Educational inequalities in cardiometabolic diseases (CMD) are globally recognised; nonetheless, the evidence on potential explanatory mechanisms and effective strategies for CMD prevention and ...inequality reduction is relatively scarce in Asia. Therefore, the current study examined the extent and potential mediators of the association of education level with CMD conditions (i.e., hypertension and diabetes) in an advanced economy in Asia.
A cross-sectional study.
This territory-wide cross-sectional Population Health Survey in 2014-2015 was performed in Hong Kong. Demographic, socio-economic and lifestyle factors were collected via questionnaire, while clinical data on blood pressure and glucose levels, lipid profiles and anthropometric measures were obtained during health examination. Hypertension and diabetes statuses were objectively defined by both clinical data and the use of relevant medications.
2297 community-dwelling adults aged between 15-84 years recruited via systematic replicated sampling of living quarters.
Multivariable binary logistic regression analysis showed that lower education level was significantly associated with hypertension among women but not men, whereas similar pattern was also observed for diabetes and other related clinical risk factors. Also, general and abdominal obesity were independently associated with hypertension and diabetes among both women and men, and substantially mediated the observed inequalities across education levels among women. Specifically, abdominal obesity was a particularly strong risk factor and mediator for diabetes.
Educational patterning of CMD was more apparent among women in Hong Kong. Obesity control appears to be important for both overall CMD prevention and reduction of educational inequalities in CMD among women.
Objective
This study aimed to examine the prospective associations of general and abdominal obesity patterns with carotid plaque development among early postmenopausal Chinese women.
Methods
A total ...of 518 postmenopausal women aged 50 to 64 years were recruited between 2002 and 2004 and were followed up at 3 years and 5 years. Carotid plaque was measured using B‐mode ultrasonography, whereas general and abdominal obesity were defined as BMI ≥ 25 kg/m2 and waist‐hip ratio ≥ 0.85, respectively. Sociodemographic, lifestyle, mental health, disease history, and clinical measurements were also assessed for confounding control. Multivariable binary logistic regression analyses on plaque development at 5 years were performed among 322 women with no carotid plaque at baseline.
Results
Over the 5‐year follow‐up period, 70 women (21.7%) developed carotid plaque. Baseline abdominal obesity independently predicted plaque development (adjusted odds ratio = 2.30; 95% CI: 1.15‐4.60), but general obesity did not. Women with normal‐weight abdominal obesity were more than twice as likely to develop carotid plaque (adjusted odds ratio = 2.43; 95% CI: 1.02‐5.75) compared with women with no obesity, with their risk comparable to women with both general and abdominal obesity.
Conclusions
Abdominal obesity was a critical predictor of subclinical carotid plaque development among early postmenopausal Chinese women. Policy makers should recognize the need to identify high‐risk midlife women with normal‐weight abdominal obesity in public health and clinical practice.
Female migrant domestic workers (MDW), approximately 8.5 million globally, often live in their employer's home under vulnerable conditions. In Hong Kong, MDWs currently comprise 5% of the population. ...This study was conducted to assess the association between employment conditions and mental health, and the mediating roles stress and job satisfaction have, among female MDWs in Hong Kong.
Participants completed an online cross-sectional survey. A total of 1,965 survey were collected between August 2020 and August 2021. Questions in the survey were related to MDWs background information, employment conditions, stress, job satisfaction, and two mental health outcomes: anxiety and depression. An employment conditions score was created to assess the cumulative effect poor employment conditions had on mental health. A multicategorical parallel mediation analysis was used to assess the direct effect employment conditions have on mental health and the indirect effects through stress and job satisfaction.
Overall, 17.7% of MDWs were reported to be suffering from anxiety and 30.8% from depression. An increase in poor employment conditions was statistically associated with an increase in both outcomes, while stress levels and job satisfaction mediated this association.
The findings call for increased scrutiny of employment conditions and mental well-being of MDWs.
Chronic Care Model (CCM) has been developed to improve patients' health care by restructuring health systems in a multidimensional manner. This systematic review aims to summarize and analyse ...programs specifically designed and conducted for the fulfilment of multiple CCM components. We have focused on programs targeting diabetes mellitus, hypertension and cardiovascular disease.
This review was based on a comprehensive literature search of articles in the PubMed database that reported clinical outcomes. We included a total of 25 eligible articles. Evidence of improvement in medical outcomes and the compliance of patients with medical treatment were reported in 18 and 14 studies, respectively. Two studies demonstrated a reduction of the medical burden in terms of health service utilization, and another two studies reported the effectiveness of the programs in reducing the risk of heart failure and other cardiovascular diseases. However, CCMs were still restricted by limited academic robustness and social constraints when they were implemented in primary care. Higher professional recognition, tighter system collaborations and increased financial support may be necessary to overcome the limitations of, and barriers to CCM implementation.
This review has identified the benefits of implementing CCM, and recommended suggestions for the future development of CCM.
•This systematic review analysed Chronic Care Models for cardiovascular diseases.•Most studies reported outcome improvements and patient compliance with treatment.•Some studies demonstrated reduction of medical burden, like healthcare utilization.•They are effective to reduce risk of heart failure & other cardiovascular diseases.•They are restricted by academic robustness and social constraints in primary care.
Gender differences in the trend of educational inequality in hypertension have been observed especially in the Asian populations, indicating the increasing importance of education as a social ...determinant of hypertension among women. This study examined the gender-specific trends of educational inequality in physician-diagnosed hypertension in Hong Kong between 1999 and 2014. Based on a series of eight government-led territory-wide household surveys conducted between 1999 and 2014, 97,481 community-dwelling Hong Kong Chinese adults aged 45 or above were analysed. The extent and trend of gender-specific educational inequality in self-reported physician-diagnosed hypertension were estimated by regression-based Relative Index of Inequality and age-standardised Slope Index of Inequality. Over the study period, age-standardised prevalence of self-reported hypertension increased in both genders, with the greatest prevalence among the least educated women. Educational inequalities in hypertension significantly widened in female from 1999 to 2009 and persisted thereafter; nonetheless, the respective inequality was negligible in male. Further adjustment for household income did not attenuate the observed inequality. To conclude, a widened and then persistent discrepancy in hypertension across education levels was observed among women, but not among men, in Hong Kong. The gender perspective should be carefully considered when designing hypertension prevention strategies and related health policies.
Menopausal changes are linked to increase in body fat mass and central fat distribution; nonetheless, the impact of socioeconomic position on such changes has rarely been examined. This cohort study ...assessed the temporal associations of socioeconomic position with changes in body mass index (BMI) and waist-to-hip ratio (WHR) among early postmenopausal women.
Between 2002 and 2004, 518 Hong Kong Chinese women aged 50 to 64 and within 10 years since menopause were recruited and followed up at 3 and 5 years. Weight, height, and waist and hip circumferences were measured by trained interviewers at baseline and follow-up interviews. Socioeconomic positions including educational attainment, economic activity status and household income level, and other baseline demographic characteristics, lifestyle behaviors, and mental health status were collected based on a structured questionnaire. In total, 287 and 267 women with no general and abdominal obesity, respectively, at baseline were included in multiple regression analyses.
Mean intrapersonal increases in BMI and WHR between baseline and 5-year interview were 0.46 kg/m and 2.80%, respectively. Women with no secondary education were 75% more likely to have a greater than-mean WHR increase than their more educated counterparts (P = 0.039). Also, having no secondary education (P = 0.041) and being a homemaker (P = 0.034) had accelerated surge in WHR. Nonetheless, baseline socioeconomic positions were not significantly associated with BMI changes.
Socioeconomic patterning was observed for the progression of WHR among nonobese Chinese women soon after menopause. Early postmenopausal stage may be a critical window for prevention of abdominal obesity among women with a lower educational attainment.
To delineate the temporal dynamics between alcohol tax policy changes and related health outcomes, this study examined the age, period and cohort effects on alcohol-related mortality in relation to ...changes in government alcohol policies. We used the age-period-cohort modeling to analyze retrospective mortality data over 30 years from 1981 to 2010 in a rapidly developed Chinese population, Hong Kong. Alcohol-related mortality from 1) chronic causes, 2) acute causes, 3) all (chronic+acute) causes and 4) causes 100% attributable to alcohol, as defined according to the Alcohol-Related Disease Impact (ARDI) criteria developed by the US Centers for Disease Control and Prevention, were examined. The findings illustrated the possible effects of alcohol policy changes on adult alcohol-related mortality. The age-standardized mortality trends were generally in decline, with fluctuations that coincided with the timing of the alcohol policy changes. The age-period-cohort analyses demonstrated possible temporal dynamics between alcohol policy changes and alcohol-related mortality through the period effects, and also generational impact of alcohol policy changes through the cohort effects. Based on the illustrated association between the dramatic increase of alcohol imports in the mid-1980s and the increased alcohol-related mortality risk of the generations coming of age of majority at that time, attention should be paid to generations coming of drinking age during the 2007-2008 duty reduction.
ObjectivesTo assess the prevalence of potentially inappropriate medication (PIM) use in Hong Kong older patients visiting general outpatient clinics (GOPCs) between 2006 and 2014 and to identify ...factors associated with PIM use among older adults visiting GOPCs in 2014.DesignCross-sectional study.SettingGOPC.ParticipantsTwo study samples were constructed including a total of 844 910 patients aged 65 and above from 2006 to 2014 and a cohort of 489 301 older patients in 2014.MeasurementsTwo subsets of the 2015 American Geriatrics Society Beers criteria—PIMs independent of diagnosis and PIMs due to drug–disease interactions—were used to estimate the prevalence of PIM use over 12 months. PIMs that were not included in the Hospital Authority drug formulary or with any specific restriction or exception in terms of indication, dose or therapy duration were excluded. Characteristics of PIM users and non-PIM users visiting GOPCs in 2014 were compared. Independent associations between patient variables and PIM use were assessed by stepwise multivariable logistic regression analysis.ResultsThe 12-month period prevalence of PIM use decreased from 55.56% (95% CI 55.39% to 55.72%) in 2006 to 47.51% (95% CI 47.37% to 47.65%) in 2014. In the multivariable regression analysis, the strongest factor associated with PIM use was the number of different drugs prescribed (adjusted OR, AOR 23.01, 95% CI 22.36 to 23.67). Being female (AOR 0.89, 95% CI 0.85 to 0.87 for males vs females) and having a greater number of GOPC visits (AOR 1.83, 95% CI 1.78 to 1.88) as well as more than six diagnoses (AOR 1.43, 95% CI 1.36 to 1.52) were associated with PIM use.ConclusionsThe overall prevalence of PIM use in older adults visiting GOPCs decreased from 2006 to 2014 in Hong Kong although the prevalence of PIM use was still high in 2014. Patients with female gender, a larger number of medications prescribed, more frequent visits to GOPCs, and more than six diagnoses were at higher risk for PIM use.
Hong Kong has been one of the fastest growing postwar economies with substantial decline in mortality risks during the past decades. Nevertheless, it is unclear whether there is a socioeconomic ...disparity in the trends of mortality risks across generations.
We conducted a series of sex-specific age-period-cohort analyses by neighborhood-level socioeconomic status (SES) using mortality data from 1976 to 2010 to examine the socioeconomic disparity of cohort effects. Outcomes included all-cause mortality and mortality from ischemic heart disease, other cardiovascular diseases (CVD), lung cancer, other cancers, respiratory diseases (RD), other medical causes, and external causes.
Age-standardized mortality rates declined in both sexes, with generally higher rates observed in those of lower SES. Socioeconomic disparity in the risks of all mortality outcomes emerged and widened starting from cohorts born around the 1930s-1940s. These results suggested that mortality risks associated with lower SES did not decline across generations as much as those associated with higher SES.
The share of health benefits brought by economic growth was notably unequal by SES with greater benefits for those of higher SES. More attention should be paid to postwar baby boomers of lower SES.
•Age-standardized mortality was generally higher in those of lower socioeconomic status (SES) and declined in both sexes.•Greater mortality risks for people of lower SES emerged because of the cohorts born in 1930s-1940s.•Socioeconomic disparity of mortality risks continued to widen till recent cohorts.•The changes of mortality risks coincided with one of the fastest postwar economic developments.•Health benefits brought by rapid economic development were greater for people of higher SES.
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