Social Inequalities in Heat-attributable Mortality in the City of Turin, Northwest of Italy: A Time Series Analysis From 1982 to 2018

Abstract BackgroundUnderstanding context specific heat-health risks in urban areas is important, especially given anticipated severe increases in summer temperatures due to climate change effects. We investigate social inequalities in the association between daily temperatures and mortality in summer in the city of Turin for the period 1982-2018 among different social and demographic group such as sex, age, educational level, marital status and household occupants. Methods Mortality data are represented by individual all-cause mortality counts for the summer months between 1982 and 2018. Socioeconomic level and daily mean temperature were assigned to each deceased. A time series Poisson regression with distributed lag non-linear models was fitted to capture the complex nonlinear dependency between daily mortality and temperature in summer. The mortality risk due to heat was represented by the Relative Risk (RR) at the 99th percentile of daily summer temperatures for each population subgroup. Results All-cause mortality risk was higher among women (1.88; 95% CI= 1.77, 2.00) and the elderly (2.13; 95% CI=1.94, 2.33). With regard to education, the highest significant effects for men was observed among higher education levels (1.66; 1.38, 1.99), while risks for women were higher for the lower educational level (1.93; 1.79, 2.08). Results on marital status highlighted a stronger association for widower in men (1.66; 95%CI=1.38, 2.00) and for separated and divorced in women (2.11; 95%CI= 1.51, 2.94). The risk ratio of household occupants revealed a stronger association for men who lived alone (1.61; 95%CI=1.39, 1.86), while for women results are almost equivalent between alone and not alone groups. Conclusions The associations between heat and mortality were unequal across different aspects of social vulnerability, and, inter alia, factors influencing the population vulnerability to temperatures can be related to demographic, social, and economic aspects. A number of issues were identified and recommendations for the prioritisation of further research are provided.A better knowledge of these effect modifiers is needed to identify the axes of social inequality across the most vulnerable population sub-groups.

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Social inequalities in heat-attributable mortality in the city of Turin, northwest of Italy: a time series analysis from 1982 to 2018

Environmental Health ◽

10.1186/s12940-020-00667-x ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Marta Ellena ◽

Joan Ballester ◽

Paola Mercogliano ◽

Elisa Ferracin ◽

Giuliana Barbato ◽

...

Keyword(s):

Time Series ◽

Marital Status ◽

Mortality Risk ◽

Educational Level ◽

Social Inequalities ◽

Attributable Mortality ◽

Mortality Data ◽

All Cause Mortality ◽

Summer Temperatures ◽

The City

Abstract Background Understanding context specific heat-health risks in urban areas is important, especially given anticipated severe increases in summer temperatures due to climate change effects. We investigate social inequalities in the association between daily temperatures and mortality in summer in the city of Turin for the period 1982–2018 among different social and demographic groups such as sex, age, educational level, marital status and household occupants. Methods Mortality data are represented by individual all-cause mortality counts for the summer months between 1982 and 2018. Socioeconomic level and daily mean temperature were assigned to each deceased. A time series Poisson regression with distributed lag non-linear models was fitted to capture the complex nonlinear dependency between daily mortality and temperature in summer. The mortality risk due to heat is represented by the Relative Risk (RR) at the 99th percentile of daily summer temperatures for each population subgroup. Results All-cause mortality risk is higher among women (1.88; 95% CI = 1.77, 2.00) and the elderly (2.13; 95% CI = 1.94, 2.33). With regard to education, the highest significant effects for men is observed among higher education levels (1.66; 95% CI = 1.38, 1.99), while risks for women is higher for the lower educational level (1.93; 95% CI = 1.79, 2.08). Results on marital status highlighted a stronger association for widower in men (1.66; 95% CI = 1.38, 2.00) and for separated and divorced in women (2.11; 95% CI = 1.51, 2.94). The risk ratio of household occupants reveals a stronger association for men who lived alone (1.61; 95% CI = 1.39, 1.86), while for women results are almost equivalent between alone and not alone groups. Conclusions The associations between heat and mortality is unequal across different aspects of social vulnerability, and, inter alia, factors influencing the population vulnerability to temperatures can be related to demographic, social, and economic aspects. A number of issues are identified and recommendations for the prioritisation of further research are provided. A better knowledge of these effect modifiers is needed to identify the axes of social inequality across the most vulnerable population sub-groups.

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Social Inequalities in Heat-attributable Mortality in the City of Turin, Northwest of Italy: A Time Series Analysis From 1982 to 2018

10.21203/rs.3.rs-30216/v2 ◽

2020 ◽

Author(s):

Marta Ellena ◽

Joan Ballester ◽

Paola Mercogliano ◽

Elisa Ferracin ◽

Giuliana Barbato ◽

...

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Social Inequalities ◽

Attributable Mortality ◽

Series Analysis ◽

The City

Abstract The authors have withdrawn this preprint due to author disagreement.

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Social inequalities differences in the association between summer temperatures and mortality in the city of Turin, northwest of Italy. A distributed lag non-linear time series analysis from 1982 to 2018

ISEE Conference Abstracts ◽

10.1289/isee.2020.virtual.p-0386 ◽

2020 ◽

Vol 2020 (1) ◽

Author(s):

M. Ellena

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Social Inequalities ◽

Linear Time ◽

Series Analysis ◽

Distributed Lag ◽

Non Linear ◽

Summer Temperatures ◽

The City

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Demographic Losses Due To Alcohol-Related Mortality in Lithuania: Results Obtained Through Combining Death Records with the 2011 Population Census Data

Lietuvos statistikos darbai ◽

10.15388/ljs.2014.13890 ◽

2014 ◽

Vol 53 (1) ◽

pp. 15-23

Author(s):

Daumantas Stumbrys ◽

Domantas Jasilionis ◽

Dalia Ambrozaitienė ◽

Vlada Stankūnienė

Keyword(s):

Marital Status ◽

Mortality Risk ◽

Census Data ◽

Population Data ◽

Mortality Data ◽

Population Census ◽

The Republic ◽

The Individual ◽

Education Groups ◽

Related Mortality

This paper presents the results of a study on sociodemographic mortality differentials in Lithuania based on censuslinked mortality data. Population data come from the individual records of the 2011 Population and Housing Census of the Republic of Lithuania. The results of the research demonstrate that education and marital status are very strong predictors of alcohol-related mortality. Among males aged 30 and older, the alcohol-related mortality risk in non-married groups is up to 3.4 times as high as in the group of married males. The alcohol-related mortality risk in lower-education groups is up to 3.7 times as high as in the group of those with higher education. The findings of the study suggest that the elimination of educational differences would allow avoiding 55.7 %, the elimination of marital status differences – 40.2 %, the elimination of ethnic group differences – 11.1 % of alcohol-related deaths.

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Increased mortality risk in patients with primary and secondary adrenal insufficiency

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab096 ◽

2021 ◽

Author(s):

Kanchana Ngaosuwan ◽

Desmond G Johnston ◽

Ian F Godsland ◽

Jeremy Cox ◽

Azeem Majeed ◽

...

Keyword(s):

Cardiovascular Disease ◽

Adrenal Insufficiency ◽

Mortality Risk ◽

Reference Population ◽

Mortality Data ◽

Adrenal Crisis ◽

Malignant Neoplasms ◽

Geographical Differences ◽

All Cause Mortality

Abstract Context Mortality data in patients with adrenal insufficiency are inconsistent, possibly due to temporal and geographical differences between patients and their reference populations. Objective To compare mortality risk and causes of death in adrenal insufficiency with an individually-matched reference population. Design Retrospective cohort study. Setting UK general practitioner database (CPRD). Participants 6821 patients with adrenal insufficiency (primary, 2052; secondary, 3948) and 67564 individually-matched controls (primary, 20366; secondary, 39134). Main outcome measures All-cause and cause-specific mortality; hospital admission from adrenal crisis. Results With follow-up of 40799 and 406899 person-years for patients and controls respectively, the hazard ratio (HR; [95%CI]) for all-cause mortality was 1.68 [1.58 - 1.77]. HRs were greater in primary (1.83 [1.66 - 2.02]) than in secondary (1.52 [1.40 - 1.64]) disease; (HR; primary versus secondary disease, 1.16 [1.03 - 1.30]). The leading cause of death was cardiovascular disease (HR 1.54 [1.32-1.80]), along with malignant neoplasms and respiratory disease. Deaths from infection were also relatively high (HR 4.00 [2.15 - 7.46]). Adrenal crisis contributed to 10% of all deaths. In the first two years following diagnosis, the patients’ mortality rate and hospitalisation from adrenal crisis were higher than in later years. Conclusion Mortality was increased in adrenal insufficiency, especially primary, even with individual matching and was observed early in the disease course. Cardiovascular disease was the major cause but mortality from infection was also high. Adrenal crisis was a common contributor. Early education for prompt treatment of infections and avoidance of adrenal crisis hold potential to reduce mortality.

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Association of 152 Biomarker Reference Intervals with All-Cause Mortality in Participants of a General United States Survey from 1999 to 2010

Clinical Chemistry ◽

10.1093/clinchem/hvaa271 ◽

2020 ◽

Author(s):

Nam Pho ◽

Arjun K Manrai ◽

John T Leppert ◽

Glenn M Chertow ◽

John P A Ioannidis ◽

...

Keyword(s):

United States ◽

Mortality Risk ◽

Diagnostic Tests ◽

Serum Alkaline Phosphatase ◽

The United States ◽

Reference Intervals ◽

Mortality Data ◽

Distribution Width ◽

Risk Of Death ◽

All Cause Mortality

Abstract Background Physicians sometimes consider whether or not to perform diagnostic testing in healthy people, but it is unknown whether nonextreme values of diagnostic tests typically encountered in such populations have any predictive ability, in particular for risk of death. The goal of this study was to quantify the associations among population reference intervals of 152 common biomarkers with all-cause mortality in a representative, nondiseased sample of adults in the United States. Methods The study used an observational cohort derived from the National Health and Nutrition Examination Survey (NHANES), a representative sample of the United States population consisting of 6 survey waves from 1999 to 2010 with linked mortality data (unweighted N = 30 651) and a median followup of 6.1 years. We deployed an X-wide association study (XWAS) approach to systematically perform association testing of 152 diagnostic tests with all-cause mortality. Results After controlling for multiple hypotheses, we found that the values within reference intervals (10–90th percentiles) of 20 common biomarkers used as diagnostic tests or clinical measures were associated with all-cause mortality, including serum albumin, red cell distribution width, serum alkaline phosphatase, and others after adjusting for age (linear and quadratic terms), sex, race, income, chronic illness, and prior-year healthcare utilization. All biomarkers combined, however, explained only an additional 0.8% of the variance of mortality risk. We found modest year-to-year changes, or changes in association from survey wave to survey wave from 1999 to 2010 in the association sizes of biomarkers. Conclusions Reference and nonoutlying variation in common biomarkers are consistently associated with mortality risk in the US population, but their additive contribution in explaining mortality risk is minor.

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Segregated in the City, Separated in the School. The Reproduction of Social Inequality through the School System

Urban Science ◽

10.3390/urbansci2040112 ◽

2018 ◽

Vol 2 (4) ◽

pp. 112

Author(s):

Aina Gomà Garcia ◽

Joel Muñoz Aranda

Keyword(s):

Educational Level ◽

Social Inequalities ◽

Educational Levels ◽

Youth Survey ◽

Level Data ◽

The Relationship ◽

The City ◽

Different Sources ◽

Educational Careers

This paper explores the relationship between urban segregation and the educational level of the population. In the first place, the impacts of segregation in educational careers are analysed. Secondly, the contribution explores the interrelationship between urban segregation and schooling in Barcelona. For this aim, different sources have been used: The map of urban segregation in Catalonia at the census tract level; data about the formal educational levels of the population, aged between 15 and 34 years, from the Catalan Youth Survey (Enquesta de Joventut de Catalunya); and schooling data in Barcelona’s schools and neighbourhoods. The research shows how urban segregation effects the educational level and fosters social inequalities amongst neighbourhoods. It also points out how choosing school and enrolment strategies could act by increasing school segregation in Barcelona. Therefore, the role of segregation in the reproduction and perpetuation of inequalities in the living conditions of the population is exposed.

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Risk Factors and Mortality Associated with Multimorbidity in People with Stroke or Transient Ischaemic Attack: A Study of 8,751 UK Biobank Participants

Journal of Comorbidity ◽

10.15256/joc.2018.8.129 ◽

2018 ◽

Vol 8 (1) ◽

pp. 1-8 ◽

Cited By ~ 11

Author(s):

Katie I. Gallacher ◽

Ross McQueenie ◽

Barbara Nicholl ◽

Bhautesh D. Jani ◽

Duncan Lee ◽

...

Keyword(s):

Risk Factors ◽

Mortality Risk ◽

Transient Ischaemic Attack ◽

Alcohol Intake ◽

Mortality Data ◽

Chronic Obstructive ◽

Uk Biobank ◽

Lifestyle Risk Factors ◽

All Cause Mortality ◽

Ischaemic Attack

Background Multimorbidity is common in stroke, but the risk factors and effects on mortality remain poorly understood. Objective To examine multimorbidity and its associations with sociodemographic/lifestyle risk factors and all-cause mortality in UK Biobank participants with stroke or transient ischaemic attack (TIA). Design Data were obtained from an anonymized community cohort aged 40–72 years. Overall, 42 comorbidities were self-reported by those with stroke or TIA. Relative risk ratios demonstrated associations between participant characteristics and number of comorbidities. Hazard ratios demonstrated associations between the number and type of comorbidities and all-cause mortality. Results were adjusted for age, sex, socioeconomic status, smoking, and alcohol intake. Data were linked to national mortality data. Median follow-up was 7 years. Results Of 8,751 participants (mean age 60.9±6.7 years) with stroke or TIA, the all-cause mortality rate over 7 years was 8.4%. Over 85% reported ≥1 comorbidities. Age, socioeconomic deprivation, smoking and less frequent alcohol intake were associated with higher levels of multimorbidity. Increasing multimorbidity was associated with higher all-cause mortality. Mortality risk was double for those with ≥5 comorbidities compared to those with none. Having cancer, coronary heart disease, diabetes, or chronic obstructive pulmonary disease significantly increased mortality risk. Presence of any cardiometabolic comorbidity significantly increased mortality risk, as did any non-cardiometabolic comorbidity. Conclusions In stroke survivors, the number of comorbidities may be a more helpful predictor of mortality than type of condition. Stroke guidelines should take greater account of comorbidities, and interventions are needed that improve outcomes for people with multimorbidity and stroke.

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Approximate Mortality Risks between Hyperuricemia and Diabetes in the United States

Journal of Clinical Medicine ◽

10.3390/jcm8122127 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2127 ◽

Cited By ~ 2

Author(s):

Po-Hsun Chen ◽

Yu-Wei Chen ◽

Wei-Ju Liu ◽

Ssu-Wei Hsu ◽

Ching-Hsien Chen ◽

...

Keyword(s):

Mortality Risk ◽

Reference Group ◽

The United States ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Low Risk ◽

Mortality Data ◽

Mortality Risks ◽

All Cause Mortality ◽

Cvd Mortality

Aim: This study aimed to compare mortality risks across uric acid (UA) levels between non-diabetes adults and participants with diabetes and to investigate the association between hyperuricemia and mortality risks in low-risk adults. Methods: We analyzed data from adults aged >18 years without coronary heart disease and chronic kidney disease (n = 29,226) from the National Health and Nutrition Examination Survey (1999–2010) and the associated mortality data (up to December 2011). We used the Cox proportional hazards models to examine the risk of all-cause and cause-specific (cardiovascular disease (CVD) and cancer) mortality at different UA levels between adults with and without diabetes. Results: Over a median follow-up of 6.6 years, 2069 participants died (495 from CVD and 520 from cancers). In non-diabetes adults at UA ≥ 5 mg/dL, all-cause and CVD mortality risks increased across higher UA levels (p-for-trend = 0.037 and 0.058, respectively). The lowest all-cause mortality risk in participants with diabetes was at the UA level of 5–7 mg/dL. We set the non-diabetes participants with UA levels of <7 mg/dL as a reference group. Without considering the effect of glycemic control, the all-cause mortality risk in non-diabetes participants with UA levels of ≥7 mg/dL was equivalent to risk among diabetes adults with UA levels of <7 mg/dL (hazard ratio = 1.44 vs. 1.57, p = 0.49). A similar result was shown in CVD mortality risk (hazard ratio = 1.80 vs. 2.06, p = 0.56). Conclusion: Hyperuricemia may be an indicator to manage multifaceted cardiovascular risk factors in low-risk adults without diabetes, but further studies and replication are warranted.

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