Educational-related gradients in coronary heart disease (CHD) and mediation by behavioral risk factors are plausible given previous research; however this has not been comprehensively addressed in ...absolute measures. Questionnaire data on health behavior of 69,513 participants, 52 % women, from seven Danish cohort studies were linked to registry data on education and incidence of CHD. Mediation by smoking, low physical activity, and body mass index (BMI) on the association between education and CHD were estimated by applying newly proposed methods for mediation based on the additive hazards model, and compared with results from the Cox proportional hazards model. Short (vs. long) education was associated with 277 (95 % CI: 219, 336) additional cases of CHD per 100,000 person-years at risk among women, and 461 (95 % CI: 368, 555) additional cases among men. Of these additional cases 17 (95 % CI: 12, 22) for women and 37 (95 % CI: 28, 46) for men could be ascribed to the pathway through smoking. Further, 39 (95 % CI: 30, 49) cases for women and 94 (95 % CI: 79, 110) cases for men could be ascribed to the pathway through BMI. The effects of low physical activity were negligible. Using contemporary methods, the additive hazards model, for mediation we indicated the absolute numbers of CHD cases prevented when modifying smoking and BMI. This study confirms previous claims based on the Cox proportional hazards model that behavioral risk factors partially mediates the effect of education on CHD, and the results seems not to be particularly model dependent.
Aims: The purpose of this study was to determine the risk for taking early retirement pension (ERP) in cancer survivors who were working at the time of diagnosis. Methods: We conducted a nationwide ...and population based cohort study including 44,905 persons aged 30-60 years diagnosed with selected cancers in the period 1981-2000 and 211,562 randomly sampled cancer-free controls. Information on socioeconomic status, demography and physical and psychiatric comorbidity was obtained from Danish administrative registries. Results: We analyzed the risk for ERP adjusted for known risk factors and found that cancer patients has an excess risk of ERP compared to cancer-free controls (RR, 1.60; 95% CI, 1.55-1.65 and RR, 1.55; 95% CI, 1.46-1.65 for women and men, respectively). The observed risk factors for taking ERP were late age, dissimilated disease, manual job, sickness leave the year before taking ERP, physical and psychological comorbidity, low education and low income. Three risk categories were identified (high, medium and low) by cancer site and we found that in the high risk category, people diagnosed with leukemia, prostate cancer or ovary cancer had a more than two-fold increased risk for ERP and the risk remained increased with up to 8 years of follow-up. Conclusions: We observed a significantly increased risk for taking early retirement up to 8 years after the cancer diagnosis and that the magnitude of the risk was dependent of cancer sites.
This study aimed to compare directly elicited individual time trade-off (TTO) values in a general population sample with the social values derived using the UK EQ-5D index tariff. In the Stockholm ...County 1998 postal Public Health Survey (
n
=
4950, 20–88 years), the EQ-5D self-classifier, a TTO and a rating scale (RS) question were included (
n
=
2549 for all three questions).
The mean TTO (EQ-5D) value was 0.943 (0.890) in the youngest age-group and 0.699 (0.733) in the oldest age-group. The difference between TTO and EQ-5D values was greater in more severe health status groups was. The same equation as for the UK EQ-5D index tariff was estimated for TTO and RS and resulted in significant and consistent coefficients for nearly all dimensions. The coefficients for moderate problems were closer to the EQ-5D index tariff than the coefficients for severe problems. Age was also significant after controlling for the EQ-5D dimensions (
p
<
0.05).
The results suggest that individual and social TTO values differ systematically and that the difference is greater the more severe the health status is. The social EQ-5D index tariff may also underestimate the severity in health status at older ages; age appears to correlate with additional health problems not captured by the EQ-5D classification.
•HIAs provide simulations of future disease levels related to an array of obesity scenarios.•In a relatively lean population, obesity still contribute to a substantial reduction in life ...expectancy.•Large reductions in diabetes and multi-morbidity is estimated as an effect of reducing obesity.•Incremental increase in future stroke and IHD cases is expected.
The aim of this study was to provide decision makers with an assessment of potential future health effects of interventions against overweight and obesity (OWOB). By means of the DYNAMO-HIA tool we conducted a health impact assessment simulating future prevented disease (ischemic heart disease (IHD), diabetes, stroke, and multi morbidity) incidence, prevalence and life expectancy (LE) related to a scenario where OWOB is reduced by 25% and a scenario where obesity is eliminated. The study covered projected number of persons living in Copenhagen, Denmark during year 2014–2040 (n 2040 = 742,129). Reducing the proportion of men/women with OWOB with 25% will increase population LE by 2.4/1.2 months and at the same time decrease LE with diabetes by 3.1/2.2 months. As a result of eliminating obesity, total LE will increase by 6.0/3.6 months and LE with diabetes will decrease with 9.8/10.3 months for men/women. We found no important effects on LE with IHD and stroke. This illustrates that the positive effects of lowering OWOB levels on IHD and stroke incidence is offset due to increasing total LE. Although the population of Copenhagen is relatively lean, reducing obesity levels will result in significant benefits for population cardiometabolic health status and LE. Future public health prevention programs may use the results as reference data for potential impact of reductions in OWOB.
Objectives This study examined differences between future shift workers and future day workers as regards cardiovascular risk factors before they began different work schedules and the differences ...that remained after control for sociodemographic factors and general self-efficacy. Methods Altogether 2870 newly educated social and health care workers filled out a questionnaire a few weeks before finishing their formal training and again 1 year after graduation. They answered questions on diabetes, hypertension, lifestyle habits, sociodemographic factors, and general self-efficacy. Results In the unadjusted analyses, baseline obesity was associated with fixed evening work at follow-up. Minimal or light-to-moderate leisure-time physical activity was associated with a decrease in the odds ratio (OR) for two or three shifts including night work. Smoking status was associated with fixed evening work, fixed night work, and two-or three-shift work including night work. After adjustment for sociodemographic factors and general self-efficacy, smoking was prospectively associated with fixed evening work OR 1.56, 95% confidence interval (95% CI) 1.21-2.02 and fixed night work (OR 1.64,95% CI 1.04-2.56). Being an ex-smoker was associated with two-or three-shift work including night work (OR 1.85, 95% CI 1.28-2.68). The association between two-and three-shift work and smoking was only of borderline significance (OR 1.37, 95% CI 1.00-1.87). Conclusions Compared with future day workers, fixed evening or fixed night workers already smoked more before they began shift work. Being an ex-smoker was significantly associated with two-or three-shift work including night work. These results indicate that smoking status should not solely be treated as a mediator between some variants of shiftwork schedules and cardiovascular diseases but should also be considered a confounder.
This quasi-experimental study investigated how an intervention aiming at increasing eldercare workers' influence on their working hours affected the flexibility, variability, regularity and ...predictability of the working hours. We used baseline (n = 296) and follow-up (n = 274) questionnaire data and interviews with intervention-group participants (n = 32). The work units in the intervention group designed their own intervention comprising either implementation of computerised self-scheduling (subgroup A), collection of information about the employees' work-time preferences by questionnaires (subgroup B), or discussion of working hours (subgroup C). Only computerised self-scheduling changed the working hours and the way they were planned. These changes implied more flexible but less regular working hours and an experience of less predictability and less continuity in the care of clients and in the co-operation with colleagues. In subgroup B and C, the participants ended up discussing the potential consequences of more work-time influence without actually implementing any changes.
Practitioner Summary: Employee work-time influence may buffer the adverse effects of shift work. However, our intervention study suggested that while increasing the individual flexibility, increasing work-time influence may also result in decreased regularity of the working hours and less continuity in the care of clients and co-operation with colleagues.
Statins are increasingly prescribed to prevent cardiovascular disease (CVD) in asymptomatic individuals. Yet, it is unknown whether those at higher CVD risk - i.e. individuals in lower socio-economic ...position (SEP) - are adequately reached by this high-risk strategy. We aimed to examine whether the Danish implementation of the strategy to prevent cardiovascular disease (CVD) by initiating statin (HMG-CoA reductase inhibitor) therapy in high-risk individuals is equitable across socioeconomic groups.
Cohort study.
Applying individual-level nationwide register information on socio-demographics, dispensed prescription drugs and hospital discharges, all Danish citizens aged 20+ without previous register-markers of CVD, diabetes or statin therapy were followed during 2002-2006 for first occurrence of myocardial infarction (MI) and a dispensed statin prescription (N = 3.3 mill).
Stratified by gender, 5-year age-groups and socioeconomic position (SEP), incidence of MI was applied as a proxy for statin need. Need-standardized statin incidence rates were calculated, applying MI incidence rate ratios (IRR) as need-weights to adjust for unequal needs across SEP.Horizontal equity in initiating statin therapy was tested by means of Poisson regression analysis. Applying the need-standardized statin parameters and the lowest SEP-group as reference, a need-standardized statin IRR > 1 translates into horizontal inequity favouring the higher SEP-groups.
MI incidence decreased with increasing SEP without a parallel trend in incidence of statin therapy. According to the regression analyses, the need-standardized statin incidence increased in men aged 40-64 by 17%, IRR 1.17 (95% CI: 1.14-1.19) with each increase in income quintile. In women the proportion was 23%, IRR 1.23 (1.16-1.29). An analogous pattern was seen applying education as SEP indicator and among subjects aged 65-84.
The high-risk strategy to prevent CVD by initiating statin therapy seems to be inequitable, reaching primarily high-risk subjects in lower risk SEP-groups.
•An epidemiological model of causal pathways in the syndemic of diabetes and depression is presented.•Depression and diabetes are clustering in the adult Brazilian population partly due to shared ...social and behavioural causes.•There is an interaction between depression and diabetes in their association with disability.•There is a differential susceptibility to the effect of obesity on diabetes across levels of education and depression.
Objective The possible interaction between individual and occupational risk factors, the need for meaningful intervention, and the demand for valid shift work research make the accumulation of ...adverse exposures at certain times of the day of special relevance with respect to occupational health. The aim of the present study was therefore to examine whether there was a clustering of detrimental work factors among female eldercare workers in fixed evening or fixed night shifts when they are compared with workers in fixed day shifts. Methods This cross-sectional, questionnaire-based study was conducted among 4590 female health care workers in the Danish eldercare sector. The participants worked in nursing homes, in home care, or in both. They answered questions on job demands, job control, and social support, together with questions on physical and psychological violence, physical workload, and passive smoking. Results We found that—compared with day workers—fixed nonday workers were more exposed to low job control, low support from leaders, physical and psychological violence, and high physical demands. Nonday workers were, however, less exposed to high demands. These differences remained after control for age, job title, and workplace. Conclusions Exposures in the work environment of Danish eldercare workers varied between shifts. In a research perspective these findings stress the importance of adequate adjustment for work factors when the health effects of shift work are studied. Moreover, the results underscore the need for an increased awareness of work factors of special importance among nonday workers when interventions against shiftwork-related occupational disorders are designed.
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