Public Health最新文献

{"title":"“Us versus Them”: is the voice of the community heard when planning communication screening programmes for preschoolers?","authors":"","doi":"10.1016/j.puhe.2024.08.003","DOIUrl":"10.1016/j.puhe.2024.08.003","url":null,"abstract":"<div><h3>Objectives</h3><p>Community consultation is necessary to ensure the uptake and use of community-based screening intervention to detect early childhood disabilities, as its absence can result in poor service acceptance and usage. To document stakeholders' perspectives regarding planning a community-based communication disorder (an impairment in the ability to receive, send, process and comprehend concepts or verbal, non-verbal and graphic symbol systems) screening programmes for pre-schoolers.</p></div><div><h3>Study design</h3><p>This qualitative research design used purposive and random sampling to recruit 46 participants from eThekwini Municipality, South Africa. These stakeholders consisted of caregivers/parents of children who underwent screening for communication disorders, People who are Deaf, their parents, early childhood development practitioners, health professionals and government officials involved with children with disabilities. All participants were adults aged between 19 and 79 years, with an average age of 39.7 years.</p></div><div><h3>Methods</h3><p>Data was collected through focus group discussions and individual interviews, which were thematically analysed.</p></div><div><h3>Results</h3><p>The four emergent themes were screening approaches, methods, location and personnel. Service users expected greater access to screening and reliable tests to identify problems by trained personnel at sites within the community. Service providers preferred a targeted approach to screening with parental input. Task shifting and sharing were seen as a solution to address staff shortages and provide services at health facilities, as resource constraints made it challenging to provide outreach services.</p></div><div><h3>Conclusion</h3><p>Stakeholder engagement revealed diverging views between service users and providers, with implications for programme provision and uptake. There is a need for ongoing, inclusive discussion to ensure consensus during the planning stage, in order to render services that address issues of equity and accessibility for people with disabilities in marginalised communities.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0033350624003470/pdfft?md5=ea9c9b6f2f63e27d84eef93bfdfd2605&pid=1-s2.0-S0033350624003470-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leprosy in Brazil: an analysis of the Global Burden of Disease estimates between 1990 and 2019","authors":"","doi":"10.1016/j.puhe.2024.07.035","DOIUrl":"10.1016/j.puhe.2024.07.035","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze the occurrence of leprosy in Brazil and its states between 1990 and 2019, according to Global Burden of Disease (GBD) estimates, and its correlation with development status.</p></div><div><h3>Study design</h3><p>A descriptive and analytical ecological epidemiological study.</p></div><div><h3>Methods</h3><p>Rates of incidence, prevalence, and years lived with disability (YLD) due to leprosy, standardized by age, per 100,000 inhabitants, were analyzed. The trend analysis consisted of the joinpoint regression model and the average annual percentage change. The correlation between the incidence rate and the sociodemographic index (SDI) was investigated (Spearman test) at a 5% significance level. Incidence, prevalence and YLD rates were presented by country's states, sex, and age.</p></div><div><h3>Results</h3><p>There was an average percentage decrease of −1.1% per year (<em>P</em> &lt; 0.001) in the incidence rate in the country and, between 1990 and 2019, a decline from 4.8 to 3.5 per 100,000 inhabitants; prevalence from 26.1 to 22.2, and YLD from 1.1 to 1.0. The incidence rate was higher among men and the elderly. Maranhão (7.0 in 1990; 4.2 in 2019), Alagoas (6.6 in 1990; 4.1 in 2019), Acre (6.1 in 1990; 4.0 in 2019), Mato Grosso (5.2 in 1990 and 3.7 in 2019), and Mato Grosso do Sul (4.8 in 1990 and 3.7 in 2019) presented the highest incidence rates. A negative correlation was observed between SDI levels and leprosy incidence rates in 1990 (R = −0.71; <em>P</em> &lt; 0.0001) and 2019 (R = −0.81; <em>P</em> &lt; 0.0001).</p></div><div><h3>Conclusions</h3><p>Despite the decrease in the rates of leprosy incidence, prevalence, and YLDs over the analyzed period, Brazil has a long way towards achieving its eradication. The greater burden of the disease in males stands out. The estimated risk of the disease was higher in the states with the lowest SDI levels. Therefore, interventions must consider the heterogeneity of the disease burden geographically and between sociodemographic groups.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0033350624003536/pdfft?md5=0431faed07e0a0df623f4d9971bbddd4&pid=1-s2.0-S0033350624003536-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between adherence to 24-Hour Movement Guidelines with continuous metabolic syndrome score among Chinese children and adolescents","authors":"","doi":"10.1016/j.puhe.2024.08.005","DOIUrl":"10.1016/j.puhe.2024.08.005","url":null,"abstract":"<div><h3>Objectives</h3><p>The objective of this study was to evaluate the associations between adherence to 24-Hour Movement Guidelines (24-HMG) with continuous metabolic syndrome score (cMetS) among Chinese children.</p></div><div><h3>Study design</h3><p>Cross-sectional study.</p></div><div><h3>Methods</h3><p>We conducted a cross-sectional study among 4604 children aged 6–17 years from Shenzhen, China. The 24-HMG was constructed using the self-report information on moderate-to-vigorous physical activity (MVPA), screen time (ST), and sleep duration. The cMetS was calculated based on waist circumference, homoeostatic model assessment for insulin resistance, mean arterial blood pressure, high-density lipoprotein cholesterol, and triglyceride. Multivariate linear regression models were used to assess the associations between adherence to recommendations of 24-HMG and cMetS.</p></div><div><h3>Results</h3><p>Among the participants, 563 (12.23%) students adhered to 3 recommendations of the 24-HMG. We found that adhering to more recommendations was negatively associated with cMetS (<em>P</em> for trend: &lt;0.001). For specific combinations, meeting the ST + MVPA recommendations was negatively associated with cMetS (coefficients [β]: −0.686; 95% confidence interval [CI]: −1.148, −0.223). Individuals who adhered to all recommendations had a lower cMetS (β: −0.693; 95% CI: −1.147, −0.238) than those who met none of the recommendations.</p></div><div><h3>Conclusions</h3><p>Our study showed that adherence to more recommendations of the 24-HMG was associated with lower levels of cMetS in Chinese children and adolescents.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142232304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explaining the role of socioeconomic, healthcare access and infrastructural shifts in nutritional transition among women in Bangladesh between 2004 and 2018","authors":"","doi":"10.1016/j.puhe.2024.08.010","DOIUrl":"10.1016/j.puhe.2024.08.010","url":null,"abstract":"<div><h3>Objectives</h3><p>Shifts in socioeconomic factors, healthcare access, lifestyle and infrastructure facilities have resulted in increased body mass index (BMI) of populations in developing countries. These shifts result in a large increase in overweight and obese individuals, with a corresponding decline in the number of those who are underweight. Although this nutritional transition among women in Bangladesh is evident, studies elucidating such change are scarce. This study aimed to explain how socioeconomic, healthcare access and infrastructural shifts contributed to the nutritional transition among women of childbearing age in Bangladesh between 2004 and 2018.</p></div><div><h3>Study design</h3><p>Repeated cross-sectional study of respondents who participated in the latest five rounds of Bangladesh Demographic Health Surveys (BDHS) from 2004 to 2017–18.</p></div><div><h3>Methods</h3><p>Applying counterfactual decomposition techniques to data from the latest five rounds of BDHS, this study examined how variations in observed nutrition-related determinants, and returns to them across rounds, contributed to the nutritional transition among women of childbearing age.</p></div><div><h3>Results</h3><p>Shifts in nutritional outcomes were primarily attributed to gains in partner's education, improved access to healthcare, a decline in breastfeeding practice and the number of births. Wealth accumulation, contraception and improved sanitation facilities appeared as secondary contributing factors. Additionally, this study identified that the BMI gap widened between the lower and the upper quantile of the distribution over the study period.</p></div><div><h3>Conclusions</h3><p>Addressing the rise in BMI and the prevalence of overnutrition is imperative for the future health of the population in Bangladesh. Considering the study findings and existing national nutrition policies and programmes, it is evident that targeted policy interventions, programmatic approaches and multisectoral collaborations are essential.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and risk factors associated with undiagnosed hypertension among adults aged 15–49 years in India: insights from the National Family Health Survey (NFHS-5)","authors":"","doi":"10.1016/j.puhe.2024.07.032","DOIUrl":"10.1016/j.puhe.2024.07.032","url":null,"abstract":"<div><h3>Objectives</h3><p>To estimate the prevalence and identify the factors associated with undiagnosed hypertension in India.</p></div><div><h3>Study design</h3><p>A secondary data analysis using the National Family Health Survey (NFHS-5) covering the period 2019–2021.</p></div><div><h3>Methods</h3><p>Information on hypertension among individuals aged 15–49 years was extracted from the survey dataset. We estimated the prevalence of undiagnosed hypertension using physical measurements along with self-reported data from the survey. A log-binomial model with survey-adjusted Poisson regression was used to estimate the prevalence ratio between undiagnosed and diagnosed hypertension. Multinomial logistic regression analysis examined the factors associated with diagnosed hypertension (vs healthy) and undiagnosed hypertension (vs healthy). All the analyses were survey-weight adjusted and stratified by gender.</p></div><div><h3>Results</h3><p>The survey-adjusted prevalence of undiagnosed hypertension was 8.75% (8.62%–8.87%) and was higher among males [13.56% (13.03%–14.12%)] than in females [8.14% (8.03%–8.25%)]. The proportion of individuals with undiagnosed hypertension among total hypertension was 44.99% (44.44%–45.55%) and was higher in males [65.94% (64.25%–67.60%)] than in females [42.18% (41.66%–42.71%)].</p></div><div><h3>Conclusions</h3><p>Our findings revealed that age, higher body mass index, no access to health care, and having no comorbidities were risk factors for undiagnosed hypertension. One in twelve people had undiagnosed hypertension, and of those with hypertension, one in two were undiagnosed, with males being disproportionately affected. Targeted public health interventions are crucial to improve hypertension screening, particularly among middle-aged and obese individuals without comorbidities.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142232306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A longitudinal study of learning difficulties in adolescence and biomarkers of cardiometabolic risk in adulthood: A gendered pathways approach","authors":"","doi":"10.1016/j.puhe.2024.09.008","DOIUrl":"10.1016/j.puhe.2024.09.008","url":null,"abstract":"<div><h3>Objectives</h3><p>Little is known about the relationship between learning difficulties (LD) in adolescence and physical health in adulthood. This study investigates the gender-specific pathways through which LD is longitudinally associated with cardiometabolic risk in adulthood.</p></div><div><h3>Study design</h3><p>We used data from the National Longitudinal Study of Adolescent to Adult Health (<em>N</em> = 11,342). To assess cardiometabolic risk, 11 biomarkers related to cardiovascular functioning, glucose metabolism, lipid metabolism, and inflammation were utilized.</p></div><div><h3>Methods</h3><p>We first estimated the association between LD in adolescence and cardiometabolic risk in adulthood. Then, we examined whether this association is mediated by educational attainment and body mass index (BMI). Finally, we employed a moderated mediation model to determine whether gender moderates these mediation patterns.</p></div><div><h3>Results</h3><p>LD in adolescence was positively associated with cardiometabolic risk in adulthood (<em>b</em> = 0.165, <em>p</em> &lt; 0.001). LD also predicted lower educational attainment (<em>b</em> = −0.724, <em>p</em> &lt; 0.001) and higher BMI (<em>b</em> = 0.589, <em>p</em> &lt; 0.05). Educational attainment and BMI explained 18 and 25 percent of the positive association between LD and cardiometabolic risk, respectively. A moderated mediation model revealed that indirect effects of LD on cardiometabolic risk via educational attainment and BMI were more pronounced among women than men.</p></div><div><h3>Conclusion</h3><p>LD in adolescence is a significant predictor of cardiometabolic risk in adulthood. Interventions focusing on the academic and health behaviors of girls with LD may be effective in improving their adult physical health.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142232307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting the risk of nursing home placement of elderly persons using a population-based stratification score","authors":"","doi":"10.1016/j.puhe.2024.08.030","DOIUrl":"10.1016/j.puhe.2024.08.030","url":null,"abstract":"<div><h3>Objective</h3><p>To develop and validate a novel score predictive of nursing home placement in elderly.</p></div><div><h3>Study design</h3><p>Population-based case-control study based on healthcare utilization databases of Lombardy, a region of Northern Italy.</p></div><div><h3>Methods</h3><p>The 2.4 million citizens aged ≥65 years who on January 1, 2018 lived outside nursing home formed the target population. Cases were citizens who experienced nursing home admission (the outcome of interest) until December 31, 2019. Cases were matched 1:1 by gender, age, and municipality of residence to one control. Conditional logistic regression was fitted to select candidate predictors (the exposure to 69 clinical conditions and 11 social and healthcare services) independently associated with the outcome. The model was built from the 26,156 cases, and as many controls (training set), and applied to a validation set (15,807 case-control couples). Predictive performance was assessed by discrimination and calibration.</p></div><div><h3>Results</h3><p>Twenty-one factors were identified as predictive of nursing home admission and were included in the “Elderly Nursing Home Placement” (ENHP) score. Mental health disorders and chronic neurological illnesses contributed most to prediction of nursing home admission. ENHP performance showed an area under the receiver operating characteristic curve of 0.77 and a remarkable calibration of observed and predicted outcome risk.</p></div><div><h3>Conclusions</h3><p>A simple score derived from data used for public health management may reliably predict the risk of nursing home placement in elderly. Its use by healthcare decision makers allows to accurately identify high-risk individuals who need home services, thereby avoiding admission to nursing homes.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0033350624003834/pdfft?md5=a7b20ddb73a2d9d1b2ae62ac8d21da28&pid=1-s2.0-S0033350624003834-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142173127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of climate and demographic changes on future mortality in Brussels, Belgium","authors":"","doi":"10.1016/j.puhe.2024.07.028","DOIUrl":"10.1016/j.puhe.2024.07.028","url":null,"abstract":"<div><h3>Objectives</h3><p>City populations are particularly vulnerable to climate change, but it is difficult to reliably estimate the impact on health due to the lack of high-resolution data. We used recently developed regional climate model projections at kilometre resolution combined with demographic projections to estimate the future mortality burden associated with temperatures in the region of Brussels, Belgium.</p></div><div><h3>Study design</h3><p>The study incorporated a time-series analysis.</p></div><div><h3>Methods</h3><p>Based on quasi-Poisson regression with distributed-lag non-linear models for the historical temperature–mortality relationship, we derive the mortality burden for the near (2020–2044) and mid (2045–2069) future and disaggregated the contributions of demographic and climate changes.</p></div><div><h3>Results</h3><p>The cold-related attributable fraction of deaths is expected to decrease from 6.22% (95% empirical confidence interval: 1.76%; 10.52%) in 1994–2019 to 5.17% (1.08%; 9.09%) in 2045–2069, whereas for heat, this fraction will increase from 1.02% (0.59%; 1.47%) to 1.83% (0.82%; 2.96%), with contributions of both climate and demographic changes. In stratified analyses by age, we found that because of demographic changes, the number of cold-attributable deaths will increase for people aged above 85 years, with 6815 (95% empirical confidence interval: 1424; 12,003) deaths expected in 2045–2069 compared to 5245 (1462; 8867) deaths in 1994–2019. For people aged below 65 years, on the other hand, the number of heat-related deaths will decrease from 456 (265; 658) to 344 (154; 561) deaths.</p></div><div><h3>Conclusions</h3><p>Public health policies that especially target the elderly and the summer-time period are needed to limit the impact of climate change on health.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0033350624003408/pdfft?md5=096e520bba38361ff425d24bf5191cf6&pid=1-s2.0-S0033350624003408-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality due to cervical and breast cancer in health regions of Brazil: impact of public policies on cancer care","authors":"","doi":"10.1016/j.puhe.2024.07.034","DOIUrl":"10.1016/j.puhe.2024.07.034","url":null,"abstract":"<div><h3>Objective</h3><p>This analysis assessed the association between regional income, screening coverage for cervical and breast cancer, and temporal trends in mortality from these cancers in different Brazilian health regions.</p></div><div><h3>Study design</h3><p>Spatiotemporal ecological study across 450 health regions of Brazil.</p></div><div><h3>Methods</h3><p>Data from 2010 Demographic Census were used to assess income. Variations in income distribution within health regions were measured using the Gini index. Data on screening coverage were obtained from the Ambulatory Information System (SIA/SUS). Mortality was assessed from the Global Burden of Disease Study 2019 data. The average annual percentage change (AAPC) in cervical and breast cancer mortality rates, 2010–2018, was calculated by health regions. Results were presented in regional maps. The associations between income, screening coverage and mortality changes were estimated by bivariate spatial correlation.</p></div><div><h3>Results</h3><p>Health regions located in the South and Southeast regions of Brazil had the greatest percentages of screening coverage and highest per capita incomes with the lowest Gini index values. From 2010 to 2018, mortality rates for cervical cancer were highest in the North and Northeast health regions. Breast cancer mortality rates were highest in the South and Southeast health regions. The AAPC in breast and cervical cancer mortality had a negative association with per capita income and screening coverage, and a positive association with the Gini index.</p></div><div><h3>Conclusions</h3><p>There are large regional variations in income, screening coverage, and mortality rates for women with breast and cervical cancer. These inequities could be mitigated by policies to address income disparities and improved access to screening.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occupational class inequalities in all-cause and cardiovascular mortality in Norwegian men and women: a population-based approach with 45 years follow-up","authors":"","doi":"10.1016/j.puhe.2024.07.033","DOIUrl":"10.1016/j.puhe.2024.07.033","url":null,"abstract":"<div><h3>Objectives</h3><p>This study assessed associations of three theoretically different occupational class schemes with all-cause and cardiovascular mortality in Norwegian men and women.</p></div><div><h3>Study design</h3><p>Pooled survey and register data from four Norwegian cohort studies.</p></div><div><h3>Methods</h3><p>We pooled survey data from four general population cohorts (<em>N</em> = 97,469) linked to national mortality registries with follow-up over 45 years. Survival was modelled using accelerated failure time models stratified by sex for three class schemes: The European Socio-Economic Classification (ESeC), The Oslo Register Data Class scheme (ORDC) and The International Socio-Economic Index (ISEI). Main analyses were adjusted for age, birth cohort, and study. Secondary analyses included smoking behaviour as a mediator.</p></div><div><h3>Results</h3><p>During median 27.6 years of observation, 37,488 participants had died (13,243 from cardiovascular disease). Hazard ratios for male all-cause mortality were lowest in the highest occupational class categories ORDC 2: 0.68 (0.65–0.72), ESeC 1: 0.76 (0.73–0.79) and ISEI 5th quintile: 0.80 (0.77–0.82) compared to working class reference categories. Female mortality risks were lowest for Cultural Lower Middle class ORDC 7: 0.84 (0.72–0.98), Small Employers and Self-employed ESeC4: 0.70 (0.50–0.97) and ISEI 5th quintile: 0.79 (0.70–0.90). Patterns for cardiovascular mortality were similar to all-cause mortality. Including smoking behaviour as a mediator attenuated associations, but overall mortality patterns according to occupational class remained unchanged.</p></div><div><h3>Conclusion</h3><p>The results underline that mortality inequalities do not simply consist of higher risks in the most disadvantaged groups. The association of occupational class with mortality is found across different categories of occupational class schemes, illustrating their continued relevance for studying social determinants of health.</p></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0033350624003457/pdfft?md5=1222c8e4653a0cc0767f6306f4caac82&pid=1-s2.0-S0033350624003457-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}