TY  - JOUR
AB  - Background Previous studies have shown that differential exposure to lifestyle factors may mediate the association between education and coronary heart diseases (CHD). However, few studies have examined the potential roles of allostatic load (AL) or differential susceptibility. Methods 25 310 men and 26 018 women aged 35–74 and CHD free at baseline were identified from 21 European cohorts and followed for a median of 10 years, to investigate the mediating role of AL, as well as of smoking, alcohol use and body mass index (BMI), on educational differences in CHD incidence, applying marginal structural models and three-way decomposition. Results AL is a mediator of the association between educational status and CHD incidence, with the highest proportion mediated observed among women and largely attributable to differential exposure, (28% (95% CI 19% to 44%)), with 8% (95% CI 0% to 16%) attributable to differential susceptibility. The mediating effects of smoking, alcohol and BMI, compared with AL, were relatively small for both men and women. Conclusion Overall, the educational inequalities in CHD incidence were partially mediated through differential exposure to AL. By contrast, the mediation of the educational gradient in CHD by investigated lifestyle risk factors was limited. As differential susceptibility in men was found to have a predominant role in the accumulation of AL in low educational classes, the investigation of AL-related risk factors is warranted.
AU  - Hicks, B.*
AU  - Veronesi, G.*
AU  - Ferrario, M.M.*
AU  - Forrest, H.*
AU  - Whitehead, M.*
AU  - Diderichsen, F.*
AU  - Tunstall-Pedoe, H.*
AU  - Kuulasmaa, K.*
AU  - Sans, S.*
AU  - Salomaa, V.*
AU  - Thorand, B.
AU  - Peters, A.
AU  - Söderberg, S.*
AU  - Cesana, G.*
AU  - Bobak, M.*
AU  - Iacoviello, L.*
AU  - Palmieri, L.*
AU  - Zeller, T.*
AU  - Blankenberg, S.*
AU  - Kee, F.*
C1  - 62175
C2  - 50678
CY  - British Med Assoc House, Tavistock Square, London Wc1h 9jr, England
SP  - 1147-1154
TI  - Roles of allostatic load, lifestyle and clinical risk factors in mediating the association between education and coronary heart disease risk in Europe.
JO  - J. Epidemiol. Community Health
VL  - 75
IS  - 12
PB  - Bmj Publishing Group
PY  - 2021
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - Background: We investigate whether socially disadvantaged individuals are more susceptible to the detrimental effects of smoking and alcohol intake on allostatic load (AL), a marker of physiological â wear and tear', resulting from adaptation to chronic stress. Methods: In a cross-sectional analysis, 27 019 men and 26 738 women aged 35-74 years were identified from 21 European cohorts in the BiomarCaRE consortium. We defined three educational classes (EDs) according to years of schooling and an AL score as the sum of z-scores of eight selected biomarkers from the cardiovascular, metabolic and inflammatory systems. We used the Oaxaca-Blinder decomposition to disentangle the ED gradient in AL score into the differential exposure (DE, attributable to different distribution of smoking and alcohol intake across EDs) and the differential susceptibility (DS, attributable to a different effect of risk factors on AL across EDs) components. Results: Less-educated men (mean AL difference: 0.68, 95% CI 0.57 to 0.79) and women (1.52, 95% CI 1.40 to 1.64) had higher AL scores. DE accounted for 7% and 6% of the gradient in men and women, respectively. In men, combining smoking and alcohol intake, DS accounted for 42% of the gradient (smoking DS coefficient=0.177, 26% of the gradient; alcohol DS coefficient=0.109; 16%, not statistically significant). DS contribution increased to 69% in metabolic markers. DS estimates were consistent across age groups, irrespective of comorbidities and robust to unmeasured confounding. No DS was observed in women. Conclusions: In men, a DS mechanism substantially contributes to the educational class gradient in allostatic load.
AU  - Veronesi, G.*
AU  - Kee, F.*
AU  - Hicks, B.*
AU  - Forrest, H.*
AU  - Tunstall-Pedoe, H.*
AU  - Kuulasmaa, K.*
AU  - Sans, S.*
AU  - Salomaa, V.*
AU  - Thorand, B.
AU  - Di Castelnuovo, A.*
AU  - Söderberg, S.*
AU  - Cesana, G.*
AU  - Bobak, M.*
AU  - De Ponti, R.*
AU  - Iacoviello, L.*
AU  - Palmieri, L.*
AU  - Zeller, T.*
AU  - Blankenberg, S.*
AU  - Ferrario, M.M.*
C1  - 60258
C2  - 49302
CY  - British Med Assoc House, Tavistock Square, London Wc1h 9jr, England
SP  - 1008-1015
TI  - Decomposing the educational gradient in allostatic load across European populations. What matters the most: Differentials in exposure or in susceptibility?
JO  - J. Epidemiol. Community Health
VL  - 74
IS  - 12
PB  - Bmj Publishing Group
PY  - 2020
SN  - 0143-005X
ER  - 

TY  - JOUR
AU  - Finke, I.*
AU  - Behrens, G.*
AU  - Schwettmann, L.
AU  - Gerken, M.*
AU  - Pritzkuleit, R.*
AU  - Holleczek, B.*
AU  - Brenner, H.*
AU  - Jansen, L.*
C1  - 57446
C2  - 47780
CY  - British Med Assoc House, Tavistock Square, London Wc1h 9jr, England
SP  - A77-A77
TI  - Socioeconomic differences and lung cancer survival in Germany: Differences in Therapy and clinical prognostic factors.
JO  - J. Epidemiol. Community Health
VL  - 73
PB  - Bmj Publishing Group
PY  - 2019
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - Background The Framingham Risk Score (FRS) and the Pooled Cohort Equations (PCE) are established tools for the prediction of cardiovascular disease (CVD) risk. In the Western world, decreases in incidence rates of CVD were observed over the last 30 years. Thus, we hypothesise that there are also temporal trends in the risk prediction performance of the FRS and PCE from 1990 to 2000. Methods We used data from n=7789 men and women aged 40-74 years from three prospective population-based cohort studies enrolled in Southern Germany in 1989/1990, 1994/1995 and 1999/2000. 10-year CVD risk was calculated by recalibrated equations of the FRS or PCE. Calibration was evaluated by percentage of overestimation and Hosmer-Lemeshow tests. Discrimination performance was assessed by receiver operating characteristic (ROC) curves and corresponding area under the curve (AUC). Results Across the three studies, we found significant temporal trends in risk factor distributions and predicted risks by both risk scores (men: 18.0%, 15.4%, 14.9%; women: 8.7%, 11.2%, 10.8%). Furthermore, also the discrimination performance evolved differently for men (AUC PCE: 76.4, 76.1, 72.8) and women (AUC PCE: 75.9, 79.5, 80.5). Both risk scores overestimated actual CVD risk. Conclusion There are temporal trends in the performance of the FRS and PCE. Although the overall performance remains adequate, sex-specific trends have to be taken into account for further refinement of risk prediction models.
AU  - Rospleszcz, S.
AU  - Thorand, B.
AU  - de Las Heras Gala, T.
AU  - Meisinger, C.
AU  - Holle, R.
AU  - Koenig, W.*
AU  - Mansmann, U.*
AU  - Peters, A.
C1  - 54429
C2  - 45559
CY  - British Med Assoc House, Tavistock Square, London Wc1h 9jr, England
SP  - 19-25
TI  - Temporal trends in cardiovascular risk factors and performance of the Framingham Risk Score and the Pooled Cohort Equations.
JO  - J. Epidemiol. Community Health
VL  - 73
IS  - 1
PB  - Bmj Publishing Group
PY  - 2019
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - BACKGROUND: Newly arriving asylum seekers in many European Union countries are assigned a place of residence based on administrative quota. This may have important consequences for the exposure to contextual health risks. We assessed the association between regional deprivation and the distribution of asylum seekers in Germany considered as vulnerable (women, children <7 years, persons >64 years) because of their increased health needs. METHODS: Using nationally representative data, we analysed the rates of observed to expected numbers of asylum seekers and vulnerable subgroups in Bayesian spatial models. Regional deprivation was measured by the German Index of Multiple Deprivation. The analyses were performed at the district level (N=402) and adjusted for district population size, effects of federal states as well as spatial effects. RESULTS: Of the 224 993 asylum seekers, 38.7% were women, 13.8% children aged <7 years and 19.8% aged >64 years. The adjusted number of asylum seekers (totals and vulnerable subgroups) was higher in more deprived districts (Q3, Q4 and Q5) relative to districts in the lowest deprivation quintile (Q1). The adjusted rate ratios for districts with highest relative to those with lowest deprivation were 1.26 (1.03-1.53) for women, 1.28 (1.04-1.58) for children aged <7 years and 1.50 (1.08-2.08) for older asylum seekers. CONCLUSION: The adjusted number of vulnerable asylum seekers was higher in districts with medium and highest deprivation compared with districts with lowest deprivation. The disproportionate distribution was highest for older asylum seekers and children <7 years. Vulnerable subgroups tend to be exposed to more deprived places of residence, which may further increase health risks and healthcare needs.
AU  - Bozorgmehr, K.*
AU  - Razum, O.*
AU  - Szecsenyi, J.*
AU  - Maier, W.
AU  - Stock, C.*
C1  - 51530
C2  - 43179
CY  - London
SP  - 857-862
TI  - Regional deprivation is associated with the distribution of vulnerable asylum seekers: A nationwide small area analysis in Germany.
JO  - J. Epidemiol. Community Health
VL  - 71
IS  - 9
PB  - Bmj Publishing Group
PY  - 2017
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - BACKGROUND: Knowledge on the origins of the social gradient in stroke incidence in different populations is limited. This study aims to estimate the burden of educational class inequalities in stroke incidence and to assess the contribution of risk factors in determining these inequalities across Europe. MATERIALS AND METHODS: The MORGAM (MOnica Risk, Genetics, Archiving and Monograph) Study comprises 48 cohorts recruited mostly in the 1980s and 1990s in four European regions using standardised procedures for baseline risk factor assessment and fatal and non-fatal stroke ascertainment and adjudication during follow-up. Among the 126 635 middle-aged participants, initially free of cardiovascular diseases, generating 3788 first stroke events during a median follow-up of 10 years, we estimated differences in stroke rates and HRs for the least versus the most educated individuals. RESULTS: Compared with their most educated counterparts, the overall age-adjusted excess hazard for stroke was 1.54 (95% CI 1.25 to 1.91) and 1.41 (95% CI 1.16 to 1.71) in least educated men and women, respectively, with little heterogeneity across populations. Educational class inequalities accounted for 86-413 and 78-156 additional stroke events per 100 000 person-years in the least compared with most educated men and women, respectively. The additional events were equivalent to 47%-130% and 40%-89% of the average incidence rates. Inequalities in risk factors accounted for 45%-70% of the social gap in incidence in the Nordic countries, the UK and Lithuania-Kaunas (men), but for no more than 17% in Central and South Europe. The major contributors were cigarette smoking, alcohol intake and body mass index. CONCLUSIONS: Social inequalities in stroke incidence contribute substantially to the disease rates in Europe. Healthier lifestyles in the most disadvantaged individuals should have a prominent impact in reducing both inequalities and the stroke burden.
AU  - Ferrario, M.M.*
AU  - Veronesi, G.*
AU  - Kee, F.*
AU  - Chambless, L.E.*
AU  - Kuulasmaa, K.*
AU  - Jørgensen, T.*
AU  - Amouyel, P.*
AU  - Arveiler, D.*
AU  - Bobak, M.*
AU  - Cesana, G.*
AU  - Drygas, W.*
AU  - Ferrieres, J.*
AU  - Giampaoli, S.*
AU  - Iacoviello, L.*
AU  - Nikitin, Y.*
AU  - Pajak, A.*
AU  - Peters, A.
AU  - Salomaa, V.*
AU  - Söderberg, S.*
AU  - Tamosiunas, A.*
AU  - Wilsgaard, T.*
AU  - Tunstall-Pedoe, H.*
C1  - 52054
C2  - 43697
CY  - London
SP  - 1210-1216
TI  - Determinants of social inequalities in stroke incidence across Europe: A collaborative analysis of 126 635 individuals from 48 cohort studies.
JO  - J. Epidemiol. Community Health
VL  - 71
IS  - 12
PB  - Bmj Publishing Group
PY  - 2017
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - Background Disease Management Programmes (DMPs) aim to improve effectiveness and equity of care but may suffer from selective enrolment. We analysed social disparities in DMP enrolment among elderly patients with coronary heart disease (CHD) in Germany, taking into account contextual effects at municipality and primary care practice levels. Methods Cross-sectional analysis of effects of educational attainment and regional deprivation on physician-reported DMP enrolment in a subsample of a large population-based cohort study in Germany, adjusting for individual-level, practice-level and area-level variables. We calculated OR and their 95% CIs (95% CI) in cross-classified, multilevel logistic regression models. Results Among N=1280 individuals with CHD (37.3% women), DMP enrolment rates were 22.2% (women) and 35% (men). The odds of DMP enrolment were significantly higher for male patients (OR=1.98 (1.50 to 2.62)), even after adjustment for potential confounding by individual-level, practice-level and area-level variables (range: OR=1.60 (1.08 to 2.36) to 2.16 (1.57 to 2.98)). Educational attainment was not significantly associated with DMP enrolment. Compared to patients living in least-deprived municipalities, the adjusted propensity of DMP enrolment was statistically significantly lower for patients living in medium-deprived municipalities (OR=0.41 (0.24 to 0.71)), and it also tended to be lower for patients living in the most-deprived municipalities (OR=0.70 (0.40 to 1.21)). Models controlling for the social situation (instead of health-related behaviour) yielded comparable effect estimates (medium-deprived/most-deprived vs least-deprived areas: OR=0.45 (0.26 to 0.78)/OR=0.68 (0.33 to 1.19)). Controlling for differences in comorbidity attenuated the deprivation effect estimates. Conclusions We found evidence for marked gender, but not educational disparities in DMP enrolment among patients with CHD. Small-area deprivation was associated with DMP enrolment, but the effects were partly explained by differences in comorbidity. Future studies on DMPs should consider contextual effects when analysing programme effectiveness or impacts on equity and efficiency.  
AU  - Bozorgmehr, K.*
AU  - Maier, W.
AU  - Brenner, H.*
AU  - Saum, K.U.*
AU  - Stock, C.*
AU  - Miksch, A.*
AU  - Holleczek, B.*
AU  - Szecsenyi, J.*
AU  - Razum, O.*
C1  - 45249
C2  - 37269
SP  - 1091-1101
TI  - Social disparities in disease management programmes for coronary heart disease in Germany: A cross-classified multilevel analysis.
JO  - J. Epidemiol. Community Health
VL  - 69
IS  - 11
PY  - 2015
SN  - 0143-005X
ER  - 

TY  - JOUR
AU  - Zanobetti, A.*
AU  - Peters, A.
C1  - 42889
C2  - 35727
CY  - London
SP  - 613-615
TI  - Disentangling interactions between atmospheric pollution and weather.
JO  - J. Epidemiol. Community Health
VL  - 69
IS  - 7
PB  - Bmj Publishing Group
PY  - 2015
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - BACKGROUND: Positive greenness effects on health are increasingly reported, although studies on allergic outcomes remain limited and conflicting. We examined whether residential greenness is associated with childhood doctor diagnosed allergic rhinitis, eyes and nose symptoms and aeroallergen sensitisation using two combined birth cohorts (GINIplus and LISAplus) followed from birth to 10 years in northern and southern Germany (Ntotal=5803). METHODS: Mean residential greenness in a 500 m buffer around the 10-year home addresses was defined using the Normalized Difference Vegetation Index, a green biomass density indicator. Longitudinal associations were assessed per study area (GINI/LISA South and GINI/LISA North) using generalised estimation equations adjusted for host and environmental covariates. RESULTS: Despite identical study designs and statistical modelling, greenness effects differed across the two study areas. Associations were elevated for allergic rhinitis and eyes and nose symptoms in the urban GINI/LISA South area. In contrast, risk estimates were significantly below one for these outcomes and aeroallergen sensitisation in rural GINI/LISA North. Area-specific associations were similar across buffer sizes and addresses (birth and 6 years) and remained heterogeneous after air pollution and population density stratification. CONCLUSIONS: Existing and future single-area studies on greenness and green spaces should be interpreted with caution.
AU  - Fuertes, E.
AU  - Markevych, I.
AU  - von Berg, A.*
AU  - Bauer, C.P.*
AU  - Berdel, D.*
AU  - Koletzko, S.*
AU  - Sugiri, D.*
AU  - Heinrich, J.
C1  - 31499
C2  - 34515
CY  - London
SP  - 787-790
TI  - Greenness and allergies: Evidence of differential associations in two areas in Germany.
JO  - J. Epidemiol. Community Health
VL  - 68
IS  - 8
PB  - Bmj Publishing Group
PY  - 2014
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - Background Population-based data are paramount to investigate the long-term course of diabetes, for planning in healthcare and to evaluate the cost-effectiveness of primary prevention. We analysed regional differences in the incidence of self-reported type 2 diabetes mellitus in Germany. Methods Data of participants (baseline age 45–74 years) from five regional population-based studies conducted between 1997 and 2010 were included (mean follow-up 2.2–7.1 years). The incidence of self-reported type 2 diabetes mellitus at follow-up was compared. The incidence rates per 1000 person-years (95% CI) and the cumulative incidence (95% CI) from regional studies were directly standardised to the German population (31 December 2007) and weighted by inverse probability weights for losses to follow-up. Results Of 8787 participants, 521 (5.9%) developed type 2 diabetes mellitus corresponding to an incidence rate of 11.8/1000 person-years (95% CI 10.8 to 12.9). The regional incidence was highest in the East and lowest in the South of Germany with 16.9 (95% CI 13.3 to 21.8) vs 9.3 (95% CI 7.4 to 11.1)/1000 person-years, respectively. The incidence increased with age and was higher in men than in women. Conclusions The incidence of self-reported type 2 diabetes mellitus shows regional differences within Germany. Prevention measures need to consider sex-specific differences and probably can be more efficiently introduced toward those regions in need.  
AU  - Schipf, S.*
AU  - Ittermann, T.*
AU  - Tamayo, T.*
AU  - Holle, R.
AU  - Schunk, M.
AU  - Maier, W.
AU  - Meisinger, C.
AU  - Thorand, B.
AU  - Kluttig, A.*
AU  - Greiser, K.H.*
AU  - Berger, K.*
AU  - Müller, G.*
AU  - Moebus, S.*
AU  - Slomiany, U.*
AU  - Icks, A.*
AU  - Rathmann, W.*
AU  - Völzke, H.*
C1  - 31837
C2  - 34797
SP  - 1088-1095
TI  - Regional differences in the incidence of self-reported type 2 diabetes in Germany: Results from five population-based studies in Germany (DIAB-CORE Consortium)
JO  - J. Epidemiol. Community Health
VL  - 68
IS  - 11
PY  - 2014
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - BACKGROUND: Finite mixture models posit the existence of a latent categorical variable and can be used for probabilistic classification. The authors illustrate the use of mixture models for dietary pattern analysis. An advantage of this approach is taking classification uncertainty into account. METHODS: Participants were a random sample of women from the European Prospective Investigation into Cancer. Food consumption was measured using dietary questionnaires. Mixture models identified latent classes in food consumption data, which were interpreted as dietary patterns. RESULTS: Among various assumptions examined, models allowing the variance of foods to vary within and between classes fit better than alternatives assuming constant variance (the K-means method of cluster analysis also makes the latter assumption). An eight-class model was best fitting and five patterns validated well in a second random sample. Patterns with lower classification uncertainty tended to be better validated. One pattern showed low consumption of foods despite being associated with moderate body mass index. CONCLUSION: Mixture modelling for dietary pattern analysis has advantages over both factor and cluster analysis. In contrast to these other methods, it is easy to estimate pattern prevalence, to describe patterns and to use patterns to predict disease taking classification uncertainty into account. Owing to substantial error in food consumptions, any analysis will usually find some patterns that cannot be well validated. While knowledge of classification uncertainty may aid pattern evaluation, any method will better identify patterns from food consumptions measured with less error. Mixture models may be useful to identify individuals who under-report food consumption.
AU  - Fahey, M.T.*
AU  - Ferrari, P.*
AU  - Slimani, N.*
AU  - Vermunt, J.K.*
AU  - White, I.R.*
AU  - Hoffmann, K.*
AU  - Wirfält, E.*
AU  - Bamia, C.*
AU  - Touvier, M.*
AU  - Linseisen, J.
AU  - Rodríguez-Barranco, M.*
AU  - Tumino, R.*
AU  - Lund, E.*
AU  - Overvad, K.*
AU  - Bueno-de-Mesquita, H.B.*
AU  - Bingham, S.*
AU  - Riboli, E.*
C1  - 7322
C2  - 29684
SP  - 89-94
TI  - Identifying dietary patterns using a normal mixture model: Application to the EPIC study.
JO  - J. Epidemiol. Community Health
VL  - 66
IS  - 1
PB  - BMJ Publishing Group
PY  - 2012
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - Environmental exposures affecting human health range from complex mixtures, such as environmental tobacco smoke, ambient particulate matter air pollution and chlorination by products in drinking water, to hazardous chemicals, such as lead, and polycyclic aromatic hydrocarbons, such as benz(a)pyrene. The exposome has been proposed to complement the genome and be the totality of all environmental exposures of an individual over his or her lifetime. However, if measurements of the exposome in biological samples are the sole tool for exposure assessment there are a number of limitations. First, it has limited utility for fully capturing the impact of complex mixtures such environmental tobacco smoke or particulate matter air pollution. Second, a number of relevant environmental exposures such as noise, heat or electromagnetic fields do not have direct correlates as metabolites or protein adducts, but there is important evidence linking them with health effects. Third, functional genomic changes are likely in many instances to be both a susceptibility factor and a marker of internal doses in response to environmental exposures. Fourth, internal dose measurements of environmental exposures might have lost the distinct signature of the relevant sources. This paper emphasises the obligation of environmental epidemiology to provide robust evidence to assist timely and sufficient protection of vulnerable subgroups of populations from environmental hazards. Therefore, in applying the exposome concept to environmental health problems, a strong link with the external environment needs to be maintained.
AU  - Peters, A.
AU  - Hoek, G.*
AU  - Katsouyanni, K.*
C1  - 7238
C2  - 29583
SP  - 103-105
TI  - Understanding the link between environmental exposures and health: Does the exposome promise too much?
JO  - J. Epidemiol. Community Health
VL  - 66
IS  - 2
PB  - BMJ Publishing Group
PY  - 2012
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - Background Strong evidence exists for an association between socioeconomic status and body mass index (BMI) as well as between genetic variants and BMI. The association of genetic variants with socioeconomic status has not yet been investigated. The aim of this study was to investigate two obesity-related loci-the transmembrane 18 (TMEM18) and the fat mass and obesity-associated (FTO) gene-for their association with educational level and per capita income, and to test whether the detected genotype-BMI association is mediated by these social factors. Methods 12 425 adults from a large population-based study were genotyped for the polymorphism rs6548238 near TMEM18 and rs9935401 within the FTO gene. Data on educational level and per capita income were based on standardised questionnaires. Results High educational level and high per capita income were significantly associated with decreased BMI (-1.503 kg/m(2), p<0.0001/-0.820 kg/m(2), p<0.0001). Neither the polymorphism rs6548238 nor rs9935401 nor their combination were significantly associated with educational level (p=0.773/p=0.827/p=0.755) or income (p=0.751/p=0.991/p=0.820). Adjustment for social factors did not change the association between rs6548238 or rs9935401 and BMI. Conclusions As far as the authors know, this is the first study to investigate the association between polymorphisms and socioeconomic status. The polymorphisms rs6548238 and rs9935401 showed no association with educational level or income.
AU  - Holzapfel, C.
AU  - Grallert, H.
AU  - Baumert, J.J.
AU  - Thorand, B.
AU  - Döring, A.
AU  - Wichmann, H.-E.
AU  - Hauner, H.*
AU  - Illig, T.
AU  - Mielck, A.
C1  - 4869
C2  - 27446
SP  - 174-176
TI  - First investigation of two obesity-related loci (TMEM18, FTO) concerning their association with educational level as well as income: The MONICA/KORA study.
JO  - J. Epidemiol. Community Health
VL  - 65
IS  - 2
PB  - BMJ Publishing Group Ltd.
PY  - 2011
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - Background An association between socioeconomic status (SES) and the incidence of type 2 diabetes mellitus (T2DM) has been found for younger and middle-aged individuals, but studies of this relationship in elderly populations are rare. Methods In a population-based cohort in southern Germany (KORA S4/F4: 1223 subjects aged 55-74 years at baseline, 887 subjects (73%) in the follow-up 7 years later) the identification of incident T2DM was based on oral glucose tolerance tests or on validated physician diagnoses. Regression models were fitted to predict incident T2DM and (pre)diabetes, respectively, with SES as the main independent variable. (Pre)diabetes here means incident T2DM or incident pre-diabetes. Results With five different SES measures (global Helmert index, income, educational level, occupational status, subjective social status), the diabetes risk of low SES groups was not significantly different from the risk of higher SES groups (ie, cumulative incidence 10% (low income), 9% (medium income), 13% (high income)). In subjects with normoglycaemia at baseline, (pre)diabetes incidence was more pronounced in lower SES groups, but almost all these associations were not significant. With measures of subjective SES stronger associations were found than with measures of objective SES. Conclusion There was no statistically significant association between objective SES and diabetes incidence in this elderly population. This might be due to a larger socioeconomic homogeneity of elderly populations and to a strong driving force for diabetes, which outweighed the influence of SES, and which was indicated by an adverse baseline metabolic profile in participants developing diabetes in the follow-up.
AU  - Kowall, B.*
AU  - Rathmann, W.*
AU  - Strassburger, K.*
AU  - Meisinger, C.
AU  - Holle, R.
AU  - Mielck, A.
C1  - 5909
C2  - 27443
SP  - 606-612
TI  - Socioeconomic status is not associated with type 2 diabetes incidence in an elderly population in Germany: KORA S4/F4 Cohort Study.
JO  - J. Epidemiol. Community Health
VL  - 65
IS  - 7
PB  - BMJ Publishing Group Ltd.
PY  - 2011
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - Background While coverage of a celebrity suicide in the mass media may trigger copycat suicides, evidence for the effect of media reports of non-prominent suicides is moderate. Diversification of current media may raise further doubts as to whether their influence on suicidal acts is still present. We examined whether widespread media coverage of a railway accident, in which several people were killed while investigating a presumed railway suicide, subsequently increased the number of railway suicides. Methods The daily incidence of railway suicides was derived from the national accident registry on the German railway net. We estimated incidence ratios by Poisson regression, adjusting for relevant confounders (eg, outdoor temperature, unemployment rate), for the 2 months following the accident (predefined index period) and predefined control periods (preceding 2 years of the same period and 1 month before/after the index period). Results The mean number of railway suicides per day in the index period increased significantly to 2.66 (95% CI 2.19 to 3.13) compared to 1.94 (95% CI 1.78 to 2.10) during both control periods. Fully adjusted Poisson regression showed a 44% daily increase in railway suicides in the index period compared to the control periods (incidence ratio 1.44, 95% CI 1.02 to 2.03). A maximum of eight suicides per day was reached about 1 week after the accident. Conclusions Non-fictional media coverage of a fatal accident appears to affect subsequent railway suicide numbers. Supposedly, media reports drew attention to railways as a means of suicide.
AU  - Kunrath, S.
AU  - Baumert, J.J.
AU  - Ladwig, K.-H.
C1  - 6540
C2  - 28845
SP  - 825-828
TI  - Increasing railway suicide acts after media coverage of a fatal railway accident? An ecological study of 747 suicidal acts.
JO  - J. Epidemiol. Community Health
VL  - 65
IS  - 9
PB  - BMJ Publishing Group
PY  - 2011
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - Living in a damp or mouldy home reportedly damages children's respiratory health, yet mould appears not to be a prominent risk factor in the public's perception. Analyses of data on over 58,000 children from the Pollution and the Young (PATY) study are presented. In this collaboration, researchers from 12 cross-sectional studies pooled their data to assess the effects of air quality on a spectrum of children's respiratory disorders. METHOD: Original studies were conducted in Russia, North America and 10 countries in Eastern and Western Europe. Pooled analyses were restricted to children aged 6-12 years. Associations between visible mould reported in the household and a spectrum of eight respiratory and allergic symptoms were estimated within each study. Logistic regressions were used, controlling for individual risk factors and for study area. Heterogeneity between study-specific results and mean effects (allowing for heterogeneity) were estimated using meta-analysis. RESULTS: Visible mould was reported by 13.9% of respondents in Russia, increasing to 39.1% in North America. Positive associations between exposure to mould and children's respiratory health were seen with considerable consistency across studies and across outcomes. Confounder-adjusted combined ORs ranged from 1.30 (95% CI 1.22 to 1.39) for "nocturnal cough" to 1.50 (1.31 to 1.73) for "morning cough". Evidence of stronger effects in more crowded households was statistically significant for only asthma and sensitivity to inhaled allergens. No consistent interactions between mould and age, sex or parental smoking were found. CONCLUSION: Indoor mould exposure was consistently associated with adverse respiratory health outcomes in children living in these diverse countries.
AU  - Antova, T.*
AU  - Pattenden, S.*
AU  - Brunekreef, B.*
AU  - Heinrich, J.
AU  - Rudnai, P.*
AU  - Forastiere, F.*
AU  - Luttmann-Gibson, H.*
AU  - Grize, L.*
AU  - Katsnelson, B.*
AU  - Moshammer, H.*
AU  - Nikiforov, B.*
AU  - Slachtova, H.*
AU  - Slotova, K.*
AU  - Zlotkowska, R.*
AU  - Fletcher, T.*
C1  - 379
C2  - 25555
SP  - 708-714
TI  - Exposure to indoor mould and children's respiratory health in the PATY study.
JO  - J. Epidemiol. Community Health
VL  - 62
IS  - 8
PB  - BMJ Publ. Group
PY  - 2008
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - Annoyance caused by air pollution has been proposed as an indicator of exposure to air pollution. The aim of this study was to assess the geographical homogeneity of the relationship between annoyance and modelled home-based nitrogen dioxide (NO2) measurements. METHODS: The European Community Respiratory Health Survey II was conducted in 2000-1, in 25 European centres in 12 countries. This analysis included 4753 subjects (from 37 in Tartu, Estonia, to 532 in Antwerp, Belgium) who answered the annoyance question and with available outdoor residential NO2 (4399 modelled and 354 measured) including 20 cities from 10 countries. Annoyance as a result of air pollution was self-reported on an 11-point scale (0, no disturbance at all; 10, intolerable disturbance). Demographic and socioeconomic factors, smoking status and the presence of respiratory symptoms or disease were measured through a standard questionnaire. Negative binomial regression was used. RESULTS: The median NO2 concentration was 27 microg.m(-3) (from 10 in Umeå, Sweden, to 57 in Barcelona, Spain). The mean of annoyance was 2.5 (from 0.7 in Reykjavik, Iceland, to 4.4 in Huelva, Spain). NO2 was associated with annoyance (ratio of the mean score 1.26 per 10 microg.m(-3), 95% CI 1.19 to 1.34). The association between NO2 and annoyance was heterogeneous among cities (p for heterogeneity 
AU  - Jacquemin, B.*
AU  - Sunyer, J.*
AU  - Forsberg, B.*
AU  - Aguilera, I.*
AU  - Briggs, D.*
AU  - Götschi, T.*
AU  - Heinrich, J.
AU  - Torén, K.*
AU  - Vienneau, D.*
AU  - Künzli, N.*
C1  - 746
C2  - 25262
TI  - Association between annoyance and individuals' values of nitrogen dioxide in a European setting.
JO  - J. Epidemiol. Community Health
VL  - 62
IS  - 5
PB  - BMJ Publ. Group
PY  - 2008
SN  - 0143-005X
ER  - 

TY  - JOUR
AU  - Barnett, A.G.*
AU  - Dobson, A.J.*
AU  - McElduff, P.*
AU  - Salomaa, V.*
AU  - Kuulasmaa, K.*
AU  - Sans, S.*
C1  - 2749
C2  - 22981
SP  - 551-557
TI  - Cold periods and coronary events: An analysis of populations worldwide.
JO  - J. Epidemiol. Community Health
VL  - 59
PY  - 2005
SN  - 0143-005X
ER  - 

TY  - JOUR
AB  - STUDY OBJECTIVE: To assess whether there are variations between 11 Western European countries with respect to the size of differences in self reported morbidity between people with high and low educational levels. DESIGN AND METHODS: National representative data on morbidity by educational level were obtained from health interview surveys, level of living surveys or other similar surveys carried out between 1985 and 1993. Four morbidity indicators were included and a considerable effort was made to maximise the comparability of these indicators. A standardised scheme of educational levels was applied to each survey. The study included men and women aged 25 to 69 years. The size of morbidity differences was measured by means of the regression based Relative Index of Inequality. MAIN RESULTS: The size of inequalities in health was found to vary between countries. In general, there was a tendency for inequalities to be relatively large in Sweden, Norway, and Denmark and to be relatively small in Spain, Switzerland, and West Germany. Intermediate positions were observed for Finland, Great Britain, France, and Italy. The position of the Netherlands strongly varied according to sex: relatively large inequalities were found for men whereas relatively small inequalities were found for women. The relative position of some countries, for example, West Germany, varied according to the morbidity indicator. CONCLUSIONS: Because of a number of unresolved problems with the precision and the international comparability of the data, the margins of uncertainty for the inequality estimates are somewhat wide. However, these problems are unlikely to explain the overall pattern. It is remarkable that health inequalities are not necessarily smaller in countries with more egalitarian policies such as the Netherlands and the Scandinavian countries. Possible explanations are discussed.
AU  - Cavelaars, A.E.*
AU  - Kunst, A.E.*
AU  - Geurts, J.J.*
AU  - Crialesi, R.*
AU  - Grötvedt, L.*
AU  - Helmert, U.*
AU  - Lahelma, E.*
AU  - Lundberg, O.*
AU  - Matheson, J.*
AU  - Mielck, A.
AU  - Mizrahi, A.*
AU  - Rasmussen, N.K.*
AU  - Regidor, E.*
AU  - Spuhler, T.*
AU  - Mackenbach, J.P.*
C1  - 24155
C2  - 31444
SP  - 219-227
TI  - Differences in self reported morbidity by educational level: A comparison of 11 western European countries.
JO  - J. Epidemiol. Community Health
VL  - 52
IS  - 4
PB  - BMJ Publishing Group
PY  - 1998
SN  - 0143-005X
ER  -