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Birth weight and perinatal mortality: a comparison of "optimal" birth weight in seven Western European countries.

https://arctichealth.org/en/permalink/ahliterature58488
Source
Epidemiology. 2002 Sep;13(5):569-74
Publication Type
Article
Date
Sep-2002
Author
Wilco C Graafmans
Jan Hendrik Richardus
Gerard J J M Borsboom
Leiv Bakketeig
Jens Langhoff-Roos
Per Bergsjø
Alison Macfarlane
S Pauline Verloove-Vanhorick
Johan P Mackenbach
Author Affiliation
Department of Public Health, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Source
Epidemiology. 2002 Sep;13(5):569-74
Date
Sep-2002
Language
English
Publication Type
Article
Keywords
Birth weight
Comparative Study
Europe - epidemiology
Humans
Infant mortality
Infant, Newborn
Research Support, Non-U.S. Gov't
Abstract
BACKGROUND: Previous studies have suggested that a population's entire birth weight distribution may be shifted towards higher or lower birth weights, and that optimal birth weight may be lower in populations with a lower average birth weight. We evaluated this hypothesis for seven western European countries. METHODS: We obtained data on all singleton births (N = 1,372,092) and extended perinatal deaths (stillbirths plus neonatal deaths; N = 7,900) occurring in Finland, Sweden, Norway, Denmark, Scotland, the Netherlands, and Flanders (Belgium) in 1993-1995. We assessed whether countries differed in the mode of their birth weight distribution and in the birth weight associated with the lowest perinatal mortality, and then correlated the two. RESULTS: Substantial international differences were found in the mode of the birth weight distribution, which ranged between 3384 gm in Flanders and 3628 gm in Finland. The position of the minimum of the perinatal mortality curve also differed considerably, ranging between 3755 gm in Flanders and 4305 gm in Norway. There was a strong relation between the two: for every 100 gm increase in modal birth weight, optimal birth weight was 170 gm higher (95% confidence interval = 104-236 gm). CONCLUSIONS: Our results confirm those of previous studies that compared two populations. To improve the identification of small babies at high risk of perinatal death, population-specific standards for birth weight should be developed and used.
PubMed ID
12192227 View in PubMed
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Differences in perinatal mortality and suboptimal care between 10 European regions: results of an international audit.

https://arctichealth.org/en/permalink/ahliterature58425
Source
BJOG. 2003 Feb;110(2):97-105
Publication Type
Article
Date
Feb-2003
Author
Jan H Richardus
Wilco C Graafmans
S Pauline Verloove-Vanhorick
Johan P Mackenbach
Author Affiliation
Department of Public Health, Erasmus MC, Erasmus Medical Centre, Rotterdam, The Netherlands.
Source
BJOG. 2003 Feb;110(2):97-105
Date
Feb-2003
Language
English
Publication Type
Article
Keywords
Abruptio Placentae - mortality
Europe - epidemiology
Female
Fetal Growth Retardation - complications - diagnosis - mortality
Gestational Age
Humans
Infant mortality
Infant, Newborn
Medical Audit
Pregnancy
Prenatal Care - standards
Quality of Health Care
Research Support, Non-U.S. Gov't
Retrospective Studies
Smoking - adverse effects
Abstract
OBJECTIVE: A European concerted action (the EuroNatal study) investigated the background of differences in perinatal mortality between countries of Europe. The study aimed to determine the contribution of differences in quality of care, by looking at differences in the presence of suboptimal factors in individual cases of perinatal death. DESIGN: Retrospective audit study. SETTING: Regions of 10 European countries. POPULATION: 1619 cases of perinatal death. METHODS: Perinatal deaths between 1993 and 1998 in regions of 10 European countries were identified. Reviewed were singleton fetal deaths (28 or more weeks of gestational age), intrapartum deaths (28 or more weeks) and neonatal deaths (34 or more weeks). Deaths with (major) congenital anomalies were excluded. Cases were blinded for region and an international audit panel reviewed them using explicit audit criteria. MAIN OUTCOME MEASURES: Presence of suboptimal factors. RESULTS: The audit covered 1619 cases of perinatal death, representing 90% of eligible cases in the regions. Consensus was reached on 1543 (95%) cases. In 715 (46%) of these cases, suboptimal factors, which possibly or probably had contributed to the fatal outcome, were identified. The percentage of cases with such suboptimal care factors was significantly lower in the Finnish and Swedish regions compared with the remaining regions of Spain, the Netherlands, Scotland, Belgium, Denmark, Norway, Greece and England. Failure to detect severe IUGR (10% of all cases) and smoking in combination with severe IUGR and/or placental abruption (12%) was the most frequent suboptimal factor. There was a positive association between the proportion of cases with suboptimal factors and the overall perinatal mortality rate in the regions. CONCLUSIONS: The findings of this international audit suggest that differences exist between the regions of the 10 European countries in the quality of antenatal, intrapartum and neonatal care, and that these differences contribute to the explanation of differences in perinatal mortality between these countries. The background to these differences in quality of care needs further investigation.
PubMed ID
12618151 View in PubMed
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Educational level and stroke mortality: a comparison of 10 European populations during the 1990s.

https://arctichealth.org/en/permalink/ahliterature67275
Source
Stroke. 2004 Feb;35(2):432-7
Publication Type
Article
Date
Feb-2004
Author
Mauricio Avendaño
Anton E Kunst
Martijn Huisman
Frank van Lenthe
Matthias Bopp
Carme Borrell
Tapani Valkonen
Enrique Regidor
Giuseppe Costa
Angela Donkin
Jens-Kristian Borgan
Patrick Deboosere
Sylvie Gadeyne
Teresa Spadea
Otto Andersen
Johan P Mackenbach
Author Affiliation
Department of Public Health, Erasmus Medical Center, PO Box 1738, 3000 DR Rotterdam, Netherlands. m.avendanopabon@erasmusmc.nl
Source
Stroke. 2004 Feb;35(2):432-7
Date
Feb-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cerebrovascular Accident - mortality
Cohort Studies
Comparative Study
Educational Status
Europe - epidemiology
Female
Follow-Up Studies
Humans
Life expectancy
Life tables
Longitudinal Studies
Male
Middle Aged
Odds Ratio
Registries - statistics & numerical data
Research Support, Non-U.S. Gov't
Sex Distribution
Abstract
BACKGROUND AND PURPOSE: Variations between countries in occupational differences in stroke mortality were observed among men during the 1980s. This study estimates the magnitude of differences in stroke mortality by educational level among men and women aged >or=30 years in 10 European populations during the 1990s. METHODS: Longitudinal data from mortality registries were obtained for 10 European populations, namely Finland, Norway, Denmark, England/Wales, Belgium, Switzerland, Austria, Turin (Italy), Barcelona (Spain), and Madrid (Spain). Rate ratios (RRs) were calculated to assess the association between educational level and stroke mortality. The life table method was used to estimate the impact of stroke mortality on educational differences in life expectancy. RESULTS: Differences in stroke mortality according to educational level were of a similar magnitude in most populations. However, larger educational differences were observed in Austria. Overall, educational differences in stroke mortality were of similar size among men (RR, 1.27; 95% CI, 1.24 to 1.30) and women (RR, 1.29; 95% CI, 1.27 to 1.32). Educational differences in stroke mortality persisted at all ages in all populations, although they generally decreased with age. Eliminating these differences would on average reduce educational differences in life expectancy by 7% among men and 14% among women. CONCLUSIONS: Educational differences in stroke mortality were observed across Europe during the 1990s. Risk factors such as hypertension and smoking may explain part of these differences in several countries. Other factors, such as socioeconomic differences in healthcare utilization and childhood socioeconomic conditions, may have contributed to educational differences in stroke mortality across Europe.
PubMed ID
14726555 View in PubMed
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Financial crisis, austerity, and health in Europe.

https://arctichealth.org/en/permalink/ahliterature115117
Source
Lancet. 2013 Apr 13;381(9874):1323-31
Publication Type
Article
Date
Apr-13-2013
Author
Marina Karanikolos
Philipa Mladovsky
Jonathan Cylus
Sarah Thomson
Sanjay Basu
David Stuckler
Johan P Mackenbach
Martin McKee
Author Affiliation
European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, UK.
Source
Lancet. 2013 Apr 13;381(9874):1323-31
Date
Apr-13-2013
Language
English
Publication Type
Article
Keywords
Delivery of Health Care - economics
Economic Recession
Europe - epidemiology
Greece - epidemiology
Health Policy - economics
Humans
Iceland - epidemiology
Mental Disorders - epidemiology
Portugal - epidemiology
Public Health - economics
Spain - epidemiology
Abstract
The financial crisis in Europe has posed major threats and opportunities to health. We trace the origins of the economic crisis in Europe and the responses of governments, examine the effect on health systems, and review the effects of previous economic downturns on health to predict the likely consequences for the present. We then compare our predictions with available evidence for the effects of the crisis on health. Whereas immediate rises in suicides and falls in road traffic deaths were anticipated, other consequences, such as HIV outbreaks, were not, and are better understood as products of state retrenchment. Greece, Spain, and Portugal adopted strict fiscal austerity; their economies continue to recede and strain on their health-care systems is growing. Suicides and outbreaks of infectious diseases are becoming more common in these countries, and budget cuts have restricted access to health care. By contrast, Iceland rejected austerity through a popular vote, and the financial crisis seems to have had few or no discernible effects on health. Although there are many potentially confounding differences between countries, our analysis suggests that, although recessions pose risks to health, the interaction of fiscal austerity with economic shocks and weak social protection is what ultimately seems to escalate health and social crises in Europe. Policy decisions about how to respond to economic crises have pronounced and unintended effects on public health, yet public health voices have remained largely silent during the economic crisis.
Notes
Comment In: Lancet. 2013 Aug 3;382(9890):39223911371
Comment In: Lancet. 2013 Aug 3;382(9890):39123911369
Comment In: Lancet. 2013 Aug 3;382(9890):391-223911370
Comment In: Lancet. 2013 Aug 3;382(9890):39223911372
Comment In: Lancet. 2013 Aug 3;382(9890):39323911373
PubMed ID
23541059 View in PubMed
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Inequalities in lung cancer mortality by the educational level in 10 European populations.

https://arctichealth.org/en/permalink/ahliterature18012
Source
Eur J Cancer. 2004 Jan;40(1):126-35
Publication Type
Article
Date
Jan-2004
Author
Johan P Mackenbach
Martijn Huisman
Otto Andersen
Matthias Bopp
Jens-Kristian Borgan
Carme Borrell
Giuseppe Costa
Patrick Deboosere
Angela Donkin
Sylvie Gadeyne
Christoph Minder
Enrique Regidor
Teresa Spadea
Tapani Valkonen
Anton E Kunst
Author Affiliation
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. j.mackenbach@erasmusmc.nl
Source
Eur J Cancer. 2004 Jan;40(1):126-35
Date
Jan-2004
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Aged, 80 and over
Educational Status
Europe - epidemiology
Female
Humans
Lung Neoplasms - mortality
Male
Middle Aged
Prevalence
Regression Analysis
Research Support, Non-U.S. Gov't
Sex Distribution
Smoking - mortality
Abstract
Previous studies have shown that due to differences in the progression of the smoking epidemic European countries differ in the direction and size of socioeconomic variations in smoking prevalence. We studied differences in the direction and size of inequalities in lung cancer mortality by the educational level of subjects in 10 European populations during the 1990's. We obtained longitudinal mortality data by cause of death, age, sex and educational level for 4 Northern European populations (England/Wales, Norway, Denmark, Finland), 3 continental European populations (Belgium, Switzerland, Austria), and 3 Southern European populations (Barcelona, Madrid, Turin). Age- and sex-specific mortality rates by educational level were calculated, as well as the age- and sex-specific mortality rate ratios. Patterns of educational inequalities in lung cancer mortality suggest that England/Wales, Norway, Denmark, Finland and Belgium are the farthest advanced in terms of the progression of the smoking epidemic: these populations have consistently higher lung cancer mortality rates among the less educated in all age-groups in men, including the oldest men, and in all age-groups in women up to those aged 60-69 years. Madrid appears to be less advanced, with less educated men in the oldest age-group and less educated women in all age-groups still benefiting from lower lung cancer mortality rates. Switzerland, Austria, Turin and Barcelona occupy intermediate positions. The lung cancer mortality data suggest that inequalities in smoking contribute substantially to the educational differences in total mortality among men in all populations, except Madrid. Among women, these contributions are probably substantial in the Northern European countries and in Belgium, but only small in Switzerland, Austria, Turin and Barcelona, and negative in Madrid. In many European countries, policies and interventions that reduce smoking in less educated groups should be one of the main priorities to tackle socioeconomic inequalities in mortality. In some countries, particularly in Southern Europe, it may not be too late to prevent women in less educated groups from taking up the smoking habit, thereby avoiding large inequalities in mortality in the future in these countries.
PubMed ID
14687796 View in PubMed
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Innovations in medical care and mortality trends from four circulatory diseases between 1970 and 2005.

https://arctichealth.org/en/permalink/ahliterature258212
Source
Eur J Public Health. 2013 Oct;23(5):852-7
Publication Type
Article
Date
Oct-2013
Author
Rasmus Hoffmann
Iris Plug
Martin McKee
Bernadette Khoshaba
Ragnar Westerling
Caspar Looman
Gregoire Rey
Eric Jougla
Jose Luis Alfonso
Katrin Lang
Kersti Pärna
Johan P Mackenbach
Author Affiliation
1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
Source
Eur J Public Health. 2013 Oct;23(5):852-7
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Cause of Death - trends
Cerebrovascular Disorders - mortality - therapy
Estonia - epidemiology
Europe - epidemiology
France - epidemiology
Germany - epidemiology
Great Britain - epidemiology
Heart Failure - mortality - therapy
Humans
Hypertension - mortality - therapy
Mortality - trends
Myocardial Ischemia - mortality - therapy
Netherlands - epidemiology
Questionnaires
Spain - epidemiology
Sweden - epidemiology
Therapies, Investigational
Time Factors
Abstract
Governments have identified innovation in pharmaceuticals and medical technology as a priority for health policy. Although the contribution of medical care to health has been studied extensively in clinical settings, much less is known about its contribution to population health. We examine how innovations in the management of four circulatory disorders have influenced trends in cause-specific mortality at the population level.
Based on literature reviews, we selected six medical innovations with proven effectiveness against hypertension, ischaemic heart disease, heart failure and cerebrovascular disease. We combined data on the timing of these innovations and cause-specific mortality trends (1970-2005) from seven European countries. We sought to identify associations between the introduction of innovations and favourable changes in mortality, using Joinpoint-models based on linear spline regression.
For both ischaemic heart disease and cerebrovascular disease, the timing of medical innovations was associated with improved mortality in four out of five countries and five out of seven countries, respectively, depending on the innovation. This suggests that innovation has impacted positively on mortality at the population level. For hypertension and heart failure, such associations could not be identified.
Although improvements in cause-specific mortality coincide with the introduction of some innovations, this is not invariably true. This is likely to reflect the incremental effects of many interventions, the time taken for them to be adopted fully and the presence of contemporaneous changes in disease incidence. Research on the impact of medical innovations on population health is limited by unreliable data on their introduction.
PubMed ID
23478209 View in PubMed
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The shape of the relationship between income and self-assessed health: an international study.

https://arctichealth.org/en/permalink/ahliterature70845
Source
Int J Epidemiol. 2005 Apr;34(2):286-93
Publication Type
Article
Date
Apr-2005
Author
Johan P Mackenbach
Pekka Martikainen
Caspar W N Looman
Jetty A A Dalstra
Anton E Kunst
Eero Lahelma
Author Affiliation
Department of Public Health, Erasmus MC, 3000 DR Rotterdam, The Netherlands. j.mackenbach@erasmusmc.nl
Source
Int J Epidemiol. 2005 Apr;34(2):286-93
Date
Apr-2005
Language
English
Publication Type
Article
Keywords
Adult
Aged
Europe
Female
Health status
Health Surveys
Humans
Income
Linear Models
Male
Middle Aged
Research Support, Non-U.S. Gov't
Self Concept
Abstract
BACKGROUND: The relationship between income and health is usually thought to be curvilinear, but previous studies have yielded inconsistent results. We therefore examined the shape of the relationship between household equivalent income and self-assessed health in seven European countries. METHODS: Data were obtained from nationally representative health, level of living, or similar surveys in Belgium, Denmark, England, Finland, France, The Netherlands, and Norway and applied to men and women aged 25 years and older in the 1990s. Smooth nonparametric curves were fitted to the data, as well as a spline regression function with three linear pieces connected by two knots. RESULTS: A higher household equivalent income is associated with better self-assessed health among men and women in all countries, particularly in the middle-income range. In the higher income ranges, the relationship is generally curvilinear and characterized by less improvement in self-assessed health per unit of rising income. In the lowest income ranges, the relationship is found to be curvilinear in four countries (Belgium, Finland, The Netherlands, and Norway), where the usual deterioration of health associated with lower incomes levels off or even reverses into an improvement. CONCLUSIONS: Further research is necessary to investigate the background of differences between countries in the shape of the relationship between income and self-assessed health, and should focus on both methodological and substantive explanations. Assuming causality, the results of our study lend some support to the notion of decreasing marginal health returns of a unit increase in income at the higher income ranges.
Notes
Comment In: Int J Epidemiol. 2005 Apr;34(2):293-415659465
PubMed ID
15561750 View in PubMed
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Trends in socioeconomic inequalities in self-assessed health in 10 European countries.

https://arctichealth.org/en/permalink/ahliterature70843
Source
Int J Epidemiol. 2005 Apr;34(2):295-305
Publication Type
Article
Date
Apr-2005
Author
Anton E Kunst
Vivian Bos
Eero Lahelma
Mel Bartley
Inge Lissau
Enrique Regidor
Andreas Mielck
Mario Cardano
Jetty A A Dalstra
José J M Geurts
Uwe Helmert
Carin Lennartsson
Jorun Ramm
Teresa Spadea
Willibald J Stronegger
Johan P Mackenbach
Author Affiliation
Department of Public Health, Erasmus MC, 3000 DR Rotterdam, The Netherlands. a.kunst@easmusmc.nl
Source
Int J Epidemiol. 2005 Apr;34(2):295-305
Date
Apr-2005
Language
English
Publication Type
Article
Keywords
Educational Status
Employment
Europe
Female
Health status
Health Surveys
Humans
Male
Odds Ratio
Research Support, Non-U.S. Gov't
Self Assessment (Psychology)
Sex Factors
Social Class
Social Conditions
Socioeconomic Factors
Abstract
BACKGROUND: Changes over time in inequalities in self-reported health are studied for increasingly more countries, but a comprehensive overview encompassing several countries is still lacking. The general aim of this article is to determine whether inequalities in self-assessed health in 10 European countries showed a general tendency either to increase or to decrease between the 1980s and the 1990s and whether trends varied among countries. METHODS: Data were obtained from nationally representative interview surveys held in Finland, Sweden, Norway, Denmark, England, The Netherlands, West Germany, Austria, Italy, and Spain. The proportion of respondents with self-assessed health less than 'good' was measured in relation to educational level and income level. Inequalities were measured by means of age-standardized prevalence rates and odds ratios (ORs). RESULTS: Socioeconomic inequalities in self-assessed health showed a high degree of stability in European countries. For all countries together, the ORs comparing low with high educational levels remained stable for men (2.61 in the 1980s and 2.54 in the 1990s) but increased slightly for women (from 2.48 to 2.70). The ORs comparing extreme income quintiles increased from 3.13 to 3.37 for men and from 2.43 to 2.86 for women. Increases could be demonstrated most clearly for Italian and Spanish men and women, and for Dutch women, whereas inequalities in health in the Nordic countries showed no tendency to increase. CONCLUSIONS: The results underscore the persistent nature of socioeconomic inequalities in health in modern societies. The relatively favourable trends in the Nordic countries suggest that these countries' welfare states were able to buffer many of the adverse effects of economic crises on the health of disadvantaged groups.
Notes
Comment In: Int J Epidemiol. 2005 Apr;34(2):306-815563585
PubMed ID
15563586 View in PubMed
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Widening socioeconomic inequalities in mortality in six Western European countries.

https://arctichealth.org/en/permalink/ahliterature18164
Source
Int J Epidemiol. 2003 Oct;32(5):830-7
Publication Type
Article
Date
Oct-2003
Author
Johan P Mackenbach
Vivian Bos
Otto Andersen
Mario Cardano
Giuseppe Costa
Seeromanie Harding
Alison Reid
Orjan Hemström
Tapani Valkonen
Anton E Kunst
Author Affiliation
Department of Public Health, Erasmus Medical Center, PO Box 1738, 3000 DR Rotterdam, The Netherlands. j.mackenbach@erasmusmc.nl
Source
Int J Epidemiol. 2003 Oct;32(5):830-7
Date
Oct-2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cardiovascular Diseases - mortality
Cause of Death
Educational Status
Europe - epidemiology
Female
Humans
Longitudinal Studies
Male
Middle Aged
Mortality - trends
Research Support, Non-U.S. Gov't
Social Class
Socioeconomic Factors
Abstract
OBJECTIVES: During the past decades a widening of the relative gap in death rates between upper and lower socioeconomic groups has been reported for several European countries. Although differential mortality decline for cardiovascular diseases has been suggested as an important contributory factor, it is not known what its quantitative contribution was, and to what extent other causes of death have contributed to the widening gap in total mortality. METHODS: We collected data on mortality by educational level and occupational class among men and women from national longitudinal studies in Finland, Sweden, Norway, Denmark, England/Wales, and Italy (Turin), and analysed age-standardized death rates in two recent time periods (1981-1985 and 1991-1995), both total mortality and by cause of death. For simplicity, we report on inequalities in mortality between two broad socioeconomic groups (high and low educational level, non-manual and manual occupations). RESULTS: Relative inequalities in total mortality have increased in all six countries, but absolute differences in total mortality were fairly stable, with the exception of Finland where an increase occurred. In most countries, mortality from cardiovascular diseases declined proportionally faster in the upper socioeconomic groups. The exception is Italy (Turin) where the reverse occurred. In all countries with the exception of Italy (Turin), changes in cardiovascular disease mortality contributed about half of the widening relative gap for total mortality. Other causes also made important contributions to the widening gap in total mortality. For these causes, widening inequalities were sometimes due to increasing mortality rates in the lower socioeconomic groups. We found rising rates of mortality from lung cancer, breast cancer, respiratory disease, gastrointestinal disease, and injuries among men and/or women in lower socioeconomic groups in several countries. CONCLUSIONS: Reducing socioeconomic inequalities in mortality in Western Europe critically depends upon speeding up mortality declines from cardiovascular diseases in lower socioeconomic groups, and countering mortality increases from several other causes of death in lower socioeconomic groups.
Notes
Comment In: Int J Epidemiol. 2003 Oct;32(5):838-914559761
PubMed ID
14559760 View in PubMed
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9 records – page 1 of 1.