scholarly journals Community-level Educational Attainment and Dementia: A 6-year Longitudinal Multilevel Study in Japan

2021 ◽  
Author(s):  
Tomo Takasugi ◽  
Taishi Tsuji ◽  
Masamichi Hanazato ◽  
Yasuhiro Miyaguni ◽  
Toshiyuki Ojima ◽  
...  
Keyword(s):  
Older People ◽  
Educational Attainment ◽  
Urban Areas ◽  
Community Level ◽  
Contextual Effect ◽  
The European Union ◽  
Term Care ◽  
Individual Level ◽  
Dementia Incidence ◽  
Lower Educational Attainment

Abstract Background:Understanding of the association between community-level socioeconomic status and dementia is insufficient. We examined the contextual effect of community-level prevalence of lower educational attainment on the risk of dementia incidence. This work further explored the potential differences in associations for urban and non-urban areas. Methods:We analyzed a six-year prospective cohort data from the Japan Gerontological Evaluation Study, a nationwide survey between 2010 and 2012 of 49,888 (23,339 men and 26,549 women) physically and cognitively independent individuals aged ≥65 years from 346 communities at 16 municipalities in seven prefectures. Dementia incidence was assessed through the public long-term care insurance system by the Ministry of Health, Labor, and Welfare in Japan. Educational years were dichotomized as ≤9 years and ≥10 years. We classified urban and non-urban areas using a Functional Urban Area defined by the European Union (EU) and Organisation for Economic Co-operation and Development (OECD). We performed a two-level (community- and individual-level) multilevel survival analysis to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results:The cumulative incidence of dementia during the follow-up period was 10.3%. The mean proportion of educational attainment with ≤9 years was 41.1% (range, 4.7%–88.4%). Higher prevalence of community-level lower educational attainment had a significant association with a higher risk of dementia incidence (HR, 1.03; 95% CI, 1.00–1.06, estimated by 10 percentage points of lower educational attainment) post adjusting for individual-level educational years, age, sex, income, residential years, disease, alcohol, smoking, social isolation, and population density. The association was significant in non-urban areas (HR, 1.05; 95% CI, 1.00–1.10). Conclusions:Older people living in communities with a higher prevalence of less educational attainment among their age demographic tended to develop dementia more often than those living in areas with a lower prevalence of less educational attainment after adjusting for individual-level educational attainment and covariates. In particular, the association was more pronounced in non-urban areas than in urban areas. Securing education for adolescence as a life course and population approach could thus be crucial to prevent dementia later in life among all older people living in non-urban areas.

scholarly journals Community-level educational attainment and dementia: a 6-year longitudinal multilevel study in Japan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tomo Takasugi ◽  
Taishi Tsuji ◽  
Masamichi Hanazato ◽  
Yasuhiro Miyaguni ◽  
Toshiyuki Ojima ◽  
...  
Keyword(s):  
Older People ◽  
Educational Attainment ◽  
Urban Areas ◽  
Evaluation Study ◽  
Community Level ◽  
Variable Model ◽  
Term Care ◽  
Individual Level ◽  
Dementia Incidence ◽  
Individual Survival

Abstract Background As the understanding of the association between community-level education and dementia is insufficient, this study examined the contextual association of community-level prevalence of low educational attainment on the risk of dementia incidence. With this study, we further explored the potential differences in the aforementioned associations for urban and non-urban areas. Methods We analyzed 6 years of prospective cohort data from the Japan Gerontological Evaluation Study, beginning with the baseline data collected between 2010 and 2012, for 51,186 physically and cognitively independent individuals aged ≥65 years (23,785 men and 27,401 women) from 346 communities in 16 municipalities across 7 prefectures. We assessed dementia incidence using available data from the long-term care insurance system in Japan. We dichotomized education years as ≤9 and ≥ 10 years and aggregated individual-level educational attainment as a community-level independent variable. Model 1 covariates were age and sex. Income, residential years, disease, alcohol, smoking, social isolation, and population density were added in Model 2. We conducted multiple imputation to address the missing data. We performed a two-level (community and individual) survival analysis to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results The results indicate that the cumulative incidence of dementia during the follow-up period was 10.6%. The mean proportion with educational attainment of ≤9 years was 40.8% (range: 5.1–87.3%). Low community-level educational attainment was significantly associated with higher dementia incidence (HR: 1.04; 95% CI: 1.01–1.07), estimated by 10 percentage points of low educational attainment after adjusting for individual-level educational years and covariates. While the association was significant in non-urban areas (HR: 1.07; 1.02–1.13), there was no association in urban areas (HR: 1.03; 0.99–1.06). Conclusions Older people living in communities with low educational attainment among their age demographic develop dementia more often compared with those living in areas with high educational attainment after adjusting for individual-level educational attainment and covariates; the association was pronounced in non-urban areas. Securing education for adolescents as a life course and population approach could thus be crucial in preventing dementia later in life among older people living in non-urban areas.

scholarly journals Hepatitis E in Bangladesh: Insights from a National Serosurvey

2021 ◽  
Author(s):  
Andrew Azman ◽  
Kishor Kumar Paul ◽  
Taufiqur Rahman Bhuiyan ◽  
Aybuke Koyuncu ◽  
Henrik Salje ◽  
...  
Keyword(s):  
Urban Areas ◽  
Case Fatality ◽  
Population Level ◽  
Hepatitis E ◽  
Community Level ◽  
Reproductive Age ◽  
Serum Samples ◽  
Household Level ◽  
Individual Level ◽  
Geostatistical Models

Background Hepatitis E virus, typically genotypes 1 and 2, is a major cause of avoidable morbidity and mortality in South Asia. Although case fatality risk among pregnant women can reach as high as 25%, a lack of population-level disease burden data has been cited as a primary factor in key global policy recommendations against the routine use of licensed hepatitis E vaccines, one of the only effective tools available for preventing disease and death. Methods We tested serum from a nationally-representative serosurvey in Bangladesh for anti-HEV IgG. We estimated the proportion of the population with evidence of historical HEV infection and used Bayesian geostatistical models to generate high resolution national maps of seropositivity. We examined variability in seropositivity by individual-level, household-level, and community-level risk factors using spatial logistic regression. Results We tested serum samples from 2924 individuals from 70 communities representing all divisions of Bangladesh and estimated a national seroprevalence of hepatitis E of 20% (95% CI 17-24%). Seropositivity increased with age and male sex (OR: 2.2, 95% CI: 1.8-2.8). Community-level seroprevalence ranged from 0-78% with the seroprevalence in urban areas being higher, including Dhaka, the capital, with 3-fold (95%CrI 2.3-3.7) higher seroprevalence than the rest of the country. Conclusion Hepatitis E infections are common throughout Bangladesh, though 90% of women reach reproductive age without any evidence of previous exposure to the virus, thus likely susceptible to infection and disease. Strengthening clinical surveillance for hepatitis E, especially in urban areas may help generate additional evidence needed to appropriately target interventions like vaccines to the populations most likely to benefit.

scholarly journals Assessing the Contextual Effect of Community in the Utilization of Postnatal Care Services in Ghana

2021 ◽  
Author(s):  
Emmanuel Dankwah ◽  
Wu Zeng ◽  
Cindy Feng ◽  
Shelley Kirychuck ◽  
Rein Lepnrum ◽  
...  
Keyword(s):  
Postnatal Care ◽  
Northern Region ◽  
Community Level ◽  
Scan Statistics ◽  
Contextual Effect ◽  
Health Seeking ◽  
Poverty Level ◽  
Individual Level ◽  
Care Services ◽  
Poor Women

Abstract BackgroundInequalities in the use of postnatal care services (PNC) in Ghana have been linked to poor maternal and neonatal health outcomes. This has ignited a genuine concern that PNC interventions with a focus on influencing solely individual-level risk factors do not achieve the desired results. This study aimed to examine the community-level effect on the utilization of postnatal care services. Specifically, the research explored clusters of non-utilization of PNC services as well as the effect of community-level factors on the utilization of PNC services, with the aim of informing equity-oriented policies and initiatives.MethodsThe 2014 Ghana Demographic and Health Survey GDHS dataset was used in this study. Two statistical methods were used to analyze the data; spatial scan statistics were used to identify hotspots of non-use of PNC services and second two-level mixed logistic regression modeling was used to determine community-level factors associated with PNC services usage. ResultsThis study found non-use of PNC services to be especially concentrated among communities in the Northern region of Ghana. Also, the analyses revealed that community poverty level, as well as community secondary or higher education level, were significantly associated with the utilization of PNC services, independent of individual-level factors. In fact, this study identified that a woman dwelling in a community with a higher concentration of poor women is less likely to utilize of PNC services than those living in communities with a lower concentration of poor women (Adjusted odds ratio (AOR) = 0.60, 95%CI: 0.44 - 0.81). Finally, 24.0% of the heterogeneity in PNC services utilization was attributable to unobserved community variability.ConclusionThe findings of this study indicate that community-level factors have an influence on women’s health-seeking behavior. Community-level factors should be taken into consideration for planning and resource allocation purposes to reduce maternal health inequities. Also, high-risk communities of non-use of obstetric services were identified in this study which highlights the need to formulate community-specific strategies that can substantially shift post-natal use in a direction leading to universal coverage.

scholarly journals PRECARITY AND LATER LIFE: UNDERSTANDING NEW INEQUALITIES AND RISKS IN LATER LIFE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S588-S588
Author(s):  
Dale Dannefer ◽  
Christopher Phillipson ◽  
Dale Dannefer
Keyword(s):  
Older People ◽  
Life Course ◽  
Social Dynamics ◽  
Later Life ◽  
Academic Disciplines ◽  
Potential Contribution ◽  
Term Care ◽  
Economic Changes ◽  
Individual Level ◽  
The Life Course

Abstract This symposium addresses debates around the theme of precarity and its implications for understanding social and economic changes affecting the lives of older people. To date, the concept of precarity has been applied to several subpopulations by various academic disciplines but has yet to be systematically applied to later life. The symposium will give particular attention to the extent to which the lens provided by precarity can illuminate different types of inequalities experienced through the life course and reflected in public policies directed at older people. Chris Phillipson reviews theoretical perspectives relating to precarity, examining their potential contribution for the development of critical gerontology. His paper also considers the extent to which the concept of ‘precarious ageing’ offers a competing or complementary view to theories of ‘active’ and ‘successful ageing’. Larry Polivka examines the growing precarity of life for older Americans emanating from austerity budgets and privatization of public services. The paper suggests that policies such as health care and long term care are in jeopardy, creating a glide path toward the extension of precarious employment into a precarious retirement for millions of older people. Wenxuan Huang examines how the focus on agency and other individual-level foci obscure understanding of social dynamics. Finally, Amanda Grenier draws on a scoping review of precarity to outline conceptual distinctions between frailty, vulnerability, and precarity. She presents reflections on what these concepts offer in terms of understandings of late life the study of disadvantage across the life course.

scholarly journals Shelter/housing options, supports and interventions for older people experiencing homelessness

2021 ◽  
pp. 1-27
Author(s):  
Sarah L. Canham ◽  
Joe Humphries ◽  
Piper Moore ◽  
Victoria Burns ◽  
Atiya Mahmood
Keyword(s):  
Older People ◽  
English Language ◽  
Later Life ◽  
Supported Housing ◽  
Empirical Literature ◽  
Future Research ◽  
Term Care ◽  
Ageing In Place ◽  
Individual Level ◽  
Housing Options

Abstract While experiences of later-life homelessness are known to vary, classification of shelter, housing and service models that meet the diverse needs of older people with experiences of homelessness (OPEH) are limited. To address this gap, a scoping review was conducted of shelter/housing options, supports and interventions for OPEH. Fourteen databases were searched for English-language peer-reviewed and/or empirical literature published between 1999 and 2019, resulting in the inclusion of 22 sources. Through a collaborative, iterative process of reading, discussing and coding, data extracted from the studies were organised into six models: (1) long-term care, (2) permanent supportive housing (PSH), including PSH delivered through Housing First, (3) supported housing, (4) transitional housing, (5) emergency shelter settings with health and social supports, and (6) case management and outreach. Programme descriptions and OPEH outcomes are described and contribute to our understanding that multiple shelter/housing options are needed to support diverse OPEH. The categorised models are considered alongside existing ‘ageing in place’ research, which largely focuses on older adults who are housed. Through extending discussions of ageing in the ‘right’ place to diverse OPEH, additional considerations are offered. Future research should explore distinct sub-populations of OPEH and how individual-level supports for ageing in place must attend to mezzo- and macro-level systems and policies.

scholarly journals Community-Level Participation in Volunteer Groups and Individual Depressive Symptoms in Japanese Older People: A Three-Year Longitudinal Multilevel Analysis Using JAGES Data

2021 ◽  
Vol 18 (14) ◽  
pp. 7502
Author(s):  
Motoki Tamura ◽  
Shinji Hattori ◽  
Taishi Tsuji ◽  
Katsunori Kondo ◽  
Masamichi Hanazato ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Depressive Symptoms ◽  
Older People ◽  
Poisson Regression ◽  
Community Level ◽  
Contextual Effect ◽  
Annual Rainfall ◽  
Group Participation ◽  
Poisson Regression Analysis ◽  
Volunteer Group

Background: The current study aimed to investigate the contextual effect of volunteer group participation on subsequent depressive symptoms in older people. Methods: We analyzed the longitudinal data of 37,552 people aged 65 years and older in 24 municipalities surveyed in the Japan Gerontological Evaluation Study. Volunteer group participation of older people was assessed in 2013 by one question and depressive symptoms were assessed by the Geriatric Depression Scale 15 in 2016. To investigate a contextual effect, we aggregated individual-level volunteer group participation by each residence area as a community-level independent variable. We conducted a two-level multilevel Poisson regression analysis using the Random Intercepts and Fixed Slopes Model. Results: The average proportion of community-level volunteer group participation was 10.6%. The results of the Poisson regression analysis showed that community-level volunteer group participation reduced the risk for the onset of depressive symptoms by 13% with a 10 percentage point increase in participation, after adjusting for sex, age, population density, total annual sunshine hours and annual rainfall (incident rate ratio, 0.87; 95% confidence interval, 0.78–0.98). Conclusions: Older people living in areas with higher volunteer group participation had a lower risk of developing depressive symptoms regardless of whether or not they participated in a volunteer group.

scholarly journals Assessing the contextual effect of community in the utilization of postnatal care services in Ghana

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emmanuel Dankwah ◽  
Cindy Feng ◽  
Shelley Kirychuck ◽  
Wu Zeng ◽  
Rein Lepnurm ◽  
...  
Keyword(s):  
Postnatal Care ◽  
Northern Region ◽  
Community Level ◽  
Scan Statistics ◽  
Contextual Effect ◽  
Health Seeking ◽  
Poverty Level ◽  
Individual Level ◽  
Care Services ◽  
Poor Women

Abstract Background Inequalities in the use of postnatal care services (PNC) in Ghana have been linked to poor maternal and neonatal health outcomes. This has ignited a genuine concern that PNC interventions with a focus on influencing solely individual-level risk factors do not achieve the desired results. This study aimed to examine the community-level effect on the utilization of postnatal care services. Specifically, the research explored clusters of non-utilization of PNC services as well as the effect of community-level factors on the utilization of PNC services, with the aim of informing equity-oriented policies and initiatives. Methods The 2014 Ghana Demographic and Health Survey GDHS dataset was used in this study. Two statistical methods were used to analyze the data; spatial scan statistics were used to identify hotspots of non-use of PNC services and second two-level mixed logistic regression modeling was used to determine community-level factors associated with PNC services usage. Results This study found non-use of PNC services to be especially concentrated among communities in the Northern region of Ghana. Also, the analyses revealed that community poverty level, as well as community secondary or higher education level, were significantly associated with the utilization of PNC services, independent of individual-level factors. In fact, this study identified that a woman dwelling in a community with a higher concentration of poor women is less likely to utilize of PNC services than those living in communities with a lower concentration of poor women (Adjusted odds ratio (AOR) = 0.60, 95%CI: 0.44–0.81). Finally, 24.0% of the heterogeneity in PNC services utilization was attributable to unobserved community variability. Conclusion The findings of this study indicate that community-level factors have an influence on women’s health-seeking behavior. Community-level factors should be taken into consideration for planning and resource allocation purposes to reduce maternal health inequities. Also, high-risk communities of non-use of obstetric services were identified in this study which highlights the need to formulate community-specific strategies that can substantially shift post-natal use in a direction leading to universal coverage.

scholarly journals Hepatitis E in Bangladesh: Insights from a National Serosurvey

2021 ◽  
Author(s):  
Andrew S Azman ◽  
Kishor Kumar Paul ◽  
Taufiqur Rahman Bhuiyan ◽  
Aybüke Koyuncu ◽  
Henrik Salje ◽  
...  
Keyword(s):  
Urban Areas ◽  
Case Fatality ◽  
Population Level ◽  
Credible Interval ◽  
Hepatitis E ◽  
Community Level ◽  
Serum Samples ◽  
Household Level ◽  
Individual Level ◽  
Geostatistical Models

Abstract Background Hepatitis E virus, typically genotypes 1 and 2, is a major cause of avoidable morbidity and mortality in South Asia. Although case fatality risk among pregnant women can reach as high as 25%, a lack of population-level disease burden data has been cited as a primary factor in key global policy recommendations against the routine use of licensed hepatitis E vaccines, one of the only effective tools available for preventing disease and death. Methods We tested serum from a nationally-representative serosurvey in Bangladesh for anti-HEV IgG. We estimated the proportion of the population with evidence of historical HEV infection and used Bayesian geostatistical models to generate high-resolution national maps of seropositivity. We examined variability in seropositivity by individual-level, household-level, and community-level risk factors using spatial logistic regression. Results We tested serum samples from 2924 individuals from 70 communities representing all divisions of Bangladesh and estimated a national seroprevalence of hepatitis E of 20% (95% CI 17-24%). Seropositivity increased with age and male sex (Odds Ratio: 2.2 male vs. female, 95% Confidence Interval: 1.8–2.8). Community-level seroprevalence ranged from 0-78% with the seroprevalence in urban areas being higher, including Dhaka, the capital, with 3.0-fold (95% Credible Interval 2.3-3.7) higher seroprevalence than the rest of the country. Conclusion Hepatitis E infections are common throughout Bangladesh. Strengthening clinical surveillance for hepatitis E, especially in urban areas may help generate additional evidence needed to appropriately target interventions like vaccines to the populations most likely to benefit.

Assessment of older people in the community: from ‘75-and-over checks’ to National Service Frameworks

2004 ◽  
Vol 14 (4) ◽  
pp. 257-267
Author(s):  
Steve Iliffe ◽  
Vari Drennan
Keyword(s):  
Older People ◽  
Population Aging ◽  
Age Discrimination ◽  
National Service ◽  
The European Union ◽  
Term Care ◽  
The Government ◽  
The Uk

Population aging, escalating costs in pensions, health care and long-term care have prompted the emergence of a new policy agenda for active aging and quality of life in old age across the European Union. In the UK, the government has made a commitment to improve services for older people through combating age discrimination, engaging with older people, better decision-making for services for older people, better meeting of older people's needs and promoting a strategic and ‘joined-up’ approach. A raft of policy initiatives not only sets the tone for service reconfiguration but also specifies objectives and time scales.

scholarly journals Bicycling-Related Mortality in Ecuador: A Nationwide Population-Based Analysis from 2004 to 2017

2021 ◽  
Vol 13 (11) ◽  
pp. 5906
Author(s):  
Simone Cordovez ◽  
Esteban Ortiz-Prado ◽  
Eduardo Vasconez ◽  
Felipe Andrade ◽  
Katherine Simbaña-Rivera ◽  
...  
Keyword(s):  
Educational Attainment ◽  
Rural Areas ◽  
Urban Areas ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Population Based ◽  
Health Determinants ◽  
The Impact ◽  
Related Mortality ◽  
Lower Educational Attainment

Urban cycling is gaining popularity worldwide. Inadequate local and international guidelines on street cycling have contributed to a significant increase in road traffic/cycling collisions. Developing countries are the least safe for cyclists. In this sense, this is the first epidemiological study that seeks to determine the impact of street cycling-related mortality in Ecuador over the last 13 years. Methods: A descriptive ecological analysis of the epidemiology of bicycling-related mortality in Ecuador was conducted. All deaths identified as V10 to V19 according to the International Code of Diseases 10th edition (ICD-10) from 2004 to 2017 were retrieved from the National Institute of Statistics and Census in Ecuador (INEC) database. Results: From 2004 to 2017, a total of 300 deaths among street cyclists were officially reported in Ecuador. From this, 91% of the victims were men (n = 273) and 9% were women (n = 27). In relationship to other traffic accidents, bicycle-related deaths accounted for 0.68% of the overall car accident mortality. Bicycle-related deaths are more frequent in urban areas with 85% (n = 257), while rural areas accounted for 15% of the deaths (n = 43). In addition, lower educational attainment (75% did not reach secondary school) seems to be linked with higher mortality rates. Conclusions: In Ecuador, fatalities involving cyclists are an important part of the burden of disease attributed to traffic accidents. These preventable deaths are becoming a growing health problem, especially among those with poorer health determinants, such as lower educational attainment, ethnic minority status, and living in rural areas. The lack of public policy related to the prevention of this type of accident, as well as the irresponsibility of cars and transport vehicle drivers, might be associated with an increasingly high portion of the overall bicycle-related mortality in Ecuador.

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