Source: http://ije.oxfordjournals.org/cgi/content/short/41/3/604?rss=1
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Miyerkules, Oktubre 31, 2012
Aspirin Use, Tumor PIK3CA Mutation, and Colorectal-Cancer Survival
New England Journal of Medicine, Volume 367, Issue 17, Page 1596-1606, October 2012.
Source: http://www.nejm.org/doi/full/10.1056/NEJMoa1207756?ai=rv&af=R&rss=currentIssue
Giardiasis and other intestinal parasitic infections in relation to anthropometric indicators of malnutrition: a large, population-based survey of schoolchildren in Tehran.
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The role of prednisolone in reducing limb oedema in children bitten by green pit vipers: a randomized, controlled trial.
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Full hazards of smoking and benefits of stopping for women
Publication year: 2012
Source:The Lancet
Rachel R Huxley, Mark Woodward
Source:The Lancet
Rachel R Huxley, Mark Woodward
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The fight to stub out tobacco... Dr Jeffrey Wigand.
Bulletin of the World Health Organization; 09/01/2012
(AN 2011692177)
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Martes, Oktubre 30, 2012
Effects of the praziquantel-based control of schistosomiasis japonica in China.
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Four Edition Special Issue of Health, Risk and Society Health Care through the Lens of Risk.
Health, Risk & Society; 09/01/2011
(AN 65638120)
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The present status of human helminthic diseases in Iran.
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Revival of a focus of visceral leishmaniasis in central Sudan.
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Risk: An introduction.
Health, Risk & Society; 09/01/2011
(AN 65638127)
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Lunes, Oktubre 29, 2012
Regional disparities in the burden of disease attributable to unsafe water and poor sanitation in China.
Bulletin of the World Health Organization; 08/01/2012
(AN 2011651285)
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Stunting and obesity in childhood: a reassessment using longitudinal data from South Africa
Background A series of cross-sectional studies have found a relationship between stunting and obesity in childhood. Because height appears in both the numerator of indices of stunting and the denominator of indices of obesity, random errors made by fieldworkers measuring heights can produce negative bias in estimates of this relationship.
Methods With longitudinal data, height can be instrumented with its lagged value in a two-stage probit regression model, purging the estimated association between the probability of being obese or underweight and the height-for-age z-score of this errors-in-variables bias. Such a model is fitted to a cohort of 1110 primary-school-age children measured in 1993–2004 in a panel study in KwaZulu-Natal, South Africa. The study also collected detailed data on households' demographic and socio-economic characteristics.
Results Risk factors for stunting, wasting and obesity differed in this population. Stunting was not associated with childhood obesity in either the cross-sectional or two-stage models. In the cross-sectional analysis, however, random measurement errors masked a negative association between children's height-for-age and their probability of being underweight or wasted that emerged in the two-stage instrumental variable models. This association was further amplified, rather than attenuated, by controlling for children's household income, racial group, residence and mother's education.
Conclusions The validity of the findings of earlier cross-sectional studies of the association between stunting and obesity in childhood is dependent on the precision with which they measured height. Random measurement error can also mask an association between being stunted and underweight in cross-sectional studies.
Source: http://ije.oxfordjournals.org/cgi/content/short/41/3/764?rss=1
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Identification of the 18S-ribosomal-DNA genotypes of Acanthamoeba isolates from the Philippines.
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Peripheral Mechanisms in Irritable Bowel Syndrome
New England Journal of Medicine, Volume 367, Issue 17, Page 1626-1635, October 2012.
Source: http://www.nejm.org/doi/full/10.1056/NEJMra1207068?ai=rv&af=R&rss=currentIssue
Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care
New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.
Source: http://www.nejm.org/doi/full/10.1056/NEJMoa1209759?ai=rv&af=R&rss=currentIssue
Linggo, Oktubre 28, 2012
The avian influenza pandemic: Discourses of risk, contagion and preparation in Australia.
Health, Risk & Society; 06/01/2011
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Results of a 10-year survey of louse-borne relapsing fever in southern Ethiopia: a decline in endemicity.
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New drugs from ancient texts.
Bulletin of the World Health Organization; 08/01/2012
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Innovative financing for health: what is truly innovative?
Publication year: 2012
Source:The Lancet
Rifat Atun, Felicia Marie Knaul, Yoko Akachi, Julio Frenk
Development assistance for health has increased every year between 2000 and 2010, particularly for HIV/AIDS, tuberculosis, and malaria, to reach US$26·66 billion in 2010. The continued global economic crisis means that increased external financing from traditional donors is unlikely in the near term. Hence, new funding has to be sought from innovative financing sources to sustain the gains made in global health, to achieve the health Millennium Development Goals, and to address the emerging burden from non-communicable diseases. We use the value chain approach to conceptualise innovative financing. With this framework, we identify three integrated innovative financing mechanisms—GAVI, Global Fund, and UNITAID—that have reached a global scale. These three financing mechanisms have innovated along each step of the innovative finance value chain—namely resource mobilisation, pooling, channelling, resource allocation, and implementation—and integrated these steps to channel large amounts of funding rapidly to low-income and middle-income countries to address HIV/AIDS, malaria, tuberculosis, and vaccine-preventable diseases. However, resources mobilised from international innovative financing sources are relatively modest compared with donor assistance from traditional sources. Instead, the real innovation has been establishment of new organisational forms as integrated financing mechanisms that link elements of the financing value chain to more effectively and efficiently mobilise, pool, allocate, and channel financial resources to low-income and middle-income countries and to create incentives to improve implementation and performance of national programmes. These mechanisms provide platforms for health funding in the future, especially as efforts to grow innovative financing have faltered. The lessons learnt from these mechanisms can be used to develop and expand innovative financing from international sources to address health needs in low-income and middle-income countries.
Source:The Lancet
Rifat Atun, Felicia Marie Knaul, Yoko Akachi, Julio Frenk
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Hypertension and diabetes increase.
Bulletin of the World Health Organization; 06/01/2012
(AN 2011594080)
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Sabado, Oktubre 27, 2012
Accountability, organisational learning and risks to patient safety in England: Conflict or compromise?
Health, Risk & Society; 06/01/2011
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Republished: The risks of smoking in patients with spondyloarthritides
The smoking prevalence in Europe varies from 14% in Sweden to nearly 38% in Greece.
The effects of nicotine, like those of other drugs with the potential for abuse and dependence, are centrally mediated. The impact of nicotine on the central nervous system is neuroregulatory in nature, affecting...
Source: http://pmj.bmj.com/cgi/content/short/88/1045/617?rss=1
A comparative analysis of risk management strategies in European Union and United States pharmaceutical regulation.
Health, Risk & Society; 08/01/2011
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Paternal alcohol consumption, family transition and child development in a former Soviet country
Background Although major societal changes have been observed in former Soviet countries, the child health consequences of these changes have rarely been studied.
Methods We examined the associations of paternal alcohol consumption and family transitions with cognitive ability and behaviour problems among healthy, early school-age Belarusian children. Our study is based on follow-up of children aged 6.5 years participating in a cluster-randomized trial of a breastfeeding promotion intervention. Paternal alcohol consumption was measured at follow-up and classified into three categories: at least weekly consumption of heavy (≥6 standard units per occasion), moderate (4–5 units per occasion), or light (≤3 units per occasion) or infrequent drinking. Family transition from birth to age 6.5 years was categorized into living stably with an intact family, having transitioned into a stepfamily, having transitioned into a single-parent family and living stably with a single-parent family. Mean differences in intelligence quotient (IQ) measured with the Wechsler Abbreviated Scales of Intelligence and in behaviour problems measured with the Strengths and Difficulties Questionnaire were compared according to paternal alcohol and family transition, after controlling for a wide range of confounding factors.
Results Children whose fathers were moderate or heavy drinkers with at least weekly alcohol consumption showed 1.5–2.5 points lower mean IQ scores and greater behaviour problems (range 0.1–0.3 SD) compared with those whose fathers were light or infrequent drinkers. Compared with children from stable intact families, children who transitioned into stepfamilies had 1 point lower IQ and greater behaviour problems by 0.1–0.4 SD, and children from stable single-parent families or with transition into single-parent families showed no cognitive deficit but greater behaviour problems (range 0.1–0.3 SD).
Conclusions The sharp rise in both alcohol consumption and divorce/re-marriage rates in former Soviet countries may have negative consequences for cognitive and behavioural development in children.
Source: http://ije.oxfordjournals.org/cgi/content/short/41/4/1086?rss=1
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Biyernes, Oktubre 26, 2012
Migrants' perceptions of health promotion messages in rural Tasmania.
Health, Risk & Society; 10/01/2012
(AN 82153796)
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Perceptions of risk and safety within injection settings: Injection drug users' reasons for attending a supervised injecting facility in Vancouver, Canada.
Health, Risk & Society; 06/01/2012
(AN 75047848)
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Feasibility of using teleradiology to improve tuberculosis screening and case management in a district hospital in Malawi.
Bulletin of the World Health Organization; 09/01/2012
(AN 2011692171)
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Visceral leishmaniasis in pregnancy — the role of amphotericin B.
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Huwebes, Oktubre 25, 2012
Profile of the Navrongo Health and Demographic Surveillance System
Located in the Kassena-Nankana districts of northern Ghana, the Navrongo health and demographic surveillance system (NHDSS) was established in 1992 by the Navrongo health research centre (NHRC). The NHRC is one of three research centres of the Ghana health service. The activities and potential of the NHDSS for collaborative research are described. The NHDSS monitors health and demographic dynamics of the two Kassena-Nankana districts of northern Ghana and facilitates evaluation of the morbidity and mortality impact of health and social interventions. The total population currently under surveillance is 152 000 residing in 32 000 households. Events monitored routinely include pregnancies, births, morbidity, deaths, migration, marriages and vaccination coverage. Data updates are done every 4 months by trained fieldworkers. The NHRC also undertakes biomedical and socio-economic studies. Additional features of the NHDSS include the community key informant system where trained volunteers routinely report key events, such as births and deaths as they occur in their locality and the verbal autopsy (VA) system for determining the probable causes of deaths that occur at the community level. Data from the NHDSS are shared with funders and collaborators and partners in the INDEPTH Network. The Director of the NHDSS is the contact person for potential collaboration with the NHDSS and the use of its data.
Source: http://ije.oxfordjournals.org/cgi/content/short/41/4/968?rss=1
Molecular characterisation of the hepatitis A virus circulating in the 2001–2005 outbreaks in Thailand.
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The epidemiological delimitation of lymphatic filariasis in an endemic area of Brazil, 41 years after the first recorded case.
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Turkey's transformation.
Bulletin of the World Health Organization; 06/01/2012
(AN 2011594084)
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Depression and stigma: from attitudes to discrimination
Publication year: 2012
Source:The Lancet
Anthony F Jorm, Nicola J Reavley
Source:The Lancet
Anthony F Jorm, Nicola J Reavley
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Miyerkules, Oktubre 24, 2012
Profile: Nanoro Health and Demographic Surveillance System
The Nanoro Health and Demographic Surveillance System (HDSS), located in the rural centre of Burkina Faso, was established in 2009 by the Clinical Research Unit of Nanoro with the aim of providing a core framework for clinical trials and also to support the Burkina Faso health authorities in generating epidemiological data that can contribute to the setup and assessment of health interventions. In the baseline of initial census, 54 781 individuals were recorded of whom 56.1% are female. After the initial census, vital events such as pregnancies, births, migrations and deaths have been monitored, and data on individuals and household characteristics are updated during regular 4-monthly household visits. The available data are categorized into demographic, cultural, socio-economic and health information, and are used for monitoring and evaluation of population development issues. As a young site, our objective has been to strengthen our skills and knowledge and share new scientific experiences with INDEPTH and HDSS sites in Burkina Faso. In addition, all data produced by the Nanoro HDSS will be made publicly available through the INDEPTH data sharing system.
Source: http://ije.oxfordjournals.org/cgi/content/short/41/5/1293?rss=1
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Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review.
Bulletin of the World Health Organization; 05/01/2012
(AN 2011575003)
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Sero-epidemiology of toxocariasis in a rural settlement in São Paulo state, Brazil.
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Generalized negative binomial distribution: a promising statistical distribution for Oncomelania hupensis in the lake- and marsh-land regions of China.
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Challenging a dogma: antimicrobial susceptibility testing breakpoints for Mycobacterium tuberculosis.
Bulletin of the World Health Organization; 09/01/2012
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Bridging the gap from knowledge to delivery in the control of childhood diarrhoea.
Bulletin of the World Health Organization; 09/01/2012
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The epidemiological and clinical characteristics and nutritional development of infants with acute diarrhoea, in north–eastern Brazil.
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Martes, Oktubre 23, 2012
Prevalences of loiasis in Ondo state, Nigeria, as evaluated by the rapid assessment procedure for loiasis (RAPLOA).
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Sentinel versus population-based surveillance of pneumococcal conjugate vaccine effectiveness.
Bulletin of the World Health Organization; 08/01/2012
(AN 2011651284)
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Case-control studies: basic concepts
The purpose of this article is to present in elementary mathematical and statistical terms a simple way to quickly and effectively teach and understand case–control studies, as they are commonly done in dynamic populations—without using the rare disease assumption. Our focus is on case–control studies of disease incidence (‘incident case–control studies’); we will not consider the situation of case–control studies of prevalent disease, which are published much less frequently.
Source: http://ije.oxfordjournals.org/cgi/content/short/41/5/1480?rss=1
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Implementing early infant diagnosis of HIV infection at the primary care level: experiences and challenges in Malawi.
Bulletin of the World Health Organization; 09/01/2012
(AN 2011692172)
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Lunes, Oktubre 22, 2012
Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper
Much has been written about the measurement of socio-economic position (SEP) in high-income countries (HIC). Less has been written for an epidemiology, health systems and public health audience about the measurement of SEP in low- and middle-income countries (LMIC). The social stratification processes in many LMIC—and therefore the appropriate measurement tools—differ considerably from those in HIC. Many measures of SEP have been utilized in epidemiological studies; the aspects of SEP captured by these measures and the pathways through which they may affect health are likely to be slightly different but overlapping. No single measure of SEP will be ideal for all studies and contexts; the strengths and limitations of a given indicator are likely to vary according to the specific research question. Understanding the general properties of different indicators, however, is essential for all those involved in the design or interpretation of epidemiological studies. In this article, we describe the measures of SEP used in LMIC. We concentrate on measures of individual or household-level SEP rather than area-based or ecological measures such as gross domestic product. We describe each indicator in terms of its theoretical basis, interpretation, measurement, strengths and limitations. We also provide brief comparisons between LMIC and HIC for each measure.
Source: http://ije.oxfordjournals.org/cgi/content/short/41/3/871?rss=1
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Profile: Nanoro Health and Demographic Surveillance System
The Nanoro Health and Demographic Surveillance System (HDSS), located in the rural centre of Burkina Faso, was established in 2009 by the Clinical Research Unit of Nanoro with the aim of providing a core framework for clinical trials and also to support the Burkina Faso health authorities in generating epidemiological data that can contribute to the setup and assessment of health interventions. In the baseline of initial census, 54 781 individuals were recorded of whom 56.1% are female. After the initial census, vital events such as pregnancies, births, migrations and deaths have been monitored, and data on individuals and household characteristics are updated during regular 4-monthly household visits. The available data are categorized into demographic, cultural, socio-economic and health information, and are used for monitoring and evaluation of population development issues. As a young site, our objective has been to strengthen our skills and knowledge and share new scientific experiences with INDEPTH and HDSS sites in Burkina Faso. In addition, all data produced by the Nanoro HDSS will be made publicly available through the INDEPTH data sharing system.
Source: http://ije.oxfordjournals.org/cgi/content/short/41/5/1293?rss=1
Methods of Measurement in epidemiology: Sedentary Behaviour
Background Research examining sedentary behaviour as a potentially independent risk factor for chronic disease morbidity and mortality has expanded rapidly in recent years.
Methods We present a narrative overview of the sedentary behaviour measurement literature. Subjective and objective methods of measuring sedentary behaviour suitable for use in population-based research with children and adults are examined. The validity and reliability of each method is considered, gaps in the literature specific to each method identified and potential future directions discussed.
Results To date, subjective approaches to sedentary behaviour measurement, e.g. questionnaires, have focused predominantly on TV viewing or other screen-based behaviours. Typically, such measures demonstrate moderate reliability but slight to moderate validity. Accelerometry is increasingly being used for sedentary behaviour assessments; this approach overcomes some of the limitations of subjective methods, but detection of specific postures and postural changes by this method is somewhat limited. Instruments developed specifically for the assessment of body posture have demonstrated good reliability and validity in the limited research conducted to date. Miniaturization of monitoring devices, interoperability between measurement and communication technologies and advanced analytical approaches are potential avenues for future developments in this field.
Conclusions High-quality measurement is essential in all elements of sedentary behaviour epidemiology, from determining associations with health outcomes to the development and evaluation of behaviour change interventions. Sedentary behaviour measurement remains relatively under-developed, although new instruments, both objective and subjective, show considerable promise and warrant further testing.
Source: http://ije.oxfordjournals.org/cgi/content/short/41/5/1460?rss=1
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Corrigendum.
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Getting research into practice: primary care management of noncommunicable diseases in low- and middle-income countries.
Bulletin of the World Health Organization; 06/01/2012
(AN 2011594087)
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Linggo, Oktubre 21, 2012
Thomas Szasz: rebel with a questionable cause
Publication year: 2012
Source:The Lancet, Volume 380, Issue 9851
Arthur R Williams, Arthur L Caplan
Source:The Lancet, Volume 380, Issue 9851
Arthur R Williams, Arthur L Caplan
Jimmy Volmink: shaping the evidence base in South Africa
Publication year: 2012
Source:The Lancet, Volume 380, Issue 9851
Richard Lane
Source:The Lancet, Volume 380, Issue 9851
Richard Lane
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Magnesium for aneurysmal subarachnoid haemorrhage
Publication year: 2012
Source:The Lancet, Volume 380, Issue 9851
Satoru Takeuchi, Kojiro Wada, Kimihiro Nagatani, Naoki Otani, Kentaro Mori
Source:The Lancet, Volume 380, Issue 9851
Satoru Takeuchi, Kojiro Wada, Kimihiro Nagatani, Naoki Otani, Kentaro Mori
Editorial Board.
Health, Risk & Society; 10/01/2011
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The aetiological agents of American cutaneous leishmaniasis in the municipality of Monte Negro, Rondônia state, western Amazonia, Brazil.
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Sabado, Oktubre 20, 2012
Global burden of cancer in 2008: a systematic analysis of disability-adjusted life-years in 12 world regions
Publication year: 2012
Source:The Lancet
Isabelle Soerjomataram, Joannie Lortet-Tieulent, D Maxwell Parkin, Jacques Ferlay, Colin Mathers, David Forman, Freddie Bray
Background Country comparisons that consider the effect of fatal and non-fatal disease outcomes are needed for health-care planning. We calculated disability-adjusted life-years (DALYs) to estimate the global burden of cancer in 2008. Methods We used population-based data, mostly from cancer registries, for incidence, mortality, life expectancy, disease duration, and age at onset and death, alongside proportions of patients who were treated and living with sequelae or regarded as cured, to calculate years of life lost (YLLs) and years lived with disability (YLDs). We used YLLs and YLDs to derive DALYs for 27 sites of cancers in 184 countries in 12 world regions. Estimates were grouped into four categories based on a country's human development index (HDI). We applied zero discounting and uniform age weighting, and age-standardised rates to enable cross-country and regional comparisons. Findings Worldwide, an estimated 169·3 million years of healthy life were lost because of cancer in 2008. Colorectal, lung, breast, and prostate cancers were the main contributors to total DALYs in most world regions and caused 18–50% of the total cancer burden. We estimated an additional burden of 25% from infection-related cancers (liver, stomach, and cervical) in sub-Saharan Africa, and 27% in eastern Asia. We noted substantial global differences in the cancer profile of DALYs by country and region; however, YLLs were the most important component of DALYs in all countries and for all cancers, and contributed to more than 90% of the total burden. Nonetheless, low-resource settings had consistently higher YLLs (as a proportion of total DALYs) than did high-resource settings. Interpretation Age-adjusted DALYs lost from cancer are substantial, irrespective of world region. The consistently larger proportions of YLLs in low HDI than in high HDI countries indicate substantial inequalities in prognosis after diagnosis, related to degree of human development. Therefore, radical improvement in cancer care is needed in low-resource countries. Funding Dutch Scientific Society, Erasmus University Rotterdam, and International Agency for research on Cancer.
Source:The Lancet
Isabelle Soerjomataram, Joannie Lortet-Tieulent, D Maxwell Parkin, Jacques Ferlay, Colin Mathers, David Forman, Freddie Bray
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Health care utilization and health outcomes: a population study of Taiwan
Facing escalating health care expenditures, the governments of countries with national health insurance programs are trying to control or even to reduce health care utilization. Little research has examined the effects of decreased health care utilization on health outcomes. Applying a natural experiment design to the Taiwan population between 2000 and 2004, which includes the 2003 SARS epidemic when an average 20% decline in health care utilization occurred, this study examines the association between a decline in health care utilization and health outcomes measured by cause-specific mortality rates. We analyse the monthly mortality rates caused by infectious diseases, cancer, diabetes mellitus, nervous system diseases, cerebrovascular diseases, heart and other vascular diseases, respiratory system diseases, digestive system diseases, genitourinary system diseases and accidents. Models control for age, sex, month and year effects. Results show the heterogeneous effect of reduced health care utilization on health outcomes. Patients with diabetes mellitus or cerebrovascular diseases are vulnerable to short-term reductions in health care; compared with the non-SARS period, mortality caused by diabetes mellitus and cerebrovascular diseases significantly increased during the SARS epidemic by 8.4% and 6.2%, respectively. No significant change in mortality rates caused by the other diseases or accidents is found. This study suggests that governments of countries where health care utilization and spending are similar to or inferior to those in Taiwan should carefully evaluate the impact of policies that attempt to reduce health care utilization. Furthermore, when an area encounters an epidemic, governments should be aware of the negative consequences of voluntary restraints on access to health care that accompany decreases in utilization.
Source: http://heapol.oxfordjournals.org/cgi/content/short/27/7/590?rss=1
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Coming together to combat rare diseases.
Bulletin of the World Health Organization; 06/01/2012
(AN 2011594083)
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Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here?
Bulletin of the World Health Organization; 05/01/2012
(AN 2011574999)
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If I was infected with HIV, I would be letting my family down: Family influences on risk and protective factors for unsafe sex among gay Asian Pacific Islander men.
Health, Risk & Society; 06/01/2011
(AN 60900028)
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Biyernes, Oktubre 19, 2012
Evidence supporting the zoonotic and non-zoonotic transmission of Enterocytozoon bieneusi.
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(AN 32778531)
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More on Failures of Cobalamin Assays in Pernicious Anemia
New England Journal of Medicine, Volume 367, Issue 16, Page 1569-1571, October 2012.
Source: http://www.nejm.org/doi/full/10.1056/NEJMc1210169?ai=rv&af=R&rss=currentIssue
Three new cases of human infection with Dirofilaria repens, one pulmonary and two subcutaneous, in the Egyptian governorate of Assiut.
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Epidemiology of multimorbidity
Publication year: 2012
Source:The Lancet, Volume 380, Issue 9851
Fuzhou Wang, Shiqin Xu, Xiaofeng Shen, Xirong Guo, Rong Shen
Source:The Lancet, Volume 380, Issue 9851
Fuzhou Wang, Shiqin Xu, Xiaofeng Shen, Xirong Guo, Rong Shen
Twin earthquakes in northwest Iran
Publication year: 2012
Source:The Lancet, Volume 380, Issue 9851
Samad EJ Golzari, Kamyar Ghabili
Source:The Lancet, Volume 380, Issue 9851
Samad EJ Golzari, Kamyar Ghabili
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Huwebes, Oktubre 18, 2012
Rising mortality from injury in urban China: demographic burden, underlying causes and policy implications.
Bulletin of the World Health Organization; 06/01/2012
(AN 2011594092)
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Clipping the wings of avian influenza.
Bulletin of the World Health Organization; 09/01/2012
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Epidemic and intervention modelling - a scientific rationale for policy decisions? Lessons from the 2009 influenza pandemic.
Bulletin of the World Health Organization; 04/01/2012
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Miyerkules, Oktubre 17, 2012
E-health in low- and middle-income countries: findings from the Center for Health Market Innovations.
Bulletin of the World Health Organization; 05/01/2012
(AN 2011575007)
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Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-InterAct study
Background Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide. In high-income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship.
Method We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340 234, 3.99 million person-years of follow-up). A random sub-cohort of 16 835 individuals and a total of 12 403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed.
Results Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69–1.85; P-trend < 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52–1.83 in men; HR: 1.88, 95% CI: 1.73–2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23–1.51 in men; HR: 1.32, 95% CI: 1.20–1.45 in women).
Conclusion This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI.
Source: http://ije.oxfordjournals.org/cgi/content/short/41/4/1162?rss=1
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