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WORLD HOSPITAL DIRECTORY
Research Medical International Journal of Epidemiology - current issue
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Features of neighbourhoods affect body mass index (BMI) but this has been poorly acknowledged within the highly heterogeneous and unequal contexts of Latin American cities. We evaluated associations between social, built, and natural environment characteristics of neighbourhoods with BMI, and investigated whether these associations were modified by individual socioeconomic position (SEP).<div class="boxTitle">Methods</div>We linked individual data (<span style="font-style:italic;">n</span> = 43 968) from national health surveys to data on neighbourhoods (<span style="font-style:italic;">n</span> = 3428) and cities (<span style="font-style:italic;">n</span> = 165) in Argentina, Chile, Colombia, and Mexico. Linear mixed models were used to estimate associations between neighbourhood education, intersection density, and greenness with BMI, adjusting for individual- and city-level characteristics.<div class="boxTitle">Results</div>Associations between neighbourhood education and BMI varied by country, in both magnitude and direction. In Argentina and Chile, higher neighbourhood education was associated with lower BMI. This negative association was also observed among women in Colombia and Mexico, although it was weaker. Among men in Colombia and Mexico, however, the association was positive. Associations of neighbourhood intersection density and greenness with BMI were less robust. In general, we did not find strong evidence of effect modification by individual SEP.<div class="boxTitle">Conclusion</div>Neighbourhood education is associated with BMI beyond individual and city characteristics, although the associations are heterogenous across countries and by gender. Associations with built and natural features were less clear. Our results highlight the relevance of context-specific analysis for planning interventions that are aimed to reduce BMI and its unequal distribution in Latin American cities.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Early onset of menarche is associated with hormonal alterations that may predispose women to diabetes. We investigated the association between age at menarche and incident diabetes in India, a setting with declining menarche age and increasing burden of diabetes.<div class="boxTitle">Methods</div>Data were from the Cardiometabolic Risk Reduction in South Asia study. Women free of diabetes at baseline (2010–12) were followed until 2021 for incident diabetes, defined as prior medical diagnosis or fasting plasma glucose ≥126 mg/dl or HbA1c ≥6.5%. Age at menarche, in years was collected through self-report. Multivariable Cox proportional hazards regression models, controlling for socio-demographic factors and potentially confounding clinical parameters, estimated the association [hazard ratio (HR)] of menarche age with incident diabetes. Effect modification by obesity status was also assessed.<div class="boxTitle">Results</div>Of 3654 women at risk of diabetes at baseline, mean age was 37.7 [Standard Deviation (SD) = 10.4] years and mean age of menarche was 13.9 (SD = 1.3) years. Younger women (age 20–39 years) had an earlier onset of menarche compared to older women. Over 11 years of follow-up (median: 9.2 years), we observed 390 cases of diabetes [cumulative incidence (CI): 10.7%, 95% CI 9.32–12.33; incidence rate: 12.4 per 1000 person-years (95% CI 11.23–13.69)]. There was no association between age at menarche and incident diabetes, HR = 1.04 (95% CI 0.95–1.14). The null association was consistent in models stratified by obesity status.<div class="boxTitle">Conclusion</div>We did not find evidence of an association between age at menarche and incident diabetes in this large cohort of Indian women.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Before the COVID-19 pandemic, life expectancy in Mexico stagnated from the early 2000s, mainly due to increased homicides. During the pandemic, Mexico experienced sizable excess mortality. We aimed to assess the contribution of violence, COVID-19, and causes of death that were amenable to healthcare to life-expectancy changes between 2015 and 2022 in Mexico.<div class="boxTitle">Methods</div>We used administrative mortality and adjusted population estimates to construct life tables. We applied demographic methods to untangle contributions of causes of death to life-expectancy changes by year and sex at the subnational level.<div class="boxTitle">Results</div>Between 2015 and 2019, life expectancy declined from 71.8 to 71.1 years for males and stagnated at 77.6 years for females. Violence among young males explains most of the decline (54.3%). Between 2019 and 2020, life expectancy decreased by 7.1 and 4.4 years for males and females, respectively. COVID-19 accounted for 55.4% of that change for males and 57.7% for females. In 2021, male life expectancy stagnated but continued to decline for females by 0.44 years due to COVID-19 deaths. In 2022, we observed unequal recovery patterns in life expectancy across regions, as northern states experienced larger improvements than central and southern states.<div class="boxTitle">Conclusion</div>We documented large variations in life-expectancy losses across Mexican states before, during, and after the COVID-19 pandemic. Before the pandemic, violence accounted for most of the male life-expectancy losses. During the pandemic, following COVID-19 deaths, mortality due to diabetes and causes that were amenable to healthcare contributed considerably to observed losses, with an uneven impact on the sexes.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>The findings regarding mortality risk attributable to psychosocial and physical work demands are inconsistent. Pooled estimates using participant-level data from multiple cohort studies may provide more conclusive evidence.<div class="boxTitle">Methods</div>Four prospective cohort studies conducted in England, Finland, France, and the USA were used (age 36–62 years; <span style="font-style:italic;">n </span>=<span style="font-style:italic;"> </span>41 760). We studied 34 903 and 36 076 individuals who had baseline (1981–2005) information on self-reported psychosocial and physical work demands, respectively. All-cause mortality until the year 2018 was ascertained through linkage to national registers, National Death Index, and company databases. We investigated the associations of psychosocial and physical demands with all-cause mortality separately for females and males using Cox regression models that were adjusted for socio-demographic and lifestyle factors. Using random-effects meta-analysis, we calculated pooled estimates of all-cause mortality for moderate and high exposure levels.<div class="boxTitle">Results</div>During the mean follow-up of 25 years, 2105 deaths occurred among females and 5048 deaths occurred among males with information on psychosocial demands. The corresponding numbers for those with information on physical demands were 2176 and 5101. Fully adjusted models indicated that psychosocial demands were associated with both lower and higher all-cause mortality risks in both sexes. Physical demands increased the risk of all-cause mortality in both sexes and the association was strongest among males with moderate exposure levels (pooled hazard ratio 1.10, 95% confidence interval 1.02–1.19).<div class="boxTitle">Conclusion</div>The relationship between psychosocial work demands and all-cause mortality remains inconclusive, whereas moderate physical work demands increase the mortality risk among males.</span>
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