk of CVD with and without adjustment for the Framingham score.ResultsDuring follow-up, 8105 and 1156 CVD events occurred in Europeans and Indians, respectively. Higher AUCs of 0.76 were found in Indian men (95% CI 0.74 to 0.78) and women (95% CI 0.73 to 0.78) compared with 0.74 (95% CI 0.73 to 0.74) in European men and 0.72 (95% CI 0.71 to 0.73) in European women. Framingham was best calibrated in Indian men, and overestimated risk in Indian women and in Europeans. BMI and deprivation were positively associated with CVD, also after adjustment for the Framingham risk score, although the BMI association was attenuated.ConclusionsThe Framingham risk model performed reasonably well in Indian men, but overestimated risk in Indian women and in Europeans. BMI and socioeconomic deprivation could be useful predictors in addition to a Framingham score.
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Guillaume, Elodie, Carole Pornet, Olivier Dejardin, Ludivine Launay, Roberto Lillini, Marina Vercelli, Marc Marí-Dell'Olmo, et al. "Development of a cross-cultural deprivation index in five European countries." Journal of Epidemiology and Community Health 70, no. 5 (December 11, 2015): 493–99. http://dx.doi.org/10.1136/jech-2015-205729.
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García-Germán, Sol, Isabel Bardají, and Alberto Garrido. "Do increasing prices affect food deprivation in the European Union?" Spanish Journal of Agricultural Research 16, no. 1 (April 26, 2018): e0103. http://dx.doi.org/10.5424/sjar/2018161-11254.
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The rise of prices of agricultural commodities in global markets during 2007-2012 was followed by increased consumer food prices around the world. More expensive food may have an impact on consumer food access and thus on their welfare, not only in developing countries but also amongst the most vulnerable in developed countries. Using a longitudinal database from the Statistics on Income and Living Conditions and population-averaged models, we tested whether increasing food prices had an impact on household food deprivation in 26 European Union (EU) member states. Results revealed a significant relationship between food deprivation and the consumer food price index and disposable income. Households in the lowest income quintile in the member states recently acceded to the EU were the most vulnerable to food deprivation. Results also showed that low-income households in densely populated areas were more vulnerable to food deprivation. This should be taken into account when evaluating food assistance programmes that focus on the segments of the population most at risk of food deprivation.
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Pornet, Carole, Cyrille Delpierre, Olivier Dejardin, Pascale Grosclaude, Ludivine Launay, Lydia Guittet, Thierry Lang, and Guy Launoy. "Construction of an adaptable European transnational ecological deprivation index: the French version." Journal of Epidemiology and Community Health 66, no. 11 (April 27, 2012): 982–89. http://dx.doi.org/10.1136/jech-2011-200311.
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Luben, Robert, Shabina Hayat, Anthony Khawaja, Nicholas Wareham, Paul P. Pharoah, and Kay-Tee Khaw. "Residential area deprivation and risk of subsequent hospital admission in a British population: the EPIC-Norfolk cohort." BMJ Open 9, no. 12 (December 2019): e031251. http://dx.doi.org/10.1136/bmjopen-2019-031251.
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ObjectivesTo investigate whether residential area deprivation index predicts subsequent admissions to hospital and time spent in hospital independently of individual social class and lifestyle factors.DesignProspective population-based study.SettingThe European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) study.Participants11 214 men and 13 763 women in the general population, aged 40–79 years at recruitment (1993–1997), alive in 1999.Main outcome measureTotal admissions to hospital and time spent in hospital during a 19-year time period (1999–2018).ResultsCompared to those with residential Townsend Area Deprivation Index lower than the average for England and Wales, those with a higher than average deprivation index had a higher likelihood of spending >20 days in hospital multivariable adjusted OR 1.18 (95% CI 1.07 to 1.29) and having 7 or more admissions OR 1.11 (95% CI 1.02 to 1.22) after adjustment for age, sex, smoking status, education, social class and body mass index. Occupational social class and educational attainment modified the association between area deprivation and hospitalisation; those with manual social class and lower education level were at greater risk of hospitalisation when living in an area with higher deprivation index (p-interaction=0.025 and 0.020, respectively), while the risk for non-manual and more highly educated participants did not vary greatly by area of residence.ConclusionResidential area deprivation predicts future hospitalisations, time spent in hospital and number of admissions, independently of individual social class and education level and other behavioural factors. There are significant interactions such that residential area deprivation has greater impact in those with low education level or manual social class. Conversely, higher education level and social class mitigated the association of area deprivation with hospital usage.
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Châtelet, Valérie, Sahar Bayat-Makoei, Cécile Vigneau, Guy Launoy, and Thierry Lobbedez. "Renal transplantation outcome and social deprivation in the French healthcare system: a cohort study using the European Deprivation Index." Transplant International 31, no. 10 (April 16, 2018): 1089–98. http://dx.doi.org/10.1111/tri.13161.
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Ribeiro, Ana Isabel, Ludivine Launay, Elodie Guillaume, Guy Launoy, and Henrique Barros. "The Portuguese version of the European Deprivation Index: Development and association with all-cause mortality." PLOS ONE 13, no. 12 (December 5, 2018): e0208320. http://dx.doi.org/10.1371/journal.pone.0208320.
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Kocheshkova, Iryna. "Energy Poverty in EU countries and Ukraine." Herald of the Economic Sciences of Ukraine, no. 2(37) (December 23, 2019): 48–55. http://dx.doi.org/10.37405/1729-7206.2019.2(37).48-55.
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The article explains what they understand under the notion of «energy poverty» in EU countries. It is established that the appraisal of the energy poverty problem’s acuity is significantly complicated due to the lack of any standardized approach to the definition, great diversity in character, quantity, and power consumption peculiarities in various countries or just frequently mediated indicators available for estimation. Initial information for the appraisal of the level of the energy poverty can be usually obtained from sociological inquiries data. Detailed consideration is done with primary indices of the energy poverty in homesteads for the annual calculation of European energy poverty index with EU countries computed as the geometrical mean value of the sub-index of the energy poverty with European homesteads and the transport sub-index of the European energy poverty for homesteads from the first income-based quintile. Every two years Ukrainian Government Statistics Service conducts the procedure of self-appraisal of own incomes by homesteads in all regions of the country including data of material deprivation, so there are statistical information to compute the index of the similar energy poverty sub-index for European homesteads however in decile groups. An extraordinary high divergence of the index was detected between regions: from 4.8 per cent in Kyiv to 93.9 per cent in Carpathian Region. The dependency was detected between the percentages of homesteads having deficiency in money to maintain sufficiently warm temperature in their houses, and of people suffering from 4 or more of the 9 signs of deprivation that is having the very low quality of life. The article represents dynamics of the portion of the homesteads with insufficient funds to maintain a pretty warm temperature in their houses the whole heating period long subject to their financial situation. It was the most well-to-do people who declared the highest growth of the value. That was the witness of the fact that one cannot solve the problem of the energy poverty level reduction with homesteads just through the people’s incomes increase. Unfortunately, power consumption in the country is still irrational. The article substantiates that decentralization and the growth of power effectiveness are exclusively prospective directions for business advance especially for those who are now involved in network or regional business providing macro-economic effect through new jobs opening meaning additional budget takings. The urgent problem of Ukraine from the viewpoint of the social protection system’s improvement against the energy poverty is separation of purely power poverty fighting measures from the general maintenance system for low-income homesteads. Keywords energy poverty; homesteads; sociological inquiries; signs of deprivation; power effectiveness.
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Ouédraogo, Samiratou, Tienhan Sandrine Dabakuyo-Yonli, Adrien Roussot, Carole Pornet, Nathalie Sarlin, Philippe Lunaud, Pascal Desmidt, et al. "European transnational ecological deprivation index and participation in population-based breast cancer screening programmes in France." Preventive Medicine 63 (June 2014): 103–8. http://dx.doi.org/10.1016/j.ypmed.2013.12.007.
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Melo, Juliana, Ana Isabel Ribeiro, Susana Aznar, Andreia Pizarro, and Maria Paula Santos. "Urban Green Spaces, Greenness Exposure and Species Richness in Residential Environments and Relations with Physical Activity and BMI in Portuguese Adolescents." International Journal of Environmental Research and Public Health 18, no. 12 (June 18, 2021): 6588. http://dx.doi.org/10.3390/ijerph18126588.
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Environmental factors play an important role in obesity-related behaviors. Evidence indicates significant associations between weight and urban green spaces in adults, but it is not clear whether this relationship applies to adolescents. Therefore, our aim was to determine the associations between urban green spaces, greenness exposure and species richness in residential environments with physical activity and body mass index. Sixty-two adolescents between 12 and 18 years of age answered a self-administered questionnaire, providing information on height, weight, age, sex and home address. Data on socioeconomic deprivation were obtained from the European Index of Deprivation for Small Portuguese Areas. Physical activity levels were assessed using accelerometers. Urban green space counts and the normalized difference vegetation index values were measured using buffers along the roads with distances of 300, 500, 1000 and 1500 m from each participant’s residence. To quantify the species richness, the species richness index was used. Linear regression models were fitted to analyze whether urban green spaces, exposure to green spaces and species richness counts for each distance were associated with physical activity and self-reported body mass index. We did not find significant associations between the independent variables and the probability of overweight or obesity. The relationship between environmental variables, adolescents’ physical activity and body weight seems to be complex and further studies may contribute to better understanding of the topic.
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Nagy, Csilla, Attila Juhász, Péter Pikó, Judit Diószegi, György Paragh, Zoltán Szabó, Orsolya Varga, and Róza Ádány. "Preventive Metformin Monotherapy Medication Prescription, Redemption and Socioeconomic Status in Hungary in 2018–2019: A Cross-Sectional Study." International Journal of Environmental Research and Public Health 18, no. 5 (February 24, 2021): 2206. http://dx.doi.org/10.3390/ijerph18052206.
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This study was designed to characterize the spatial distribution of metformin medication used as first-line monotherapy for prevention of T2DM in relationship with the socioeconomic status (level of deprivation) and T2DM mortality at district level in a nationwide cross-sectional ecological study for the first time in a European country, Hungary. Risk analysis was used to estimate the relationships between socioeconomic status, characterized by tertiles of deprivation index, and mortality caused by diabetes, and metformin medication (both prescription and redemption) for the years of 2018 and 2019 at the district level. The spatial distribution of districts with a higher relative frequency of metformin prescriptions and redemptions showed a positive correlation with socio-economic deprivation. Significant association between the relatively high T2DM mortality and the highest level of deprivation could also be detected, but less-deprived regions with high T2DM mortality and low metformin utilization could also be identified. Although the statistical associations detected in this ecological study do not indicate a causal relationship, it is reasonable to suppose that the underuse of metformin medication may contribute to the unfavourable T2DM mortality in certain regions. Our findings underline the need for more effective preventive services including metformin medication to decrease T2DM morbidity and mortality burden.
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Robles-Bonilla, Tiare, and Karla G. Cedano. "Addressing Thermal Comfort in Regional Energy Poverty Assessment with Nussbaumer’s MEPI." Sustainability 13, no. 1 (January 2, 2021): 352. http://dx.doi.org/10.3390/su13010352.
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Research on energy poverty (EP) started in the United Kingdom and other Western European countries in response to the Oil Crisis in 1973. In the last few years, the European community has made important breakthroughs on the topic, by establishing clear terminology as well as funding different multidisciplinary and intersectoral task groups that have EP understanding and alleviation as their goal. Several different methodologies have been developed to measure EP. For instance, the multidimensional energy poverty index (MEPI) by Nussbaumer et al. (2012) has been successfully used in Africa and in seven Latin American countries. Mexico does not have an official measure, indicator, or index on EP. However, a very important energy service has been overlooked: thermal comfort. In the present work, MEPI was understood as an energy services deprivation calculation, and thermal comfort was included. Understanding the regional nature of thermal comfort, we searched for weather-based regionalizations that could address a whole country diversity. We applied two regionalizations, one strongly related to political divisions (called climatic), and a another used for household design and construction standards (bioclimatic). The bioclimatic regionalization had a better fit when assessing energy services deprivation, since it addresses exclusively geographical and weather conditions, instead of the artificial political divisions. Having better ways to assess the level of EP in the local context is a key factor to develop effective public policies that might alleviate EP in a sustainable way.
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Moriceau, Guillaume, Aurélie Bourmaud, Fabien Tinquaut, Mathieu Oriol, Jean-Philippe Jacquin, Pierre Fournel, Nicolas Magné, and Franck Chauvin. "Social inequalities and cancer: can the European deprivation index predict patients' difficulties in health care access? a pilot study." Oncotarget 7, no. 1 (November 2, 2015): 1055–65. http://dx.doi.org/10.18632/oncotarget.6274.
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Oudin Åström, Daniel, Jan Sundquist, and Kristina Sundquist. "Differences in declining mortality rates due to coronary heart disease by neighbourhood deprivation." Journal of Epidemiology and Community Health 72, no. 4 (January 12, 2018): 314–18. http://dx.doi.org/10.1136/jech-2017-210105.
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BackgroundCardiovascular disease (CVD) is the main cause of death in most industrialised countries, including those in Europe. The mortality rates due to coronary heart disease (CHD), one of the most serious CVD conditions, have been decreasing in most European countries during the last decades. However, whether the trends over time in CHD mortality rates differ depending on neighbourhood deprivation has rarely been investigated.MethodsFor each year of the study period, 1988–2012, in Sweden, age-standardised mortality rates were calculated for three different types of neighbourhoods, characterised by a Neighbourhood Deprivation Index. Joinpoint regression was used to investigate potential changes in age-standardised mortality rates by neighbourhood deprivation and over time.ResultsOver the study period, age-standardised mortality rates due to CHD were consistently the highest in the deprived neighbourhoods and the lowest in the affluent neighbourhoods. We observed a statistically significant overall decline, ranging from 67% to 59%, in the age-standardised CHD mortality rates for each level of neighbourhood deprivation. Furthermore, the decline for the affluent neighbourhoods was significantly higher compared with the decline in the deprived neighbourhoods.ConclusionAge-standardised CHD mortality rates decreased significantly in Sweden between 1988 and 2012. This decline was more pronounced in the affluent neighbourhoods, which indicates that the improvements in prevention and treatment of CHD have not benefited individuals residing in deprived neighbourhoods to an equal extent. Knowledge of time trends in CHD mortality by level of neighbourhood deprivation may help guide decision-makers in the development of appropriate healthcare policies for deprived neighbourhoods.
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Hadjar, Andreas, and Susanne Backes. "Migration Background and Subjective Well-Being A Multilevel Analysis Based on the European Social Survey." Comparative Sociology 12, no. 5 (2013): 645–76. http://dx.doi.org/10.1163/15691330-12341279.
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Abstract Contributing to the debate on the integration of migrants in Europe, this study focuses on Subjective Well-Being (SWB) of people with migration backgrounds compared to people without a migration background – specifying SWB in terms of successful integration. The analyses employ a multilevel perspective (data base: European Social Survey). On the macro level, gross domestic product (GDP), welfare regime, xenophobia and the migrant integration policy index (MIPEX) are considered; on the micro level, social origin, education, unemployment, income deprivation, relationship status, health status and controls. Findings indicate a disadvantage in SWB of first-generation migrants that goes beyond deficits regarding well-studied SWB determinants. The SWB gap between migrants and non-migrants is larger in countries with a high GDP and smaller in countries with a high MIPEX score.
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Ouidir, Marion, Johanna Lepeule, Valérie Siroux, Laure Malherbe, Frederik Meleux, Emmanuel Rivière, Ludivine Launay, et al. "Is atmospheric pollution exposure during pregnancy associated with individual and contextual characteristics? A nationwide study in France." Journal of Epidemiology and Community Health 71, no. 10 (August 22, 2017): 1026–36. http://dx.doi.org/10.1136/jech-2016-208674.
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BackgroundExposure to atmospheric pollutants is a danger for the health of pregnant mother and children. Our objective was to identify individual (socioeconomic and behavioural) and contextual factors associated with atmospheric pollution pregnancy exposure at the nationwide level.MethodAmong 14 921 women from the French nationwide ELFE (French Longitudinal Study of Children) mother-child cohort recruited in 2011, outdoor exposure levels of PM2.5, PM10 (particulate matter <2.5 µm and <10 µm in diameter) and NO2 (nitrogen dioxide) were estimated at the pregnancy home address from a dispersion model with 1 km resolution. We used classification and regression trees (CART) and linear regression to characterise the association of atmospheric pollutants with individual (maternal age, body mass index, parity, education level, relationship status, smoking status) and contextual (European Deprivation Index, urbanisation level) factors.ResultsPatterns of associations were globally similar across pollutants. For the CART approach, the highest tertile of exposure included mainly women not in a relationship living in urban and socially deprived areas, with lower education level. Linear regression models identified different determinants of atmospheric pollutants exposure according to the residential urbanisation level. In urban areas, atmospheric pollutants exposure increased with social deprivation, while in rural areas a U-shaped relationship was observed.ConclusionWe highlighted social inequalities in atmospheric pollutants exposure according to contextual characteristics such as urbanisation level and social deprivation and also according to individual characteristics such as education, being in a relationship and smoking status. In French urban areas, pregnant women from the most deprived neighbourhoods were those most exposed to health-threatening atmospheric pollutants.
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Beaumier, Mathilde, Clémence Béchade, Olivier Dejardin, Mathilde Lassalle, Cécile Vigneau, Nathalie Longlune, Ludivine Launay, et al. "Is self-care dialysis associated with social deprivation in a universal health care system? A cohort study with data from the Renal Epidemiology and Information Network Registry." Nephrology Dialysis Transplantation 35, no. 5 (December 10, 2019): 861–69. http://dx.doi.org/10.1093/ndt/gfz245.
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Abstract Background Socioeconomic status is associated with dialysis modality in developed countries. The main objective of this study was to investigate whether social deprivation, estimated by the European Deprivation Index (EDI), was associated with self-care dialysis in France. Methods The EDI was calculated for patients who started dialysis in 2017. The event of interest was self-care dialysis 3 months after dialysis initiation [self-care peritoneal dialysis (PD) or satellite haemodialysis (HD)]. A logistic model was used for the statistical analysis, and a counterfactual approach was used for the causal mediation analysis. Results Among the 9588 patients included, 2894 (30%) were in the most deprived quintile of the EDI. A total of 1402 patients were treated with self-care dialysis. In the multivariable analysis with the EDI in quintiles, there was no association between social deprivation and self-care dialysis. Compared with the other EDI quintiles, patients from Quintile 5 (most deprived quintile) were less likely to be on self-care dialysis (odds ratio 0.81, 95% confidence interval 0.71–0.93). Age, sex, emergency start, cardiovascular disease, chronic respiratory disease, cancer, severe disability, serum albumin and registration on the waiting list were associated with self-care dialysis. The EDI was not associated with self-care dialysis in either the HD or in the PD subgroups. Conclusions In France, social deprivation estimated by the EDI is associated with self-care dialysis in end-stage renal disease patients undergoing replacement therapy.
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Rollet, Quentin, Élodie Guillaume, Ludivine Launay, and Guy Launoy. "Socio-Territorial Inequities in the French National Breast Cancer Screening Programme—A Cross-Sectional Multilevel Study." Cancers 13, no. 17 (August 30, 2021): 4374. http://dx.doi.org/10.3390/cancers13174374.
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Background. France implemented in 2004 the French National Breast Cancer Screening Programme (FNBCSP). Despite national recommendations, this programme coexists with non-negligible opportunistic screening practices. Aim. Analyse socio-territorial inequities in the 2013–2014 FNBCSP campaign in a large sample of the eligible population. Method. Analyses were performed using three-level hierarchical generalized linear model. Level one was a 10% random sample of the eligible population in each département (n = 397,598). For each woman, age and travel time to the nearest accredited radiology centre were computed. These observations were nested within 22,250 residential areas called “Îlots Regroupés pour l’Information Statistique” (IRIS), for which the European Deprivation Index (EDI) is defined. IRIS were nested within 41 départements, for which opportunistic screening rates and gross domestic product based on purchasing power parity were available, deprivation and the number of radiology centres for 100,000 eligible women were computed. Results. Organized screening uptake increased with age (OR1SD = 1.05 [1.04–1.06]) and decreased with travel time (OR1SD = 0.94 [0.93–0.95]) and EDI (OR1SD = 0.84 [0.83–0.85]). Between départements, organized screening uptake decreased with opportunistic screening rate (OR1SD = 0.84 [0.79–0.87]) and départements deprivation (OR1SD = 0.91 [0.88–0.96]). Association between EDI and organized screening uptake was weaker as opportunistic screening rates and as département deprivation increased. Heterogeneity in FNBCSP participation decreased between IRIS by 36% and between départements by 82%. Conclusion. FNBCSP does not erase socio-territorial inequities. The population the most at risk of dying from breast cancer is thus the less participating. More efforts are needed to improve equity.
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Lokar, Katarina, Tina Zagar, and Vesna Zadnik. "Estimation of the Ecological Fallacy in the Geographical Analysis of the Association of Socio-Economic Deprivation and Cancer Incidence." International Journal of Environmental Research and Public Health 16, no. 3 (January 22, 2019): 296. http://dx.doi.org/10.3390/ijerph16030296.
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Ecological deprivation indices at the level of spatial units are often used to measure and monitor inequalities in health despite the possibility of ecological fallacy. For the purpose of this study, the European Deprivation Index (EDI) was used, which is based on Townsend theorization of relative deprivation. The Slovenian version of EDI (SI-EDI) at the aggregated level (SI-EDI-A) was calculated to the level of the national assembly polling stations. The SI-EDI was also calculated at the individual level (SI-EDI-I) by the method that represents a methodological innovation. The degree of ecological fallacy was estimated with the Receiver Operating Characteristics (ROC) curves. By calculating the area under the ROC curve, the ecological fallacy was evaluated numerically. Agreement between measuring deprivation with SI-EDI-A and SI-EDI-I was analysed by graphical methods and formal testing. The association of the socio-economic status and the cancer risk was analysed in all first cancer cases diagnosed in Slovenia at age 16 and older in the period 2011–2013. Analysis was done for each level separately, for SI-EDI-I and for SI-EDI-A. The Poisson regression model was implemented in both settings but adapted specifically for aggregated and individual data. The study clearly shows that ecological fallacy is unavoidable. However, although the association of cancer incidence and socio-economic deprivation at individual and aggregated levels was not the same for all cancer sites, the results were very similar for the majority of investigated cancer sites and especially for cancers associated with unhealthy lifestyles. The results confirm the assumptions from authors’ previous research that using the level of the national assembly polling stations would be the acceptable way to aggregate data when explaining inequalities in health in Slovenia in ecological studies.
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Howe, Laura D., Roshni Kanayalal, Sean Harrison, Robin N. Beaumont, Alisha R. Davies, Timothy M. Frayling, Neil M. Davies, et al. "Effects of body mass index on relationship status, social contact and socio-economic position: Mendelian randomization and within-sibling study in UK Biobank." International Journal of Epidemiology 49, no. 4 (December 4, 2019): 1173–84. http://dx.doi.org/10.1093/ije/dyz240.
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Abstract Background We assessed whether body mass index (BMI) affects social and socio-economic outcomes. Methods We used Mendelian randomization (MR), non-linear MR and non-genetic and MR within-sibling analyses, to estimate relationships of BMI with six socio-economic and four social outcomes in 378 244 people of European ancestry in UK Biobank. Results In MR of minimally related individuals, higher BMI was related to higher deprivation, lower income, fewer years of education, lower odds of degree-level education and skilled employment. Non-linear MR suggested both low (bottom decile, <22 kg/m2) and high (top seven deciles, >24.6 kg/m2) BMI, increased deprivation and reduced income. Non-genetic within-sibling analysis supported an effect of BMI on socio-economic position (SEP); precision in within-sibling MR was too low to draw inference about effects of BMI on SEP. There was some evidence of pleiotropy, with MR Egger suggesting limited effects of BMI on deprivation, although precision of these estimates is also low. Non-linear MR suggested that low BMI (bottom three deciles, <23.5 kg/m2) reduces the odds of cohabiting with a partner or spouse in men, whereas high BMI (top two deciles, >30.7 kg/m2) reduces the odds of cohabitation in women. Both non-genetic and MR within-sibling analyses supported this sex-specific effect of BMI on cohabitation. In men only, higher BMI was related to lower participation in leisure and social activities. There was little evidence that BMI affects visits from friends and family or having someone to confide in. Conclusions BMI may affect social and socio-economic outcomes, with both high and low BMI being detrimental for SEP, although larger within-family MR studies may help to test the robustness of MR results in unrelated individuals. Triangulation of evidence across MR and within-family analyses supports evidence of a sex-specific effect of BMI on cohabitation.
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Kaivo-oja, Jari, Samuli Aho, and Theresa Lauraéus. "European COVID -19 Pandemic Data and Social Inclusion Policy in the European Union: Drivers-Driven Trend Analysis." Economics and Culture 18, no. 1 (June 1, 2021): 82–99. http://dx.doi.org/10.2478/jec-2021-0007.
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Abstract Research purpose. The study is focused on the Covid-19 pandemic crisis in the European Union. This study investigates the current driving trends and trade-offs of the Covid-19 pandemic phenomenon and social inclusion trends in the European countries. Design / Methodology / Approach. The methodology is based on conventional statistical index theory and statistics. The study investigates cases, deaths, and key Covid-19 statistics. The research design combines key social inclusion statistics of the Eurostat and the official Covid-19 statistics of the European Centre for Disease Prevention and Control. Covid-19 data is updated to 1.3.2021. Social inclusion variables are selected from the Eurostat database. Social inclusion variables cover poverty, material deprivation, income distribution, income, quality of life, employment, and education matters. Scattering matrices on the relationships among the key variables under review are reported. Findings. The study reports basic trends of Covid-19 cases, deaths, deaths/cases and calculates these Covid-19 trends in 29 European countries. This study reports trade-off analyses of key social inclusion trends of the European Union countries. Key indicators are linked to economic income, income distribution, poverty, gender issues, and housing statistics. The 19 key indicators of social inclusion are analysed and reported with Covid-19 data. Statistical correlation analysis tables (2a and 2b) are calculated with key European social inclusion indicators. The study reveals some relevant aspects of the social inclusion policy of the European Union about the ongoing Covid-19 crisis and exit strategies. Originality / Value / Practical implications. This conference paper demonstrates novel and exciting possibilities of integrated data pooling (The Eurostat and the European Centre for Disease Prevention and Control). Original results of key trend drivers are provided by the authors. Value-adding and interesting results are delivered for European governments and the business community. Results and findings of the study can be used in the planning of economic recovery and Covid-19 exit policies in the member states of the European Union.
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Matel, Anna, and Jacek Marcinkiewicz. "Did the elderly suffer more from housing deprivation? Evidence from Poland." International Journal of Social Economics 48, no. 1 (December 11, 2020): 105–19. http://dx.doi.org/10.1108/ijse-06-2020-0363.
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PurposeThe elderly seem to be more subject to housing problems due to lower income, older age of the housing stock and lower mobility. Nonetheless, housing deprivation (HD) is commonly analysed amongst the general population. Less is known about the differences between age clusters, which seems to be a crucial issue in countries like Poland due to population ageing. What is more, the current literature usually analyses only the occurrence of HD, while also an accumulation of its indicators seems to be substantial. The aim of this article is to identify the differences in HD (its occurrence and accumulation) amongst elderly and non-elderly households and to diagnose the risk factors behind those phenomena.Design/methodology/approachThe HD index was calculated and compared. Next, the multinomial logit models were used to assess risk factors of HD.FindingsThe study showed that, surprisingly, HD in Poland occurs more frequently amongst non-elderly households. The elderly ones suffered more from housing cost overburden, while non-elderly from the overpopulation. In large part, analysed risk factors had a stronger influence on housing conditions of the elderly than non-elderly households.Social implicationsSocial policy tools should focus on the situation of single elderly households, especially living in houses, often in villages. This group is particularly affected by problems with the quality of the dwelling and housing cost overburden.Originality/valueIn the paper, the occurrence and accumulation of HD indicators were analysed. The authors applied a methodological framework that is applicable to other European Union (EU) member states based on the EU Survey on Income and Living Conditions (EU-SILC) data. It is possible to continue the research study and compare different economies.
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Zimmermann, Katharina, and Paolo Graziano. "Mapping Different Worlds of Eco-Welfare States." Sustainability 12, no. 5 (February 28, 2020): 1819. http://dx.doi.org/10.3390/su12051819.
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Attention towards topics such as environmental pollution, climate change, or biodiversity has strongly increased in the last years. The struggles to balance market powers and ecological sustainability somehow evoke memories of the early days of European welfare states, when social protection emerged as a means to prevent industrial capitalism from disruptive social tensions due to excessive social inequalities. In fact, social and environmental crises are inseparably intertwined, as ecological destruction is likely to be followed by social deprivation, and a lack of social security can be a crucial barrier for ecologically sustainable action. Our paper seeks to provide a step towards such an integrated perspective by studying problem pressure and public interventions in the area of green welfare, that is, in social and environmental protection. By using available data from Eurostat and Environmental Performance Index (EPI) databases, we contrast environmental and social performances to detect links between the social and the ecological dimension in these areas and unearth different configurations of green welfare among European countries. Our findings suggest that there are different “worlds of eco-welfare states” which only partially overlap with the more conventional “world of welfare states” but show how the Nordic countries are in the relatively-better performing cluster.
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Bergamaschi, Roberto, Maria Cristina Monti, Leonardo Trivelli, Giulia Mallucci, Leonardo Gerosa, Enrico Pisoni, and Cristina Montomoli. "PM2.5 exposure as a risk factor for multiple sclerosis. An ecological study with a Bayesian mapping approach." Environmental Science and Pollution Research 28, no. 3 (September 7, 2020): 2804–9. http://dx.doi.org/10.1007/s11356-020-10595-5.
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AbstractSome environmental factors are associated with an increased risk of multiple sclerosis (MS). Air pollution could be a main one. This study was conducted to investigate the association of particulate matter 2.5 (PM2.5) concentrations with MS prevalence in the province of Pavia, Italy. The overall MS prevalence in the province of Pavia is 169.4 per 100,000 inhabitants. Spatial ground-level PM2.5 gridded data were analysed, by municipality, for the period 2010–2016. Municipalities were grouped by tertiles according to PM2.5 concentration. Ecological regression and Bayesian statistics were used to analyse the association between PM2.5 concentrations, degree of urbanization, deprivation index and MS risk. MS risk was higher among persons living in areas with an average winter PM2.5 concentration above the European annual limit value (25 μg/m3). The Bayesian map revealed sizeable MS high-risk clusters. The study found a relationship between low MS risk and lower PM2.5 levels, strengthening the suggestion that air pollution may be one of the environmental risk factors for MS.
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Papacocea, Ioana Raluca, Ioana Anca Badarau, Mariana Catalina Ciornei, Sofia Lider Burciulescu, and Marius Toma Papacocea. "The Effects of Caffeine Intake on Cardiovascular Parameters in Sleep Deprived Medical Residents." Revista de Chimie 70, no. 4 (May 15, 2019): 1445–48. http://dx.doi.org/10.37358/rc.19.4.7146.
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Physicians and medical residents are particularly affected by sleep deprivation are, especially in East European countries. The aim of our study is to analyze the effect of caffeine intake on cardiovascular functions in sleep deprived residents (clinicians in-training) after continuous 24h on-call duty. 26 medical residents aged between 22-33 years old, 12 men and 14 women, who began their activity at 2 pm were included. Each subject consumed coffee or caffeinated drinks such as Coca cola during this period, after 2 am, expressed in caffeine units. We have evaluated their cardiovascular function using impedance cardiography (ICG-M501) and blood pressure measurement using the manometric method, before (at 7 pm) and after caffeine consumption (at 7 am), during one night of on-call duty. Surprisingly, after caffeine consumption, all subjects have had a decrease of the heart rate after one night of sleep deprivation (from mean: 83 b/min before to 69.73 b/min after, p = 0.000), also the mean arterial blood pressure is lower after the overnight call (from mean: 95.3 mmHg before to 88.9 mmHg after). Moreover, cardiac output, stroke volume and cardiac index decreases along with an increase of peripheral vascular resistance. Caffeine intake exerts a paradoxical effect on sleep deprived subjects; acute sleep loss, due to continuously, intense on-call work, modifies several cardiovascular parameters, such as heart rate, blood pressures, stroke volume and cardiac output.
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Freitag, Lara, Jane L. Ireland, and Isabella J. M. Niesten. "Exploring the relationship between sleep quality, emotional well-being and aggression levels in a European sample." Journal of Aggression, Conflict and Peace Research 9, no. 3 (July 10, 2017): 167–77. http://dx.doi.org/10.1108/jacpr-08-2016-0239.
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Purpose Sleep deprivation is well known to negatively affect mood, cognition and behaviour. The purpose of this paper is to explore the relationship between sleep quantity, subjective sleep quality and aggression, hostility and well-being levels among adults in a non-clinical population. Design/methodology/approach In total, 201 participants aged 18 and above from Germany, UK and the Netherlands completed an online survey consisting of a Pittsburgh Sleep Quality Index along with measures of psychological well-being, implicit and explicit aggression, and intent attributions. Findings Sleep disturbances were related to decreased levels of psychological well-being. Subjective poor sleep quality predicted increased hostile attributions. The overall sleep experience, however, was not associated with aggression levels. Nevertheless, both a poor sleep experience and low sleep quality were related to increased reactive aggression, but only in British participants. Practical implications The importance of perceived sleep quality rather than sleep quantity in predicting hostile and aggressive behaviours is indicated. The quality of sleep and perception of this quality should be the focus of clinical intervention to limit unwanted behavioural impacts. The importance of accounting for sleep quality perception in intervention that examines attributional biases such as hostility is indicated. Differences across countries should be identified and accommodated for in intervention. Originality/value This is the first study to consider a role for sleep quality (including perception) and sleep quantity in relation to aggression and hostility in a cross-country European sample.
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Ben Khadhra, H., F. Saint, E. Trecherel, B. Lapotre-Ledoux, S. Zerkly, and O. Ganry. "Social Deprivation, Waiting Time for Diagnosis and Therapeutic Management of Patients With Prostatic Cancer in the Somme Area, France." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 66s. http://dx.doi.org/10.1200/jgo.18.35400.
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Background: In France, prostate cancer is at the top of the list of the most common cancers in men. The morbidity and mortality of this cancer were found to be related to the geographic level of socioeconomic deprivation with a higher rate of mortality and more frequent aggressive cases among men with low socioeconomic level, this was associated with health disparities in the management of this cancer. Our study region is considered as an economically deprived area with a poverty rate significantly higher than the national average. Aim: The aim of our study was to assess the impact of the socioeconomic level on the incidence, mortality, aggressiveness and management of prostate cancer, using data from a population-based cancer registry. Methods: For this research, prostate cancer data, between 2006 and 2010, were obtained from the Somme area cancer registry. Social economic status was assessed using the European Deprivation Index (EDI). This index has been used to classify each geographical unit (IRIS) according to social deprivation. IRIS is the smallest submunicipal geographical entity for which census data are available. Each prostate cancer case was allocated to the corresponding IRIS by geolocalizing the addresses using geographic information system (GIS). For spatial analysis, hierarchical generalized linear modeling was fitted. To assess for spatial autocorrelation, Moran's I test was conducted and then spatial autocorrelation was modeled by a set of random effects that are assigned a conditional autoregressive (CAR) prior distribution. Results: A total of 2405 incident cases of prostate cancer were registered in the Somme area. The age-standardized rate was 98.2 cases per 100,000 person-years (PY). The standardized mortality rate was 28.1 deaths per 105 PY. The coefficient associated with the EDI obtained from the spatial analysis of prostate cancer incidence was negative (-0.348; 95% CI: −0.0831) which indicates that prostate cancer incidence was more important in the less deprived areas. The relative risk of prostate cancer mortality associated with the quintile 5 of the EDI relatively to quintile 1 was 3.09; 95% CI: [1.70-5.59]. For the aggressiveness, the coefficient associated with the EDI was 0.0493 with a 95% CI: [0.0162-0.0810], and the Q5/Q1 RR was equal to 1.36 95% CI: [1.09-1.73]. EDI estimated coefficient for proportion of cases who received curative treatment versus patients who received palliative treatment was −0.1089, 95 CI%: [−0.1505 to −0.0693]. EDI coefficient for waiting time was not significant. Conclusion: Our study showed a significant association between socioeconomic deprivation and prostate cancer with worse outcomes among men with the lowest socioeconomic status. Geographical differences in screening rate could explain this pattern. More in-depth research with a source data review is required to know precisely the determinism of this association and therefore adjust the eventual disparities.
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Ariza, Juan Manuel, Anne Cowppli-Bony, Solenne Billon, Stephanie Ayrault-Piault, Audrey Blanc-Lapierre, and Florence Florence Molinie. "Socioeconomic background in relation to stage at diagnosis in women with breast cancer." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 10574. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.10574.
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10574 Background: Breast cancer (BC) has been associated with socioeconomic deprivation and rural residence. However, it’s still unclear how these factors interplay to affect the frequency and incidence of early and advanced BC. Methods: Taking advantage of the Loire-Atlantique/Vendée cancer registry (France), we investigated the association between early (TNM stage < 2) and advanced (TNM stage ≥2) BC and the socio-economic background (SB) of women diagnosed in the study region from 2008 to 2015. Socioeconomic status was studied using the residence information of every patient linked to the European Deprivation Index (EDI), an ecological index constructed to reflect individual deprivation experienced at the smallest geographical unit of France (IRIS = 2000 inhabitants). To investigate SB, we created a composite variable using the EDI and the urban/rural context information, to define 4 categories: affluent-urban, affluent-rural, deprived-urban, and deprived-rural. Two statistical approaches were implemented: i) mixed-effects logistic regression models to examine the likelihood (relative risk, RR) of being diagnosed with advanced BC, and ii) Poisson regression for modeling incidence rates of early and advanced stages. Analyses were stratified by age ( < 45, 45 to 74, > 75 years) with a random intercept at the IRIS level. For the strata 45 to 74, the models were adjusted for organized screening. Results: During the study period, 14,542 BC cases were recorded. Compared to the women diagnosed in the most affluent-urban areas, a higher proportion of cancer diagnosed at an advanced stage was observed in the women living in more deprived-rural areas (aged < 45 years, RR = 1.48 95% CI 1.17 - 1.73; aged 45 to 74 years, RR = 1.22, 95% CI 1.02-1.42; aged > 74 years, RR = 1.08, 95% CI 0.85-1.27). Furthermore, while in the population under 74 years, incidence rates of early BC in deprived-rural women were reduced by 25-85 % in comparison to affluent-urban women (IRR: 0.33 to 0.97 95% CI 0.16 -0.98), the rates of advanced BC were unaffected by deprivation-rurality (Deprived rural vs Affluent urban, IRR: 1.06 to 1.13 95% CI 0.79 -1.72). For the population over 74 years, we were unable to detect any associations between SB and BC incidence by stage at diagnosis. Conclusions: Advanced stage at diagnosis was more frequent among deprived–rural women aged under 74 years and coincided with the low incidence rates of early stages in this population. No disparities in the incidence rates of advanced BC were detected according to their SB in any age classes, suggesting other factors may be stronger contributors to the advanced stage at diagnosis. Future research should investigate whether screening practices may influence the disparities in the early stage at diagnosis for women under 74.
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Meredith-Jones, Kim, Sheila Williams, and Rachael Taylor. "Agreement between parental perception of child weight status and actual weight status is similar across different ethnic groups in New Zealand." Journal of Primary Health Care 8, no. 4 (2016): 316. http://dx.doi.org/10.1071/hc16002.
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ABSTRACT INTRODUCTION Accurate parental perception of their child's weight is poor. Accuracy may be influenced by differences in ethnicity but this is currently unknown. AIM To determine whether agreement between parental perception of child weight status and actual child weight status differs according to ethnic group (NZ European, Māori, Pacific, Asian), and to investigate whether it is influenced by various demographic and behavioural factors. METHODS A total of 1093 children (4–8 years old) attended a weight screening initiative. Parents completed questionnaires on demographics, beliefs about child weight, parenting style, parental feeding practices and social desirability. Actual measured weight status was compared with parental perception of weight status (underweight, normal weight, overweight). RESULTS Agreement about child weight status was apparent in 85% of NZ European, 84% of Māori, 82% of Pacific and 88% of Asian children. However, adjusting for chance led to kappas of 0.34, 0.38, 0.41 and 0.53, respectively, indicating only fair-to-moderate agreement. Overall, agreement between measured body mass index and parental perception was not related to ethnic group, child sex and age, maternal age and education, and household deprivation (k ranged from 0.16 to 0.47). However, agreement about weight status was higher in parents who reported higher levels of restrictive feeding than in parents who reported less restriction (P < 0.01) but agreement was only fair. CONCLUSION Agreement between parental perception and actual weight status was fair and did not differ between the ethnic groups examined.
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Nurse, Alexander, and Olivier Sykes. "It’s more complicated than that!: Unpacking ‘Left Behind Britain’ and some other spatial tropes following the UK’s 2016 EU referendum." Local Economy: The Journal of the Local Economy Policy Unit 34, no. 6 (September 2019): 589–606. http://dx.doi.org/10.1177/0269094219881356.
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In the aftermath of the UK’s vote to leave the European Union, a number of dominant narratives and spatial imaginaries of ‘Brexit’ have come to the fore including the notion of a revolt of a ‘Left Behind Britain’, and of a generational splintering manifested in different political attitudes. Informed by this context, this paper considers some of these issues at the micro-scale, using voting data from two contiguous local authority districts within the same city region. It presents data from wards that have similar socio-economic conditions and which are highly ranked in the Index of Multiple Deprivation but which voted differently in the referendum. The data reinforce the arguments of those who have claimed that the phenomenon of Brexit is powerfully contextual and that general socio-economic analyses of its causes do not fully explain why some areas and populations voted to leave the EU and others with comparable profiles voted to remain. With poorer regions predicted to be the biggest economic losers of ‘Brexit’, an understanding of such issues is of material consequence and might inform progressive responses to such populist phenomena.
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Naper, Jennifer, Luis Manetto, and Diane Wiren. "A project to improve the quality of care for overweight and obese patients in a Nelson general practice." Journal of Primary Health Care 9, no. 4 (2017): 321. http://dx.doi.org/10.1071/hc17009.
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ABSTRACT INTRODUCTION Local guidelines exist in Nelson to assist general practitioners (GPs) in supporting overweight and obese patients with weight loss and improvements in their overall health. This audit measures whether this role is fulfilled in a Very Low Cost Access practice in Nelson, in which 76% of enrolled patients reside in New Zealand social deprivation index quintiles 4 and 5. AIM This study measured whether Nelson Marlborough District Health Board Health Pathways and the Ministry of Health Clinical Guidelines are followed in identifying risk and initiating management, including treatment of additional risk factors, lifestyle modification and dietitian referral. RESULTS Although limited by sample size and consecutive patient screening methodology, the results of this study indicate that overweight and obesity rates in this practice are comparable with the national average, with Māori and Pacific Island populations more likely to be affected compared to their New Zealand European counterparts. Of the patients who had their body mass index recorded, 65% were overweight or obese. Risk factors were assessed and treated in all, green prescriptions were issued in 4%, and 23% were referred to a dietitian. DISCUSSION Audit findings were presented at an intervention session where strategies for improvement were considered including routine waist circumference measurement, dietitian referral, exercise on prescription and providing individualised tailored approaches that integrate patients’ cultural and social context. While risk factors are being managed appropriately, improvements can be made in identifying high-risk patients, promoting lifestyle modifications and early dietitian referral.
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Balourdos, Dionyssis, and Maria Petraki. "Immigrant social inclusion in Europe: A descriptive investigation." Europa XXI 37 (2019): 105–24. http://dx.doi.org/10.7163/eu21.2019.37.7.
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This paper represents an empirical investigation into the risk of poverty or social exclusion facing immigrants across Europe. The methodological approach is based on the set of ‘Zaragoza indicators’, in the domain of social inclusion, together with some proposed additional ones: income distribution and monetary poverty, material deprivation, in-work poverty, child poverty and risk of poverty or social exclusion. The main research question concerns whether immigrants/third-country nationals and nationals constitute two rather distinct groups in terms of exposure to poverty or social exclusion. Mainly using data from the EU-SILC Survey, we find that third-country nationals are severely disadvantaged in most countries, and are occasionally exposed to risks multiple times higher than nationals. There are European countries with similar immigrant populations in which these immigrants experience less favorable outcomes compared to other populations in other countries. Comparative analysis allows us to test the significance of different welfare systems in protecting vulnerable groups such as immigrants, using Eurostat statistics and the Migrant Integration Policy Index (MIPEX). In a cross-country analysis, taking demographic and macro-economic differences into account, results show that the impact of social expenditure on poverty is not significant when it comes to protecting third-country nationals.
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Gardy, Joséphine, Olivier Dejardin, Alexandre Thobie, Yassine Eid, Anne-Valérie Guizard, and Guy Launoy. "Impact of socioeconomic status on survival in patients with ovarian cancer." International Journal of Gynecologic Cancer 29, no. 4 (February 1, 2019): 792–801. http://dx.doi.org/10.1136/ijgc-2018-000097.
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ObjectiveSocioeconomic status may impact survival in cancer patients. This study assessed whether low socioeconomic status has an impact on survival in patients with ovarian cancer and investigated whether differences in survival may be explained by type of therapy received.MethodsThe study population comprised 318 patients with ovarian cancer diagnosed between 2011 and 2015 in the François Baclesse regional cancer care center in Caen, North-West France. Socioeconomic status was assessed by using the European deprivation index and overall survival was calculated at 3 years.ResultsThe unadjusted 3-year overall survival rate was 52% (95% CI 47 to 58). In a multivariable logistic regression model, a low socioeconomic status was associated with a lower probability of surgical resection (OR 0.34, 95% CI 0.16 to 0.74). A high socioeconomic status was associated with improved survival, adjusted for age, performance status, grade, and International Federation of Gynecology and Obstetrics (FIGO) stage (adjusted HR 1.53, 95% CI 1.04 to 2.26). When adjusting for treatment variables, there was no longer any significant difference in survival according to socioeconomic status (adjusted HR 1.24, 95% CI 0.83 to 1.84).ConclusionsHigher socioeconomic status is associated with a greater probability of undergoing surgical resection and with improved survival in patients with ovarian cancer.
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Borrell, Carme, Laia Palència, Lucia Bosakova, Mercè Gotsens, Joana Morrison, Claudia Costa, Dagmar Dzurova, et al. "Socioeconomic Inequalities in Chronic Liver Diseases and Cirrhosis Mortality in European Urban Areas before and after the Onset of the 2008 Economic Recession." International Journal of Environmental Research and Public Health 18, no. 16 (August 20, 2021): 8801. http://dx.doi.org/10.3390/ijerph18168801.
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Objective: To analyse the trends in chronic liver diseases and cirrhosis mortality, and the associated socioeconomic inequalities, in nine European cities and urban areas before and after the onset of the 2008 financial crisis. Methods: This is an ecological study of trends in three periods of time: two before (2000–2003 and 2004–2008), and one after (2009–2014) the onset of the economic crisis. The units of analysis were the geographical areas of nine cities or urban areas in Europe. We analysed chronic liver diseases and cirrhosis standardised mortality ratios, smoothing them with a hierarchical Bayesian model by each city, area, and sex. An ecological regression model was fitted to analyse the trends in socioeconomic inequalities, and included the socioeconomic deprivation index, the period, and their interaction. Results: In general, chronic liver diseases and cirrhosis mortality rates were higher in men than in women. These rates decreased in all cities during the financial crisis, except among men in Athens (rates increased from 8.50 per 100,000 inhabitants during the second period to 9.42 during the third). Socioeconomic inequalities in chronic liver diseases and cirrhosis mortality were found in six cities/metropolitan areas among men, and in four among women. Finally, in the periods studied, such inequalities did not significantly change. However, among men they increased in Turin and Barcelona and among women, several cities had lower inequalities in the third period. Conclusions: There are geographical socioeconomic inequalities in chronic liver diseases and cirrhosis mortality, mainly among men, that did not change during the 2008 financial crisis. These results should be monitored in the long term.
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Barnett, Ross, and Laurence Malcolm. "GP practice variation in hospitalisation rates: a study of Partnership Healthenrolled patients." Journal of Primary Health Care 2, no. 2 (2010): 111. http://dx.doi.org/10.1071/hc10111.
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AIM: This project aims to provide information to support the planning and implementation of strategies to reduce hospitalisation. It examines variations in hospital discharge rates between practice populations and the use of special general practice access funding. METHODS: Practice enrolment data for 345 254 patients enrolled with 102 Partnership Health Primary Health Organisation (PHO) general practices were sent to New Zealand Health Information Service. Data linked to the patient National Health Index (NHI) relating to hospital discharges were attached to the practice enrolment data for the two years ending June 2007 and returned to the researchers with the NHI numbers encrypted. Total discharges were 127426.The data were analysed for rates of hospital discharges for different population groups and by general practice. RESULTS: There is a substantial variation in hospital discharge rates between general practices, but this is only partly accounted for by practice population characteristics. Furthermore while there is a strong social gradient in European admissions, this is much less true for Maori. There was also a wide variation between practices in the uptake of High Use Health Cards, special funding for frequent attenders at general practices and Care Plus funding for patients with chronic conditions. Practice deprivation, ethnicity and age only explained a minor part of this variation. DISCUSSION: The high rate of unexplained practice variation in chronic care management and hospitalisation rates, especially for Maori, is of concern. Further investigation of the causes of such variability is needed as a first step in reducing hospitalisation. KEYWORDS: Hospitalization; ethnic groups; data collection
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Uccelli, Raffaella, Marina Mastrantonio, Pierluigi Altavista, Francesca Pacchierotti, Antonio Piersanti, and Luisella Ciancarella. "Impact of modelled PM2.5, NO2 and O3 annual air concentrations on some causes of mortality in Tuscany municipalities." European Journal of Public Health 29, no. 5 (October 10, 2018): 871–76. http://dx.doi.org/10.1093/eurpub/cky210.
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Abstract Background In 2014, the European Environment Agency estimated 59 630 premature deaths in Italy attributable to long-term exposure to PM2.5, 17 290 to NO2 and 2900 to O3. The aim of this study was to test an approach for assessing health impact of the above pollutants analyzing possible associations between annual municipal concentrations, estimated by the national dispersion model developed by ENEA, and mortality rates for trachea, bronchus and lung (TBL) cancer, total respiratory diseases (RD) and chronic obstructive pulmonary diseases (COPD). Tuscany was selected as test case. Methods For the 287 municipalities, 2009–13 standardized mortality rates (SMRates) for each cause of death were calculated by the ENEA epidemiological database. The SMRates of municipalities, aggregated on the basis of the 2003 or 2010 estimated pollutant concentration tertiles, were also computed. Results TBL cancer SMRate in municipalities with 2003 PM2.5 levels >15.2 μg/m3 was significantly higher than the SMRates of the two lowest tertiles and COPD SMRates in the two highest O3 tertiles were significantly higher than that of the lower tertile. No association between PM2.5 or NO2 concentrations and RD and COPD was detected. Approximately 625 TBL cancer deaths attributable to PM2.5 levels above 10 μg/m3 in 2003 were estimated in the region. Smoking habits and deprivation index were homogeneously distributed among municipalities. Conclusion This methodological approach allowed detecting associations between mortality and specific air pollutants even at levels below the Italian normative limits and could be employed to evaluate the potential health impact of air pollution in areas where direct measures of concentration are unavailable.
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Brundage, Michael, Matthew R. Sydes, Wendy R. Parulekar, Padraig Warde, Richard Cowan, Andrea Bezjak, Peter Kirkbride, et al. "Impact of Radiotherapy When Added to Androgen-Deprivation Therapy for Locally Advanced Prostate Cancer: Long-Term Quality-of-Life Outcomes From the NCIC CTG PR3/MRC PR07 Randomized Trial." Journal of Clinical Oncology 33, no. 19 (July 1, 2015): 2151–57. http://dx.doi.org/10.1200/jco.2014.57.8724.
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Purpose The NCIC CTG PR3/MRC PR07 randomized phase III trial compared androgen-deprivation therapy (ADT) alone versus ADT with radiotherapy (RT) for patients with locally advanced prostate cancer. This article reports the health-related quality-of-life (HRQOL) outcomes of this trial. Patients and Methods A total of 1,205 patients were randomly allocated to either ADT alone or ADT with RT. HRQOL was assessed at baseline and every 6 months thereafter using the European Organisation for Research and Treatment of Cancer Core Questionnaire and a prostate cancer–specific checklist or the Functional Assessment of Cancer Therapy–Prostate questionnaire. Mean changes from baseline scores for five function domains and nine symptom domains were analyzed as those most relevant to ADT and RT. The proportions of patients with improved, stable, or worsened HRQOL scores according to instrument-specific minimal important differences were calculated. Results Baseline questionnaires were completed by 1,028 patients (88%). At 6 months, RT had a statistically significant impact on mean score for bowel symptoms (P = .02), diarrhea (P < .001), urinary function (P = .003), and erectile dysfunction (P = .008); by 3 years, however, there were no significant between-group differences in any domain. Generalized linear mixed modeling revealed no significant between-arm differences in any of the function scales but showed significant deterioration in both arms over time for Functional Assessment of Cancer Therapy–Prostate total score, treatment outcome index, and physical and functional well-being. Conclusion The addition of RT to ADT for patients with locally advanced prostate cancer significantly improved overall survival and had only modest and transient negative impact on relevant domains of HRQOL.
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Galluzzo, Nicola. "A Quantitative Assessment of the Rurality and an Efficiency Analysis of Emigration in Romania." Applied Studies in Agribusiness and Commerce 12, no. 3-4 (December 13, 2018): 39–46. http://dx.doi.org/10.19041/apstract/2018/3-4/5.
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In Romania, as in many other Eastern European countries, the early 1990s were marked by a significant emigration from the countryside as a consequence of the transition from a centralised economy to an open one and due to key changes in the political framework. The permanent emigration has predominantly been concentrated in rural areas where multiple socio-economic variables such as GDP per capita, unemployment, and public financial subsidies aimed at supporting people at risk of severe deprivation and poverty have all had a direct effect on rural depopulation. The rurality is a complex theoretical construct comprising many items and variables and is, therefore, difficult to define in a concise manner. The aim of this paper is to assess the evolution of emigration in Romania between 2001 and 2016 through a quantitative approach, estimating an index of rurality for the same period composed of a set of socio-economic variables having a direct or indirect nexus to it. In the first phase of research, a matrix of correlation and a multiple regression model has been used in order to estimate the direct links among all investigated variables. Following the quantitative methodology, in the second phase Partial Least Square Structural Equation Modelling (PLS-SEM) has been used in order to assess the main cause-effect relationships among a few selected endogenous variables and a set of socio-economic items. Furthermore, using a non-parametric Data Envelopment Analysis (DEA) output-oriented model, this research has assessed the efficiency in terms of permanent emigration from Romania estimated as an output to minimise and not as an output to maximise, as investigated by traditional efficiency approaches. In terms of efficiency, financial subsidies allocated by national authorities and the level of per capita Gross Domestic Product have acted directly on the level of emigration. The index of rurality in 2016 has been influenced in particular by he pluriactivity in farms in terms of agritourism, the dimension of farms in terms of land capital endowment, and the level of GDP per capita.
JEL Classification: Q10; Q18
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Chan, Henry, Alana Cavadino, and Clinton Lewis. "Epidemiology of Acute Myeloid Leukaemia in New Zealand: A National Cancer Registry Analysis." Blood 136, Supplement 1 (November 5, 2020): 36–37. http://dx.doi.org/10.1182/blood-2020-136524.
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Background: Acute myeloid leukaemia (AML) is a blood cancer characterised by the expansion of a malignant myeloid progenitor. The estimated age-standardised incidence rate in many western countries has remained static over the last 2 decades at 3-4 per 100,000, whilst long-term survival has improved, especially for the younger individuals. However, disparities remain for the older individuals, people of ethnic minority background, and those who are more socio-economically deprived. Previous evaluation of population data from New Zealand has shown a similar pattern, but a more recent analysis has not been done. Here we present the incidence and long-term survival of patients with AML in New Zealand (NZ), using the New Zealand Cancer Registry (NZCR). Method: The NZCR was established in 1948 and it became mandatory by law to report all new cases of malignancy by 1994. We extracted all AML cases from the registry between 1 January 1997 and 31 December 2016. Cases with an ICD-10-CM code for acute myeloid leukaemia and its subtypes including acute promyelocytic leukaemia (e.g. C92.0) were included. Individuals residing overseas or without an address were excluded, and individuals with a diagnosis of acute promyelocytic leukaemia (APML) were analyzed separately. The socio-economic status of the individual was estimated based on their domicile area using the New Zealand 2013 Index of Deprivation (NZDep2013) which is a geographically based composite measure of deprivation. Overall survival was calculated from the date of diagnosis to the date of death or last follow-up (31 December 2016). Multivariable Cox-proportional hazard models were used to evaluate potential associations with survival time in NZ AML cases. Results: During this 20-year period, 154 cases of APML and 2876 cases of AML (excluding APML) were reported to the registry on individuals residing in New Zealand. Of the AML cases, 53% were male and the median age at the time of diagnosis was 67 (IQR 52-77), with a small positive correlation between year of diagnosis and age at diagnosis (Spearman's rho=0.05, p=0.009). The majority of cases (77%) were of European descent, 12% were New Zealand Maori, and 6% were Pacific Islanders. Individuals of European descent were significantly older at diagnosis compared to other ethnicities (median of 70 vs 51 for Maori, 56 for Pacific Islanders, and 58 for all other ethnicities, p<0.001). AML appeared to disproportionally affect those more socio-economically deprived, with 23% of cases reported in the most deprived 20% of the population, compared with only 16% of the cases in the least deprived 20%. The annual crude incidence remained stable during this period at an average of 3.42 per 100,000 (ranging from 2.57 to 4.29, figure 1), and was significantly higher in the older adults (figure 2). Age-standardised rates were lower (figure 1), with an average of 2.6 (range 1.9 to 3.4) cases per 100,000, and a small but significant average annual decrease over the study period. The estimated 1, 2, and 5-year survival for the entire cohort was 38%, 27%, and 22%, respectively. Age at diagnosis was a significant predictor of inferior survival, with a hazard ratio (HR) for all-cause mortality of 2.06, 3.95, 6.39 and 10.84 for the 50-59, 60-69, 70-79 and >80 age groups, respectively, compared to those aged <50. Shorter overall survival was also noted in individuals in the more socio-economically deprived 50% of the population (HR 1.13, 95% CI 1.03-1.23). Conclusion The incidence of AML in New Zealand has remained static in the last 2 decades, consistent with data from other western countries. Lower age-standardised rates and the small decrease in these observed over the study period are likely to reflect the increasingly and comparatively older population in NZ. Maori and Pacific Islanders appeared to present at a younger age than individuals of European descent. Age at diagnosis and socio-economic deprivation were shown to be an adverse prognostic factor for overall survival. Further in-depth analysis is required to determine the cause of these observations at a population level. Disclosures Chan: AbbVie:Membership on an entity's Board of Directors or advisory committees;Janssen:Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding, Speakers Bureau;Celgene:Other: TRAVEL, ACCOMODATIONS, EXPENSES (paid by any for-profit health care company);Amgen:Other: TRAVEL, ACCOMODATIONS, EXPENSES (paid by any for-profit health care company);Roche:Other: TRAVEL, ACCOMODATIONS, EXPENSES (paid by any for-profit health care company).
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Thomson, Christine D., Sarah K. McLachlan, Winsome R. Parnell, Noela Wilson, Mark Wohlers, Robert Scragg, David Schaaf, and Eljon D. Fitzgerald. "Serum selenium concentrations and dietary selenium intake of New Zealand children aged 5–14 years." British Journal of Nutrition 97, no. 2 (February 2007): 357–64. http://dx.doi.org/10.1017/s0007114507336738.
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Serum Se concentrations and dietary Se intakes have been determined in relation to age, sex, ethnicity, region and index of deprivation in a nationally representative sample of New Zealand children aged 5–14 years from the 2002 National Children's Nutrition Survey. Dietary intake was assessed from computer-assisted, multiple-pass 24 h diet recall interviews (n3275). Serum Se concentrations were obtained from a subset of urban-based children (n1547). Mean (95 % CI) serum Se concentration in children was 0·96 (0·93, 1·00) μmol/l. Males (1·00 μmol/l) had higher serum Se levels than females (0·93 μmol/l;P = 0·027). Mäori children had lower serum Se than Pacific Islands children (P = 0·038) and New Zealand European and Other children (P = 0·005). Children in the Upper North Island (1·06 μmol/l) had higher mean serum Se values than those in the Lower North Island (0·98 μmol/l,P < 0·0005) and South Island (0·79 μmol/l,P < 0·0005), and serum Se in the Lower North Island was higher than that in the South Island (P < 0·0005). Mean dietary Se intake was 36 (34, 37) μg/d. The intakes of children aged 5–6 years (31 μg/d) were lower than those of children aged 7–10 and 11–14 years (35 and 38 μg/d, respectively;P < 0·00 005) and the intakes of 7–10-year-olds were lower than those of 11–14-year-olds (P = 0·002). Serum Se was associated with dietary Se after adjusting for all variables, including region (P = 0·006). The Se status of our children falls in the middle of the international range of serum Se concentrations, but that for children in the South Island is among the lowest values reported and may be a cause for concern.
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Anderson, Yvonne C., Lisa E. Wynter, Katharine F. Treves, Cameron C. Grant, Joanna M. Stewart, Tami L. Cave, Trecia A. Wouldes, José G. B. Derraik, Wayne S. Cutfield, and Paul L. Hofman. "Assessment of health-related quality of life and psychological well-being of children and adolescents with obesity enrolled in a New Zealand community-based intervention programme: an observational study." BMJ Open 7, no. 8 (August 2017): e015776. http://dx.doi.org/10.1136/bmjopen-2016-015776.
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ObjectiveTo describe health-related quality of life (HRQOL) and psychological well-being of children and adolescents at enrolment in a multidisciplinary community-based obesity programme and to determine association with ethnicity. This programme targeted indigenous people and those from most deprived households. Further, this cohort was compared with other populations/normative data.MethodsThis study examines baseline demographic data of an unblinded randomised controlled clinical trial. Participants (recruited from January 2012-August 2014) resided in Taranaki, New Zealand, and for this study we only included those with a body mass index (BMI) ≥98th percentile (obese). HRQOL and psychological well-being were assessed using the Pediatric Quality of Life Inventory (PedsQL V.4.0TM) (parent and child reports), and Achenbach’s Child Behavior Checklist (CBCL)/Youth Self Report (YSR).ResultsAssessments were undertaken for 233 participants (45% Māori, 45% New Zealand European, 10% other ethnicities, 52% female, 30% from the most deprived household quintile), mean age 10.6 years. The mean BMI SD score (SDS) was 3.12 (range 2.01–5.34). Total PedsQL generic scaled score (parent) was lower (mean=63.4, SD 14.0) than an age-matched group of Australian children without obesity from the Health of Young Victorians study (mean=83.1, SD 12.5). In multivariable models, child and parental generic scaled scores decreased in older children (β=−0.70 and p=0.031, β=−0.64 and p=0.047, respectively). Behavioural difficulties (CBCL/YSR total score) were reported in 43.5% of participants, with the rate of emotional/behavioural difficulties six times higher than reported norms (p<0.001).ConclusionsIn this cohort, children and adolescents with obesity had a low HRQOL, and a concerning level of psychological difficulties, irrespective of ethnicity. Obesity itself rather than ethnicity or deprivation appeared to contribute to lower HRQOL scores. This study highlights the importance of psychologist involvement in obesity intervention programmes.Trial registration numberAustralian NZ Clinical Trials Registry ANZCTR 12611000862943; Pre-results.
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Williams, Thomas C., Mark D. Lyttle, Steve Cunningham, Ian Sinha, Olivia V. Swann, Abigail Maxwell-Hodkinson, and Damian Roland. "Study Pre-protocol for “BronchStart - The Impact of the COVID-19 Pandemic on the Timing, Age and Severity of Respiratory Syncytial Virus (RSV) Emergency Presentations; a Multi-Centre Prospective Observational Cohort Study”." Wellcome Open Research 6 (May 19, 2021): 120. http://dx.doi.org/10.12688/wellcomeopenres.16778.1.
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Background: Bronchiolitis (most frequently caused by respiratory syncytial virus; RSV) is a common winter disease predominantly affecting children under one year of age. It is a common reason for presentations to an emergency department (ED) and frequently results in hospital admission, contributing to paediatric units approaching or exceeding capacity each winter. During the SARS-CoV-2 pandemic, the circulation of RSV was dramatically reduced in the United Kingdom and Ireland. Evidence from the Southern Hemisphere and other European countries suggests that as social distancing restrictions for SARS-CoV-2 are relaxed, RSV infection returns, causing delayed or even summer epidemics, with different age distributions. Study question: The ability to track, anticipate and respond to a surge in RSV cases is critical for planning acute care delivery. There is an urgent need to understand the onset of RSV spread at the earliest opportunity. This will influence service planning, to inform clinicians whether the population at risk is a wider age range than normal, and whether there are changes in disease severity. This information is also needed to inform decision on the timing of passive immunisation of children at higher risk of hospitalisation, intensive care admission or death with RSV infection, which is a public health priority. Methods and likely impact: This multi-centre prospective observational cohort study will use a well-established research network (Paediatric Emergency Research in the UK and Ireland, PERUKI) to report in real time cases of RSV infection in children aged under two years, through the collection of essential, but non-identifying patient information. Forty-five centres will gather initial data on age, index of multiple deprivation quintile, clinical features on presentation, and co-morbidities. Each case will be followed up at seven days to identify treatment, viral diagnosis and outcome. Information be released on a weekly basis and used to support clinical decision making.
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Nijman, Ruud G., Dorine H. Borensztajn, Joany M. Zachariasse, Carine Hajema, Paulo Freitas, Susanne Greber-Platzer, Frank J. Smit, et al. "A clinical prediction model to identify children at risk for revisits with serious illness to the emergency department: A prospective multicentre observational study." PLOS ONE 16, no. 7 (July 15, 2021): e0254366. http://dx.doi.org/10.1371/journal.pone.0254366.
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Background To develop a clinical prediction model to identify children at risk for revisits with serious illness to the emergency department. Methods and findings A secondary analysis of a prospective multicentre observational study in five European EDs (the TRIAGE study), including consecutive children aged <16 years who were discharged following their initial ED visit (‘index’ visit), in 2012–2015. Standardised data on patient characteristics, Manchester Triage System urgency classification, vital signs, clinical interventions and procedures were collected. The outcome measure was serious illness defined as hospital admission or PICU admission or death in ED after an unplanned revisit within 7 days of the index visit. Prediction models were developed using multivariable logistic regression using characteristics of the index visit to predict the likelihood of a revisit with a serious illness. The clinical model included day and time of presentation, season, age, gender, presenting problem, triage urgency, and vital signs. An extended model added laboratory investigations, imaging, and intravenous medications. Cross validation between the five sites was performed, and discrimination and calibration were assessed using random effects models. A digital calculator was constructed for clinical implementation. 7,891 children out of 98,561 children had a revisit to the ED (8.0%), of whom 1,026 children (1.0%) returned to the ED with a serious illness. Rates of revisits with serious illness varied between the hospitals (range 0.7–2.2%). The clinical model had a summary Area under the operating curve (AUC) of 0.70 (95% CI 0.65–0.74) and summary calibration slope of 0.83 (95% CI 0.67–0.99). 4,433 children (5%) had a risk of > = 3%, which was useful for ruling in a revisit with serious illness, with positive likelihood ratio 4.41 (95% CI 3.87–5.01) and specificity 0.96 (95% CI 0.95–0.96). 37,546 (39%) had a risk <0.5%, which was useful for ruling out a revisit with serious illness (negative likelihood ratio 0.30 (95% CI 0.25–0.35), sensitivity 0.88 (95% CI 0.86–0.90)). The extended model had an improved summary AUC of 0.71 (95% CI 0.68–0.75) and summary calibration slope of 0.84 (95% CI 0.71–0.97). As study limitations, variables on ethnicity and social deprivation could not be included, and only return visits to the original hospital and not to those of surrounding hospitals were recorded. Conclusion We developed a prediction model and a digital calculator which can aid physicians identifying those children at highest and lowest risks for developing a serious illness after initial discharge from the ED, allowing for more targeted safety netting advice and follow-up.
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Aidukaite, Jolanta. "Welfare reforms and socio-economic trends in the 10 new EU member states of Central and Eastern Europe." Communist and Post-Communist Studies 44, no. 3 (August 6, 2011): 211–19. http://dx.doi.org/10.1016/j.postcomstud.2011.07.005.
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The paper reviews recent socio-economic changes in the 10 new EU member states of Central and Eastern Europe and the earlier and latest debates on the emergence of the post-communist welfare state regime. It asks two questions: are the new EU member states more similar to each other in their social problems encountered than to the rest of the EU world? Do they exhibit enough common socio-economic and institutional features to group them into the distinct/unified post-communist welfare regime that deviates from any well-known welfare state typology? The findings of this paper indicate that despite some slight variation within, the new EU countries exhibit lower indicators compared to the EU-15 as it comes to the minimum wage and social protection expenditure. The degree of material deprivation and the shadow economy is on average also higher if compared to the EU-15 or the EU-27. However, then it comes to at-risk-of-poverty rate after social transfers or Gini index, some Eastern European outliers especially the Check Republic, but also Slovenia, Slovakia and Hungary perform the same or even better than the old capitalist democracies. Latvia, Lithuania, Estonia, Romania, Bulgaria, Poland, however, show many similarities in their social indicators and performances and this group of countries never perform better than the EU-15 or the EU-27 averages. Nevertheless, the literature reviews on welfare state development in the CEE region reveal a number of important institutional features in support of identifying the distinct/unified post-communist welfare regime. Most resilient of it are: an insurance-based programs that played a major part in the social protection system; high take-up of social security; relatively low social security benefits; increasing signs of liberalization of social policy; and the experience of the Soviet/Communist type of welfare state, which implies still deeply embedded signs of solidarity and universalism.
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McRobbie, Hayden, Peter Hajek, Sarrah Peerbux, Brennan C. Kahan, Sandra Eldridge, Dominic Trépel, Steve Parrott, Chris Griffiths, Sarah Snuggs, and Katie Myers Smith. "Tackling obesity in areas of high social deprivation: clinical effectiveness and cost-effectiveness of a task-based weight management group programme – a randomised controlled trial and economic evaluation." Health Technology Assessment 20, no. 79 (October 2016): 1–150. http://dx.doi.org/10.3310/hta20790.
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BackgroundAn increasing number of people require help to manage their weight. The NHS recommends weight loss advice by general practitioners and/or a referral to a practice nurse. Although this is helpful for some, more effective approaches that can be disseminated economically on a large scale are needed.ObjectiveTo assess whether or not a task-based weight management programme [Weight Action Programme (WAP)] has better long-term effects than a ‘best practice’ intervention provided in primary care by practice nurses.DesignRandomised controlled trial with cost-effectiveness analysis.SettingGeneral practices in east London, UK.ParticipantsThree hundred and thirty adults with a body mass index (BMI) of ≥ 30 kg/m2or a BMI of ≥ 28 kg/m2plus comorbidities were recruited from local general practices and via media publicity. Those who had a BMI of > 45 kg/m2, had lost > 5% of their body weight in the previous 6 months, were currently pregnant or taking psychiatric medications were excluded. Participants were randomised (2 : 1) to the WAP or nurse arms.InterventionsThe WAP intervention was delivered in eight weekly group sessions that combined dietary and physical activity, advice and self-monitoring in a group-oriented intervention. The initial course was followed by 10 monthly group maintenance sessions open to all participants in this study arm. The practice nurse intervention (best usual care) consisted of four one-to-one sessions delivered over 8 weeks, and included standard advice on diet and physical activity based on NHS ‘Change4Life’ materials and motivational support.Main outcome measuresThe primary outcome measure was weight change at 12 months. Secondary outcome measures included change in BMI, waist circumference and blood pressure, and proportion of participants losing at least 5% and 10% of baseline body weight. Staff collecting measurements at the 6- and 12-month follow-ups were blinded to treatment allocation. The primary outcome measure was analysed according to the intention-to-treat principle, and included all participants with at least one recorded outcome at either 1, 2, 6 or 12 months. The analysis employed a mixed-effects linear regression model, adjusted for baseline weight, age, sex, ethnicity, smoking status and general practice. The European Quality of Life-5 Dimensions-5 Levels questionnaire was completed and used to estimate quality-adjusted life-years (QALYs) within the cost-effectiveness analysis.ResultsThere were 330 participants (WAP arm,n = 221; nurse arm,n = 109; 72% women). A total of 291 (88%) participants (WAP arm,n = 194; nurse arm,n = 97) were included in the main analysis for the primary outcome. Weight loss at 12 months was greater in the WAP arm than in the nurse intervention arm [–4.2 kg vs. –2.3 kg; difference –1.9 kg, 95% confidence interval (CI) –3.7 to –0.1 kg;p = 0.04]. Participants in the WAP arm were more likely than participants in the nurse arm to have lost at least 5% of their baseline body weight at 12 months (41% vs. 27%; odds ratio 14.61, 95% CI 2.32 to 91.96;p = 0.004). The incremental cost-effectiveness ratio for WAP over and above the nurse arm is £7742 per QALY.ConclusionsA WAP delivered in general practice better promotes weight loss over 12 months than a best usual practice nurse-led weight loss programme.LimitationsThe trial recruited mostly women. Research is needed into factors that would make weight loss programmes more attractive to men.Trial registrationCurrent Controlled Trials ISRCTN45820471.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 79. See the NIHR Journals Library website for further project information.
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Farcy, Anne-lise, Lacaze Jean Louis, Charlotte Vaysse, Cyrille Delpierre, Gabrielle Selmes, Mony Ung, Clemence BRAC de la PERRIERE, et al. "Are neglected breast cancer relates to lifestyle and socioeconomic environment?" Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18542-e18542. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18542.
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e18542 Background: The incidence of patients with neglected breast cancer (NBC) in high-income countries remains an issue. It may be important to clarify their characteristics to adapt prevention policy. The purpose of present study was to describe the clinical and socio-economic features of patients with NBC at diagnosis. Methods: We conducted a retrospective analysis of 110 patients treated in our institution between January 2018 and December 2019 for a NBC. Diagnosis of NBC was made when patients deliberately delayed the first consultation for more than 3 months, despite the suspicious nature of the abnormality, or when breast cancer was described as neglected by physicians. Locally advanced breast cancer related to diagnostic delay and those for which the patients did not initially worry, were not retained. Results: The median age was 70 years [31-98], 51.8 % had more than 70 years. Delay between the first signs and the first consultation, was 3 to 6 months for 17 patients (20.5%), 6 and 12 months for 24 (21.1%) and more than 1 year for 36 (43.4%). 51 (47.2 %) patients lived alone, 52 (48.1%) lived with a third person and 5 (4.6%) were institutionalized. 47 (44.3%) were in a relationship, 27 (25.5%) were single and 32 (30.2%) were widow or separated, 84 (76.4%) had at least one child, 79 (76.4%) patients had at least one caregiver. 63 patients (57.3%) had regular medical follow-up due to chronic disease. 26 (23.6%) had psychiatric disorders. Concerning socio-economic position, 57 (51%) were employees, 16 (14%) were executive or intermediate profession, 11 (10%) had a higher intellectual profession, 11 (10%) were workers, 9 (10%) did not have an occupation, 3 (3%) were craftsmen, shopkeepers, or company managers and 3 (3%) were farmers. According to the score of the French European Deprivation Index (FEDI), 60 (55.6%) lived in areas of low to extremely low socio-economic level. In comparison with a series of 89 patients, treated for a non-neglected BC, NBC was more prevalent among single, separated, or widowed patients (p=0,0002), those living alone or institutionalized (p=0,01). It also concerns childless patients (p=0,02) and those who had no caregiver (p=0,02) or with psychiatric disorder (p=0,004). Employees and workers are more represented among negligent patients (p=0,01). There was no statistical difference in socioeconomic feature according to the FEDI (p=0,2). In multivariate analysis, living alone and psychiatric disorders were independent risk factors for NBC (respectively: OR= 2,27, IC95% [1,11-5,65], p=0,02; OR= 6,88, IC95% [1,76;26,84], p=0,005). Conclusions: We present the largest cohort of NBC. Patients with NBC appear to be more precarious psychologically, socially, and economically. Prospective studies are necessary to strengthen and deepen the associations found to optimize the screening policy and the education of physicians.
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Bradshaw, Jonathan, and Yekaterina Chzhen. "Child poverty policies across Europe." Journal of Family Research 21, no. 2 (September 1, 2009): 128–49. http://dx.doi.org/10.20377/jfr-223.
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This article is in two parts. In the first part, we present the results of a comparative analysis of the European Union Statistics on Income and Living Conditions (SILC) to explore child poverty. Countries’ child poverty rates are compared using the conventional income definition and deprivation and economic strain. The extent of overlap in these different measures is explored. Variations in child poverty rates by employment, child age, number of children, education level of the parents and family type are explored. Then logistic regression is used to explore how countries’ child poverty varies having taken account of these characteristics. In the second part we explore how policy affects child poverty, presenting child poverty rates before and after transfers; analysis of spending and its relationship to child poverty; and the analysis of child benefit packages using model family methods. Child poverty is increasing in most EU countries. The article argues that the data available on what policies work is not really good enough. The OECD Benefits and Wages series is too limited and the EU should invest in a framework that collects data on how tax and benefit policies are working to combat child poverty across the EU.
Zusammenfassung
Im ersten der zwei Teile dieses Aufsatzes stellen wir die Ergebnisse einer vergleichenden Analyse der European Union Statistics on Income and Living Conditions (SILC) vor, um die Kinderarmut unter die Lupe zu nehmen. Die Kinderarmutsraten in den einzelnen Ländern werden mithilfe von einer konventionellen Einkommensdefinition, Mangelerscheinungen und wirtschaftlichen Zwängen miteinander verglichen. Dabei wird das Ausmaß der Überschneidungen der einzelnen Messungen und Variationen in der Kinderarmut aufgrund der Beschäftigungsverhältnisse, des Alters der Kinder, der Kinderzahl, des Bildungsniveaus der Eltern und des Familientyps untersucht. Danach kommt die logistische Regression zum Einsatz, um zu untersuchen, inwieweit die Kinderarmut in den jeweiligen Ländern variiert, wenn man all diese Ausprägungen berücksichtigt. Im zweiten Teil untersuchen wir, welchen Einfluss familienpolitische Maßnahmen auf die Kinderarmut haben, indem wir Kinderarmutsraten vor und nach der Einbeziehung von Transferleistungen vorstellen, die Staatsausgaben und ihr Verhältnis zur Kinderarmut und – mithilfe von Methoden der Modellierung von Familien – Kinderunterstützungspakete analysieren. Die Kinderarmut nimmt in den meisten EU-Ländern zu. Im Beitrag wird dann argumentiert, dass die Daten darüber, welchen familienpolitischen Maßnahmen funktionieren, nicht wirklich gut genug sind. Die Benefits and Wages-Zeitreihen der OECD sind Beschränkungen unterworfen – die EU sollte in ein Rahmenprogramm investieren, in signifikante negative Effekte vorausgegangener ökonomischer Deprivation auf das Wohlbefinden gibt, zusätzlich zu den Effekten des Bildungsniveaus der Eltern und der Familienformen. Diese Effekte waren bei Mädchen stärker ausgeprägt als bei Jungen. Ein eingeschränktes Wohlbefinden im Jahre 1996 trug nicht vollständig zur Erklärung von Langzeiteffekten ökonomischer Deprivation bei. Mütterliche Negativität erwies sich als stärkerer Mediator für die Reaktion von Mädchen auf ökonomischen Stress. Insgesamt legen die Daten nahe, dass ökonomische Deprivation ein signifikanter Risikofaktor mit negativen Langzeitfolgen, insbesondere für Mädchen, ist.