[show abstract][hide abstract] ABSTRACT: Evidence on the effect of community social capital on suicide mortality rates is fragmentary and inconsistent. The present study aims to determine whether geographic variations in suicide mortality across the Netherlands were associated with community social capital.
We included 3507 neighbourhoods with 6207 suicide deaths in the period 1995--2000. For each neighbourhood, we measured perceived social capital using information from interview surveys, and we measured structural aspects of social capital using population registers. Associations with mortality were determined using Poisson regression analysis with control for confounders at individual level (age, sex, marital status, country of origin) and area level (area income, population density, religious orientation).
Suicide mortality rates were related to the measure of perceived social capital. Mortality rates were 8 percent higher (95% confidence interval (CI): 2 to 16 percent) in areas with low capital. In stratified analyses, this difference was found to be significantly larger among men (12 percent, CI: 2 to 22) than women (1 percent, CI: -9 to 13), larger among those age 0--50 (18 percent, CI: 8 to 29) than older residents (-2 percent, CI: -12 to 8), and larger among the unmarried (30 percent, CI: 16--45) than the married (-2 percent, CI: -12 to 9). Associations with the structural aspect of social capital were in the same direction, but weaker, and not statistically significant.
This study contributed some evidence to assume a modest effect of community social capital on suicide mortality rates. This effect may be restricted to specific population groups such as younger unmarried men.
BMC Public Health 10/2013; 13(1):969. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: There is a paucity of empirical work on the potential population health impact of living under a regime marred by corruption. African countries differ in the extent of national corruption, and we explore whether perceived national corruption is associated with population health across all rungs of society.
World Health Survey data were analysed on 72 524 adults from 20 African countries. The main outcome was self-reported poor general health. Multilevel logistic regression was used to assess the association between poor health and perceived corruption, while jointly accounting for individual- and country-level human development factors. In this research, we use Transparency International's corruption perception index (CPI), which measures 'both administrative and political corruption' on a 0-10 scale. A higher score pertains to a higher rate of perceived corruption within society. We also examined effect modification by gender, age and socio-economic status.
Higher national corruption perception was consistently associated with an increase in poor health prevalence, also after multivariable adjustments, with odds ratio (OR) of 1.62 (95% CI: 1.01-2.60). Stratified analyses by age and gender suggested this same pattern in all subgroups. Positive associations between poor health and perceived corruption were evident in all socio-economic groups, with the association being somewhat more positive among less educated people (OR = 1.61, 95% CI: 1.01-2.58) than among more educated people (OR = 1.40, 95% CI: 0.83-2.37).
This study is a cautious first step in empirically testing the general health consequences of corruption. Our results suggest that higher perceived national corruption is associated with general health of both men and women within all socio-economic groups across the lifespan. Further research is needed using more countries to assess the magnitude of the health consequences of corruption.
Tropical Medicine & International Health 10/2013; 18(10):1240-7. · 2.94 Impact Factor
[show abstract][hide abstract] ABSTRACT: Current disease burden estimates do not provide evidence across different ethnic groups. This study aims to assess the disease burden as measured by the disability-adjusted life years (DALYs) for six ethnic groups in Amsterdam, the Netherlands, for 2011 and 2030.
The DALYs were calculated by combining three components: disease-/sex-/age-specific DALYs per person; disease-specific relative risks (RRs) by ethnicity; and sex-/age-specific population sizes by ethnicity in Amsterdam in 2011 and 2030. Disease-specific DALYs were derived from the National Institute of Public Health. The RRs were obtained through a systematic review of studies published in 1997-2008. The population figures were gathered from the Statistics Netherlands and municipality of Amsterdam.
The findings suggest that cardiovascular diseases and anxiety and depressive disorders dominate disease burden in all ethnic groups in 2011 and 2030. In most of the non-Western ethnic minorities, diabetes mellitus is the strongest contributor to the disease burden. The total disease burden will increase more strongly in non-Western ethnic minorities than ethnic Dutch. The 2030 disease burden is estimated to be highest among Surinamese and Antilleans.
In ethnic minorities, diabetes plays an important role in the disease burden, and the total disease burden will grow stronger than ethnic Dutch, resulting in a higher total disease burden for some ethnic groups in 2030. We encourage researchers to estimate the disease burden by ethnicity so that health priorities can be set in the fields of policy, health care and research.
The European Journal of Public Health 09/2013; · 2.52 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: The aim of this study was to assess the patterns of socio-economic inequalities in leisure-time physical activity (LTPA) in the different member states of the European Union. METHODS: Comparable data on subjects aged 16-64 years derived from national health interview surveys from 15 European countries were used for the analysis. We used log-binominal regression to assess prevalence rate ratios (PRRs). The PRR measured the risk of showing a low level of LTPA for a given educational level, relative to the highest educational group. RESULTS: Within Europe, large cross-national differences in the overall prevalence of a low level of LTPA were observed. However, a low level of LTPA was always more common among those of lower educational attainment. The educational inequalities in a low level of LTPA were more pronounced in men. For the lowest compared with the highest educational level, the PRR was 1.53 (95% CI: 1.49-1.57) in males and 1.36 (95% CI: 1.33-1.39) in females. There was no consistent relationship between the absolute level of prevalence rate, as measured by the rate for the highly educated, and the magnitude of these inequalities. CONCLUSIONS: Throughout Europe, physical activity during leisure time is less common among the lower educational groups compared with the higher educational groups. Programs to promote LTPA should consider strategies that target people of lower educational attainment.
The European Journal of Public Health 06/2013; · 2.52 Impact Factor
[show abstract][hide abstract] ABSTRACT: Previous studies have shown that smoking prevalence is higher in deprived areas than in affluent areas. We aimed to determine whether smoking initiation or continuation contributes most to inequalities in current smoking, and in which population subgroups these area differences were largest. Therefore, we assessed the relationship between area deprivation and current smoking, initiation and continuation in urban areas, in subgroups defined by gender, generation and educational level. Cross-sectional data of 20,603 Dutch adults (18 years and over) living in 963 urban areas in The Netherlands were obtained from the annual national health survey (2003-2009). Three interrelated smoking outcomes were used: current smoking (smokers/total population), initiation (ever-smokers/total population) and continuation (smokers/ever-smokers). Area deprivation was dichotomised; deprived urban areas (as defined by the Dutch government) and non-deprived urban areas (reference group) were distinguished. Multilevel logistic regression models controlled for individual characteristics (including education and income) and tested for interaction with gender, generation and education. After controlling for individual characteristics, odds for smoking were not significantly higher in deprived areas (current smoking: OR = 1.04 [0.92-1.18], initiation: OR = 1.05 [0.93-1.18], continuation: OR = 1.03 [0.88-1.19]). For smoking initiation, significant differences between deprived areas and other areas remained in younger generations (OR = 1.19 [1.02-1.38]) and higher educated (OR = 1.23 [1.04-1.45]) respondents. For continuation and current smoking, after controlling for individual characteristics, no associations were found in any subgroups. In conclusion, area deprivation appears to be independently related to smoking initiation in, respectively, higher educated and younger generations. These results suggest that initiatives to reduce area-level inequalities in smoking should focus on preventing smoking initiation in deprived areas.
Social Science [?] Medicine 06/2013; 87:132-7. · 2.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: OBJECTIVE: The aim of this study was to analyze socioeconomic position (SEP) inequalities in the prevalence and incidence of type 2 diabetes mellitus (T2DM) in people aged 50 years and over in Europe and to describe the contribution of body mass index (BMI) and other possible mediators. METHODS: This was a cross-sectional and longitudinal study including men and women ≥50 years old in 11 European countries in 2004 and 2006 (n=21,323). The prevalence and cumulative incidence of T2DM were calculated with self-reported T2DM or when the individual took drugs for diabetes. Prevalence ratio (PR) and relative risk (RR) of prevalent and incident T2DM were calculated according to educational level and adjusted by BMI and other possible mediators. RESULTS: The age-adjusted and country-adjusted prevalence of T2DM in 2004 was 10.2% in men and 8.5% in women. Compared to those with higher education, men and women with lower education had a PR [95% CI] of T2DM of 1.29 [1.12-1.50] and 1.61 [1.39-1.86], respectively. SEP-related inequalities in incidence (RR [95%CI]) were 1.88 [1.35-2.62] in women and 1.04 [0.78-1.40] in men. Adjusting for potential mediators reduced inequalities in the prevalence and incidence of T2DM among women by 26.2% and 21.6%, respectively, and inequalities in prevalence among men by 44.8%. CONCLUSIONS: We observed significant inequalities in the prevalence and incidence (women only) of T2DM as a function of socioeconomic position. These inequalities were mediated by BMI.
[show abstract][hide abstract] ABSTRACT: PURPOSE: It has been suggested that the cancer risk of migrants from low-income to high-income countries will converge toward the levels of their host country. However, comparisons with country of origin are mostly lacking. We compared cancer incidence and mortality rates of Surinamese migrants in the Netherlands to both native Dutch and Surinamese levels. METHODS: Data covering the period 1995-2008 were obtained from Surinamese and Dutch national cancer registries and national cause-of-death registries. Cancer incidence was studied for 21 types of cancer and cancer mortality for nine types. We calculated age-standardized incidence/mortality ratios (SIR/SMR) for the Surinamese migrants and for Suriname, using the native Dutch population as reference. RESULTS: Significantly lower overall cancer incidence (SIR = 0.77, 95 % CI = 0.69-0.84) and mortality rates (SMR = 0.63, 95 % CI = 0.55-0.72) were found for Surinamese migrants compared to native Dutch. Generally, cancer risk was lower for most cancers (e.g., cancer of the breast, colon and rectum, lung), but higher for other cancers (e.g., cancer of the uterine cervix, liver). For most cancers, cancer risk of the Surinamese migrants was in-between Surinamese and native Dutch levels. Importantly, for many cancers, migrants' incidence and mortality rates had not closely approached native Dutch rates. For skin cancer, incidence levels for Surinamese migrants were lower than both Surinamese and native Dutch levels. CONCLUSIONS: The results suggest that cancer incidence and mortality rates of Surinamese migrants generally converge from Surinamese toward Dutch levels, though not for all cancer types. Overall, Surinamese migrants still had a much more favorable cancer profile than the native Dutch population.
Cancer Causes and Control 04/2013; · 3.20 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Previous studies have shown that mortality inequalities are smaller in Italy than in most European countries. This may be due to the weak association between socioeconomic status and smoking in Italy. However, most published studies were based on data from a single city in northern Italy (Turin). In this study, we aimed to assess the size of mortality inequalities in Italy as a whole, their geographical pattern of variation within Italy, and the contribution of smoking to these inequalities. METHODS: Participants in the National Health Interview Survey 1999-2000 were followed up for mortality until 31 December 2007. Using Cox regression, we computed the age-adjusted relative index of inequality (RII) for all-cause mortality with and without controlling for smoking status and intensity. Education was used as an indicator of socioeconomic status. RESULTS: Among 72 762 individuals aged 30-74 years at baseline, 4092 died during the follow-up. The age-adjusted RII of mortality was 1.69 (95% CI 1.44 to 2.00) among men and 1.43 (95% CI 1.13 to 1.82) among women. Among men, inequalities were larger in both northern and southern regions than in the middle of the country, whereas among women they were larger in the south. After controlling for smoking RII decreased to 1.63 (95% CI 1.38 to 1.92) among men and increased to 1.54 (95% CI 1.21 to 1.96) among women. The geographical variation in mortality inequalities was not affected by smoking adjustment. CONCLUSIONS: Mortality inequalities in Italy are smaller than in most European countries. This is due, among other factors, to the weak socioeconomic pattern of smoking over the past decades in Italy.
Journal of epidemiology and community health 04/2013; · 3.04 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Earlier research has shown that residents of Dutch deprived neighbourhoods drink less alcohol than people in other areas. We aimed to assess the role of individual and neighbourhood characteristics in a cross-sectional, nationwide, multilevel study. METHODS: Individual data of 30 117 Dutch adults, living in 1722 neighbourhoods across the Netherlands, were obtained from the 2004 to 2009 national health survey (POLS). Chronic heavy alcohol consumption was measured as ≥14 drinks/week for women and ≥21 for men, and episodic heavy drinking as ≥6 drinks/day at least once a week. Neighbourhood deprivation was dichotomous; deprived districts as selected by the Dutch government versus other areas. Multilevel logistic regression models of the association between deprivation and heavy drinking were corrected for age, gender, household composition, population density and potential predictors ethnicity, socioeconomic status (education, income), neighbourhood-level social cohesion and percentage Muslims. RESULTS: The prevalence of heavy drinking was lower in deprived neighbourhoods than in the rest of the Netherlands. This association was found for both chronic and episodic heavy drinking (OR=0.58 (0.47 to 0.72) and OR=0.57 (0.45 to 0.72), respectively). Adding ethnicity to the model reduced these associations by approximately one half. Socioeconomic composition did not contribute to the relationship. The proportion of Muslims explained a small part, while social cohesion explained even less of the association. Stronger associations were observed for women and older adults than for men and younger adults. CONCLUSIONS: The lower prevalence of heavy drinking occurring in deprived areas is largely explained by the ethnicity of neighbourhood residents.
Journal of epidemiology and community health 03/2013; · 3.04 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Poor health is more prevalent in the East of Europe as compared with the West. This variation is often attributed to Soviet communism. Few studies investigate this health discrepancy within young adults who were children during this period. We studied the health of young adults by examining variations between world regions in general health between generations (18-65+). The individual and contextual mechanisms that might influence their health were also investigated. METHODS: World Health Survey data were analysed on young adults aged 18-34 (n = 91 823) and their elders aged 35+ (n = 132 362) from 59 countries. Main outcome was self-reported general health. Multi-level logistic regression was used to assess associations between general health and regions, while accounting for individual- and country-level socio-economic factors across age ranges. RESULTS: The prevalence of poor health was much higher for young adults in the Former Soviet Union region than in Western Europe, with the Central European region being in-between.This pattern remained even after full adjustments, for the Former Soviet Union citizens [odds ratio 4.26 (95% confidence interval 1.77-10.24)] and for Central Europeans [odds ratio 1.73 (95% confidence interval 0.90-3.32)] as compared with Western Europe. Age-specific analyses showed East-West health differences usually being larger as age increases (up to 65+). This age pattern seemed reversed for the South-West divide. CONCLUSIONS: The East-West health gap seems more pronounced for the Former Soviet Union young adults, rather than Central Europeans. It appears as though young adults from Central Europe might have been somewhat insulated from the ill-health effects of communism.
The European Journal of Public Health 03/2013; · 2.52 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Circulatory disease mortality inequalities by country of birth (COB) have been demonstrated for some EU countries but pan-European analyses are lacking. We examine inequalities in circulatory mortality by geographical region/COB for six EU countries. METHODS: We obtained national death and population data from Denmark, England and Wales, France, the Netherlands, Scotland and Sweden. Mortality rate ratios (MRRs) were constructed to examine differences in circulatory, ischaemic heart disease (IHD) and cerebrovascular disease mortality by geographical region/COB in 35-74 years old men and women. RESULTS: South Asians in Denmark, England and Wales and France experienced excess circulatory disease mortality (MRRs 1.37-1.91). Similar results were seen for Eastern Europeans in these countries as well as in Sweden (MRRs 1.05-1.51), for those of Middle Eastern origin in Denmark (MRR = 1.49) and France (MRR = 1.15), and for East and West sub-Saharan Africans in England and Wales (MRRs 1.28 and 1.39) and France (MRRs 1.24 and 1.22). Low ratios were observed for East Asians in France, Scotland and Sweden (MRRs 0.64-0.50). Sex-specific analyses showed results of similar direction but different effect sizes. The pattern for IHD mortality was similar to that for circulatory disease mortality. Two- to three-fold excess cerebrovascular disease mortality was found for several foreign-born groups compared with the local-born populations in some countries. CONCLUSIONS: Circulatory disease mortality varies by geographical region/COB within six EU countries. Excess mortality was observed for some migrant populations, less for others. Reliable pan-European data are needed for monitoring and understanding mortality inequalities in Europe's multiethnic populations.
The European Journal of Public Health 03/2013; · 2.52 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Several neighbourhood elements have been found to be related to leisure-time walking and cycling. However, the association with neighbourhood safety remains unclear. This study aimed to assess the association of neighbourhood-level safety with leisure-time walking and cycling among Dutch adults. METHODS: Data were derived from the national health survey (POLS) 2006--2009, with valid data on 20046 respondents residing in 2127 neighbourhoods. Multilevel logistic regression models were used to examine the association between neighbourhood-level safety (general safety and specific safety components: physical disorder, social disorder, crime-related fear, traffic safety) and residents' engagement in outdoor leisure-time walking and cycling for at least 30 minutes per week. RESULTS: An increase in neighbourhood safety (both general safety and each of the safety components) was significantly associated with an increase in leisure-time cycling participation. Associations were strongest for general safety and among older women. In the general population, neighbourhood safety was not significantly associated with leisure-time walking. However, among younger and older adult men and lower educated individuals, an increase in general safety was associated with a decrease in leisure-time walking participation. CONCLUSIONS: In the Netherlands, neighbourhood safety appears to be related to leisure-time cycling but not to walking. Leisure-time cycling may best be encouraged by improving different safety components at once, rather than focusing on one safety aspect such as traffic safety. Special attention is needed for older women.
International Journal of Behavioral Nutrition and Physical Activity 01/2013; 10(1):11. · 3.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: We present a new mortality projection methodology that distinguishes smoking- and non-smoking-related mortality and takes into account mortality trends of the opposite sex and in other countries. We evaluate to what extent future projections of life expectancy at birth (e (0)) for the Netherlands up to 2040 are affected by the application of these components. All-cause mortality and non-smoking-related mortality for the years 1970-2006 are projected by the Lee-Carter and Li-Lee methodologies. Smoking-related mortality is projected according to assumptions on future smoking-attributable mortality. Projecting all-cause mortality in the Netherlands, using the Lee-Carter model, leads to high gains in e (0) (4.1 for males; 4.4 for females) and divergence between the sexes. Coherent projections, which include the mortality experience of the other 21 sex- and country-specific populations, result in much higher gains for males (6.4) and females (5.7), and convergence. The separate projection of smoking and non-smoking-related mortality produces a steady increase in e (0) for males (4.8) and a nonlinear trend for females, with lower gains in e (0) in the short run, resulting in temporary sex convergence. The latter effect is also found in coherent projections. Our methodology provides more robust projections, especially thanks to the distinction between smoking- and non-smoking-related mortality.
[show abstract][hide abstract] ABSTRACT: The study of the relationship between residential environment and health at micro area level has a long time been hampered by a lack of micro-scale data. Nowadays data is registered at a much more detailed scale. In combination with Geographic Information System (GIS)-techniques this creates opportunities to look at the relationship at different scales, including very local ones. The study illustrates the use of a 'bespoke environment' approach to assess the relationship between health and socio-economic environment.
We created these environments by buffer-operations and used micro-scale data on 6-digit postcode level to describe these individually tailored areas around survey respondents in an accurate way. To capture the full extent of area effects we maximized variation in socio-economic characteristics between areas. The area effect was assessed using logistic regression analysis.
Although the contribution of the socio-economic environment in the explanation of health was not strong it tended to be stronger at a very local level. A positive association was observed only when these factors were measured in buffers smaller than 200 meters. Stronger associations were observed when restricting the analysis to socioeconomically homogeneous buffers. Scale effects proved to be highly important but potential boundary effects seemed not to play an important role. Administrative areas and buffers of comparable sizes came up with comparable area effects.
This study shows that socio-economic area effects reveal only on a very micro-scale. It underlines the importance of the availability of micro-scale data. Through scaling, bespoke environments add a new dimension to study environment and health.
PLoS ONE 01/2013; 8(7):e68790. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Despite higher levels of obesity, West African migrant women appear to have lower rates of type 2 diabetes than their male counterparts. We investigated the role of body fat distribution in these differences.
Cross-sectional study of Ghanaian migrants (97 men, 115 women) aged 18-60 years in Amsterdam, the Netherlands. Weight, height, waist and hip circumferences were measured. Logistic regression was used to explore the association of BMI, waist and hip measurements with elevated fasting glucose (glucose≥5.6 mmol/L). Linear regression was used to study the association of the same parameters with fasting glucose.
Mean BMI, waist and hip circumferences were higher in women than men while the prevalence of elevated fasting glucose was higher in men than in women, 33% versus 19%. With adjustment for age only, men were non-significantly more likely than women to have an elevated fasting glucose, odds ratio (OR) 1.81, 95% CI: 0.95, 3.46. With correction for BMI, the higher odds among men increased and were statistically significant (OR 2.84, 95% CI: 1.32, 6.10), but with consideration of body fat distribution (by adding both hip and waist in the analysis) differences were no longer significant (OR 1.56 95% CI: 0.66, 3.68). Analysis with fasting glucose as continuous outcome measure showed somewhat similar results.
Compared to men, the lower rates of elevated fasting glucose observed among Ghanaian women may be partly due to a more favorable body fat distribution, characterized by both hip and waist measurements.
PLoS ONE 01/2013; 8(6):e66516. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: There is limited evidence on the causality of previously observed associations between neighborhood traffic safety and physical activity (PA). This study aims to contribute to this evidence by assessing the extent to which changes over time in neighborhood traffic safety were associated with PA.
Data were accessed from the national survey Netherlands Housing Research for 2006 and 2009. The two samples of in total 57,092 Dutch residents aged 18-84 years lived in 320 neighbourhoods. Using multi-level hurdle models, the authors assessed whether the odds of being physically active and the mean hours of PA among active people (in 2009) were related to the levels of neighborhood traffic safety (in 2006) and changes in the levels of neighborhood traffic safety (between 2006 and 2009). Next, we examined if these associations varied according to gender, age, and employment status.
Higher levels of neighborhood traffic safety were associated with higher odds of being active (OR 1.080 (1.025-1.139)). An increase in levels of neighborhood traffic safety was associated with increased odds of being active (OR 1.060 (1.006-1.119)). This association was stronger among women, people aged 35 to 59, and those who were gainfully employed. Neither levels of traffic safety nor changes in these levels were associated with the mean hours of PA among people who were physically active (OR 0.997 (0.975-1.020); OR 1.001 (0.978-1.025), respectively).
Not only levels of neighborhood traffic safety, but also increases in neighborhood traffic safety were related to increased odds of being active. This relationship supports claims for a causal relationship between neighborhood traffic safety and PA.
PLoS ONE 01/2013; 8(5):e62525. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Smoking among migrants is known to differ from the host population, but migrants' smoking is rarely ever compared to the prevalence of smoking in their country of origin. The goal of this study is to compare the smoking prevalence among migrants to that of both the US-born population and the countries of origin. Further analyses assess the influence of sex, age at time of entry to the US and education level.
Data of 248,726 US-born and migrants from 14 countries were obtained from the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) from 2006-2007. Data on 108,653 respondents from the corresponding countries of origin were taken from the World Health Survey (WHS) from 2002-2005.
THE PREVALENCE OF SMOKING AMONG MIGRANTS (MEN: 14.2%, women: 4.1%) was lower than both the US-born group (men: 21.4%, women: 18.1%) and countries of origin (men: 39.4%, women: 11.0%). The gender gap among migrants was smaller than in the countries of origin. Age at time of entry to the US was not related to smoking prevalence for migrants. The risk of smoking for high-educated migrants was closer to their US counterparts.
The smoking prevalence among migrants is consistently lower than both the country of origin levels and the US level. The theory of segmented assimilation is supported by some results of this study, but not all. Other mechanisms that might influence the smoking prevalence among migrants are the 'healthy migrant effect' or the stage of the smoking epidemic at the time of migration.
PLoS ONE 01/2013; 8(3):e58654. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Surveillance systems often present data by means of summary measures, like age-standardized rates. In this study, we aimed at comparing information derived from commonly used measures of smoking with that presented in modified population pyramids (PPs), using the example of the diffusion of smoking in Italy over the past two decades. METHODS: Data were derived from four National Health Interview Surveys carried out in 1983, 1990 to 1991, 1999 to 2000, and 2004 to 2005. After computing both age-specific and age-standardised rates of current, former, and never smoking, we constructed modified PPs by stratifying the male and female populations according to smoking status and educational level. RESULTS: Modified PPs showed several features of the smoking epidemic in Italy that were not apparent from conventional surveillance techniques. First, they showed that the population of smokers is aging, with most current smokers in 2005 being males aged 25 to 39 and females aged 40 to 49, whereas in 1983 most smokers belonged to the youngest age groups. Second, they showed that in 2005 most smokers were found among subjects with middle and higher education, whereas two decades earlier most smokers were (male) subjects with the lowest education. CONCLUSIONS: Modified PPs were able to show how absolute numbers of smokers were distributed by age and sex, how these numbers varied between population subgroups, and how they changed over time. PPs may help provide information on past and future trends in the absolute number of smokers and in their sociodemographic characteristics, which may be missed using only traditional surveillance methods.
Population Health Metrics 11/2012; 10(1):23. · 2.11 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this study on cancer mortality among Turkish immigrants, for the first time, traditional comparisons in migrant health research have been extended simultaneously in two ways. First, comparisons were made to cancer mortality from the immigrants' country of origin and second, cancer mortality among Turkish immigrants across four host countries (Belgium, Denmark, France and the Netherlands) was compared. Population-based cancer mortality data from these countries were included. Age-standardized mortality rates were computed for the local-born and Turkish population of each country. Relative differences in cancer mortality were examined by fitting country-specific Poisson regression models. Globocan data on cancer mortality in Turkey from 2008 were used in order to compare mortality rates of Turkish immigrants with those from their country of origin. Turkish immigrants had lower all-cancer mortality than the local-born populations of their host countries, and mortality levels comparable to all-cancer mortality rates in Turkey. In the Netherlands and France breast cancer mortality was consistently lower in Turkish immigrants women than among local-born women. Lung cancer mortality was slightly lower in Turkish immigrants in the Netherlands and France but varied considerably between migrants in these two host countries. Stomach cancer mortality was significantly higher in Turkish immigrants when compared to local-born French and Dutch. Our findings indicate that exposures both in the country of origin and in the host country can have an effect on the cancer mortality of immigrants. Despite limitations affecting any cross-country comparison of mortality, the innovative multi-comparison approach is a promising way to gain further insights into determinants of trends in cancer mortality of immigrants.
European Journal of Epidemiology 11/2012; · 5.12 Impact Factor