BackgroundThe opioid overdose mortality crisis in the USA is an ongoing public health epidemic. Ongoing law enforcement strategies to disrupt local unregulated drug markets can have an iatrogenic effect of increasing overdose by driving consumers towards new suppliers with unpredictable drug products of unknown potency.MethodsCross-sectional study using point-level information on law enforcement opioid-related drug seizures from property room data, opioid-related non-fatal overdose events from emergency medical services and block group-level social determinants of health data from multiple sources. Using an endemic-epidemic spatiotemporal regression model, we estimated the degree to which exposure to drug supply disruptions triggers future overdose events within small space-time distances in Indianapolis, Indiana.ResultsNeighbourhoods with more structural racism, economic deprivation or urban blight were associated with higher rates of non-fatal overdose. Exposure to an opioid-related drug seizure event had a significant and positive effect on the epidemic probability of non-fatal overdose. An opioid seizure that occurred within 250 m and 3 days, 250 m and 7 days, and 250 m and 14 days of an overdose event increased the risk of a new non-fatal overdose by 2.62 (rate ratio (RR)=2.62, 95% CI 1.87 to 3.67), 2.17 (RR=2.17, 95% CI 1.87 to 2.59) and 1.83 (RR=1.83, 95% CI 1.66 to 2.02), respectively. Similar spatiotemporal patterns were observed in a smaller spatial bandwidth.ConclusionsResults demonstrated that overdoses exhibit a community spread process, which is exacerbated following law enforcement strategies to disrupt the unregulated drug market. We discuss decriminalisation and increasing resources that promote safer drug use to combat this public health crisis.

BackgroundThe UK legalised same-sex marriage in 2014. We examine whether same-sex marriage legalisation (SSML), an exogenous policy change, affected the health outcomes among ethnic minority lesbian, gay, bisexual and other (LGB+) individuals.MethodsUsing the UK Household Longitudinal Survey, we applied the Callaway and Sant’Anna difference-in-differences to compare physical and mental health across (a) ethnic LGB+ individuals (treatment group), (b) ethnic heterosexual individuals (control group 1) and (c) British white LGB+ individual (control group 2). The study cohort (n=7054) comprised individuals aged 16+ years at baseline in 2011, and were employed in the study period (2011–2019). The outcomes included physical component scores from the short-form 12 health survey (physical component score (PCS-12)), long-standing illnesses and psychological distress (General Health Questionnaire (GHQ)).ResultsAfter SSML, the PCS-12 among the ethnic LGB+ individuals improved significantly compared with both ethnic heterosexuals and British white LGB+ individuals (2.081, 95% CI 0.487 to 3.675). While no clear patterns were found for long-standing illnesses, the GHQ in the treatment group had modest decreases relative to ethnic heterosexuals, and relative to British white LGB+ individuals, by year 2 after SSML.ConclusionSSML in the UK led to improved physical functioning and reduced psychological distress in ethnic minority LGB+ individuals. Our study shows that ethnic LGB+ individuals may derive even greater health benefits than British white LGB+ people, providing evidence that SSML may help address racial health inequalities within LGB+ communities. As countries worldwide consider legalising same-sex marriage, it is imperative for policymakers to consider the health consequences for sexual and ethnic minorities.

BackgroundAustralia has experienced extreme fire weather in recent years. Information on the impact of fine particulate matter (PM2.5) from landscape fires (LFs) on cardiorespiratory hospital admissions is limited.MethodsWe conducted a population-based time series study to assess associations between modelled daily elevated PM2.5 at a 1.5×1.5 km resolution using a modified empirical PM2.5 exposure model during LFs and hospital admissions for all-cause and cause-specific respiratory and cardiovascular diseases for the study period (2015–2017) in Perth, Western Australia. Multivariate Poisson regressions were used to estimate cumulative risk ratios (RR) with lag effects of 0–3 days, adjusted for sociodemographic factors, weather and time.ResultsAll-cause hospital admissions and overall cardiovascular admissions increased significantly across each elevated PM2.5 concentration on most lag days, with the strongest associations of 3% and 7%, respectively, at the high level of ≥12.60 µg/m3 on lag 1 day. For asthma hospitalisation, there was an excess relative risk of up to 16% (RR 1.16, 95% CI 1.00 to 1.35) with same-day exposure for all people, up to 93% on a lag of 1 day in children and up to 52% on a lag of 3 days in low sociodemographic groups. We also observed an increase of up to 12% (RR 1.12, 95% CI 1.02 to 1.24) for arrhythmias on the same exposure day and with over 154% extra risks for angina and 12% for heart failure in disadvantaged groups.ConclusionsExposure to elevated PM2.5 concentrations during LFs was associated with increased risks of all-cause hospital admissions, total cardiovascular conditions, asthma and arrhythmias.

BackgroundLower socioeconomic positions (SEP) and poor academic achievement increase children’s risk for mental health problems. The Finnish education system is officially non-selective and unified, but a part of children can be selected into emphasised teaching classes by aptitude tests, which are known to segregate students by SEP and academic achievement. We study here if allocation of students to mainstream and selective classes segregates students by mental health, too.MethodsStudents from primary school (6th grade) were followed to lower secondary school (7th grade). The number in selective classes was n=209 and in mainstream classes n=551. Outcomes were depressed mood, anxiety and daily health complaints. Association between class type and the outcomes was analysed by cross-tabulation and logistic regression models. Gender, academic achievement, SEP and previous mental health were independent and confounding/moderating variables.ResultsStudents in selective classes had better academic achievement and higher SEP compared with students in mainstream classes. Girls reported poorer mental health than boys. Depressive mood did not vary by class type, but anxiety and daily health complaints were more common among girls in mainstream classes. When academic achievement and background factors were considered, among girls only anxiety was more common in mainstream classes, but among boys, anxiety appeared to be statistically significantly more common in selective classes.ConclusionGrouping students by aptitude tests to different classes may select them by mental health, too. Longer follow-up and gender-specific studies would give more reliable answers for education policy makers about student grouping by aptitude test and its effects on segregation.

BackgroundIn the USA, states can set higher minimum wages than the federal government. We investigated the association between state minimum wages and racial/ethnic inequities in food insecurity.MethodsHousehold-level food insecurity and sociodemographic data were obtained from the cross-sectional Current Population Survey 2015–2019 (n=189 665 households) and merged by state and year with minimum wage and cost-of-living data obtained from the US Department of Labor and US Bureau of Economic Analysis, respectively. We fitted Poisson regression models with robust standard errors with 12-month or 30-day household food insecurity as the outcome, and minimum wage or inflation-adjusted minimum wage (ie, real wage) as the predictor, adjusting for cost of living, sociodemographic covariates and state fixed-effects. We tested interactions between minimum wage and race/ethnicity and ran race/ethnicity-stratified models.ResultsIn adjusted models, the real wage was not associated with 12-month or 30-day food insecurity. Minimum wage was associated with 5% lower prevalence rate of 12-month food insecurity (PR 0.95, 95% CI=0.93 to 0.98) and 7% lower prevalence rate of 30-day food insecurity (PR 0.93, 95% CI 0.91 to 0.96) for all households. The interaction p values for race/ethnicity with real wage and minimum wage were p<0.001. In stratified models, results were statistically significant for minimum wage and 12-month food insecurity among non-Hispanic (NH) white households (PR 0.93, 95% CI 0.89 to 0.96) and Hispanic households (PR 0.95, 95% CI 0.92 to 0.98), and minimum wage and 30-day food insecurity among NH white (PR 0.92, 95% CI 0.88 to 0.96), NH black (PR 0.94, 95% CI 0.89 to 0.99) and Hispanic (PR 0.90, 95% CI 0.85 to 0.95) households.ConclusionsHigher state-level minimum wages, but not real wages, were associated with lower food insecurity prevalence overall and for racial/ethnic subgroups.

BackgroundAlcohol misuse is a major public health issue. Understanding factors that contribute to alcohol misuse or risky drinking behaviour is important for policy. This study examined if crime rates in the neighbourhood (postcode) where a person lives influences their likelihood of engaging in risky drinking behaviour. We further explored social capital and mental health as channels through which neighbourhood crime influences risky drinking behaviour.MethodsUsing 18 waves of household longitudinal data from the Household, Income and Labour Dynamics in Australia Survey for the period 2002 to 2019 merged with official police statistics on neighbourhood crime rates, we adopted fixed-effect regression models that allow us to address concerns relating to endogenous sorting of participants as well as omitted variable bias.ResultsWe find that an increase in neighbourhood crime is associated with an increase in the likelihood of risky drinking (OR=1.107, 95% CI 1.073 to 1.120), alcohol expenditure (b=0.063, 95% CI 0.041 to 0.076), alcohol consumption frequency (b=0.071, 95% CI 0.055 to 0.083) and quantity (b=0.046, 95% CI 0.032 to 0.052). We present exploratory evidence that social capital and mental health mediate the relationship between neighbourhood crime and alcohol use. Specifically, our results suggest that by eroding the level of trust and decreasing mental health, neighbourhood crime tends to increase the probability that people engage in risky alcohol behaviour.ConclusionOur findings suggest that targeting crime and in particular the channels through which crime influences risky alcohol behaviour (ie, trust and mental health) can be instrumental in addressing alcohol misuse.

The recent paper by Dunn et al showed that the positive relationship between US state-level income inequality and mortality was small in the 1950s, rose to a large value around 1990 but had largely disappeared by 2019. We consider these findings in the context of the mechanisms that have been advanced for reasons why a positive relationship might be expected, and in relation to studies using alternative methods included in systematic reviews that fail to confirm an independent inequality/mortality relationship. Ecological studies, such as by Dunn et al, using subnational data have advantages compared with similar studies using cross-national data, but controls are typically confined to those available from sources such as decennial census, so scope for incorporating lagged effects and life course factors is limited. However, they are often the only studies with the statistical power to identify subnational differentials and time trends so they are complementary to rarely available sources such as high-quality long-term individual-level microdata data required for causal analyses. Income equality can arise not only due to citizens’ positive preferences but also to external choices such as economic decline and globalisation, so examining the wider context is important when explaining excess levels of ‘deaths of despair’ in low-inequality US states. The apparent increasingly strong association between income levels and low mortality with a weakening inequality/mortality relationship has implications for policy recommendations.

BackgroundThe association between change in high-sensitivity cardiac troponin T (hs-cTnT) and stroke risk in the general population remains unknown. We aimed to assess the association of a 6-year change in hs-cTnT with incident stroke and its subtypes in the general American adult population.Methods8675 middle-aged adults without prevalent cardiovascular disease from the Atherosclerosis Risk in Communities study were included. Hs-cTnT was measured at two time points (visits 2 and 4), 6 years apart. The relative percentage change of hs-cTnT was defined as hs-cTnT at visit 4 minus that at visit 2, divided by hs-cTnT at visit 2. The study outcome was incident stroke and its subtypes. All data were analysed in 2023.ResultsOver a median follow-up of 20.1 years, 682 incident strokes occurred, including 593 ischaemic and 89 haemorrhagic strokes. For absolute change, using low/low group as reference category, the low/high (adjusted HR 1.44, 95% CI 1.03 to 2.02) and high/high (adjusted HR 1.47, 95% CI 0.93 to 2.34) groups were associated with higher risk of stroke. Moreover, the relative percentage change in hs-cTnT with stroke followed an inverted L-shaped association, levelling off at about 75% increase in hs-cTnT (P for nonlinearity=0.009). Compared with those with ≤50% change in hs-cTnT, participants with >50% increase in hs-cTnT had a higher risk of stroke (adjusted HR 1.30, 95% CI 1.03 to 1.64). Similar results were found for ischaemic stroke. No significant association was found for haemorrhagic stroke.ConclusionTemporal increase in hs-cTnT was associated with a higher risk of incident total and ischaemic stroke in the general population.

BackgroundDiet is an important risk factor for cardiovascular disease and shows well-established socioeconomic patterning among adults. However, less clear is how socioeconomic inequalities in diet develop across the life course. This study assessed the associations of early adulthood socioeconomic trajectories (SETs) with adult diet quality, adjusting for childhood socioeconomic position (SEP) and testing for mediation by adulthood SEP.MethodsParticipants from the 1970 British Cohort Study with socioeconomic data in early adulthood were included (n=12 434). Diet quality at age 46 years, evaluated using the Mediterranean diet pyramid, was regressed on six previously identified classes of early adulthood SETs between ages 16 and 24 years including a continued education class, four occupation-defined classes and an economically inactive class. Causal mediation analyses tested the mediation of the association via household income and neighbourhood deprivation at age 46 years separately. Models were adjusted for sex, childhood SEP, adolescent diet quality and adolescent health.ResultsThe continued education class showed the best diet quality at age 46 years while little difference in diet quality was found among the remaining SET classes. The association between the continued education class and adult diet quality was independent of parental SEP in childhood and was largely not mediated by household income or neighbourhood deprivation (0.7% and 3.7% of the total effect mediated, respectively) in mid-adulthood.ConclusionsEarly adulthood SETs independently contribute to adult diet quality with continuing education associated with better adherence to the Mediterranean diet. Early adulthood therefore represents a sensitive period for intervention to alleviate dietary inequalities in later life.

BackgroundLittle is known about education-related inequalities in late-life disability. Here, we use individual-level register data on the receipt of the Austrian long-term care allowance (ALTCA) to assess education-related inequalities in the duration of late-life disability.MethodsIn this retrospective mortality follow-back study, we analyse receipt of ALTCA, a universal cash benefit based on physician-assessed disability in activities of daily living, during the last 5 years of life among all decedents aged 65 years and over from 2020 in Austria (n=76 772).ResultsThe higher the level of education, the shorter the period for which ALTCA was received. Over the last 5 years of life, those with the primary/lower secondary education received ALTCA for 47% or 10 months (men), respectively, 38% or 12 months (women) longer than those with tertiary education. Education-related inequalities decreased with time to death and age at death.ConclusionWe found education-related inequalities in the duration of late-life disability, that is, higher education was associated with a prolonged ability to live independently during the last years of life. Inequalities in disability decreased with time to death and age at death, pointing to a gradual levelling due to mortality-related declines as well as selective mortality.