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Park, G.-R; Grignon, M, Young, M, Dunn, J. R. Pages: 65 - 73 Abstract: BackgroundIt has been shown that the high cost of housing can be detrimental to individual health. However, it is unknown (1) whether high housing costs pose a threat to population health and (2) whether and how social policies moderate the link between housing cost burden and mortality. This study aims to reduce these knowledge gaps.MethodsCountry-level panel data from Organisation for Economic Co-operation and Development (OECD) countries are used. Housing cost to income ratio and age-standardised mortality were obtained from the OECD database. Fixed effects models were conducted to estimate the extent to which the housing cost to income ratio was associated with preventable mortality, treatable mortality, and suicides. In order to assess the moderating effects of social and housing policies, different types of social spending per capita as well as housing policies were taken into account.ResultsHousing cost to income ratio was significantly associated with preventable mortality, treatable mortality, and suicide during the post-global financial crisis (2009–2017) but not during the pre-global financial crisis (2000–2008). Social spending on pensions and unemployment benefits decreased the levels of mortality rate associated with housing cost burden. In countries with higher levels of social housing stock, the link between housing cost burden and mortality was attenuated. Similar patterns were examined for countries with rent control.ConclusionOur findings suggest that housing cost burden can be related to population health. Future studies should examine the role of protective measures that alleviate health problems caused by housing cost burden. Keywords:
Editor's choice, Press releases
PubDate: 2023-01-10T01:00:24-08:00 DOI: 10.1136/jech-2022-219545 Issue No:Vol. 77, No. 2 (2023)
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Oude Groeniger, J; Houweling, T. A, Jansen, P. W, Horoz, N, Buil, J. M, van Lier, P. A, van Lenthe, F. J. Pages: 74 - 80 Abstract: BackgroundStressful family conditions may contribute to inequalities in child development because they are more common among disadvantaged groups (ie, differential exposure) and/or because their negative effects are stronger among disadvantaged groups (ie, differential impact/susceptibility). We used counterfactual mediation analysis to investigate to what extent stressful family conditions contribute to inequalities in child development via differential exposure and susceptibility.MethodsWe used data from the Generation R Study, a population-based birth cohort in the Netherlands (n=6842). Mother’s education was used as the exposure. Developmental outcomes, measured at age 13 years, were emotional and behavioural problems (Youth Self-Report), cognitive development (Wechsler Intelligence Scale for Children) and secondary education entry level. Financial and social stress at age 9 years were the putative mediators.ResultsDifferential exposure to financial stress caused a 0.07 (95% CI –0.12 to –0.01) SD worse emotional and behavioural problem -score, a 0.05 (95% CI –0.08 to –0.02) SD lower intelligence score and a 0.05 (95% CI –0.05 to –0.01) SD lower secondary educational level, respectively, among children of less-educated mothers compared with children of more-educated mothers. This corresponds to a relative contribution of 54%, 9% and 6% of the total effect of mother’s education on these outcomes, respectively. Estimates for differential exposure to social stress, and differential susceptibility to financial or social stress, were much less pronounced.ConclusionAmong children of less-educated mothers, higher exposure to financial stress in the family substantially contributes to inequalities in socioemotional development, but less so for cognitive development and educational attainment. Keywords:
Open access
PubDate: 2023-01-10T01:00:24-08:00 DOI: 10.1136/jech-2022-219548 Issue No:Vol. 77, No. 2 (2023)
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Lee, M; Harrati, A, Rehkopf, D. H, Modrek, S. Pages: 81 - 88 Abstract: BackgroundEmergency employment programmes during the 1930s and 1940s invested income, infrastructure and social services into communities affected by the Great Depression. We estimate the long-term associations of growing up in an area exposed to New Deal emergency employment in 1940 with cognitive functioning in later life.MethodsMembers of the Health and Retirement Study cohort (N=5095; mean age 66.3 at baseline) who were age 0–17 in 1940 were linked to their census record from that year, providing prospective information about childhood contextual and family circumstances. We estimated the association between subcounty-level emergency employment participation in 1940 and baseline cognition and rate of cognitive decline between 1998 and 2016.ResultsCompared with those living in the lowest emergency employment quintile in 1940, those who were exposed to moderate levels of emergency employment (third quintile) had better cognitive functioning in 1998 (b=0.092 SD, 95% CI 0.011 to 0.173), conditional on sociodemographic factors. This effect was modestly attenuated after adjusting for respondents’ adult education, finances and health factors. There were no significant effects of area-level emergency employment on rate of cognitive decline.ConclusionsExposure to New Deal employment policies during childhood is associated with long-term cognitive health benefits. This is partially explained by increases in educational attainment among those with greater levels of emergency employment activity in the place where they were raised. Future research should investigate which types of New Deal investments may most be related to long-term cognitive health, or if the associations we observe are due to co-occurring programmes. PubDate: 2023-01-10T01:00:24-08:00 DOI: 10.1136/jech-2022-219259 Issue No:Vol. 77, No. 2 (2023)
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Klinte, M; Hermansen, A, Andersen, A.-M. N, Urhoj, S. K. Pages: 89 - 96 Abstract: BackgroundParental cancer as well as economic hardship in the family during childhood can affect the child negatively. Our aim was to examine the association between the joint exposure to parental cancer and income loss in childhood and the child’s socioeconomic position in early adulthood.MethodsWe conducted a register-based prospective cohort study of children born in Denmark between 1978 and 1986 and in Norway between 1979 and 1987. The children were followed from 1 January 1994 (in Denmark) or 1995 (in Norway). Educational level and personal income were measured at age 30 years. Children who experienced parental cancer between the years they turned 8 and 16 years were identified, and exposure to income loss was measured in the same period. Adjusted multinomial logistic regression model was used to estimate relative risk ratios for the joint exposure of parental cancer and income loss during childhood.ResultsChildren who experienced parental cancer and an income loss during childhood had an increased risk of low education and lower income at age 30 years. The associations were weaker for children only exposed to income loss and less clear for those only exposed to parental cancer. Further, exposure to parental cancer with a severe cancer type was associated with lower educational level.ConclusionThe child’s educational attainment and income level in early adulthood were negatively affected by exposure to income loss in childhood, and even more so if exposed to both parental cancer and income loss. The associations with educational attainment were stronger for more severe cancer types. PubDate: 2023-01-10T01:00:24-08:00 DOI: 10.1136/jech-2022-219374 Issue No:Vol. 77, No. 2 (2023)
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Sigglekow, F; Wilson, N, Blakely, T. Pages: 97 - 100 Abstract: ObjectiveTo estimate the income loss from having two or more diseases, over and above the independent and separate effects of having a single disease.MethodsWe used linked health income data from 2006–2007 to 2015–2016 for 25–64 years, for the entire New Zealand population. Fixed effects OLS regression was used to estimate within-individual income loss for diseases separately, and to estimate if having two or more diseases together resulted in reduced (subadditive) or additional (superadditive) income impacts (relative to adding together the income impacts for each disease when experienced singly).ResultsOf the 169 comorbidity pairs for both sexes, 28 (17%) had a statistically significant superadditive (n=14) or subadditive (n=14) effect of having two diseases. The combined total income gain from deleting all diseases and comorbidities was US$2.269 billion (95% CI US$$2.125 to US$2.389 billion), or a 3.61% (95% CI 3.38% to 3.80%) increase in income. Of this, 8.8% or US$200 million (95% CI US$193 to US$207 million) was attributable to a tendency for comorbidity interactions to increase income loss more than expected for common disease pairings.ConclusionsThis national longitudinal study found that disease is associated with income loss, but most of this impact is due to the distinct and independent impact of separate diseases. Nevertheless, there was a tendency for two or more diseases to disproportionately increase income loss more than the summed impacts of each of these diseases if experienced singly. PubDate: 2023-01-10T01:00:24-08:00 DOI: 10.1136/jech-2021-218255 Issue No:Vol. 77, No. 2 (2023)
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Dalecka, A; Pikhart, H, Bartoskova, A, Capkova, N, Bobak, M. Pages: 101 - 107 Abstract: BackgroundNumerous studies reported higher levels of mental health issues during the COVID-19 pandemic but only a minority used repeated measurements. We investigated change in depressive symptoms in the Czech ageing cohort and the impact of pre-existing and COVID-19-related stressors.MethodsWe used data on 2853 participants (mean age 73.4 years) from the Czech part of the prospective Health, Alcohol and Psychosocial factors In Eastern Europe cohort that participated in postal questionnaire surveys before (September 2017–June 2018) and during the pandemic (October 2020–April 2021). Participants reported their depressive symptoms using the Centre for Epidemiological Studies-Depression Scale including 10 (CESD-10) tool. A principal component analysis (PCA) was used to create representative components of the pandemic-related stressors. The impact of the stressors on change in depressive symptoms was tested using multivariable linear regression, after adjustment for age and potential confounders.ResultsThree patterns of the pandemic-related stressors (‘financial stressors’, ‘social and perception stressors’ and ‘death and hospitalisation stressors’) were extracted from the PCA. The mean CESD-10 score increased from 4.90 to 5.37 (p Keywords:
Open access, COVID-19
PubDate: 2023-01-10T01:00:24-08:00 DOI: 10.1136/jech-2022-219412 Issue No:Vol. 77, No. 2 (2023)
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Lian, Q; Li, R, Elgar, F. J, Su, Q. Pages: 108 - 114 Abstract: BackgroundAlthough adolescents are generally healthy, subjective health complaints (SHC) are common in this age group, especially in adolescent girls. We explored the association between early menarche and the frequency of psychosomatic symptoms and how this association varies between countries.MethodsOur sample included 298 000 adolescent girls from 2002, 2006, 2010 and 2014 cycles of the Health Behaviour in School-aged Children (HBSC) study in 41 European and North American countries. School surveys measured the frequency of eight psychosomatic symptoms in the past 6 months. Early maturation was defined as self-reported age at menarche below 11 years. Using logistic regression, we estimated adjusted ORs (aORs) and 95% CIsof experiencing each psychosomatic symptom at least more than once a week and experiencing two or more symptoms at least more than once a week.ResultsEarly menarche occurred in 4.73% of the sample and was positively related to headache, stomachache, backache, feeling low, irritability or bad temper, feeling nervous, difficulties in sleeping, feeling dizzy and two or more of these symptoms, respectively (all p values PubDate: 2023-01-10T01:00:24-08:00 DOI: 10.1136/jech-2022-219547 Issue No:Vol. 77, No. 2 (2023)
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Jensen, H. A. R; Lau, C. J, Davidsen, M, Ekholm, O, Christensen, A. I. Pages: 116 - 122 Abstract: BackgroundAgreement may be low when comparing self-reported diseases in health surveys with registry data. The aim of the present study was to examine the agreement between seven self-reported diseases among a representative sample of Danish adults aged ≥16 years and data from medical records. Moreover, possible associations with sociodemographic variables were examined.MethodsNationally representative data on self-reported current or previous diabetes, asthma, rheumatoid arthritis, osteoporosis, myocardial infarction, stroke and cancer, respectively, were derived from the Danish National Health Survey in 2017 (N=183 372). Individual-level data were linked to data on the same diseases from medical records in registries. Logistic regression models were used to explore potential associations between sociodemographic variables and total agreement.ResultsFor all included diseases, specificity was>92% and sensitivity varied between 66% (cancer) and 95% (diabetes). Negative predictive value (NPV) was>96% for all diseases and positive predictive value (PPV) varied between 13% (rheumatoid arthritis) and 90% (cancer). Total agreement varied between 91% (asthma) and 99% (diabetes), whereas the kappa value was lowest for rheumatoid arthritis (0.21) and highest for diabetes (0.88). Sociodemographic variables were demonstrated to be significantly associated with total agreement for all diseases, with sex, age and educational level exhibiting the strongest associations. However, the directions of the associations were inconsistent across diseases.ConclusionOverall, self-reported data were accurate in identifying individuals without the specific disease (ie, specificity and NPV). However, sensitivity, PPV and kappa varied greatly between diseases. These findings should be considered when interpreting similar results from surveys. PubDate: 2023-01-10T01:00:24-08:00 DOI: 10.1136/jech-2022-219944 Issue No:Vol. 77, No. 2 (2023)
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Kirvalidze, M; Beridze, G, Wimo, A, Morin, L, Calderon-Larranaga, A. Pages: 125 - 132 Abstract: BackgroundThe negative effects of informal caregiving are determined by the characteristics of the caregiver-care receiver dyad and the context of care. In this study, we aimed to identify which subgroups of older informal caregivers (1) experience the greatest subjective burden and (2) incur a faster decline in objective health status.MethodsFrom a total of 3363 older participants in the Swedish National study on Aging and Care in Kungsholmen (SNAC-K), we identified 629 informal caregivers (19.2%, mean age 69.9 years). Limitations to life and perceived burden were self-reported, and objective health status was quantified using the comprehensive clinical and functional Health Assessment Tool (HAT) score (range: 0–10). Ordered logistic regressions and linear mixed models were used to estimate the associations between caregiving-related exposures and subjective outcomes (cross-sectionally) and objective health trajectories (over 12 years), respectively.ResultsHaving a dual role (providing and receiving care simultaneously), caring for a spouse, living in the same household as the care receiver and spending more hours on caregiving were associated with more limitations and burden. In addition, having a dual role (β=–0.12, 95% CI –0.23 to –0.02) and caring for a spouse (β=–0.08, 95% CI –0.14 to –0.02) were associated with a faster HAT score decline. Being female and having a poor social network were associated with an exacerbation of the health decline.ConclusionsBoth the heterogeneity among caregivers and the related contextual factors should be accounted for by policymakers as well as in future research investigating the health impact of informal caregiving. Keywords:
Open access
PubDate: 2023-01-10T01:00:24-08:00 DOI: 10.1136/jech-2022-219095 Issue No:Vol. 77, No. 2 (2023)
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