Low Gross Domestic Product Research Articles

Regional Disparities, Economic Development, and Neonatal Mortality and Hospital Delivery in China

A negative association between neonatal mortality and hospital delivery has been found in some low- and lower-middle-income countries but not in rural settings characterized by poor quality of maternal and child health care. To examine the association between neonatal mortality and hospital delivery in China across urban and rural regions, regional disparities, and varying levels of economic development. This retrospective cohort study used county-level data from 2008 to 2020 from the National Maternal & Child Health Statistics across mainland China. Statistical analysis was conducted from March to December 2023. Since 2008, China has strategically leveraged hospital deliveries with national subsidies to diminish neonatal mortality, particularly in rural areas. Neonatal mortality and hospital delivery rates were calculated, and their association was estimated using multivariable fixed-effects linear models of county-level cohort data to adjust for time-invariant differences across counties and controls for gross domestic product (GDP) per capita, women's years of education, hospital beds, and health workers. The analysis included data from 2930 counties, with 198.7 million live births across 36 255 county-year records between 2008 and 2020. The mean (SD) neonatal mortality rate per 1000 live births decreased in rural areas from 12.3 (7.5) in 2008 to 3.9 (2.7) in 2020 and decreased in urban areas from 5.0 (3.1) in 2008 to 2.0 (1.3) in 2020. Hospital delivery rates increased in rural areas from a mean (SD) of 93.4% (11.8%) in 2008 to 99.9% (0.6%) in 2020 and increased in urban areas from 97.7% (6.1%) in 2008 to 100.0% (0.1%) in 2020. In rural areas, an increase of 10 percentage points in hospital deliveries was associated with a neonatal mortality rate of -1.4 (95% CI, -1.9 to -1.0; P < .001) per 1000 live births, whereas this negative association was not observed in urban areas. When the analysis was stratified by regions and incomes, the negative association became considerably stronger in the western and central regions of China, as well as in counties with lower GDP per capita. This cohort study of more than 2900 counties in China suggests that an increase in hospital deliveries was associated with reduced neonatal mortality in rural and economically underdeveloped areas in China. To further reduce neonatal mortality and improve newborn health, it is imperative to increase the accessibility of hospital delivery services.

Do tobacco regulatory and economic factors influence smoking cessation outcomes? A post-hoc analysis of the multinational EAGLES randomised controlled trial

IntroductionWe previously reported global regional differences in smoking cessation outcomes, with smokers of US origin having lower quit rates than smokers from some other countries. This post-hoc analysis examined global...

Why some countries but not others? Urbanisation, GDP and endemic disease predict global SARS-CoV-2 excess mortality patterns

ContextThe global impact of the SARS-CoV-2 pandemic has been uneven, with some regions experiencing significant excess mortality while others have been relatively unaffected. Yet factors which predict this variation remain enigmatic, particularly at large spatial scales.ObjectivesWe aimed to uncover the key drivers of excess mortality across countries and regions to help understand the factors contributing to the varied impacts of the pandemic worldwide.MethodsWe used spatially explicit Bayesian models that integrate environmental, socio-demographic and endemic disease data at the country level to provide robust global estimates of excess SARS-CoV-2 mortality (P-scores) for the years 2020 and 2021.ResultsWe find that urbanization, gross domestic product (GDP) and spatial patterns are strong predictors of excess mortality, with countries characterized by low GDP but high urbanization experiencing the highest levels of excess mortality. Intriguingly, we also observed that the prevalence of malaria and human immunodeficiency virus (HIV) are associated with country-level SARS-CoV-2 excess mortality in Africa and the Western Pacific, whereby countries with low HIV prevalence but high malaria prevalence tend to have lower levels of excess mortality. While these associations are correlative in nature at the macro-scale, they emphasize that patterns of endemic disease and socio-demographic factors are needed to understand the global dynamics of SARS-CoV-2.ConclusionsOur study identifies factors associated with variation in excess mortality across countries, providing insights into why some were more impacted by the pandemic than others. By understanding these predictors, we can better inform global outbreak management strategies, such as targeting medical resources to highly urban countries with low GDP and high HIV prevalence to reduce mortality during future outbreaks.

The COVID-19 pandemic as a modifier of DGBI symptom severity: A systematic review and meta-analysis.

This SRMA reviewed and assessedthe changes in the severity of disorders of gut-brain interaction (DGBI) symptoms during the COVID-19 pandemic, and evaluated factors associated with symptom severity changes. Electronic databases were searched until February 2024, for articles reporting on changes in symptom severity in DGBI patients during the COVID-19 pandemic. The proportion of DGBI patients who reported a change in their symptom severity were pooled using a random-effects model, and subgroup analyses were conducted to assess the effect of socio-cultural modifiers on symptom severity in DGBI. Twelve studies including 3610 DGBI patients found that 31.4% (95% CI, 15.9-52.5) of DGBI patients experienced symptom deterioration, while 24.3% (95% CI, 10.2-47.5) experienced improvement. Countries with high gross domestic product (GDP) had a 43.5% (95% CI, 16.3-75.2) likelihood of symptom deterioration, compared to 9.2% (95% CI, 1.4-42.2) in lower GDP countries. Similarly, countries with low COVID fatality rates had a 60.1% (95% CI, 19.7-90.3) likelihood of symptom deterioration, compared to 18.3% (95% CI, 7.8-36.9) in higher fatality rate countries. Countries with lenient COVID policies had a 58.4% (95% CI, 14.1-92.3) likelihood of symptom deterioration, compared to 19% (95% CI, 8.2-38.1) in countries with stricter policies. Patients in high vaccine hesitancy countries had a 51.4% (95% CI, 19.5-82.2) likelihood of symptom deterioration, compared to 10.6% (95% CI, 2.7-33.4) in low vaccine hesitancy countries. This meta-analysis reveals that a significantly higher proportion of DGBI patients experienced deterioration of symptoms during the COVID-19 pandemic. Various sociocultural, economic and environmental factors potentially modify the effects of the COVID-19 pandemic on DGBI.

Assessment of the impact of integrated disease surveillance and response system on surveillance management at healthcare facilities in Pakistan.

Disease surveillance is very crucial especially in high vulnerability settings like Pakistan. However, surveillance and outbreak response management are still evolving in the country and research studies are needed to assess the existing system. To assess the impact of integrated disease surveillance and response system (IDSRS) implemented by the provincial government to strengthen infectious disease surveillance and reporting in 6 districts of Pakistan in 2016. A baseline cross-sectional assessment of health facilities and the healthcare workforce was conducted in 2016 to identify needs and gaps in public sector health facilities and the health system of 6 selected districts of Khyber Pakhtunkhwa Province, Pakistan. This was followed by a 2018 endline survey of the same facilities using the same variables. Overall, there was improvement in district management and facility level performance (χ2 (1, 314) = 21.19, P < 0.001, V = 0.26). District level management improved significantly in areas with relatively lower Gross Domestic Product (GDP)? χ2(1, 154) = 30.41, P <0.001, V = 0.44). Facilitation domain variables improved in the lower GDP districts (χ2 (1, 74) = 5.76, P = 0.016, V = 0.28) and showed counterintuitive deterioration (χ2 (1, 74) = 4.80, P = 0.028, V = 0.25) in relatively higher GDP areas. IDSRS is effective in improving surveillance and response systems, however, its effectiveness appears to depend on locale-specific economies and can be enhanced by modifying the implementation approach. Better empowerment of the local workforce can contribute to such improvement.

Changes in tuberculosis burden and its associated risk factors in Guizhou Province of China during 2006–2020: an observational study

BackgroundUnderstanding the trends of tuberculosis (TB) burden and its risk factors at the provincial level in the context of global End TB targets is crucial to identify the progress and challenges in TB control. We aimed to estimate the burden of TB and risk factors for death from 2006 to 2020 for the first time in Guizhou Province, China.MethodsData were collected from the national TB surveillance system. Four indicators of TB burden and their corresponding age-standardized rates (ASRs), including incidence (ASIR), prevalence (ASPR), mortality (ASMR) and disability-adjusted life years (DALYs) (ASDR), were estimated and stratified by year, age, gender and prefecture. Temporal trends of ASRs were presented by locally weighted regression, and the annual percentage change was calculated. The correlation between gross domestic product (GDP) per capita and ASRs was evaluated by Pearson correlation analysis. The associated risk factors for death in PTB patients were determined using logistic regression models.ResultsA total of 557,476 pulmonary TB (PTB) cases and 11,234 deaths were reported, including 2233 (19.9%) TB specific deaths and 9001 (80.1%) deaths from other causes. The 15-year average incidence, prevalence and mortality rates were 94.6, 102.6 and 2.1 per 100,000 population, respectively. The average DALY rate was 0.60 per 1000 population. The ASIR and ASPR have shown downward trends since 2012, with the largest percentage decrease in 2020 (ASIR: -29.8%; ASPR: -30.5%). The number in TB specific deaths consistently decreased during the study period (P<0.001), while the increase in deaths from other causes drove the overall upward trend in ASMR and ASDR. Four ASRs remained high in males and 5 prefectures. GDP per capita was negatively associated with the ASIR, ASPR and ASDR (P<0.05). Among PTB patients, men, patients with no fixed job, those with a low GDP level, patients with increasing age, those previously treated, those with severe symptoms, those transferred in and those receiving directly observed treatment were more likely to suffer death.ConclusionGuizhou has made progress in reducing PTB cases and TB specific deaths over the last 15 years. Targeted interventions are needed to address these risk factors for death in PTB patients and high-risk areas.

Increasing ratio of opportunistic infections associated with sunshine exposure and economic level burdening Chinese inflammatory bowel disease hospitalized patients: the first nationwide survey from 2014 to 2019

BackgroundThe rising prevalence of opportunistic infections (OIs) in inflammatory bowel disease (IBD) in conjunction with the use of biologics/immunosuppressive agents has garnered attention. However, there is a dearth of research on OIs in Mainland China. This study seeks to evaluate the national ratio trend of OIs in IBD and elucidate the influence of economic and climate factors on IBD patients with OIs and their outcomes.MethodsThe nationwide data was obtained from the Inpatient medical record home page via the Health Statistics and Information Reporting System (HSRS). Patients diagnosed with IBD were enlisted for participation, and their demographic and clinical information, encompassing infection type, surgical procedures, and expenses, were gathered. The National Bureau of Statistics provided data on monthly sunshine exposure hours and yearly Gross Domestic Product (GDP).ResultsFindings indicate that between 2014 and 2019, a total of 381,752 patients with IBD were admitted to hospitals, with 364,249 patients lacking OIs and 17,503 patients presenting with OIs. The annual proportion of OIs exhibited an upward trend, rising from 3.54% in 2014 to 4.81% in 2019. There was a significant correlation observed between individuals who identified as male, those who visited hospitals in southern regions, or those originating from areas with lower GDP or shorter sunshine exposure hours, and a higher incidence of OIs. Among patients diagnosed with either Crohn’s disease (CD) or ulcerative colitis (UC), Clostridium difficile was found to be the most prevalent infection, followed by Epstein-Barr virus and cytomegalovirus. Furthermore, the occurrence of OIs was found to be associated with an increased rate of surgical interventions in UC patients.ConclusionsThe rising prevalence of OIs among hospitalized patients with IBD necessitates heightened attention towards mitigating associated risk factors, particularly among IBD patients residing in less developed regions or experiencing limited exposure to sunlight. This approach aims to minimize hospital stays and associated costs.

ДОСЛІДЖЕННЯ ВІДМІННОСТЕЙ У РІВНІ ІНКЛЮЗИВНОГО РОЗВИТКУ КРАЇН ЦЕНТРАЛЬНОЇ ТА СХІДНОЇ ЄВРОПИ

Using modern tools – the analytical platform Deductor – the method of data clustering analyzed socio-economic differences between the countries of Central and Eastern Europe in terms of their inclusive development. Attention is drawn to the fact that the Inclusive Development Index (IDI) in our time is promoted as an adjunct and even a substitute for the indicator Gross Domestic Product (GDP). According to the results of modeling by the Kohonen map method, sixteen countries of Central and Eastern Europe (including Ukraine) were involved in the study, which, on the basis of intellectual data processing, were grouped into three clusters based on the analysis of twelve X1...X12 indicators selected to characterize inclusive development. For each of the clusters, the characteristics of inclusive development for those countries included in the corresponding cluster were identified and analyzed. The cluster with the conditional number "0" includes 6 countries (Estonia, Lithuania, Hungary, Latvia, Poland and Croatia), which have relatively high indicators of the economic and environmental component of inclusive development, but relatively low standards of the social component of inclusive development. In addition to Poland, these countries have a relatively small population. All countries in cluster "0" are faced with demographic challenges, such as a decrease in the birth rate and an increase in the average age of the population. This cluster "0" includes Estonia - a country that belongs to developed countries when calculating the of Inclusive Development Index, despite the fact that the remaining countries in this cluster belong to developing countries. The cluster with the conditional number "1" includes countries (the Czech Republic, Slovenia and the Slovak Republic) that have a relatively high level of GDP per capita and a high level of labor productivity, that is, they have relatively high indicators of the economic component of inclusive development. These countries also observe relatively high standards of the social component and the environmental component of inclusive development. The cluster with the conditional number "2" includes countries (Romania, Bulgaria, Macedonia, Albania, Moldova, Serbia and Ukraine), which are characterized by low GDP per capita and low median household income, that is, these countries have low indicators of the economic component of inclusive development. These countries also observe relatively low standards of the social and environmental component of inclusive development.

The clean energy development path and sustainable development of the ecological environment driven by big data for mining projects

Clean energy is urgently needed to realize mining projects’ sustainable development (SD). This study aims to discuss the clean energy development path and the related issues of SD in the ecological environment driven by big data for mining projects. This study adopts a comprehensive research approach, including a literature review, case analysis, and model construction. Firstly, an in-depth literature review of the development status of clean energy is carried out, and the existing research results and technology applications are explored. Secondly, some typical mining projects are selected as cases to discuss the practice and effect of their clean energy application. Finally, the corresponding clean energy development path and the SD analysis model of the ecological environment are constructed based on big data technology to evaluate the feasibility and potential benefits of promoting and applying clean energy in mining projects. (1) It is observed that under different Gross Domestic Product (GDP) growth rates, the new and cumulative installed capacities of wind energy show an increasing trend. In 2022, under the low GDP growth rate, the cumulative installed capacity of global wind energy was 370.60 Gigawatt (GW), and the new installed capacity was 45 GW. With the high GDP growth rate, the cumulative and new installed capacities were 367.83 GW and 46 GW. As the economy grows, new wind energy capacity is expected to increase significantly by 2030. In 2046, 2047, and 2050, carbon dioxide (CO2) emissions reductions are projected to be 8183.35, 8539.22, and 9842.73 Million tons (Mt) (low scenario), 8750.68, 9087.16, and 10,468.75 Mt (medium scenario), and 9083.03, 9458.86, and 10,879.58 Mt (high scenario). By 2060, it is expected that CO2 emissions reduction will continue to increase. (2) The proposed clean energy development path model has achieved a good effect. Through this study, it is hoped to provide empirical support and decision-making reference for the development of mining projects in clean energy, and promote the SD of the mining industry, thus achieving a win-win situation of economic and ecological benefits. This is of great significance for protecting the ecological environment and realizing the sustainable utilization of resources.

Wasted GDP in the USA

Whether or to what extent Gross Domestic Product (GDP) can measure human development is disputed. This article develops a notion of “wasted GDP”, with a case study on the performance of the USA based on analysis of Human Development Index (HDI) data. Like Herman Daly’s notion of ‘uneconomic growth’, the perspective of wasted GDP addresses the benefits and costs of economic growth and favors prioritization of policies that promote genuinely sustainable wellbeing. Over the last three decades, the USA has fallen behind several other highly developed countries in the HDI, despite solid economic growth. More than 20 countries, large and small, now outperform the USA on the Human Development Index, and 27 countries currently do better than the USA by nonincome HDI. 21 countries outperform the USA by this measure despite having a lower GDP per capita. The notion of “wasted GDP” implies that GDP is wasted if it does not support welfare. While a country´s welfare performance is measured by nonincome HDI, a comparison with better-performing countries that have a lower GDP indicates the share of GDP that is wasted from a human development perspective. The results, based on highly conservative estimates, show that the top 5 performers by lowest GDP per capita achieve better outcomes than the USA with an average GDP per capita that is 37.5% lower. All better performers achieve better outcomes with an average GDP per capita that is 26.9% lower. Without any wasted GDP, the annual US CO2 emissions could have been at least 1.268 million tonnes lower (all better performers estimate) and possibly as much as 1.767 million tonnes lower (top 5 performers estimate), accounting for 3.6–5.0% of global emissions. Similarly, the USA´s material footprint could have been between 2.625 million and 3.659 million tonnes lower, accounting for 2.7–3.8% of humanity´s global material footprint.

Interaction patterns between economic growth and atmospheric environment in China under the "carbon neutrality" target.

Clarifying the interaction patterns between economic growth and atmospheric environment (EG-AE) in China is important to achieve the "carbon neutrality" target. A conceptual framework of air pollutant emission in urban economic growth (APEUEG) was proposed to explore the interaction patterns in China from 2007 to 2017. The empirical analysis revealed that a N-shaped EKC exists between aerosol optical depth (AOD) and gross domestic product (GDP), with inflection points of $5000 and $27,000, respectively. Therefore, we speculated that when GDP per capita of a city exceeded $5000, the AOD gradually decreased. However, when GDP per capita of a city gained over $27,000, the economic growth and the atmospheric environment would be coordinated steadily. The interaction of EG-AE experienced three stages-pollution, improvement, and coordination-in China. Spatially, the interaction patterns of EG-AE presented five clusters, which were associated with the spatial distribution of city levels. China's prefecture-level cities have undergone the cluster of low AOD-low GDP (LL), the cluster of high AOD-high GDP (HH), and the cluster of low AOD-high GDP (LH), as urban level improves. By 2017, about 44% of Chinese cities had not completed the coordinated development yet. We found that policymakers should formulate differentiated urban greener economic development policies to reduce APEUEG.

Premature exit from and delayed entrance into the less developed status: An empirical appraisal of the structural funds allocation criterion

AbstractThis paper investigates the impact of the main criterion employed by the European Commission for the allocation of the largest portion of Structural Funds, based on the threshold of the 75% of European Union (EU) average gross domestic product (GDP) per capita. We focus on the 2014–2020 programming period and on EU‐15 regions to analyze if this criterion has penalized some of them, as a consequence of the 2004 EU enlargement, which has represented an exogenous shock in the allocation process, due to the economic backwardness of new member states. Through the application of Synthetic Control Methods and Difference‐in‐Differences estimators at different geographical scales, we show that regions that did not obtain the less developed status in both the programming period 2007–2013 and 2014–2020, but that would have obtained it in the period 2014–2020 without the 2004 EU enlargement, experienced a significantly lower GDP per capita growth between −10.5% and −5.7%. Conversely, territories that in the period 2014–2020 lost the less developed status, previously obtained in the time frame 2007–2013, were not characterized by a significantly lower economic growth, providing some evidence of the effectiveness of the safety net.

Effect of air pollution on the prevalence of breast and cervical cancer in China: a panel data regression analysis.

The association between the prevalence of breast and cervical cancer in Chinese women and air pollution is obscure. The study aims to analyze the correlation between air pollution and the prevalence of breast and cervical cancer, and whether the gross domestic product (GDP) has a modifying effect on the impact of air pollution on the prevalence of breast and cervical cancer. Extracting panel data from 31 provinces and cities between 2006 and 2020, we evaluated the association between breast and cervical cancer prevalence and pollutant emissions from 2006 to 2015 with two-way fixed-effect models. We also analyzed the interaction between GDP and pollutant emissions and further check the robustness of the moderating effect results using group regression from 2016 to 2020. Cluster robust standard errors were used to correct for the heteroskedasticity and autocorrelation. The coefficients of models show that the coefficients of logarithmic soot and dust emissions are estimated to be significantly positive, and the coefficients of their square terms are significantly negative. The robust results suggest that the relationship between soot and dust emissions and breast or cervical cancer prevalence is non-linear, from 2006 to 2015. In the analysis of particulate matter (PM) data in 2016-2020, the PM-GDP interaction term was also significantly negative, indicating that GDP growth weakened the effect of PM on the prevalence of breast cancer and cervical cancer. In provinces with higher GDP, the indirect effect of PM emissions concerning breast cancer is -0.396 while in provinces with lower GDP, it is about -0.215. The corresponding coefficient concerning cervical cancer is about -0.209 in provinces with higher GDP but not significant in provinces with lower GDP. Our results suggest that there is an inverted U-shaped relationship between the prevalence of breast cancer and cervical cancer and air pollutants from 2006 to 2015. GDP growth has a significant negative moderating effect on the impact of air pollutants on the prevalence of breast cancer and cervical cancer. PM emissions have a higher effect on the prevalence of breast and cervical cancer in provinces with higher GDP and a lower impact in provinces with lower GDP.

Understanding the relationship between states' unemployment rates and gross domestic product

This research paper examines the factors that affect the unemployment rate in public sector states of America. The study is based on the relationship between states' unemployment rates and Gross Domestic Product (GDP). The research question is: What is the relationship between states' unemployment rates and GDP? The hypothesis is that states with high unemployment rates will have lower GDPs. The research design contains three studies and one theory for different authors in the literature review section relevant to this study. The unit of analysis is the states of America. The paper proposes a methodology that describes the measures of the study. The researcher used nominal-level data to measure states and scale to measure GDP, states' unemployment rate, and population. The study concludes that higher unemployment rates caused lower GDP in states of America. An interesting subject for future study is the effects of states' unemployment rates on the state's GDP.

Changes in the Association between GDP and Night-Time Lights during the COVID-19 Pandemic: A Subnational-Level Analysis for the US

Night-time light (NTL) data have been widely used as a remote proxy for the economic performance of regions. The use of these data is more advantageous than the traditional census approach is due to its timeliness, low cost, and comparability between regions and countries. Several recent studies have explored monthly NTL composites produced by the Visible Infrared Imaging Radiometer Suite (VIIRS) and revealed a dimming of the light in some countries during the national lockdowns due to the COVID-19 pandemic. Here, we explicitly tested the extent to which the observed decrease in the amount of NTL is associated with the economic recession at the subnational level. Specifically, we explore how the association between Gross Domestic Product (GDP) and the amount of NTL is modulated by the pandemic and whether NTL data can still serve as a sufficiently reliable proxy for the economic performance of regions even during stressful pandemic periods. For this reason, we use the states of the US and quarterly periods within 2014–2021 as a case study. We start with building a linear mixed effects model linking the state-level quarterly GDPs with the corresponding pre-processed NTL data, additionally controlling only for a long-term trends and seasonal fluctuations. We intentionally do not include other socio-economic predictors, such as population density and structure, in the model, aiming to observe the ‘pure’ explanatory potential of NTL. As it is built only for the pre-COVID-19 period, this model demonstrates a rather good performance, with R2 = 0.60, while its extension across the whole period (2014–2021) leads to a considerable worsening of this (R2 = 0.42), suggesting that not accounting for the COVID-19 phenomenon substantially weakens the ‘natural’ GDP–NTL association. At the same time, the model’s enrichment with COVID-19 dummies restores the model fit to R2 = 0.62. As a plausible application, we estimated the state-level economic losses by comparing actual GDPs in the pandemic period with the corresponding predictions generated by the pre-COVID-19 model. The states’ vulnerability to the crisis varied from ~8 to ~18% (measured as a fraction of the pre-pandemic GDP level in the 4th quarter of 2019), with the largest losses being observed in states with a relatively low pre-pandemic GDP per capita, a low number of remote jobs, and a higher minority ratio.

Long-term exposure to fine particulate matter and site-specific cancer mortality: A difference-in-differences analysis in Jiangsu province, China

BackgroundAccumulating studies have reported that chronic exposure to ambient fine particulate matter (PM2.5) can lead to adverse effects on lung cancer mortality; however, such chronic effects are less clear for mortality from other site-specific cancers. ObjectiveTo explore the causal effect of long-term PM2.5 exposure on mortality from all-site and a variety of site-specific cancers in Jiangsu province, China during 2015–2020 using a difference-in-differences analysis. MethodsFor each of 53 county-based spatial units in Jiangsu province, we calculated annual death counts for all-site cancer and 23 site-specific cancers. Using a validated high-resolution PM2.5 grid dataset, long-term PM2.5 exposure of a spatial unit within a given year was evaluated as the average of population-weighted annual concentrations during recent 10 years. Conditional Poisson regression models were employed to evaluate exposure-response associations adjusting for spatial and temporal variables, seasonal temperatures, relative humidity, and gross domestic product (GDP). ResultsDuring the study period, we identified 947,337 adult cancer deaths in Jiangsu province. Each 1 μg/m3 increment in PM2.5 exposure was significantly associated with a 2.7% increase in the risk of all-site cancer mortality. PM2.5-mortality associations were also observed in cancer of lip, oral cavity and pharynx, stomach, colorectum, pancreas, lung, bone and joints, ovary, prostate, and lymphoma (all adjusted P < 0.05), with the relative risks ranging from 1.028 (95% confidence interval [CI]: 1.011, 1.046) for stomach cancer to 1.201 (95% CI: 1.120, 1.308) for bone and joints cancers. Exposure-response curves showed that these associations were close to linearity, though most of them had increasing slopes at high exposure levels. Overall, women and subjects in low GDP regions were more vulnerable to PM2.5 exposures. ConclusionsLong-term exposure to ambient PM2.5 contributes to a higher risk of mortality from multiple site-specific cancers.

Insomnia, Daytime Sleepiness, and Quality of Life among 20,139 College Students in 60 Countries around the World-A 2016-2021 Study.

Sleep disorders are a widespread phenomenon, and the number of individuals suffering from them is increasing every year, especially among young adults. Currently, the literature lacks studies that cover both countries with different levels of development and a period before the announcement of the ongoing COVID-19 pandemic. Therefore, this study aims to globally assess the prevalence of insomnia and daytime sleepiness among students and assess their quality of life. For this purpose, our own questionnaire was distributed online via Facebook.com. In addition to the questions that assessed socioeconomic status, the survey included psychometric tools, such as the Athens insomnia scale (AIS), the Epworth sleepiness scale (ESS), and the Manchester short assessment of the quality of life (MANSA). The survey distribution period covered 31 January 2016 to 30 April 2021. The survey involved 20,139 students from 60 countries around the world. The vast majority of the students were women (78.2%) and also those residing in countries with very high levels of development and/or high GDP (gross domestic product) per capita at 90.4% and 87.9%, respectively. More than half (50.6%) of the respondents (10,187) took the survey before the COVID-19 pandemic was announced. In the group analyzed, 11,597 (57.6%) students obtained a score indicative of insomnia and 5442 (27.0%) a score indicative of daytime sleepiness. Women, low-income residents, and nonmedical students were significantly more likely to have scores indicating the presence of insomnia. Individuals experiencing both sleepiness (B = -3.142; p &lt; 0.001) and daytime sleepiness (B = -1.331; p &lt; 0.001) rated their quality of life significantly lower. Insomnia and excessive daytime sleepiness are common conditions among students worldwide and are closely related. The COVID-19 pandemic significantly altered students' diurnal rhythms, which contributed to an increase in insomnia. Students in countries with a high GDP per capita index are significantly less likely to develop insomnia compared to the residents of countries with a low GDP per capita index. Sleep disorders definitely reduce the quality of life of students.

The impact of cancer on psychosocial function and quality of life: A cross-sectional study in 18 pan-European countries.

To improve psychosocial cancer care in Europe, more information is needed on psychosocial function and quality of life (QoL) among cancer patients in European countries. To investigate differences in psychosocial function between cancer survivors and the general population in Europe, in relation to national economic status and personal factors. Data were from the Survey of Health, Aging and Retirement in Europe (Wave 6). Main outcomes were psychosocial functioning: activity limitations, income adequacy, loneliness, depression, and QoL. Factors possibly associated with the main outcomes were ever having cancer, gross domestic product (GDP), and personal factors (age, gender, education, marriage status, employment status, number of children, number of chronic diseases). The study sample featured 6238 cancer survivors and 60,961 individuals without cancer aged 50 or older in 17 European countries and Israel. Levels of depression were higher and QoL was lower among cancer survivors compared to individuals without cancer and worse in low GDP countries, whereas differences in income adequacy and loneliness were not statistically significant. The interaction of cancer groups and country groups indicated a significant interactional effect on activity limitations, loneliness, depression, and QoL. In a multivariate regression analysis, personal factors, GDP, and being a cancer survivor predicted the main outcome variables. Cancer has a persistent negative effect on survivors that is related to a country's GDP. Cancer survivors in low-GDP countries are affected by the consequences of cancer intertwined with the hardships of living in a low-GDP country.

Desigualdade socioeconômica na letalidade e no cuidado hospitalar de crianças e adolescentes internados por COVID-19 no Brasil

To analyze the association of hospital case fatality rate and care received by children and adolescents hospitalized for COVID-19 with the gross domestic product (GDP) per capita of Brazilian municipalities and regions of residence. Data were collected from the Influenza Epidemiological Surveillance Information System and the Brazilian Institute of Geography and Statistics. The dichotomous outcomes analyzed were hospital case fatality rate of COVID-19, biological samples collected for COVID-19 diagnosis, X-rays, computed tomography (CT) scans, use of ventilatory support, and intensive care unit hospitalization. The covariates were municipal GDP per capita and the Brazilian region of residence. Poisson regression was used for the outcomes recorded in 2020 and 2021 in Brazil, covering the two COVID-19 waves in the country, adjusted for age and gender. The hospital case fatality rate was 7.6%. In municipalities with lower GDP per capita deciles, the case fatality rate was almost four times higher among children and twice as high in adolescents compared to cities with higher deciles. Additionally, residents of municipalities with lower GDP per capita had fewer biological samples collected for diagnosis, X-ray examinations, and CT scans. We found regional disparities associated with case fatality rate, with worse indicators in the North and Northeast regions. The findings remained consistent over the two COVID-19 waves. Municipalities with lower GDP per capita, as well as the North and Northeast regions, had worse indicators of hospital case fatality rate and care.

Significant Differences in IBD Care and Education across Europe: Results of the Pan-European VIPER Survey

Background: Inflammatory bowel disease (IBD) care and education might differ around Europe. Therefore, we conducted this European Variation In IBD PracticE suRvey (VIPER) to investigate potential differences between countries. Methods: This trainee-initiated survey, run through SurveyMonkey®, consisted of 47 questions inquiring basic demographics, IBD training, and clinical care. Results were compared according to gross domestic product (GDP) per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank). Results: The online survey was completed by 1,285 participants from 40 European countries, with a majority of specialists (65.3%) working in academic institutions (50.4%). Significant differences in IBD-specific training (55.9% vs. 38.4%), as well as availability of IBD units (58.4% vs. 39.7%) and multidisciplinary meetings (73.2% vs. 40.1%), were observed between respondees from high and low GDP countries (p < 0.0001). In high GDP countries, IBD nurses are more common (85.9% vs. 36.0%), also mirrored by more nurse-led IBD clinics (40.6% vs. 13.7%; p < 0.0001). IBD dieticians (33.4% vs. 16.5%) and psychologists (16.8% vs. 7.5%) are mainly present in high GDP countries (p < 0.0001). In the current COVID era, telemedicine is available in 73.2% versus 54.1% of the high/low GDP countries, respectively (p < 0.0001). Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly. Conclusion: Much variability in IBD practice exists across Europe, with marked differences between high and low GDP countries. Further work is required to help address some of these inequalities, aiming to improve and standardize IBD care and training across Europe.