Prevalence Rates Of Chronic Diseases Research Articles

Estimating incidence and prevalence rates of chronic diseases using disease modeling

BackgroundMorbidity estimates between different GP registration networks show large, unexplained variations. This research explores the potential of modeling differences between networks in distinguishing new (incident) cases from existing (prevalent) cases in obtaining more reliable estimates.MethodsData from five Dutch GP registration networks and data on four chronic diseases (chronic obstructive pulmonary disease [COPD], diabetes, heart failure, and osteoarthritis of the knee) were used. A joint model (DisMod model) was fitted using all information on morbidity (incidence and prevalence) and mortality in each network, including a factor for misclassification of prevalent cases as incident cases.ResultsThe observed estimates vary considerably between networks. Using disease modeling including a misclassification term improved the consistency between prevalence and incidence rates, but did not systematically decrease the variation between networks. Osteoarthritis of the knee showed large modeled misclassifications, especially in episode of care-based registries.ConclusionRegistries that code episodes of care rather than disease generally provide lower estimates of the prevalence of chronic diseases requiring low levels of health care such as osteoarthritis. For other diseases, modeling misclassification rates does not systematically decrease the variation between registration networks. Using disease modeling provides insight in the reliability of estimates.

Gender differences in general mental health, smoking, drinking and chronic diseases in older adults in Jilin province, China

There is little information on gender differences in general mental health, smoking, drinking and chronic diseases in Chinese elderly. We examined the gender differences in general mental health, smoking, drinking and a number of chronic diseases in a large Chinese old population. Multistage stratified cluster sampling was used in this cross-sectional study. A total of 4115 people (2198 women; 1917 men) aged between 60 and 79 years were included and their general mental health, smoking, drinking and chronic diseases were recorded with standardized assessment tools. Multivariate analyses revealed that women were less likely to be current smokers and frequent drinkers, but had higher prevalence of poor mental health compared with their male counterparts. In addition, the prevalence rate of chronic diseases and multi-morbidities were higher in women than that in men (both p values <0.05). Health professionals and policy makers need to pay special attention to the common chronic diseases and poor mental health in older women and higher prevalence of smoking and drinking in men.

Study on relationship between milk intake and prevalence rates of chronic diseases in adults based on 5thand 6thKorea National Health and Nutrition Examination Survey data

Purpose: The purpose of this study was to explore the relationship between milk intake and prevalence rates of chronic diseases using KNHANES data, and the significance of the relationship was tested based on meditators, socioeconomic status (income, education), dietary behaviors (smoking, alcohol drinking, breakfast, and eating out), and physical activity (walking, medium, and high). Methods: Using the 5th and 6th survey data of KNHANES, milk intake rates and presence of seven chronic diseases were summarized and analyzed by ANOVA for two groups of adult men and women as follows: hypertension, hypertriglyceridemia, low HDL-cholesterol, diabetes, abdominal obesity, obesity, and metabolic syndrome. The dependent variables for the presence of seven chronic diseases regressed with socioeconomic, dietary behavior, and physical activity variables according to Logistic models. The dependent variables for milk intake using predictor variables of socioeconomic, dietary behaviors and physical activity were analyzed according to Logistic models. Finally, the significant socioeconomic, dietary behavior, and physical activity variables in the above model along with milk intake as a control variable or mediator variable regressed with significant chronic diseases according to Logistic models. Results: Milk intake, socioeconomic status, dietary behaviors, and physical activity were significantly different among the two groups of adult men and women, which were also critical factors to the prevalence of chronic diseases. The dependent variable for prevalence of chronic diseases regressed with significant factors of socioeconomic status, dietary behavior, and physical activity variables according to chronic diseases using the control or mediator variable of milk intake and summarized as follows: For adult men, milk intake controlled the education effect on diabetes partly, alcohol on hypertension and hypertriglyceridemia, low HDL-cholesterol, metabolic syndrome, breakfast on metabolic syndrome, eating out on obesity, and medium physical activity on hypertriglyceridemia. For adult women, household income on hypertriglyceridemia, diabetes, abdominal obesity, education level on hypertension, alcohol drinking, eating out, and walking activity on abdominal obesity, alcohol, breakfast, eating out, walking activity on low HDL-cholesterol, and medium physical activity on hypertriglyceridemia and low HDL-cholesterol were partly controlled by milk intake. Other significant socioeconomic status, dietary behavior, and physical activity variables related to prevalence of chronic diseases were fully controlled or mediated by milk intake. Conclusion: This study shows that milk intake (daily more than 200 g) prevents chronic diseases such as hypertension, hypertriglyceridemia, low HDL-cholesterol, diabetes, obesity, abdominal obesity, and metabolic syndrome.

Time trends in adult chronic disease inequalities by education in Brazil: 1998-2013.

BackgroundSocioeconomic differences in health in Brazil are largely driven by differences in educational attainment. In this paper, we assess whether educational gradients in chronic disease prevalence have narrowed in Brazil from 1998 to 2013, a period of a booming economy accompanied by major investments in public health in the country.MethodsIndividual-level data came from the 1998, 2003 and 2008 Brazilian National Household Survey and the 2013 National Health Survey. We first evaluate age-standardized prevalence rates of chronic disease by education and second, we predict the estimated prevalence rate between those in low vs. high education to assess if relative changes in chronic disease have narrowed over time. Third, we estimate the slope index of inequality (SII) that evaluates the absolute change in the predicted prevalence of a disease between those in low vs. high education. Finally, we tested for statistically significant time trends in adult chronic disease inequalities by education.ResultsPrevalence of diabetes and hypertension have increased over the period, whereas the prevalence of heart disease decreased. Brazilian adults with no education had higher levels of diabetes, hypertension and heart disease than those with some college or more. Adjusted prevalence for hypertension and heart disease indicate some progress in reducing educational disparities over time. However, for diabetes, adjusted results show a continuously increasing educational disparity from 1998 to 2013. By 2013, individuals with no education had about two times higher diabetes prevalence than those with higher education with larger disparity among women.ConclusionsResults confirm findings from previous work that educational inequalities in health are large in Brazil but also provide evidence suggesting some improvement in narrowing these differentials in recent times. Recent policies aiming at reducing the prevalence of obesity, smoking and alcohol consumption, and increasing physical activity and consumption of fruits and vegetables may increase the overall health and wellbeing of the Brazilian population. These programs are likely to be more effective if they target those with low socioeconomic status, as they appeared to be at a higher risk of developing chronic conditions, and promote educational opportunities.

Associations of Undergoing a Routine Medical Examination or Not with Prevalence Rates of Hypertension and Diabetes Mellitus: A Cross-Sectional Study.

Background: Undergoing a routine medical examination may be associated with the prevalence rate of chronic diseases from a population-based household interview survey. However, this important issue has not been examined so far. Methods: Data came from the first health service household interview of Hunan province, China, in 2013. A Rao–Scott chi-square test was performed to examine the difference in prevalence rates between subgroups. Adjusted odds ratio (OR) was calculated using the PROC SURVEYLOGISTIC procedure of SAS9.1 statistical software. Results: In total, 24,282 residents of 8400 households were surveyed. A higher proportion of elderly adults had undergone a medical examination within the prior 12 months compared with young adults (≥65 years, 60%; 45–64 years, 46%; 18–44 years, 37%). After controlling for location, sex, and household income per capita, undergoing a medical examination was significantly associated with high prevalence rates of hypertension (adjusted OR: 2.0, 95% CI: 1.1–3.5) and of diabetes mellitus (adjusted OR: 3.3, 95% CI: 1.7–6.5) for young adults aged 18–44 years. The associations were not statistically significant for age groups 45–64 years and 65 years or older. Conclusion: The prevalence rates of hypertension and diabetes mellitus may be seriously underestimated for young adults not undergoing a routine medical examination in a health household interview survey.

Investigation on health status of elderly people in Hubei province

Objective To study the health status of the elderly in Hubei province, in order to provide the evidence for health management in the elderly. Methods A stratified cluster random sampling method was applied.60 resident families who lived there for more than half a year were randomly extracted from each villages or community in 20 pre-confirmed counties(or cities, districts)from October to November 2013.Household questionnaire survey was conducted among these families.5 self-assessment indexes for health were selected.The health status of residents was evaluated by using comprehensive health assessment, and the score ranges were from 0 to 100, with a value of 0 indicating the worst health status and 100 indicating the best.The prevalence of chronic diseases in the elderly and its related factors were analyzed. Results The total number of study people aged 60 years and above were 8 358, with 3 738 urban residents(44.7%)and 4 620 rural residents(55.3%), 4 092 males(49.0%)and 4 266 females(51.0%), and the average age was(68.5± 7.1)years.The score of health self-assessment of the elderly was(72.7±14.7). The two-week morbidity rate in the elderly was 45.7%(3 816 cases), and the prevalence rate of chronic diseases was 73.8%(6 169). Hypertension and diabetes were the major diseases in the elderly based on the analysis of two-week morbidity and chronic diseases.Multiple logistic regression analysis showed that urban-rural difference, gender, age, education level, marital status and employment status were the related factors for the two-week morbidity rate(all P<0.05). And urban-rural difference, gender, age, education level, employment status and economic status were also the related factors for the prevalence rate of chronic disease(all P<0.05). Conclusions The self-evaluation of health and chronic diseases status are not optimistic in the elderly in Hubei province, which are associated with urban-rural, social, economic and environmental factors.Thus chronic disease management strategy for the elderly should be developed based on these characteristics. Key words: Health surveys; Prevalence; Chronic disease

Evaluation of daily ginger consumption for the prevention of chronic diseases in adults: A cross-sectional study

ObjectivesThe aim of this study was to assess daily ginger consumption and explore its correlation with chronic diseases among adults and to analyze further how different levels of ginger intake affect the prevalence of chronic diseases. MethodsWe examined the prevalence rate of chronic diseases (diabetes, hypertension, coronary heart disease [CHD], hyperlipidemia, cerebrovascular disease, fatty liver, anemia, and tumor), as well as the daily ginger intake in a large cross-sectional study. In all, 4628 participants (1823 men and 2805 women) ages 18 to 77 y completed face-to-face dietary and health questionnaires. We extracted diagnoses and investigation results from the participants' health records. The association between the level of ginger intake (0–2 g/d, 2–4 g/d, and 4–6 g/d) and the prevalence of chronic diseases was analyzed by using χ2 statistical test and unconditional logistic model. ResultsOverall, daily ginger consumption was associated with decreased risk for hypertension (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.86–0.98) and CHD (OR, 0.87; 95% CI, 0.78–0.96) in adults ages ≥18 y. Differences were also observed in adults ages ≥40 y: hypertension (OR, 0.92; 95% CI, 0.87–0.99), CHD (OR, 0.87; 95% CI, 0.78–0.97). However, after 20 y, no association was seen for hypertension but there was still a difference between ginger consumption and CHD in adults ages ≥60 y (OR, 0.84; 95% CI, 0.73–0.96). Again, the probability of illness (hypertension or CHD) decreased when the level of daily ginger intake increased. ConclusionsThese data indicate that ginger has a potential preventive property against some chronic diseases, especially hypertension and CHD, as well as its ability to reduce the probability of illness.

Investigation on chronic disease-related lifestyle and behavior in adults in Chengdu

To investigate the chronic disease related lifestyle and behavior in adults in Chengdu. 8 324 residents (more than 18 years old) were investigated through random selection and stratified multi-stage cluster sampling method in Chengdu. Distributions on chronic diseases and relevant factors between chronic diseases and lifestyle/behavior were analyzed. 1 329 cases were suffered from chronic diseases, with prevalence rate as 16.0%. Smoking, passive smoking, irregular diet, intake smoked or pickled food, hardcore diet and lack of physical exercises were factors significantly related to the prevalence rates on chronic diseases (P < 0.05). Irregular diet, intake smoked and pickled food, hardcore diet and lack of physical exercise belonged to independent risk factors for chronic diseases in adults (P < 0.05). The overall prevalence rate of chronic disease was high in adults in Chengdu. The related risk factors were closely related to lifestyle or behavior of the population that called for the development of programs on healthy life style and good habits.

From fragmented to integrated healthcare: an imperative for rural populations

Introduction: Providing healthcare to rural populations is often challenging. Long distances, low population densities, difficulties recruiting and retaining staff, limited opportunities to harness economies of scale, and an ageing population with high prevalence rates of chronic disease – all of these factors place fragmentary pressures on healthcare organisations. In the face of such pressures, there is a particular imperative to integrate services for rural people. Objective: To draw on patient survey data to assess the extent of variation in key elements of healthcare integration across hospitals situated in outer regional/remote, inner regional and major city areas of NSW. Methods: Results from a postal/ online survey of adults admitted to NSW public hospitals between January and June 2013 [Sample size 17,746]. Results were weighted to represent the age and stay type of each hospital’s admitted patient population. Questions relating to communication, coordination of care, patient engagement and integration were included in the study. Results: Patients admitted to hospitals situated in rural areas of NSW scored questions relevant to integration of care more positively than those admitted to hospitals in urban areas. This was particularly the case for questions related to communication and patient involvement in care. Results regarding the extent to which patients were definitely involved in decisions regarding their discharge from hospital were the most variable across aggregated rurality categories (72% for outer regional/remote, 69% for inner regional and 61% for major cities). Results for whether patients felt they were definitely involved in decisions about their care and treatment showed greatest variability across hospitals within rurality categories (rural hospital range 55% 79% patients; metropolitan hospital range 46% 80% patients). Discussion: Complementary data drawn from the 2013 Commonwealth Fund International Health Policy Survey echoed these patterns. Data for NSW respondents show more positive results for people living in outer regional/remote and inner regional areas of NSW with regards to World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116662– http://www.ijic.org/ communication regarding prescription medications, the extent to which general practitioners engage patients in their own care, and confidence that patients with chronic conditions report in managing their own health problems. It is not clear whether the isolation and distance that characterise rural life encourages patients to become more engaged in their care; or encourages healthcare providers to facilitate greater engagement of their patients; or a combination of the two. Limitations: The analysis has not taken account of potential confounders such as variation in case mix across hospitals and rurality. It can be argued however, that patients should be engaged in their care, regardless of their specific diagnosis or severity. Further, while the study includes a range of elements pertinent to healthcare integration, there may be elements that have not been captured by the survey instrument. Conclusion: Patients hospitalised in rural NSW report better communication and greater involvement in decisions about their care than those hospitalised in urban areas.

PCV115 Burden of Hypertension in Selected EU Countries: 2010-2025

The burden of chronic diseases is an important parameter for financial resource allocation and health care system capacity planning. Future prevalence and distribution of chronic conditions depend on the development of population size and structure. The European population is expected to slowly grow and rapidly age in the next decades. Our contribution aims at evaluating the impact of demographic change on prevalence of hypertension in Europe. The use of projections to support long-term planning of health care resources will be discussed. A prevalence-projection scenario was developed combining age-/sex-specific population projections with chronic disease prevalence rates. Population projections were taken from Eurostat statistics. Hypertension prevalence rates were estimated from the European Healthcare Access Panel (EHP, 2008), a representative health and health care utilization survey in five EU countries (Germany, UK, France, Italy and Spain). The weighted sample comprised 136.397 respondents aged 20-79. Multiplying projected population numbers with the respective age- and sex-specific hypertension rates from 2008 provided an estimate for the number of hypertensives by country in forthcoming years. As calculated from EHP data, in 2010, 15.9M Germans aged 20 to 79 years suffered from hypertension (10.4M in UK, 8.2M in France, 9.7M in Italy and 6.4M in Spain). For the year 2025, our model predicts the prevalence figures to increase to 17.3M in Germany, 12.3M in UK, 9.6M in France, 11.3M in Italy and 7.8M in Spain. For all five countries combined hypertension is calculated to increase by 15.3%, from 50.6M to 58.4M. The projections show a considerable increase in the prevalence of hypertension: the total population in the five biggest EU countries will grow only by 5.7% but the number of people with hypertension will increase by 15.3%. These data quantify the influence of ageing on disease burden and reflect an increased need for appropriate health care expenditure and capacities.

The disabling effect of diseases: a study on trends in diseases, activity limitations, and their interrelationships.

Data from the Netherlands indicate a recent increase in prevalence of chronic diseases and a stable prevalence of disability, suggesting that diseases have become less disabling. We studied the association between chronic diseases and activity limitations in the Netherlands from 1990 to 2008. Five surveys among noninstitutionalized persons aged 55 to 84 years (n = 54,847) obtained self-reported data on chronic diseases (diabetes, heart disease, peripheral arterial disease, stroke, lung disease, joint disease, back problems, and cancer) and activity limitations (Organisation for Economic Co-operation and Development [OECD] long-term disability questionnaire or 36-item Short Form Health Survey [SF-36]). Prevalence rates of chronic diseases increased over time, whereas prevalence rates of activity limitations were stable (OECD) or slightly decreased (SF-36). Associations between chronic diseases and activity limitations were also stable (OECD) or slightly decreased (SF-36). Surveys varied widely with regard to disease and limitation prevalence rates and the associations between them. The hypothesis that diseases became less disabling from 1990 to 2008 was only supported by results based on activity limitation data as assessed with the SF-36. Further research on how diseases and disability are associated over time is needed.

Limited concordance between teachers, parents and healthcare professionals on the presence of chronic diseases in ID-adolescents

Evidence on teachers’ knowledge about somatic and mental chronic diseases among ID-adolescent compared to the knowledge parents and healthcare professionals have, is limited. The aim of this study is: (1) to assess the knowledge of teachers on the presence of chronic diseases in ID-adolescents; (2) to compare teachers with parents and healthcare professionals and parents with healthcare professionals regarding the knowledge on the presence of chronic diseases in ID-adolescents. We obtained data on 1044 ID-adolescents attending secondary schools, fully covering one region of the Netherlands. Teachers, parents and general practitioners (GPs) of the adolescents completed a questionnaire about the occurrence of chronic diseases in their child during the previous 12 months. The questionnaire was derived from the Dutch National Permanent Survey on Living Conditions questionnaire periodically administered in a representative population sample (n≈10,000). Concordance between teachers, parents and healthcare professionals on the presence of chronic diseases in ID-adolescents was relatively low. In about half of all 66 dyads the concordance was for the most part fair and just in 10 dyads good to very good; nine of these latter cases concerned somatic chronic diseases. In addition, teachers reported mostly lower prevalence rates of chronic diseases in ID-adolescents compared to the parents, in particular on mental chronic diseases. Although prevalence rates of chronic diseases among ID-adolescents are very high, knowledge on this among teachers is limited. While information on chronic diseases in ID-adolescents is available among different informants, the disagreement between them reflects different points of view between the informants and probably indicates a lack of communication. The communication among teachers, parents and GPs should be improved to combine the knowledge and information on the presence of chronic diseases in ID-adolescents. This may provide opportunities to improve the support of these adolescents in their school career and in their transition from school to work.

Prevalence of chronic diseases in adolescents with intellectual disability

Valid community-based data on the prevalence of chronic diseases in adolescents (12–18 years) with intellectual disability (ID-adolescents) are scarce. The aim of this study was to assess the prevalence rates and the nature of chronic diseases in a population of ID-adolescents and to compare them with the rates among adolescents in the general population. Therefore, we obtained data on 1083 ID-adolescents attending secondary schools, day care centers or living in residential centers fully covering one region of the Netherlands. Parents of the adolescents completed a questionnaire about the occurrence of chronic diseases in their child during the previous 12 months and about background characteristics. The questionnaire was derived from the Dutch National Permanent Survey on Living Conditions questionnaire periodically administered in a representative population sample ( n ≈ 10,000). Prevalence rates of chronic diseases in ID-adolescents were compared with those in adolescents in the Dutch general population. Among ID-adolescents, high prevalence rates of a wide range of chronic diseases were found. The five most prevalent were: ADHD (21.1%), PDD-NOS (14.0%), dyslexia (13.9%), migraine or chronic headache (12.7%), and autistic disorder (10.9%). These prevalence rates were all higher ( p < 0.05) than among adolescents in the general population. Of all ID-adolescents, 62.9% was reported to have at least one chronic disease. The burden of chronic diseases among ID-adolescents is very high, showing a high need for adequate care. These high prevalence rates should alert policymakers and clinicians regarding the widespread of chronic diseases among ID-adolescents.

Prevalencia de enfermedades crónicas diagnosticadas en población inmigrante y autóctona

Objective To estimate the prevalence rates of chronic disorders in immigrants and to compare them with those in the native population, based on electronic clinical records in primary care (ECRPC). Methods We performed a descriptive cross-sectional study in patients aged 16 and over included in the Madrid Regional Public Health System. Age-adjusted prevalence rates for each sex and region were estimated on the basis of medically examined cases registered in the ECRPC with any new data entry made in 2005 or 2006. Results After age-adjustment, a total of 36.8% immigrants had some chronic health problem (vs. 55.3% natives). These disorders were more frequent among women and among the population from Africa and Latin America. The highest overall prevalence rates in the foreign population were allergy (10.2% crude rate), low-back pain (9.1%), chronic skin problems (6.8%) and mental disorders (6.4%). Conclusions The prevalence rate of chronic disease is lower in the foreign population and differs according to sex and country of origin.

Forecasting the cost of U.S. Health Care in 2040

One of the most important debates among health economists in rich nations is whether advances in biotechnology will spare their health care systems from a financial crisis. We must consider that prevalence rates of chronic diseases declined during the twentieth century and that this rate of decline has accelerated. However, health care costs may continue to increase even as the age of onset of chronic diseases is delayed, because the proportion of a cohort living to late ages will increase. The accelerating decline in the prevalence of chronic diseases during the course of the twentieth century supports the proposition that increases in life expectancy during the twenty-first century will be fairly large, but the effect on health care in the U.S. will be modest. The income elasticity for health services is calculated at 1.6, meaning that income expenditures on health care in the U.S. are likely to rise from a current level of about 15 percent to about 29 percent of GDP in 2040.

Disparities between persons with and without disabilities in their participation rates in mass screening

The purpose of this study was to determine the number of persons with and without disabilities who participated in the National Health Insurance (NHI) chronic disease mass screening programs in South Korea. The data were obtained from mass screening claims submitted to the NHI and National Disability Registry. Factors affecting the participation rate included demographic variables, socioeconomic status, residential region, and disability type and severity. A multiple logistic regression analysis was used to evaluate the relationship between participation rates and disability type and severity adjusted for confounding factors. The analysis revealed that persons with a disability were less likely to participate in mass screening programs than those without a disability (35.8% vs. 40.2%). Multiple logistic regression analysis indicated that persons with severe disabilities had lower participation rates than those without disabilities [adjusted odds ratio (aOR): 0.64, 95% confidence interval (CI): 0.63-0.64]. In particular, persons with severe disabilities such as limb, brain, visual and internal organ impairment, were less likely to participate in the mass screening programs. However, persons with mild disability had higher participation rates than those without disabilities (1.03, 1.02-1.03). Although the prevalence rates of chronic diseases are higher among persons with disabilities, various types of impairments such as limb, brain, visual and internal organ impairment, hinder participation in mass screening programs for chronic diseases. The reasons for this disparity must be investigated and health policies must be altered to make preventative treatments more accessible to persons with disabilities.

Are Americans Getting Sicker or Healthier?

The rising cost of healthcare causes many injustices, and is not sustainable. Cost inflation is partly caused by the nature of medicine. When doctors save lives, the lives we save are usually people with chronic illnesses. Decreases in the mortality rate often lead to increases in the prevalence rate of chronic diseases and duration of chronic diseases, which are expensive to treat. As a result of advances in medical sciences, more and more people live with chronic illnesses, and therefore healthcare costs are rising. This is consistent with the conclusion that the more money a society like the USA spends on medical care, the more expensive medical care becomes. This is the dark side of medicine, which counterbalances the well-known breakthroughs of medical science. Spiritual people seek a balanced view of health that includes both viewpoints.

Changes in the Disparities in Chronic Diseases During the Course of the 20th Century

Longitudinal studies support the proposition that the extent and severity of chronic conditions in middle and late ages are to a large extent the outcome of environmental insults at early ages, including in utero. Data from the Early Indicators Project, undertaken at the Center for Population Economics, suggest that the range of differences in exposure to disease has narrowed greatly over the course of the 20th century, that age-specific prevalence rates of chronic diseases were much lower at the end of the 20th century than they were at the beginning of the last century or during the last half of the 19th century, and that there has been a significant delay in the onset of chronic diseases over the course of the 20th century. These trends appear to be related to changes in levels of environmental hazards and in body size. These findings have led investigators to posit a synergism between technological and physiological improvements. This synergism has contributed to reductions in inequality in real income, body size, and life expectancy during the 20th century.

Changes in the Disparities in Chronic Diseases During the Course of the 20th Century

Longitudinal studies support the proposition that the extent and severity of chronic conditions in middle and late ages are to a large extent the outcome of environmental insults at early ages, including in utero. Data from the Early Indicators Project, undertaken at the Center for Population Economics, suggest that the range of differences in exposure to disease has narrowed greatly over the course of the 20th century, that age-specific prevalence rates of chronic diseases were much lower at the end of the 20th century than they were at the beginning of the last century or during the last half of the 19th century, and that there has been a significant delay in the onset of chronic diseases over the course of the 20th century. These trends appear to be related to changes in levels of environmental hazards and in body size. These findings have led investigators to posit a synergism between technological and physiological improvements. This synergism has contributed to reductions in inequality in real income, body size, and life expectancy during the 20th century.

Education was associated with injuries requiring hospital admission

Objectives We describe educational inequalities in the incidence of injuries resulting in hospital admission and explore the contribution of exposure variables and chronic diseases, alcohol consumption, and sedative use to the observed inequalities. Study design and setting Data from the Dutch prospective GLOBE study were linked to the National Hospital Discharge Register after 7 years of follow-up. Results Significantly higher hazard ratios (HRs) of traffic injuries in lower compared with higher educational groups were substantially reduced after adjustment for differences in the use of cars and mopeds between these groups. Significantly increased HRs in occupational, home, and sports (OHS) injuries in lower compared with higher educational groups were reduced after adjustment for higher prevalence rates of chronic diseases, very excessive alcohol consumption, and sedative use in lower educational groups. Conclusion Exposure variables, chronic diseases, alcohol consumption, and sedative use contribute to educational inequalities in traffic and OHS injuries resulting in hospital admission.