Journal of Epidemiology and Community Health最新文献

{"title":"Economic deprivation as a mediator in the relationship between housing affordability stress and mental and general health among humanitarian migrants in Australia.","authors":"Kritika Rana, Sandro Sperandei, Sithum Munasinghe, Jennifer L Kent, Andrew Page","doi":"10.1136/jech-2025-224802","DOIUrl":"10.1136/jech-2025-224802","url":null,"abstract":"<p><strong>Background: </strong>Housing is a critical social determinant of health for migrant and refugee populations in high-income countries; however, the causal pathways linking housing affordability to health outcomes remain underexplored. This study aimed to examine the relationship between housing affordability stress and both mental and general health, and to assess the role of economic deprivation as a mediator of this relationship.</p><p><strong>Methods: </strong>This study uses data from the five waves (2013-2018) of the Building a New Life in Australia study, which followed 2399 humanitarian migrants who arrived in Australia or were granted a permanent protection visa in 2013. Causal mediation analyses using marginal structural models were conducted to decompose the total effect of housing affordability stress on mental and general health into the natural direct effect and natural indirect effect mediated through economic deprivation.</p><p><strong>Results: </strong>The total effect of housing affordability stress on mental health was 1.56 (95% CI 1.26 to 1.92). Economic deprivation mediated 37% (95% CI 19.5% to 68.8%) of the total effect, and 79.6% (95% CI 60.3% to 113.9%) of the total effect could potentially be eliminated by intervening on economic deprivation. For self-rated general health, the total effect of housing affordability stress was 1.43 (95% CI 1.15 to 1.74). Economic deprivation accounted for 27.7% (95% CI 5.3% to 62.6%) of the total effect, and 65.9% (95% CI 29.9% to 101.9%) of the total effect could potentially be eliminated by intervening on economic deprivation.</p><p><strong>Conclusions: </strong>The findings demonstrate that housing affordability stress leads to elevated psychological distress and poor self-rated general health among humanitarian migrants. A substantial portion of this impact occurs through economic deprivation, which could be attenuated by targeting economic deprivation as a key intervention point during early years of resettlement.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":"343-351"},"PeriodicalIF":3.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: <i>Measuring older people's socioeconomic position: a scoping review of studies of self-rated health, health service and social care use</i>.","authors":"","doi":"10.1136/jech-2021-218265corr1","DOIUrl":"10.1136/jech-2021-218265corr1","url":null,"abstract":"","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":"80 5","pages":"368"},"PeriodicalIF":3.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a school-based water and hygiene intervention on the health and attendance of preschool pupils in Addis Ababa, Ethiopia: a cluster-randomised controlled trial.","authors":"Sarah Bick, Alem Ezezew, Charles Opondo, Baptiste Leurent, Wossen Argaw, Oliver Cumming, Elizabeth Allen, Robert Dreibelbis","doi":"10.1136/jech-2025-225148","DOIUrl":"https://doi.org/10.1136/jech-2025-225148","url":null,"abstract":"<p><strong>Background: </strong>Children under the age of 5 bear the highest burden of disease related to inadequate water, sanitation and hygiene (WASH). However, evidence of the effectiveness of WASH interventions in preschool settings is limited. Nested within a cluster-randomised controlled trial in Addis Ababa, Ethiopia, this substudy evaluated the impact of a water and hygiene intervention on health and school attendance among preschool children.</p><p><strong>Methods: </strong>Schools were randomly assigned 1:1 to receive the intervention during the 2021/2022 academic year or the following year (waitlist control). We included schools enrolled in the main trial with preschool classes and randomly selected and allocated additional schools with preschool classes to reach 20 schools in each arm. The intervention comprised school-wide infrastructure improvements (water storage and filtration systems, drinking water and handwashing stations) and hygiene behaviour change promotion. Planned sanitation improvements were not delivered within the trial duration. Within each school, we randomly selected 20 preschool pupils (ages 3-6), recording caregiver-reported diarrhoea, respiratory illness and absence over four consecutive weekly telephone interviews with caregivers of the selected pupils from April to June 2022, following intervention delivery.</p><p><strong>Results: </strong>We found no evidence of effects on caregiver-reported diarrhoea (adjusted odds ratio (aOR) 0.85; 95% CI 0.46 to 1.59; p=0.61), respiratory illness (aOR 0.84; 95% CI 0.60 to 1.17; p=0.30) or absence (aOR 0.75; 95% CI 0.51 to 1.08; p=0.13).</p><p><strong>Conclusions: </strong>Dropout of three schools and challenges in telephone-based data collection resulted in large loss to follow-up, reducing statistical power. Further research should examine improving telephone-based methods to obtain sufficient follow-up data for school-based evaluations.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topics in this issue: from novel methods insights to musings about what makes for a 'good society'.","authors":"Arjumand Siddiqi","doi":"10.1136/jech-2026-226229","DOIUrl":"https://doi.org/10.1136/jech-2026-226229","url":null,"abstract":"","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":"80 5","pages":"277-278"},"PeriodicalIF":3.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorporating an equity perspective in systematic reviews of interventions: potential methodological approaches.","authors":"Mhairi Campbell, G J Melendez-Torres, Vivian Welch, Jennifer Petkovic, Ffion Curtis, S Vittal Katikireddi","doi":"10.1136/jech-2025-224306","DOIUrl":"10.1136/jech-2025-224306","url":null,"abstract":"<p><p>Health inequities are unnecessary, avoidable and unjust differences in health across social groups. Addressing them is a priority for governments and health systems worldwide, requiring not only specific interventions targeting inequity but also embedding equity across all decision-making. Systematic reviews of interventions underpin health decision-making and could, therefore, be a key mechanism to address inequities, but most reviews are limited in their approach to considering equity and often only conclude data for subgroup analyses are unavailable. While some guidance is available, it largely focuses on reviews of interventions specifically seeking to reduce inequities and is published in disparate literature. We describe approaches to incorporate an equity perspective relevant to all systematic reviews of interventions, even when equity is not the primary review focus.Consideration of equity may be needed at all stages of the review process. Planning the review involves examining theory, using logic models, involving relevant people and organisations, and considering if additional sources of evidence are needed. Investigating the data requires examining the external validity of primary studies, including who was involved in the primary studies, and the reach of interventions. The synthesis process includes selecting appropriate analysis, considering the implications of reporting absolute or relative equity effects of the intervention, exploring and understanding mechanisms and assessing certainty of the evidence in relation to equity. Interpreting results involves linking theory with evidence and discussing implications and limitations. We hope this article helps review authors make best use of the available evidence to incorporate equity into systematic reviews.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":"357-364"},"PeriodicalIF":3.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on: '<i>Mortality by income in the elderly population in Italy: new evidence from an innovative micro-data integration</i>'.","authors":"Gerry McCartney","doi":"10.1136/jech-2025-225818","DOIUrl":"https://doi.org/10.1136/jech-2025-225818","url":null,"abstract":"","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":"80 5","pages":"279-280"},"PeriodicalIF":3.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating effects of targeted public health interventions using the interventional disparity indirect effect among the exposed.","authors":"Amalie Lykkemark Møller, Kathrine Kold Sørensen, Nerissa Nance, Julie Thietje Mortensen, Thomas Alexander Gerds, Christian Torp-Pedersen, Helene Charlotte Wiese Rytgaard","doi":"10.1136/jech-2025-224627","DOIUrl":"10.1136/jech-2025-224627","url":null,"abstract":"<p><p>Disadvantaged groups are often defined by characteristics such as income or ethnicity. Reducing health disparities by directly manipulating such exposures may be infeasible. Instead, interventions can target mediators between these exposures and health outcomes. Indirect effects estimated using mediation analysis, interventional effects or the interventional disparity measure can quantify the expected impact of such disparity-reducing interventions. They capture the impact of changing the mediator distribution evaluated among the total population. This means keeping individuals in their exposure group but hypothetically assigning them the mediator distribution of another group. However, when indirect effects are intended to inform about disparity-reducing interventions implemented among disadvantaged groups, estimating effects in the total population does not quantify the effect among those targeted. Instead, we propose evaluating the interventional disparity indirect effect directly among the disadvantaged individuals. We introduce the estimand and illustrate it using a register-based study examining a potential intervention improving medication initiation in low-income heart failure patients. We compare the expected change in 1-year mortality in a hypothetical world where low-income patients were as likely to initiate medication as high-income patients. We included 1700 patients and assessed intervention effects in low-income patients and the total population, respectively. Under the intervention, the 1-year mortality declined from 10.3% to 9.3% (95% CI 8.6% to 10.1%) among low-income patients but 6.6% to 6.2% (95% CI 6.0% to 6.5%) in the total population. In disparity research, evaluating intervention effects in the total population, rather than among disadvantaged groups, may impact the effect size. Therefore, when guiding future disparity-targeted interventions, measuring effects within disadvantaged groups is important.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":"309-315"},"PeriodicalIF":3.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145936532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic differences in the risk of suicides in children and young people: a population level linked study in England, 2011 to 2022.","authors":"Emma Sharland, Rachel Mullis, Emyr John, Isobel L Ward, Cathryn Rodway, Daniel Ayoubkhani, Vahe Nafilyan","doi":"10.1136/jech-2025-224302","DOIUrl":"10.1136/jech-2025-224302","url":null,"abstract":"<p><strong>Background: </strong>Suicide is one of the leading causes of death in children and young people (CYP) globally. Over the past decade, there has been a steady increase in the number of suicide deaths in CYP in the UK. This study aims to identify sociodemographic differences in the risk of suicide in CYP.</p><p><strong>Methods: </strong>Using linked 2011 Census and death registrations data, we created a cohort of 7 747 345 CYP aged 10 to 17 years in England. We estimated adjusted incidence rate ratios (IRRs) using generalised linear models with a Poisson link function, to identify sociodemographic characteristics associated with death by suicide in CYP.</p><p><strong>Results: </strong>The rate of suicide was lowest in females compared with males (IRR=0.6, 95% CI 0.5 to 0.7) and highest in CYP of Mixed or Multiple ethnic groups (IRR=1.5, 95% CI 1.1 to 2.0) compared with those who were White. We also found an increased risk of suicide where the household reference person's (HRPs) highest level of education was a degree-level or above qualification (IRR=1.5, 95% CI 1.1 to 1.9) compared with households where the HRP had no qualifications.</p><p><strong>Conclusion: </strong>We found some similar risk factors in CYP as have been found for adults, including being male and from a Mixed or Multiple ethnic group; however, some, which are protective in adults, including employment status and education, increase the risk of suicide in CYP at the household level. Our findings suggest CYP living in households with better educated parents may be a key group at risk of dying by suicide in England.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":"294-300"},"PeriodicalIF":3.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Good Society (and how we make it).","authors":"Kate E Pickett","doi":"10.1136/jech-2025-225408","DOIUrl":"10.1136/jech-2025-225408","url":null,"abstract":"<p><p>What is a good society and how might we build one? This essay, an edited version of the Cochrane lecture delivered at the Society for Social Medicine and Population Health in Bradford 2025, sets out my personal vision of what we should be aspiring to and how we might achieve it. I open with evidence connecting socioeconomic inequalities to well-being and highlight that component parts of a utopian place exist, but not all in the same place. Building upon public health lessons around prevention and upstream intervention, I then introduce what I believe are the two most promising policies we can implement: a universal basic income and a wealth tax, underpinned by citizen's assemblies, participatory budgeting and institutional structures to support evidence-based social policymaking. I make the case that we have the evidence and tools needed to collectively create a good society and that it is possible to change course and bequeath a better world on future generations. A good society is one where everyone's physical and mental health is as good as it could be, because prevention is prioritised, and health inequalities are levelled out by addressing the wider determinants of health. It is one where those who need care-whether children, those with disabilities or the elderly-are looked after without incurring financial stress, in settings where their emotional and social well-being are as important as their physical needs. Our children and young people should flourish in an education system that engages their imaginations, inspires their creativity, equips them with skills for life and leaves no one behind.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":"327-333"},"PeriodicalIF":3.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coevolution of education and income inequalities in mortality: is the double burden of basic education and low income becoming more lethal in Finland and Sweden over time?","authors":"Lasse Tarkiainen, Olof M Östergren, Luca Dei Bardi, Pekka Martikainen","doi":"10.1136/jech-2025-224182","DOIUrl":"10.1136/jech-2025-224182","url":null,"abstract":"<p><strong>Background: </strong>Education and income are independent predictors of mortality, but they also interact so that educational inequalities in mortality are larger at low levels of income. However, the average educational attainment in high-income countries has risen during recent decades and it is unclear how these associations have changed over time. We studied these interactions in Finland and Sweden.</p><p><strong>Data & methods: </strong>We used individual level register-linked data from both countries covering all individuals aged 30-64 in 3-year periods from 1994-1996 to 2018-2020. We modelled age-adjusted mortality rates (per 10 000 person-years) with three-way interactions between educational level, household income quintile and study period separately for both countries and genders using Poisson regression.</p><p><strong>Results: </strong>Educational inequalities in mortality are substantially larger in lower levels of income and these inequalities are slightly larger in Finland compared with Sweden. Absolute educational inequalities in the lowest income quintile remained unchanged among men but increased substantially among women. The rate difference between basic and higher educated increased from 21 (95% CI 15 to 26) to 37 (CI 32 to 41) in Finland and from 19 (CI 14 to 24) to 31 (CI 27 to 35) in Sweden, mostly due to increasing mortality among women with basic education and low income.</p><p><strong>Conclusion: </strong>Due to educational expansion, the proportion of those bearing the double burden of basic education and low income is declining but they are experiencing increasing or stagnating mortality, likely driven by changes in labour market dynamics and composition of lowest educational group. Policy measures aimed at tackling health inequalities should target groups with multiple disadvantages.</p>","PeriodicalId":54839,"journal":{"name":"Journal of Epidemiology and Community Health","volume":" ","pages":"320-326"},"PeriodicalIF":3.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}