| 1. |
- Abbafati, Cristiana, et al.
(författare)
-
- 2020
-
Tidskriftsartikel (refereegranskat)
|
|
| 2. |
- Agardh, Emilie E, et al.
(författare)
-
Burden of type 2 diabetes attributed to lower educational levels in Sweden
- 2011
-
Ingår i: Population Health Metrics. - : Springer Science and Business Media LLC. - 1478-7954. ; 9, s. 60-
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Type 2 diabetes is associated with low socioeconomic position (SEP) in high-income countries. Despite the important role of SEP in the development of many diseases, no socioeconomic indicator was included in the Comparative Risk Assessment (CRA) module of the Global Burden of Disease study. We therefore aimed to illustrate an example by estimating the burden of type 2 diabetes in Sweden attributed to lower educational levels as a measure of SEP using the methods applied in the CRA.METHODS: To include lower educational levels as a risk factor for type 2 diabetes, we pooled relevant international data from a recent systematic review to measure the association between type 2 diabetes incidence and lower educational levels. We also collected data on the distribution of educational levels in the Swedish population using comparable criteria for educational levels as identified in the international literature. Population attributable fractions (PAF) were estimated and applied to the burden of diabetes estimates from the Swedish burden of disease database for men and women in the separate age groups (30-44, 45-59, 60-69, 70-79, and 80+ years).RESULTS: The PAF estimates showed that 17.2% of the diabetes burden in men and 20.1% of the burden in women were attributed to lower educational levels in Sweden when combining all age groups. The burden was, however, most pronounced in the older age groups (70-79 and 80+), where lower educational levels contributed to 22.5% to 24.5% of the diabetes burden in men and 27.8% to 32.6% in women.CONCLUSIONS: There is a considerable burden of type 2 diabetes attributed to lower educational levels in Sweden, and socioeconomic indicators should be considered to be incorporated in the CRA.
|
|
| 3. |
- Agardh, Emilie, et al.
(författare)
-
Type 2 diabetes incidence and socio-economic position : a systematic review and meta-analysis
- 2011
-
Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 40:3, s. 804-818
-
Forskningsöversikt (refereegranskat)abstract
- Background We conducted a systematic review and meta-analysis, the first to our knowledge, summarizing and quantifying the published evidence on associations between type 2 diabetes incidence and socio-economic position (SEP) (measured by educational level, occupation and income) worldwide and when sub-divided into high-, middle- and low-income countries. Methods Relevant case-control and cohort studies published between 1966 and January 2010 were searched in PubMed and EMBASE using the keywords: diabetes vs educational level, occupation or income. All identified citations were screened by one author, and two authors independently evaluated and extracted data from relevant publications. Risk estimates from individual studies were pooled using random-effects models quantifying the associations. Results Out of 5120 citations, 23 studies, including 41 measures of association, were found to be relevant. Compared with high educational level, occupation and income, low levels of these determinants were associated with an overall increased risk of type 2 diabetes; [relative risk (RR) = 1.41, 95% confidence interval (CI): 1.28-1.51], (RR = 1.31, 95% CI: 1.09-1.57) and (RR = 1.40, 95% CI: 1.04-1.88), respectively. The increased risks were independent of the income levels of countries, although based on limited data in middle- and low-income countries. Conclusions The risk of getting type 2 diabetes was associated with low SEP in high-, middle- and low-income countries and overall. The strength of the associations was consistent in high-income countries, whereas there is a strong need for further investigation in middle- and low-income countries.
|
|
| 4. |
- Antai, Diddy, et al.
(författare)
-
Inequities in Under-Five Mortality in Nigeria : Differentials by Religious Affiliation of the Mother
- 2009
-
Ingår i: Journal of religion and health. - : Springer Science and Business Media LLC. - 0022-4197 .- 1573-6571. ; 48:3, s. 290-304
-
Tidskriftsartikel (refereegranskat)abstract
- Observations in Nigeria have indicated polio vaccination refusal related to religion that ultimately affected child morbidity and mortality. This study assessed the role of religion in under-five (0-59 months) mortality using a cross-sectional, nationally representative sample of 7,620 women aged 15-49 years from the 2003 Nigeria Demographic and Health Survey and included 6,029 children. Results show that mother's affiliation to Traditional indigenous religion is significantly associated with increased under-five mortality. Multivariable modelling demonstrated that this association is explained by differential use of maternal and child health services, specifically attendance to prenatal care. To reduce child health inequity, these results need to be incorporated in the formulation of child health policies geared towards achieving a high degree of attendance to prenatal care, irrespective of religious affiliation.
|
|
| 5. |
- Aremu, Olatunde, et al.
(författare)
-
Socio-economic determinants in selecting childhood diarrhoea treatment options in Sub-Saharan Africa: A multilevel model
- 2011
-
Ingår i: ITALIAN JOURNAL OF PEDIATRICS. - London, UK : BioMed Central. - 1720-8424 .- 1824-7288. ; 37:13
-
Tidskriftsartikel (refereegranskat)abstract
- ackground: Diarrhoea disease which has been attributed to poverty constitutes a major cause of morbidity and mortality in children aged five and below in most low-and-middle income countries. This study sought to examine the contribution of individual and neighbourhood socio-economic characteristics to caregivers treatment choices for managing childhood diarrhoea at household level in sub-Saharan Africa. less thanbrgreater than less thanbrgreater thanMethods: Multilevel multinomial logistic regression analysis was applied to Demographic and Health Survey data conducted in 11 countries in sub-Saharan Africa. The unit of analysis were the 12,988 caregivers of children who were reported to have had diarrhoea two weeks prior to the survey period. less thanbrgreater than less thanbrgreater thanResults: There were variability in selecting treatment options based on several socioeconomic characteristics. Multilevel-multinomial regression analysis indicated that higher level of education of both the caregiver and that of the partner, as well as caregivers occupation were associated with selection of medical centre, pharmacies and home care as compared to no treatment. In contrast, caregivers partners occupation was negatively associated with selection medical centre and home care for managing diarrhoea. In addition, a low-level of neighbourhood socio-economic disadvantage was significantly associated with selection of both medical centre and pharmacy stores and medicine vendors. less thanbrgreater than less thanbrgreater thanConclusion: In the light of the findings from this study, intervention aimed at improving on care seeking for managing diarrhoea episode and other childhood infectious disease should jointly consider the influence of both individual SEP and the level of economic development of the communities in which caregivers of these children resides.
|
|
| 6. |
|
|
| 7. |
- Manrique-Garcia, Edison, et al.
(författare)
-
Socioeconomic position and incidence of acute myocardial infarction : a meta-analysis
- 2011
-
Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 65:4, s. 301-309
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundA negative socioeconomic gradient is established for coronary heart disease (CHD) mortality and survival, while socioeconomic patterning of disease incidence is less well investigated. To study socioeconomic inequalities in the incidence of acute myocardial infarction (AMI), the major component of CHD, a meta-analysis was undertaken to summarise existing evidence on the issue.MethodsA systematic search was performed in PubMed and EMBASE databases for observational studies on AMI incidence and socioeconomic position (SEP), published in English to April 2009. A random-effects model was used to pool the risks estimates from the individual studies.ResultsAmong 1181 references, 70 studies fulfilled the inclusion criteria. An overall increased risk of AMI among the lowest SEP was found for all three indicators: income (pooled RR 1.71, 95% CI 1.43 to 2.05), occupation (pooled RR 1.35, 95% CI 1.19 to 1.53) and education (pooled RR 1.34, 95% CI 1.22 to 1.47). The strongest associations were seen in high-income countries such as USA/Canada and Europe, while the results were inconsistent for middle and low-income regions.ConclusionAMI incidence is associated with low SEP. The nature of social stratification at the level of economic development of a country could be involved in the differences of risk of AMI between social groups.
|
|
| 8. |
- Micah, Angela E., et al.
(författare)
-
Tracking development assistance for health and for COVID-19 : a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050
- 2021
-
Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 398:10308, s. 1317-1343
-
Forskningsöversikt (refereegranskat)abstract
- Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached $8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this, $13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and $1.4 billion was repurposed from existing health projects. $3.1 billion (22.4%) of the funds focused on country-level coordination and $2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34.3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.
|
|
| 9. |
- Moradi, Tahereh
(författare)
-
The role of physical activity in the prevention of breast and endometrial cancer
- 2000
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to explore through epidemiologic studies the role of physical activity in preventing breast and endometrial cancer in women. First, we assessed risk for endometrial (Paper I) and breast (Paper II) cancer in relation to occupational physical activity in a large nationwide cohort generated through linkage between census data in 1960 and 1970 and the Cancer Register 1971-1989. We focused on women with the same level of estimated occupational physical activity in 1960 and 1970. During the nineteen years of follow-up, we observed a total of 1, 949 cases of endometrial and 8,261 cases of breast cancer. We found a regularly increasing risk for endometrial cancer with decreasing level of occupational physical activity notably among women aged 50-69. Socioeconomic status did not appear to confound the risk estimates. The risk of breast cancer increased with decreasing level of occupational physical activity and with increasing socio-economic status. After adjustment for socioeconomic status, a 30% gradient in risk remained only among women 50-59 years old. Second, we investigated the role of both leisure-time and occupational physical activity on endometrial (Paper III) and breast (Paper IV) cancer risk in a nation-wide case-control study among Swedish women aged 50-74 years. Information on leisure-time physical activity during childhood, at ages 18-30 and in recent years as well as anthropometric, reproductive, and hormone-related factors was assessed through a detailed questionnaire. We estimated occupational physical activity through record linkage to the census data (19601990). Among 709 women with endometrial cancer and 3,368 population controls, women with sustained low leisure-time physical activity were at a 50% higher risk of endometrial cancer than the most physically active women. Low occupational physical activity level during peri-menopausal years increased the endometrial cancer risk notably among women who were non-obese or smoked. Among 3,347 women with breast cancer and 3,455 population controls, high leisure time physical activity at ages 50-74 was associated with risk reduction. Women with sedentary occupations during their reproductive years had a 50% higher risk compared to those with the physically most demanding jobs. In comparison with active women, those with the combination of sedentary jobs and lack of leisure-time exercise had a 3-fold higher risk. The protective effect of occupational physical activity on breast cancer risk was limited to leaner women and more pronounced in those who never used hormone replacement therapy. Third, we evaluated the effect of leisure time physical activity during most period of reproductive years and occupational physical activity on breast cancer risk in a cohort of 11,408 female twins born 1886 through 1925 (Paper V). Information on physical activity, anthropometric measures, reproductive and social factors were assessed through a questionnaire. A total of 506 breast cancer cases occurred during follow-up from 1967 to 1997. Women with regular leisure-time physical activity had 20% lower risk for breast cancer compared with inactive women. We found some evidence that the level of risk reduction was modified by birth cohort, age and body mass index in that the reduction in risk was more pronounced among older women with no overweight.
|
|
| 10. |
- Moradi, Tahereh, et al.
(författare)
-
Translation of questionnaire increases the response rate in immigrants : filling the language gap or feeling of inclusion?
- 2010
-
Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 38:8, s. 889-892
-
Tidskriftsartikel (refereegranskat)abstract
- Sweden has a long history of conducting questionnaire-based Public Health Surveys (PHS) to monitor health determinants. As Sweden has become a multi-ethnic society a linguistically adapted instrument to collect data was first used in Stockholm PHS 2006 to overcome the barrier of lack of Swedish language proficiency, but more importantly to overcome the psychological barrier of being excluded. The questionnaire was translated into the six most spoken languages among Swedish immigrants, namely Arabic, English, Farsi, Finnish, Spanish, and Turkish. In spite of a decrease in participation rate (-2.9%, p < 0.0001) among native Swedes in PHS 2006 compared with PHS 2002, there was a substantial increase in participation rate among immigrants in PHS 2006 who received a translated questionnaire or were interviewed in their mother tongue. The increase in response rate varied from 2.1% among Finnish-speaking immigrants up to 12.4% among Turkish-speaking immigrants and was significant for Arabic-speaking (p < 0.0001), Farsi-speaking (p = 0.003), Spanish-speaking (p < 0.0001) and Turkish-speaking (p < 0.0001) immigrants. Various attempts to increase participation rate will be of importance to policy makers involved in the integration of the immigrant population, to healthcare professionals, and obviously to the public.
|
|
