Trends in income-related health inequalities in self-assessed health in Korea, 1998–2011

This study assesses income-related health inequalities in self-assessed health (SAH) and its trend from 1998 to 2011 in Korea that covers important time periods of financial crisis and post-crisis. Data came from the Korean National Health and Nutrition Examination Survey from 1998 to 2011. A population-representative sample aged 46 years and older was analysed. SAH was used as an indicator of health status, with household equivalence income as a proxy for socio-economic position. Age-adjusted prevalence rates of SAH were analysed to estimate both absolute and relative measures of health inequalities and the trend over time by the relative index of inequality (RII) and the slope index of inequality (SII). Results indicated that the highest level of health inequalities was found among men aged 46–59 years, especially in 2001 and 2005. For men, there was no clear, consistent pattern of increase or decrease in the trend over time. On the other hand, increasing trends in the RII and SII were found for women, except for women aged 46–59 years who reported a decreasing trend in the SII. Trends in health inequalities over time were influenced by economic crisis, demonstrating the need for macro-level economic policies as well as health policies addressing health gaps.     

Effects of study area size on geographic characterizations of health events: Prostate cancer incidence in Southern New England, USA, 1994–1998

Background

In this paper we analyse the Plasmodium sp. prevalence in three villages with different isolation status on the island of Bioko (Equatorial Guinea) where malaria is a hyper-endemic disease. We also describe the genetic diversity of P. falciparum, using several plasmodia proteins as markers which show a high degree of polymorphism (MSP-1 and MSP-2). The results obtained from three different populations are compared in order to establish the impact of human movements and interventions.

Methods

Plasmodium sp. were analysed in three villages on Bioko Island (Equatorial Guinea), one of which (Southern) is isolated by geographical barriers. The semi-nested multiplex polymerase chain reaction (PCR) technique was used to determine the prevalence of the four human plasmodia species. The genotyping and frequency of P. falciparum populations were determined by PCR assay target polymorphism regions of the merozoite surface proteins 1 and 2 genes (MSP-1 and MSP-2).

Results

The data obtained show that there are no differences in plasmodia population flow between the Northwest and Eastern regions as regards the prevalence of the different Plasmodium species. The Southern population, on the other hand, shows a minor presence of P. malariae and a higher prevalence of P. ovale, suggesting some kind of transmission isolated from the other two. The P. falciparum genotyping in the different regions points to a considerable allelic diversity in the parasite population on Bioko Island, although this is somewhat higher in the Southern region than the others. There was a correlation between parasitaemia levels and the age of the individual with the multiplicity of infection (MOI).

Conclusion

Results could be explained by the selection of particular MSP alleles. This would tend to limit diversity in the parasite population and leading up to the extinction of rare alleles. On the other hand, the parasite population in the isolated village has less outside influence and the diversity of P. falciparum is maintained higher. The knowledge of parasite populations and their relationships is necessary to study their implications for control intervention.     

Breast Cancer in Mass Circulating Magazines in the U.S.A. and Canada, 1974–1995

ABSTRACT

This paper presents the results of a study of the images of breast cancer in the highest circulating periodicals in the USA and Canada over a twenty year period of time. Both manifest and latent themes are noted and described. The emphasis in the manifest themes is on the medical aspects of the treatment and early detection of breast cancer. The latent themes emphasize the contrast in the ways that women with the disease, as compared to their doctors, are described. Notably, women are portrayed as being 'worried about their health' and, in particular, the most feared of 'their' diseases, breast cancer. Breast cancer is said to be caused by everything, especially women's own traitorous bodies. Women are described as isolates, as emotional and preoccupied with their sexual attractiveness. Doctors are described in contrasting ways, as moral truth-seekers, infused with rationality and intelligence. The ubiquitous causes of breast cancer are also noted. The paper concludes with a discussion of the possible implications of the gendered character of the reporting about breast cancer.     

Cancer incidence and mortality in France over the 1980–2012 period: Solid tumors

BackgroundCancer incidence and mortality estimates for 19 cancers (among solid tumors) are presented for France between 1980 and 2012.MethodsIncidence data were collected from 21 local registries and correspond to invasive cancers diagnosed between 1975 and 2009. Mortality data for the same period were provided by the Institut national de la santé et de la recherche médicale. The national incidence estimates were based on the use of mortality as a correlate of incidence. The observed incidence and mortality data were modeled using an age-period-cohort model. The numbers of incident cases and deaths for 2010–2012 are the result of short-term projections.ResultsIn 2012, the study estimated that 355,000 new cases of cancer (excluding non-melanoma skin cancer) and 148,000 deaths from cancer occurred in France. The incidence trend was not linear over the study period. After a constant increase from 1980 onwards, the incidence of cancer in men declined between 2005 and 2012. This recent decrease is largely related to the reduction in the incidence of prostate cancer. In women, the rates stabilized, mainly due to a change in breast cancer incidence. Mortality from most cancer types declined over the study period. A combined analysis of incidence and mortality by cancer site distinguished cancers with declining incidence and mortality (e.g., stomach) and cancers with increasing incidence and mortality (e.g., lung cancer in women). Some other cancers had rising incidence but declining mortality (e.g., thyroid).ConclusionThis study reveals recent changes in cancer incidence trends, particularly regarding breast and prostate cancers.     

Cancer incidence in Ireland—the possible role of diet,nutrition and lifestyle

Aim

This observational ecological study aims to compare Ireland’s age-specific cancer incidence rates (ASRs) with equivalent European and global data and to highlight possible dietary, nutritional and lifestyle contributors to cancer in Ireland.

Subjects and methods

Using the International Agency for Research on Cancer’s (IARC) GLOBOCAN database, Irish ASRs for all-site cancer and for “lifestyle-related” cancers such as those of the colo-rectum, oesophagus, breast, lung and prostate were compared with European and global incidence data. Irish dietary and nutrient intake data were reviewed and evaluated in the context of these cancer incidence data and in relation to the established dietary, nutritional, lifestyle and anthropometric predictors of increased cancer risk previously articulated in the literature.

Results

Incidence rates of colorectal, oesophageal, breast, lung, prostate and all-site cancer are higher in Ireland than in most other countries. National nutrition surveys in Ireland indicate that dietary, nutritional, lifestyle and anthropometric risk factors for cancer occur with high frequency in the Irish population. For example, low fruit and vegetable consumption, high red and processed meat intake, low fish intake, low dairy consumption, high saturated fat intake, low folate and vitamin D intakes, and excessive alcohol consumption are all common amongst Irish adults.

Conclusions

Our data suggest that unfavourable diet and nutrient intakes prevail in Ireland and that these may contribute to Ireland’s excess cancer burden. These risk factors should be targeted by interventions seeking to sustainably redress Ireland’s high cancer incidence. Such initiatives may provide a template for intervention in other high-risk countries.

     

A graphical study of tuberculosis incidence and trends in the WHO’s European region (1980–2006)

A graphical output was obtained using classical principal component analysis techniques in order to analyse tuberculosis trends in Europe over a 27-year period (1980–2006). Taxonomic methods were used to better define the interrelationship between the data in the 52 countries studied. Data were provided by the World Health Organization. Differences in the overall incidence and trends were identified during the 1980–2006 period. The highest rates of incidence were reported in Kazakhstan, Bosnia and Herzegovina, Romania and Kyrgyzstan. High and moderately high rates were reported in the former Soviet Union, the former Yugoslavia, some countries from the former Eastern Bloc, Turkey and Portugal. The lowest rates were reported in the eastern Mediterranean, Scandinavia and Iceland. Risk of infection was determined by social conditions, intravenous drug use, HIV infection and immigration from countries where tuberculosis is endemic. As regards development of tuberculosis in Europe, 1992 represents the change in the decreasing trend in the incidence observed from 1980, when the incidence presented a minimum general trend and started to increase. The linear model calculated to project the rate of increase from 2006 to 2015, reveals the tuberculosis rates observed during the 1980s.

Shift within age-groups of mumps incidence,hospitalizations and severe complications in a highly vaccinated population. Spain, 1998–2014

The mumps vaccine (Jeryl-Lynn-strain) was introduced in Spain in 1981, and a vaccination policy which included a second dose was added in 1995. From 1992–1999, a Rubini-strain based vaccine was administered in many regions but later withdrawn due to lack of effectiveness. Despite high levels of vaccination coverage, epidemics have continued to appear.We characterized the three epidemic waves of mumps between 1998 and 2014, identifying major changes in susceptible populations using Poisson regression.For the period 1998–2003 (P1), the most affected group was from 1 to 4 years old (y) [Incidence Rate (IR) = 71.7 cases/100,000 population]; in the periods 2004–2009 (P2) and 2010–2014 (P3) IR ratio (IRR) increased among 15–24y (P2 = 1.46; P3 = 2.68) and 25–34y (P2 = 2.17; P3 = 4.05).Hospitalization rate (HR), complication rate (CR) and neurological complication rate (NR) among hospitalized subjects decreased across the epidemics, except for 25–34y which increased: HR ratio (HRR) (P2 = 2.18; P3 = 2.16), CRR (P3 = 2.48), NRR (P3 = 2.41).In Spain mumps incidence increased, while an overall decrease of hospitalizations and severe complications occurred across the epidemics. Cohorts born during periods of low vaccination coverage and those vaccinated with Rubini-strain were the most affected populations, leading to a shift in mumps cases from children to adolescents and young adults; this also reveals the waning immunity provided by the mumps vaccine. Despite not preventing all mumps cases, the vaccine appears to prevent serious forms of the disease.     

Cancer in wildlife, a case study: beluga from the St. Lawrence estuary, Québec, Canada

A population of approximately 650 beluga (Delphinapterus leucas) inhabits a short segment of the St. Lawrence estuary (SLE). Over 17 years (1983-1999), we have examined 129 (or 49%) of 263 SLE beluga carcasses reported stranded. The major primary causes of death were respiratory and gastrointestinal infections with metazoan parasites (22%), cancer (18%), and bacterial, viral, and protozoan infections (17%). We observed cancer in 27% of examined adult animals found dead, a percentage similar to that found in humans. The estimated annual rate (AR) of all cancer types (163/100,000 animals) is much higher than that reported for any other population of cetacean and is similar to that of humans and to that of hospitalized cats and cattle. The AR of cancer of the proximal intestine, a minimum figure of 63 per 100,000 animals, is much higher than that observed in domestic animals and humans, except in sheep in certain parts of the world, where environmental contaminants are believed to be involved in the etiology of this condition. SLE beluga and their environment are contaminated by polycyclic aromatic hydrocarbons (PAHs) produced by the local aluminum smelters. The human population living in proximity of the SLE beluga habitat is affected by rates of cancer higher than those found in people in the rest of Québec and Canada, and some of these cancers have been epidemiologically related to PAHs. Considered with the above observations, the exposure of SLE beluga to PAHs and their contamination by these compounds are consistent with the hypothesis that PAHs are involved in the etiology of cancer in these animals.     

Breast Cancer Survival in Ontario and California, 1998–2006: Socioeconomic Inequity Remains Much Greater in the United States

This study re-examined the differential effect of socioeconomic status on the survival of women with breast cancer in Canada and the United States. Ontario and California cancer registries provided 1,913 cases from urban and rural places. Stage-adjusted cohorts (1998–2000) were followed until 2006. Socioeconomic data were taken from population censuses. SES-survival associations were observed in California, but not in Ontario, and Canadian survival advantages in low-income areas were replicated. A better controlled and updated comparison reaffirmed the equity advantage of Canadian health care.     

Socioeconomic Disparities in Colorectal Cancer Mortality in the United States, 1990–2007

United States colorectal cancer mortality rates have declined; however, disparities by socioeconomic status and race/ethnicity persist. The objective of this study was to describe the temporal association between colorectal cancer mortality and socioeconomic status by sex and race/ethnicity. Cancer mortality rates in the United States from 1990 to 2007, which were generated by the National Center for Health Statistics, and county-level socioeconomic status, which was estimated as the proportion of county residents living below the national poverty line based on 1990 US Census Bureau data, were obtained from the Surveillance, Epidemiology, and End Results program. The Kunst–Mackenbach relative index of inequality, which considers data across all poverty levels when comparing risks in the poorest (≥20 %) and richest counties (<10 %), was calculated as the measure of association. The study found that colorectal cancer mortality rates were significantly lower in the poorest counties than the richest counties during 1990–1992 among non-Hispanic whites, non-Hispanic black women and non-Hispanic API men. Over time though the tendency was for the poorest counties to have higher mortality rates. By 2003–2007 colorectal cancer mortality rates were significantly higher in the poorest than the richest counties among all sex-race/ethnicity groups. This disparity was most noticeable and appeared to be increasing most among Hispanic men. This suggests that socioeconomic disparities in colorectal cancer mortality were apparent after stratifying by sex and race/ethnicity and reversed over time. Further studies into the causes of these disparities would provide a basis for targeted cancer control interventions and allocation of public health resources.     

Perinatal health and mother-child health care in the municipality of S?o Luís, Maranh?o State, Brazil.

The purpose of this article was to evaluate socioeconomic and demographic indicators, reproductive health, use of prenatal, childbirth, and neonatal services, and anthropometric data for mothers and infants. The authors performed a cross-sectional analysis of a systematic sample of 2,831 hospital births in S?o Luís, Maranh?o State, from March 1997 to February 1998 at ten public and private maternity hospitals. The sample was stratified proportionally according to the number of births in each maternity hospital. Mothers answered a standard questionnaire. Of the total, 97.9% were live births and 98% were singletons. Prenatal coverage was 89.5%, and prevalence of cesarean sections was 33.8%. A physician provided prenatal care in 75.7% of cases and performed 73.8% of the deliveries. The Unified Health System covered the costs of 76.4% of the prenatal visits and 89.7% of the deliveries. A pediatrician was present in the delivery room in 50.2% of cases. The low birth weight rate was 9.6% and the preterm birth rate 13.9%. Reasons for concern included a high percentage of adolescent mothers, single mothers (or without partners), the high cesarean rate, and the high percentage of births attended by unqualified personnel.     

Self-rated health in the elderly: a population-based study in Campinas, São Paulo, Brazil

This study analyzed self-rated health in the elderly according to demographic, socioeconomic, and health-related behavior. This was a cross-sectional, population-based study with a cluster sample using data from a survey in Campinas, S?o Paulo State, Brazil (ISACamp 2008-2009). Adjusted prevalence ratios were estimated using multiple Poisson regression. The study enrolled 1,432 elderly. Prevalence of excellent/very good health was 24.6% and was significantly higher in the elderly with more schooling, higher income, no religion, living alone, home computer, alcohol consumption 1-4 times a month, physical activity during leisure-time, no obesity, and fruit and vegetable consumption ≥ 4 times a week. Some of the findings are scarce in the literature and indicate relevant topics for further investigation. The results highlight the need for greater attention to socially vulnerable groups and the development of strategies to promote healthy habits in the elderly.     

A Retrospective Cohort Study of Lung Cancer Incidence in Nylon Flock Workers, 1998–2008

Abstract

During an investigation of a novel interstitial lung disease in a cohort of nylon flock workers, a former worker was found to have developed bilateral synchronous pulmonary adenocarcinomas three decades after he quit smoking, suggesting that exposures in this industry might pose excessive risk of lung cancer. We conducted a retrospective cohort study of lung cancer incidence in the original study cohort (n = 162) from August 15, 1998, to August 14, 2008. The Rhode Island Cancer Registry identified cohort members with lung cancer and provided age-gender-era-specific rates of lung cancer in Rhode Island. Five cases of lung cancer occurred among cohort members versus 1.61 cases expected for a standardized incidence ratio of 3.1 (95%CI, 1.01–7.23). The observed threefold increase in lung cancer incidence could not be readily ascribed to chance, study bias, or uncontrolled confounding. Workers in this industry should be notified of their potentially increased risk of lung cancer.