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Unemployment, public-sector health-care spending and breast cancer mortality in the European Union: 1990-2009

Date

Source

28.03.2015

Maruthappu, M., Watkins, J. A., Waqar, M., Williams, C., Ali...


Background: The global economic crisis has been associated with increased unemployment, reduced health-care spending and adverse health outcomes. Insights into the impact of economic variations on cancer mortality, however, remain limited. Methods: We used multivariate regression analysis to assess how changes in unemployment and public-sector expenditure on health care (PSEH) varied with female breast cancer mortality in the 27 European Union member states from 1990 to 2009. We then determined how the association with unemployment was modified by PSEH. Country-specific differences in infrastructure and demographic structure were controlled for, and 1-, 3-, 5- and 10-year lag analyses were conducted. Several robustness checks were also implemented. Results: Unemployment was associated with an increase in breast cancer mortality [P < 0.0001, coefficient (R) = 0.1829, 95% confidence interval (CI) 0.0978–0.2680]. Lag analysis showed a continued increase in breast cancer mortality at 1, 3, 5 and 10 years after unemployment rises (P < 0.05). Controlling for PSEH removed this association (P = 0.063, R = 0.080, 95% CI –0.004 to 0.163). PSEH increases were associated with significant decreases in breast cancer mortality (P < 0.0001, R = –1.28, 95% CI –1.67 to –0.877). The association between unemployment and breast cancer mortality remained in all robustness checks. Conclusion: Rises in unemployment are associated with significant short- and long-term increases in breast cancer mortality, while increases in PSEH are associated with reductions in breast cancer mortality. Initiatives that bolster employment and maintain total health-care expenditure may help minimize increases in breast cancer mortality during economic crises.


Thinness in the era of obesity: trends in children and adolescents in The Netherlands since 1980

Date

Source

28.03.2015

Schonbeck, Y., van Dommelen, P., HiraSing, R. A., van Buuren...


Background: Although children both at the upper and lower tail of the body mass index (BMI) distribution are at greater health risk, relatively little is known about the development of thinness prevalence rates in developed countries over time. We studied trends in childhood thinness and assessed changes in the BMI distribution since the onset of the obesity epidemic. Methods: Growth data from 54 814 children aged 2–18 years of Dutch, Turkish and Moroccan origin living in The Netherlands were used. Anthropometric measurements were performed during nationwide cross-sectional growth studies in 1980 (only Dutch), 1997 and 2009. Prevalence rates of thinness grades I, II and III were calculated according to international cut-offs. BMI distributions for 1980, 1997 and 2009 were compared. Results: Since 1980, thinness (all grades combined) reduced significantly from 14.0% to 9.8% in children of Dutch origin, but the proportion of extremely thin children (grade III) remained constant. Thinness in children of Moroccan origin decreased significantly from 8.8% to 6.2% between 1997 and 2009. No significant difference was observed in children of Turkish origin (5.4% in 1997 vs. 5.7% in 2009). Thinness occurred most often in children aged 2–5 years. There were no differences between boys and girls. The BMI distribution widened since 1980, mainly due to an upward shift of the upper centiles. Conclusion: Since the onset of the obesity epidemic, prevalence rates of thinness decreased. However, we found a small but persistent group of extremely thin children. More research is needed to gain insight into their health status.


Do lifestyle, health and social participation mediate educational inequalities in frailty worsening?

Date

Source

28.03.2015

Etman, A., Kamphuis, C. B. M., van der Cammen, T. J. M., Bur...


Background: Lower educated older persons are at increased risk of becoming frail as compared with higher educated older persons. To reduce educational inequalities in the development of frailty, we investigated whether lifestyle, health and social participation mediate this relationship. Methods: Longitudinal data of 14 082 European community-dwelling persons aged 55 years and older participating in the Survey on Health, Ageing, and Retirement in Europe (SHARE) in 2004 and 2006, were used. Associations of lifestyle (smoking behaviour and alcohol consumption), health (depression, memory function, chronic diseases) and social participation, with educational level and frailty worsening were investigated using regression models. In multinomial logistic regression analysis, mediators were added to models in which educational level was associated with worsening in frailty over 2 years follow-up. Results: In all countries, frailty worsening was more prevalent among lower as compared with higher educated persons, although odds ratios were only statistically significant in five of the 11 countries included [ORs varying from 1.40 (95% CI: 1.06–1.84) to 1.61 (95% CI: 1.21–2.14)]. Except for smoking behaviour and memory function, the factors under study all showed associations with educational level and frailty worsening that met the conditions for mediation. After inclusion of the four relevant mediators, attenuation of odds ratios varied between 4.9 and 31.5%. Conclusion: While lifestyle, health and social participation were associated with frailty worsening over 2 years among European community-dwelling older persons, only small to moderate parts of educational inequalities in frailty worsening were explained by these factors.


European Public Health News * President's Column * EUPHA office column * Message from the WHO Regional Director for Europe: Investing in Health over the Life-Course * Health and Food Safety: 'promotion, protection and prevention' Vytenis Andriukaitis, EU Commissioner for Health and Food Safety since November 2014, sets out his health priorities * 8th European Public Health Conference--'Health in Europe--from global to local policies, methods and practices

Date

Source

28.03.2015

Zeegers Paget, D., McKee, M., Zeegers Paget, D., Jakab, Z., ...



Weight change and sickness absence--a prospective study among middle-aged employees

Date

Source

28.03.2015

Roos, E., Laaksonen, M., Rahkonen, O., Lahelma, E., Lallukka...


Background: Obesity is associated with an increased risk of work disability, but studies concerning weight change are few. We examined the associations of weight change with subsequent sickness absence. Methods: Weight status data of 4164 (83% women) employees of the City of Helsinki were gathered from the Helsinki Health Study baseline survey in 2000–2002 and follow-up survey in 2007. Data were linked prospectively with the employer’s sickness absence registers. Employees were categorized according to their baseline Body Mass Index (normal weight, overweight, obese) as well as weight change (weight gainer, weight loser, weight maintainer) between the two surveys. The association of weight change with sickness absence spells was analysed with Poisson regression. Results: Among women, those who maintained normal weight had the lowest risk for sickness absence. Weight loss, weight gain and stable obesity increased the risk for sickness absence spells of all lengths. Adjustments for covariates attenuated the association only slightly. Among men, the achieved results were mostly not statistically significant. Conclusions: Preventing obesity and weight gain is important for employee well-being and work ability. Early support measures in occupational health care could benefit obese employees and those with weight gain to maintain work ability. The association between weight loss and sickness absence should be corroborated in further studies.


The development in body mass index, overweight and obesity in three regions in Denmark

Date

Source

28.03.2015

Toft, U., Vinding, A. L., Larsen, F. B., Hvidberg, M. F., Ro...


Background: The prevalence of overweight and obesity has increased markedly the past decades. However, recent studies have indicated that the development differ between different socio-economic groups and different geographic regions. The aim of this study was to assess the development in prevalence of overweight and obesity from 2006/2007 to 2010 by age, gender, socio-economic factors and geographical regions. Methods: Two cross-sectional surveys in three regions in Denmark (The Capital Region of Denmark, The Central Denmark Region and The North Denmark Region) were performed in 2006/2007 and 2010. A random sample of citizens aged more than or equal to 25 years was invited to participate. The overall response rate was 57.5% (n = 177 076). Data from questionnaire and central registers were included. Results: In 2006/2007, the prevalence of overweight, including obesity, was 54.3% and 36.8% among men and women, respectively. Of the overweight men 12.8% were obese and 11.8% women were obese. The prevalence was highest in the Northern region and among those who were older, had short education, was outside labour market, had low income and residents in rural areas. In 2010, the prevalence of overweight had increased to 56.3% and 39.6% in men and women, respectively (P < 0.0001). However, overweight increased the most in the Northern Region whereas no significant increase in body mass index was found among men in the Capital Region. Among women prevalence of overweight increased but not in those retired or above 60 years, and with high income. Conclusion: The prevalence of overweight and obesity was high and increased. The development, however, was heterogenic.


Increasing disability-free life expectancy among older adults in Palestine from 2006 to 2010

Date

Source

28.03.2015

Bronnum-Hansen, H., Duraidi, M., Qalalwa, K., Jeune, B.


Background: The population of Palestine comprises almost 200 000 Palestinians aged 60 or older. The purpose of the study was to estimate disability-free life expectancy for Palestinians living in the West Bank and Gaza Strip and to evaluate changes from 2006 to 2010. Methods: The study combined mortality data and prevalence of activity limitation derived from the Palestinian Family Health Surveys carried out in 2006 and 2010. Based on questions about the ability to perform five basic daily activities, disability-free life expectancy was estimated. Changes between 2006 and 2010 were decomposed into contributions from changes in mortality and disability. Results: Life expectancy at age 60 increased from 17.1 years in 2006 to 17.3 years in 2010 for men and from 18.7 years to 19.0 years for women. Disability-free life expectancy increased significantly, by 1.3 years for 60-year-old men (from 12.8 years to 14.1 years) and 1.8 years for 60-year-old women (from 12.6 years to 14.4 years). This increase was seen in the Gaza Strip as well as in the West Bank. While the modest contribution of the mortality effect did not differ between gender and regions, the strong contributions from the disability effects varied, being greatest for women in the Gaza Strip. Conclusion: The significant increase in disability-free life expectancy for both genders is remarkable and, to our knowledge, not seen in other low-income countries. This change may be due to decreasing incidence of disability and greater recovery from disability as a result of better prevention, care and rehabilitation of chronic diseases.


Excess Winter Deaths in Europe: a multi-country descriptive analysis

Date

Source

28.03.2015

Fowler, T., Southgate, R. J., Waite, T., Harrell, R., Kovats...


Background: Winter deaths are a known health and social care challenge for many countries. A previous international comparison showed significant differences in excess winter deaths across Europe in the 1990s, with the northern countries having lower excess winter mortality than those in southern Europe. Methods: The Excess Winter Deaths Index (EWDI) is the ratio of deaths in the winter period (December to March) compared with deaths in the non-winter period. Data from the Eurostat database and national registries were used to calculate the EWDI for 31 countries in Europe across the time period 2002/2003 to 2010/2011. Results: National EWDI values show heterogeneity, with a broad pattern of increasing EWDI values from northern to southern Europe and increasing mean winter temperature (r2 = 0.50, P > 0.0001). Malta, Portugal, Spain, Cyprus and Belgium all had an EWDI that was statistically significantly higher than the average EWDI for the other 30 European countries. There was no clear association between country-level EWDI and the level of inter-annual variability in winter temperature across Europe. Discussion: This article demonstrates the differences in EWDI that exist between European countries with implications for both research and policy. Many deaths may be avoidable as environmental, social and personal factors are known to contribute to winter mortality. We now need to work to better understand the causes of inter-country differences.


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