Regional Differences In Health Research Articles

Regional differences in health further explained

AbstractLike in most Western countries, regional health inequalities are also present in the Netherlands. Explaining these inequalities is necessary for policymakers to target interventions to reduce them. Regional health inequalities are usually attributed to demographic and socio-economic factors, while lifestyle and psychosocial factors are increasingly shown to impact individuals’ health. Therefore, this study analyses the role of lifestyle, loneliness, and self-mastery in explaining regional inequalities, in addition to demographic factors and SES, for self-rated health, presence of chronic diseases, and psychological distress. Analyses are performed in the linked dataset from the Dutch Public Health Services, Statistics Netherlands, and the National Institute for Public Health and the Environment for the year 2016 (n = 334,721). The results show that lifestyle, loneliness and self-mastery contribute to the regional health inequalities in self-rated health and presence of chronic diseases. For psychological distress, both loneliness and self-mastery contribute to the regional health inequalities. Addressing lifestyle and psychosocial factors can offer policymakers additional pathways to bridge regional health inequalities. In this study, the region of Zuid-Limburg represents the reference region. Use compare regions for health and healthcare costs (Regiovergelijker gezondheid en zorgkosten [1]) in order to select all other Dutch regions as reference region.

The Berlin index of health and social deprivation: a data based tool to tackle health inequality

Abstract Background Reducing socially induced health inequalities is a key task of urban and regional public health authorities. The Berlin index of health and social deprivation (BIHSD) 2022 aims to show regional differences in health and social situation in sub-areas of the city, to observe developments over time and to identify socially deprived sub-areas of the city. Methods The BIHSD 2022 is based on 20 indicators, most of which come from official statistics. Principal component analyses were applied to calculate subindices for the dimensions employment (e.g. unemployment rate), social conditions (e.g. risk-of-poverty rate) and health (e.g. premature mortality). Based on these subindices the final health and social index was derived. The (sub)indices are available on different spatial levels. Relative changes compared to the BIHSD 2013 were calculated to identify regional trends in the transitions in the social structure and health of the city over time. Results Besides improvements for most indicators over time in most regions of Berlin, there is still significant evidence for health and social inequality across the city. For example, long-term unemployment rate varies between 0.5% and 40.4% on the lowest spatial level. Following a secular trend, there are substantial improvements in former deprived areas in the inner city while in many peripheral residential areas with an average social structure in the past a downwards trend was observed. Conclusions Deprivation indices are helpful tools for research and health reporting in providing evidence for regional inequality. Additionally, they can be used to tailor health promotion strategies and to promote a targeted allocation of financial resources. For example, results of the BIHSD 2022 are being used in epidemiological analyses (e.g. regional inequalities in the risk of SARS-CoV-2 infection) and for (health) policy planning (e.g. needs- and demand-based planning of healthcare). Key messages • The Berlin index of health and social deprivation 2022 show regional differences in health and social situation in sub-areas of the city and documents developments over time. • The index is being used in epidemiological analyses, to tailor health promotion strategies, and to promote a targeted allocation of financial resources.

Remote Care Assistance in Emergency Department Based on Smart Medical.

Smart medical care is user-centric, medical information is the main line, and big data, Internet of Things, cloud computing, artificial intelligence, and other technologies are used to establish scientific and accurate information, as well as an efficient and reasonable medical service system. Smart medical plays an important role in alleviating doctor-patient conflicts caused by information asymmetry, regional health differences caused by irrational allocation of medical resources, and improving medical service levels. This article mainly introduces the remote care assistance system of emergency department based on smart medical and intends to provide some ideas and directions for the technical research of patients in emergency department receiving remote care. This paper proposes a research method for remote care assistance in emergency departments based on smart medical, including an overview of remote care based on smart medical, remote care sensor real-time monitoring algorithms based on smart medical, signal detection algorithms, and signal clustering algorithms for smart medical. Remote care in the emergency department assisted in research experiments. The experimental results show that 86.0% of patients like the remote care system based on smart medical studied in this paper.

Are the Sick Left Behind at the Peripheries? Health Selection in Migration to Growing Urban Centres in Finland

We study health selection in rural–urban migration in Finland using register data. Specifically, we ask whether ‘movers’ differ from ‘stayers’ in their use of special health care services prior to moving. We focus on migration to twelve growing urban centres in different sub-groups of the population as well as in different regions, using multinomial logistic regression and multilevel modelling and by distinguishing between short- and long-distance moves. The results show that urban centres attract healthier individuals, while people with health problems are also prone to move, but not to urban centres. The results were similar when looking only at psychiatric diagnoses. The findings suggest that it is important to distinguish between different types of moves when studying health-selective migration. Studying the patterns of migration according to health enables us to understand drivers of regional health differences. Moreover, such evidence will help in projecting future demand for healthcare across the country.

The role of health literacy in explaining regional health differences among adolescents

Abstract Background Health disparities in adolescence track forward to adulthood. In understanding disparities better, health literacy (HL) - as a broad range of health-related competencies - has been identified as a valuable construct. Higher HL has been associated with better health outcomes, also among adolescents. Not much is known about how language or region in a bilingual country is associated with HL, or how HL is associated with regional health disparities. The aim of this study, in a bilingual country, was a) to examine and compare HL and health levels among majority and minority language speaking adolescents in different regions of Finland, and b) to explore if HL explains possible regional health differences in these two language groups, taking into account other important structural stratifying factors. Methods The data of 13- and 15-year-olds were obtained from the Health Behaviour in School-aged Children study, conducted in Finnish- and Swedish-speaking schools in Finland in 2014 (N = 3853/1123; 85/83%). HL was measured with the HLSAC-instrument. The data were analysed by logistic regression and interaction analyses. Results In the total sample, 23% rated their health as excellent; 33% had a high and 10% a low HL. The preliminary findings showed no differences in health or HL between the language groups. However, regional health differences were found in both language groups: in the Finnish-speaking sample among boys, and in the Swedish-speaking sample among girls. Findings also showed regional differences in HL levels in both language groups, especially among the Swedish-speaking minority group. Comprehensive HL was an independent factor in explaining these regional health differences. Conclusions This study adds to prior studies on the role of HL as a modifiable health resource by showing that in addition to other structural stratifying factors comprehensive HL explains regional health disparities among adolescents in a bilingual country. Key messages This study in a bilingual country found regional health disparities and regional differences in HL levels among both majority and minority language speaking adolescents. In both language groups, taking into account other important structural stratifying factors, comprehensive HL was an independent factor in explaining the regional health differences.

30 years after the fall of the Berlin Wall: Regional health differences in Germany.

Following the fall of the Berlin Wall in November 1989, considerable effort was made to bring the living conditions and levels of social participation in the former East German federal states into line with the former West German federal states. As a result, differences in health between the East and the West diminished significantly, in many cases as early as the 1990s, examples being life expectancy and cardiovascular mortality. In regard to health behaviour, the overall tendency has also clearly been one of convergence. Thus, only very small differences can be observed today, for example in the use of tobacco or in the prevalence of obesity. Yet the results also highlight the insufficiency of regarding the remaining differences as a simple comparison between East and West. Instead, the focus should shift towards smaller-scale approaches that take regional differences in living conditions into account.

REGIONAL AND AGE-RELATED VARIATIONS IN HAPTOGLOBIN CONCENTRATIONS IN STELLER SEA LIONS (EUMETOPIAS JUBATUS) FROM ALASKA, USA

Varying concentrations of the highly conserved acute phase response protein, haptoglobin, can indicate changes to the health and disease status of mammals, including the Steller sea lion (SSL; Eumetopias jubatus). To better understand factors relating to acute phase response in SSLs, circulating haptoglobin concentrations (Hp) were quantified in plasma collected from 1,272 individuals sampled near rookeries and haulouts off the coast of Alaska, US. We compared Hp in SSLs between sexes and among different age classes (young pups, young-of-the-year, yearlings, subadults, and adults) sampled within distinct regions in Alaska (Aleutian Islands, Gulf of Alaska, Southeast Alaska). Regional and age-related differences were observed, particularly in younger SSLs. No sex-related differences were detected. We identified weakly significant relationships between Hp and hematology measurements including white blood cell counts and hematocrit in young pups from the Aleutian Islands and Southeast Alaska. No relationship between Hp and body condition was found. Lastly, a nonlinear relationship of plasma Hp and whole blood total mercury concentrations (THg) was observed in SSLs from the endangered western distinct population segment in Alaska. These results demonstrated that regional variation in Hp, especially in younger SSLs, may reflect regional differences in health and circulating THg.

Regional health differences - developing a socioeconomic deprivation index for Germany.

For Germany, regional differences for various health indicators, which are also associated with socioeconomic factors, have been documented. This article aims to develop a regional socioeconomic deprivation index for Germany that (1) can be used to analyse regional socioeconomic inequalities in health and (2) provides a basis for explaining regional health differences in Germany. The core data stem from the INKAR (indicators and maps on spatial and urban development in Germany and Europe) database compiled by Germany's Federal Institute for Research on Building, Urban Affairs and Spatial Development. Factor analysis is used for indexing and the weighting of indicators for the three dimensions of education, occupation and income. The German Index of Socioeconomic Deprivation (GISD) is generated at the levels of associations of municipalities, administrative districts and administrative regions for the years 1998, 2003, 2008 and 2012. Aggregate data and individual data from the German Health Update 2014/2015-EHIS (GEDA 2014/2015-EHIS) study are used to analyse associations between the index and selected health indicators. For around two thirds of the causes of death, the German Index of Socioeconomic Deprivation reveals significant socioeconomic inequalities at the level of Germany's administrative regions. At district level, life expectancy in the bottom fifth of districts presenting the highest levels of deprivation is, depending on the observation period, 1.3 years lower for women and 2.6 years lower for men in comparison to the upper fifth of districts presenting the lowest levels of deprivation. The index can explain 45.5% and 62.2% of regional differences in life expectancy for women and men, respectively. Moreover, the population in regions characterised by high levels of deprivation has significantly higher rates of smokers, engages less frequently in leisure-time physical activities and is more often obese. The German Index of Socioeconomic Deprivation illustrates regional socioeconomic differences at different spatial levels and contributes to explaining regional health differences. This index is intended for use in research as well as by federal and federal state health reporting systems and should enable access to new sources of data for investigating the links between social inequalities and health in Germany.

Regional variation in the predictive validity of self-rated health for mortality

Self-rated health (SRH) is a commonly used measure for assessing general health in surveys in the United States. However, individuals from different parts of the United States may vary in how they assess their health. Geographic differences in health care access and in the prevalence of illnesses may make it difficult to discern true regional differences in health when using SRH as a health measure. In this article, we use data from the 1986 and 1989–2006 National Health Interview Survey Linked Mortality Files and estimate Cox regression models to examine whether the relationship between SRH and five-year all-cause mortality differs by Census region. Contrary to hypotheses, there is no evidence of regional variation in the predictive validity of SRH for mortality. At all levels of SRH, and for both non-Hispanic white and non-Hispanic black respondents, SRH is equally and strongly associated with five-year mortality across regions. Our results suggest that differences in SRH across regions are not solely due to differences in how respondents assess their health across regions, but reflect true differences in health. Future research can, therefore, employ this common measure to investigate the geographic patterning of health in the United States.

Regional differences in health, diet and weaning patterns amongst the first Neolithic farmers of central Europe.

Across much of central Europe, the Linearbandkeramik (LBK) represents the first Neolithic communities. Arising in Transdanubia around 5500 cal. BC the LBK spread west to the Rhine within two to three hundred years, carrying elements of a mixed agricultural economy and a relatively homogeneous material culture. Colonisation of new regions during this progress would have required economic adaptations to varied ecological conditions within the landscape. This paper investigates whether such adaptation at a local scale affected health patterns and altered the dietary habits of populations that otherwise shared a common cultural and biological origin. Analysis of non-specific stress (linear enamel hypoplasia, porotic hyperostosis, cribra orbitalia) within five LBK populations from across central Europe in conjunction with published carbon and nitrogen stable isotope data from each site revealed a high prevalence of porotic hyperostosis and cribra orbitalia in western populations that was associated with a lower animal protein intake. Hypoplastic enamel was more frequently observed in eastern populations however, and may reflect geographic differences in childhood morbidity and mortality as a result of variation in social practices relating to weaning. Local socio-economic adaptations within the LBK were therefore an important factor in the exposure of populations to non-specific stress.

Are the differences in adulthood ill-health across the north-south divide and between Scotland and England also evident in early childhood health indicators?

Regional differences in adult morbidity and mortality within England (i.e., north-south divide or gradient) and between England and Scotland (i.e., Scottish effect) are only partly explained by adult levels of socioeconomic status or risk factors. This suggests variation in early life, and is supported by the foetal origins and life-course literature which posits that birth outcomes and subsequent, cumulative exposures influence adult health. However, no studies have examined the north-south gradient or Scottish effect in health in the earliest years of life. The aims of the study were: i) to examine health indicators in English and Scottish children at birth and age three to establish whether regional differences exist; and ii) to establish whether observed changes in child health at age three were attributable to birth and/or early life environmental exposures. Respondents included 10,639 biological Caucasian mothers of singleton children recruited to the Millennium Cohort Study (MCS) in the year 2000. Outcome variables were: gestational age and birth weight, and height, body mass index (BMI), and externalising behavioural problems at age three. Region/country was categorised as: South (reference), Midlands, North (England), and Scotland. Respondents provided information on child, maternal, household, and socioeconomic characteristics. Results indicated no significant regional variations for gestational age or birth weight. At age three there was a north-south gradient for externalising behaviour and a north-south divide in BMI which attenuated on adjustment. However, a north-south divide in height was not fully explained by adjustment. There was also evidence of a ‘Midlands effect’, with increased likelihood of shorter stature and behaviour problems. Results showed a Scottish effect for height and BMI in the unadjusted models, and height in the adjusted model, but a decreased likelihood of behaviour problems. Findings indicated no regional differences in health at birth, but some regional variation at age three supports the cumulative life-course model.

The color of health: Skin color, ethnoracial classification, and discrimination in the health of Latin Americans

Latin America is one of the most ethnoracially heterogeneous regions of the world. Despite this, health disparities research in Latin America tends to focus on gender, class and regional health differences while downplaying ethnoracial differences. Few scholars have conducted studies of ethnoracial identification and health disparities in Latin America. Research that examines multiple measures of ethnoracial identification is rarer still. Official data on race/ethnicity in Latin America are based on self-identification which can differ from interviewer-ascribed or phenotypic classification based on skin color. We use data from Brazil, Colombia, Mexico, and Peru to examine associations of interviewer-ascribed skin color, interviewer-ascribed race/ethnicity, and self-reported race/ethnicity with self-rated health among Latin American adults (ages 18–65). We also examine associations of observer-ascribed skin color with three additional correlates of health – skin color discrimination, class discrimination, and socio-economic status. We find a significant gradient in self-rated health by skin color. Those with darker skin colors report poorer health. Darker skin color influences self-rated health primarily by increasing exposure to class discrimination and low socio-economic status.

A Comparison of Health between Upland and Coastal Late Prehistoric Agriculturists from the Southeast USA

During the late prehistoric period (ad 1250–1550) in the southeast USA, when native populations transitioned to living in permanent, nucleated settlements practicing maize agriculture, most experienced a decline in health. However, some research shows that not all groups experienced the decline in the same way as there were regional differences in dental caries and iron deficiency anaemia frequencies and patterns of physical activity. Therefore, the purpose of this study is to determine if regional differences in health also existed between late prehistoric upland and coastal inhabitants from one part of the southeastern USA. Pathological lesion frequencies were calculated for 441 individuals from 23 upland archaeological sites and compared with previously published data for 340 individuals from 11 coastal sites. Significant differences in lesion frequencies were observed between upland and coastal groups. For example, upland adult men have more carious teeth among the maxillary first incisors, maxillary second molars, mandibular canines, and mandibular second molars. For women, greater caries frequencies are found among the maxillary first and third molars, mandibular first incisors, and mandibular third premolars. Upland children show higher percentages of caries for 14 tooth classes. Coastal juveniles have a greater frequency of porotic hyperostosis, and more of them exhibit an enamel hypoplasia. Periosteal lesion frequency is greater for the coastal group at the humerus, radius, femur, and tibia. Lesions indicative of degenerative joint disease are more often found on the thoracic spinal segment, sacrum and shoulder of upland men with upland women having more lesions at the cervical, thoracic, and lumbar spinal segments, the sacrum, and the shoulder. Taken together, these results show that adults from the upland region consumed more maize and lived a more physically demanding life while coastal adults struggled more with infection. Among children, more coastal inhabitants were anaemic and more of the experienced significant growth disturbances. Copyright © 2013 John Wiley & Sons, Ltd.

Soziale Unterschiede bei der Inanspruchnahme der Schwangerschafts-Vorsorgeuntersuchungen, beim Rauchen der Mutter während der Schwangerschaft und beim Geburtsgewicht des Neugeborenen. Empirische Analyse auf Basis der Bayerischen Perinatal-Studie

Perinatal studies provide an excellent database for public health research, to date this potential has rarely been used, however. Taking the example of the Perinatal Study in Bavaria, the objective is to demonstrate the pros and cons of this database. As it includes only very few variables on socio-economic status, an additional variable is calculated assessing the socio-economic status of the community where the mother lives. This is rarely done in Germany, and as far as we know the procedure proposed here has not been applied before.The analyses are based on the data from 2004. They focus on three dependent variables: number of prenatal screenings, maternal smoking during pregnancy, birth weight of the baby. The following independent variables are included as well: age of the mother, nationality of the mother (e.g., German, Mediterranean countries), single mother (yes/no), occupational status of the mother, community where the mother lives (4- or 5-digit postal code). The socio-economic status of the community is assessed by the poverty rate, linking two other datasets, one for transferring the postal codes to community names, the other providing information per community. The multivariate analyses are conducted by logistic regressions.Information was available from about 76 000 births. Concerning the variable 'few prenatal screenings', the analyses show an increased risk for mothers from Eastern Europe and from the Mediterranean countries, for single mothers and for mothers with low occupational status. The risk factor 'maternal smoking during pregnancy' is increased for mothers from the Mediterranean countries and for single mothers. It is especially high, however, for low status blue collar workers: compared with white collar workers their smoking prevalence is 4.67-times (large cities) or even 6.14-times (smaller communities) higher. The risk factor 'low birth weight of the baby' is again increased for single mothers and for mothers with low occupational status. An association with the poverty rate is mainly seen for the variable 'maternal smoking during pregnancy', with higher smoking prevalences in the poor communities.The results demonstrate that the data from the perinatal studies are important for public health research. Concerning the risk factors analysed here, large social differences can be observed. In order to show time trends, it would be important to repeat these analyses on a routine basis. From a methodological point of view, it can be stressed that regional differences in health and health care have rarely been looked at in Germany, and that the procedure proposed here provides a new starting point for closing this research gap.

Track D3: Inequalities and regional differences in health

Track D3: Inequalities and regional differences in health

DOES RESIDENCE SETTING INFLUENCE HEALTH AND FITNESS?

Regional differences in health may be related to lifestyle and these differences may impact lifestyle interventions. PURPOSE: We explored Canadian regional and urban-rural associations among lifestyle characteristics (levels of fitness, energy expenditure) and perceived benefits/barriers to adoption of physical activity in older adults. METHODS: A total of 305 healthy community dwelling older adults were examined at baseline in the STEP study, an exercise prescription and counselling intervention conducted in communities throughout Canada. Setting included four regions (Maritimes, Ontario, Alberta, British Columbia) stratified for urban-rural residence in Canada. Thirty-seven phyaicians, 17 urban-20 rural, participated in the study. Outcome measures were the region of Canada, urban or rural residence; cardiorespiratory fitness; energy expenditure (7-day PAR); and exercise benefits and barriers (EBBS). RESULTS: Overall, mean VO2max values between regions were the lowest in the Ontario and highest in Western provinces. In Western provinces, rural setting showed higher energy expenditure than urban setting, whereas in Ontario and Maritimes, urban setting had higher energy expenditure than rural. Perceived benefits of exercise were low overall, however urban setting showed greater perceived benefit than their rural counterparts. Urban-rural difference in perceived barriers to exercise was greatest in western Canada. CONCLUSION: Lifestyle habits related to fitness and physical activity and perceptions of benefit/barrier vary with regional and urban-rural distribution. The impact of these differences on response to physical activity intervention will be explored in the STEP study. Supported by CIHR and Pfizer Canada Inc.

Regional equity in childhood health — register-based follow-up of the Finnish 1987 birth cohort

Our objective was to investigate regional health differences among Finnish children using a population-based longitudinal register data. All live births born in 1987 were included in the study ( N=59,546) and followed-up until the age of seven years. Statistically significant regional variation was found for all health indicators but diabetes. Background variables, such as maternal age and social class, explained only the difference in mortality. Various indicators gave different geographical patterns. Regional equity in childhood health has not been achieved in Finland. Existing health registers were feasible in studying regional variation in health, but a set of comprehensive morbidity indicators — preferably derived from different data sources — should be developed to monitor equity in health.

Indirect effects of soil and water on animal health

Some variations in animal health among geographic areas are associated with variations in soils, water supplies or soil parent materials. Geochemical bases for health problems arising from essential nutrient element deficiencies or from toxic levels or imbalances of several elements are widely recognized. Less attention has been directed to the possibilities of geochemical influences upon regional differences in health resulting from pathogens, parasites, mycotoxins and poisonous plants. This review is an effort to collect and interpret such evidence as has been published on the subject since Louis Pasteur's original observation associating soil character and probability of anthrax.