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- Merlo, Juan, et al.
(författare)
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The tyranny of the averages and the indiscriminate use of risk factors in public health : The case of coronary heart disease
- 2017
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Ingår i: SSM - Population Health. - : Elsevier BV. - 2352-8273. ; 3, s. 684-698
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Tidskriftsartikel (refereegranskat)abstract
- Modern medicine is overwhelmed by a plethora of both established risk factors and novel biomarkers for diseases. The majority of this information is expressed by probabilistic measures of association such as the odds ratio (OR) obtained by calculating differences in average "risk" between exposed and unexposed groups. However, recent research demonstrates that even ORs of considerable magnitude are insufficient for assessing the ability of risk factors or biomarkers to distinguish the individuals who will develop the disease from those who will not. In regards to coronary heart disease (CHD), we already know that novel biomarkers add very little to the discriminatory accuracy (DA) of traditional risk factors. However, the value added by traditional risk factors alongside simple demographic variables such as age and sex has been the subject of less discussion. Moreover, in public health, we use the OR to calculate the population attributable fraction (PAF), although this measure fails to consider the DA of the risk factor it represents. Therefore, focusing on CHD and applying measures of DA, we re-examine the role of individual demographic characteristics, risk factors, novel biomarkers and PAFs in public health and epidemiology. In so doing, we also raise a more general criticism of the traditional risk factors' epidemiology. We investigated a cohort of 6103 men and women who participated in the baseline (1991-1996) of the Malmö Diet and Cancer study and were followed for 18 years. We found that neither traditional risk factors nor biomarkers substantially improved the DA obtained by models considering only age and sex. We concluded that the PAF measure provided insufficient information for the planning of preventive strategies in the population. We need a better understanding of the individual heterogeneity around the averages and, thereby, a fundamental change in the way we interpret risk factors in public health and epidemiology.
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| 2. |
- Wemrell, Maria
(författare)
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An intersectional approach in social epidemiology: Understanding health heterogeneity
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Critical debates within the science of (social) epidemiology concern the relative lackof social theory in epidemiological research and the low discriminatory accuracy (DA)of much epidemiological knowledge on factors and markers of risk for disease.Against this background, this thesis integrates intersectionality theory intoepidemiological study. The purposes are to improve the understanding ofheterogeneities in population groups and thus increase DA, and to incorporate atheoretical framework that directs attention toward power dynamics driving theproduction of health disparities as well as toward their measurement. Anintersectionality perspective is incorporated into empirical study of risk for ischemicheart disease in Sweden, and of influenza vaccination uptake in the US. A categoricalintersectionality perspective is operationalized through assessment of difference inaverage risk between intersectional strata. The measurement of the DA of the socialand racial/ethnic categorizations used is aligned to an anti-categorical intersectionality perspective, as this DA is found to be low due to heterogeneities within and/or overlaps between groups.Despite the integration of intersectionality theory, the DA of the social andracial/ethnic categories under study remains low. Such measurements of low DApoint to a current limitation in knowledge about causation mechanisms andindividual heterogeneity in (social) epidemiology. This project has therefore beenpartially driven by an interest in other possible ontological ways of understandinghealth, risk and prevention of disease, found in complementary or alternative forms ofmedicine (CAM). The thesis includes a pilot study measuring the use of, andattitudes towards, CAM and conventional medicine in Skåne, the southernmostprovince of Sweden.
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| 3. |
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| 4. |
- Wemrell, Maria, et al.
(författare)
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Intersectionality and risk for ischemic heart disease in Sweden : Categorical and anti-categorical approaches
- 2017
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Ingår i: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 177, s. 213-222
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Tidskriftsartikel (refereegranskat)abstract
- Intersectionality theory can contribute to epidemiology and public health by furthering understanding of power dynamics driving production of health disparities, and increasing knowledge about heterogeneities within, and overlap between, social categories. Drawing on McCall, we relate the first of these potential contributions to categorical intersectionality and the second to anti-categorical intersectionality. Both approaches are used in study of risk of ischemic heart disease (IHD), based on register data on 3.6 million adults residing in Sweden by 2010, followed for three years. Categorical intersectionality is here coupled with between-group differences in average risk calculation, as we use intersectional categorizations while estimating odds ratios through logistic regressions. The anti-categorical approach is operationalized through measurement of discriminatory accuracy (DA), i.e., capacity to accurately categorize individuals with or without a certain outcome, through computation of the area under the curve (AUC). Our results show substantial differences in average risk between intersectional groupings. The DA of social categorizations is found to be low, however, due to outcome variability within and overlap between categories. We argue that measures of DA should be used for proper interpretation of differences in average risk between social (or any other) categories. Tension between average between group risk and the DA of categorizations, which can be related to categorical and anti-categorical intersectional analyses, should be made explicit and discussed to a larger degree in epidemiology and public health.
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| 9. |
- Wemrell, Maria, et al.
(författare)
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Two-Thirds of Survey Respondents in Southern Sweden Used Complementary or Alternative Medicine in 2015
- 2017
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Ingår i: Complementary Medicine Research. - : S. Karger. - 2504-2092 .- 2504-2106. ; 24:5, s. 302-309
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Tidskriftsartikel (refereegranskat)abstract
- Background: Research has long suggested that a large and possibly growing number of people use complementary or alternative medicine (CAM). However, in many countries, such as Sweden, national and regional research on CAM use is still very limited. Existing prevalence studies are few and characterized by low comparability. This study aims to contribute towards addressing this knowledge gap.Methods: A web-based survey measured the use of and attitude towards CAM and conventional medicine in the southernmost Swedish province of Scania, while taking part in the development of a measurement tool for the standardized study of CAM use within the European Union (EU; I-CAM-Q).Results: 71% of the respondents (n = 1,534) reported having used some form of CAM in the past year. CAM consumption here includes visits to CAM providers, use of natural remedies, and use of self-help methods. Reported use was more common among women, younger age groups, and people with tertiary education. 69% of the respondents stated that collaboration between conventional medicine and complementary medicine should increase. The survey's response rate was 31%.Conclusions: The study confirms that CAM forms a considerable part of the health care offered to and used by the population. In the face of the existing lack of national and regional data on CAM usage, it affirms the importance of furthered investigation of CAM consumption, policy, practice, regulation, and education.
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