Publications
123 results found
Howe LD, Kanayalal R, Beaumont RN, et al., 2019, Effects of body mass index on relationship status, social contact, and socioeconomic position: Mendelian Randomization study in UK Biobank
<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>To assess whether body mass index (BMI) has a causal effect on social and socioeconomic factors, including whether both high and low BMI can be detrimental.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Mendelian Randomization, using genetic variants for BMI to obtain unconfounded estimates, and non-linear Mendelian Randomization.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>UK Biobank.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>378,244 men and women of European ancestry, mean age 57 (SD 8 years).</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>Townsend deprivation index, income, age completed full time education, degree level education, job class, employment status, cohabiting relationship status, participation in leisure and social activities, visits from friends and family, and having someone to confide in.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Higher BMI was causally associated with higher deprivation, lower income, fewer years of education, lower odds of degree-level education and skilled employment. For example, a 1 SD higher genetically-determined BMI (4.8kg/m<jats:sup>2</jats:sup> in UK Biobank) was associated with £1,660 less income per annum [95%CI: £950, £2,380]. Non-linear Mendelian Randomization provided evidence that both low BMI (bottom decile, <22kg/m<jats:sup>2</jats:sup>) and high BMI (top seven deciles, >24.6kg/m<jats:sup>2</jats:sup>) can increase deprivation and reduce income. In men only, higher BMI was related to lower participation in leisu
Pimpin L, Retat L, Fecht D, et al., 2018, Estimating the costs of air pollution to the National Health Service and social care: An assessment and forecast up to 2035, PLoS Medicine, Vol: 15, ISSN: 1549-1277
BACKGROUND: Air pollution damages health by promoting the onset of some non-communicable diseases (NCDs), putting additional strain on the National Health Service (NHS) and social care. This study quantifies the total health and related NHS and social care cost burden due to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in England. METHOD AND FINDINGS: Air pollutant concentration surfaces from land use regression models and cost data from hospital admissions data and a literature review were fed into a microsimulation model, that was run from 2015 to 2035. Different scenarios were modelled: (1) baseline 'no change' scenario; (2) individuals' pollutant exposure is reduced to natural (non-anthropogenic) levels to compute the disease cases attributable to PM2.5 and NO2; (3) PM2.5 and NO2 concentrations reduced by 1 μg/m3; and (4) NO2 annual European Union limit values reached (40 μg/m3). For the 18 years after baseline, the total cumulative cost to the NHS and social care is estimated at £5.37 billion for PM2.5 and NO2 combined, rising to £18.57 billion when costs for diseases for which there is less robust evidence are included. These costs are due to the cumulative incidence of air-pollution-related NCDs, such as 348,878 coronary heart disease cases estimated to be attributable to PM2.5 and 573,363 diabetes cases estimated to be attributable to NO2 by 2035. Findings from modelling studies are limited by the conceptual model, assumptions, and the availability and quality of input data. CONCLUSIONS: Approximately 2.5 million cases of NCDs attributable to air pollution are predicted by 2035 if PM2.5 and NO2 stay at current levels, making air pollution an important public health priority. In future work, the modelling framework should be updated to include multi-pollutant exposure-response functions, as well as to disaggregate results by socioeconomic status.
Pimpin L, Retat L, Fecht D, et al., 2018, Estimation of costs to the NHS and social care due to the health impacts of air pollution
Nugent R, Bertram MY, Jan S, et al., 2018, Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals, The Lancet, Vol: 391, Pages: 2029-2035, ISSN: 0140-6736
Reduction of the non-communicable disease (NCD) burden is a global development imperative. Sustainable Development Goal (SDG) 3 includes target 3·4 to reduce premature NCD mortality by a third by 2030. Progress on SDG target 3·4 will have a central role in determining the success of at least nine SDGs. A strengthened effort across multiple sectors with effective economic tools, such as price policies and insurance, is necessary. NCDs are heavily clustered in people with low socioeconomic status and are an important cause of medical impoverishment. They thereby exacerbate economic inequities within societies. As such, NCDs are a barrier to achieving SDG 1, SDG 2, SDG 4, SDG 5, and SDG 10. Productivity gains from preventing and managing NCDs will contribute to SDG 8. SDG 11 and SDG 12 offer clear opportunities to reduce the NCD burden and to create sustainable and healthy cities.
Sassi F, Belloni A, Mirelman AJ, et al., 2018, Equity impacts of price policies to promote healthy behaviours, The Lancet, Vol: 391, Pages: 2059-2070, ISSN: 0140-6736
Governments can use fiscal policies to regulate the prices and consumption of potentially unhealthy products. However, policies aimed at reducing consumption by increasing prices, for example by taxation, might impose an unfair financial burden on low-income households. We used data from household expenditure surveys to estimate patterns of expenditure on potentially unhealthy products by socioeconomic status, with a primary focus on low-income and middle-income countries. Price policies affect the consumption and expenditure of a larger number of high-income households than low-income households, and any resulting price increases tend to be financed disproportionately by high-income households. As a share of all household consumption, however, price increases are often a larger financial burden for low-income households than for high-income households, most consistently in the case of tobacco, depending on how much consumption decreases in response to increased prices. Large health benefits often accrue to individual low-income consumers because of their strong response to price changes. The potentially larger financial burden on low-income households created by taxation could be mitigated by a pro-poor use of the generated tax revenues.
de Preux Gallone LB, Sassi F, 2018, Chapter 5 Economics of Pollution Interventions, Chief Medical Officer annual report 2017: health impacts of all pollution – what do we know?, Publisher: Department of Health and Social Care, 5
Interventions to reduce pollution have the potential toincrease social welfare through improvements in health,social and economic outcomes. This potential has beenshown in a range of economic analyses focusing on specificinterventions. In this chapter we present evidence fromstudies focusing on the health impacts of environmentalinterventions that have been evaluated from an economicperspective. Overall, this body of evidence is stronglysuggestive of beneficial welfare impacts from mostinterventions. However, there remains significant scope forexpanding and strengthening the current evidence base inorder to provide clearer guidance to policy makers in policydesign and investment decisions. Salient points made in thischapter include:1) England has successfully managed to “decouple” trendsof economic growth and polluting emissions, achievingreductions in emissions of a large range of pollutants withan expanding economy. However, the detrimental healthimpacts of current levels of pollution are still large, asare the potential benefits of taking more incisive actionsagainst pollution.2) Economic analysis approaches typically applied in theappraisal of environmental interventions are at oddswith those prevailing in the health care domain. A goldstandardeconomic evaluation approach in the area ofenvironmental health interventions should take a societalperspective and aim at assessing overall impacts onsocial welfare. Available evidence neglecting these keycomponents likely underestimates the net benefit ofpollution reduction measures.3) Research priorities should now include the evaluation ofthe societal benefits of measures to address pollutionin order to justify economically beneficial interventionsthat reduce individuals’ pollution exposure or remove thesource of emissions.
Matz M, Coleman MP, Carreira H, et al., 2017, Erratum to "Worldwide comparison of ovarian cancer survival: Histological group and stage at diagnosis (CONCORD-2)" [Gynecol. Oncol. 144 (2017) 396-404]., Gynecol Oncol, Vol: 147
Matz M, Coleman MP, Sant M, et al., 2017, Erratum to "The histology of ovarian cancer: Worldwide distribution and implications for international survival comparisons (CONCORD-2)" [Gynecol. Oncol. 144 (2017) 405-413]., Gynecol Oncol, Vol: 147
Tordrup D, Chouaid C, Cuijpers P, et al., 2017, PRIORITIES FOR HEALTH ECONOMIC METHODOLOGICAL RESEARCH: RESULTS OF AN EXPERT CONSULTATION, INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE, Vol: 33, Pages: 609-619, ISSN: 0266-4623
Bonaventure A, Harewood R, Stiller CA, et al., 2017, Worldwide comparison of survival from childhood leukaemia for 1995-2009, by subtype, age, and sex (CONCORD-2): a population-based study of individual data for 89 828 children from 198 registries in 53 countries, The Lancet Haematology, Vol: 4, Pages: e202-e217, ISSN: 2352-3026
BACKGROUND: Global inequalities in access to health care are reflected in differences in cancer survival. The CONCORD programme was designed to assess worldwide differences and trends in population-based cancer survival. In this population-based study, we aimed to estimate survival inequalities globally for several subtypes of childhood leukaemia. METHODS: Cancer registries participating in CONCORD were asked to submit tumour registrations for all children aged 0-14 years who were diagnosed with leukaemia between Jan 1, 1995, and Dec 31, 2009, and followed up until Dec 31, 2009. Haematological malignancies were defined by morphology codes in the International Classification of Diseases for Oncology, third revision. We excluded data from registries from which the data were judged to be less reliable, or included only lymphomas, and data from countries in which data for fewer than ten children were available for analysis. We also excluded records because of a missing date of birth, diagnosis, or last known vital status. We estimated 5-year net survival (ie, the probability of surviving at least 5 years after diagnosis, after controlling for deaths from other causes [background mortality]) for children by calendar period of diagnosis (1995-99, 2000-04, and 2005-09), sex, and age at diagnosis (<1, 1-4, 5-9, and 10-14 years, inclusive) using appropriate life tables. We estimated age-standardised net survival for international comparison of survival trends for precursor-cell acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML). FINDINGS: We analysed data from 89 828 children from 198 registries in 53 countries. During 1995-99, 5-year age-standardised net survival for all lymphoid leukaemias combined ranged from 10·6% (95% CI 3·1-18·2) in the Chinese registries to 86·8% (81·6-92·0) in Austria. International differences in 5-year survival for childhood leukaemia were still large as recently as 2005-09, when age-s
Sassi F, 2017, COUNTING THE COSTS OF ALCOHOL: HOW USEFUL AN AID TO POLICYMAKING?, ADDICTION, Vol: 112, Pages: 569-570, ISSN: 0965-2140
Matz M, Coleman MP, Carreira H, et al., 2017, Worldwide comparison of ovarian cancer survival: histological group and stage at diagnosis (CONCORD-2), Gynecologic Oncology, Vol: 144, Pages: 396-404, ISSN: 0090-8258
OBJECTIVE: Ovarian cancer comprises several histological groups with widely differing levels of survival. We aimed to explore international variation in survival for each group to help interpret international differences in survival from all ovarian cancers combined. We also examined differences in stage-specific survival. METHODS: The CONCORD programme is the largest population-based study of global trends in cancer survival, including data from 60 countries for 695,932 women (aged 15-99years) diagnosed with ovarian cancer during 1995-2009. We defined six histological groups: type I epithelial, type II epithelial, germ cell, sex cord-stromal, other specific non-epithelial and non-specific morphology, and estimated age-standardised 5-year net survival for each country by histological group. We also analysed data from 67 cancer registries for 233,659 women diagnosed from 2001 to 2009, for whom information on stage at diagnosis was available. We estimated age-standardised 5-year net survival by stage at diagnosis (localised or advanced). RESULTS: Survival from type I epithelial ovarian tumours for women diagnosed during 2005-09 ranged from 40 to 70%. Survival from type II epithelial tumours was much lower (20-45%). Survival from germ cell tumours was higher than that of type II epithelial tumours, but also varied widely between countries. Survival for sex-cord stromal tumours was higher than for the five other groups. Survival from localised tumours was much higher than for advanced disease (80% vs. 30%). CONCLUSIONS: There is wide variation in survival between histological groups, and stage at diagnosis remains an important factor in ovarian cancer survival. International comparisons of ovarian cancer survival should incorporate histology.
Matz M, Coleman MP, Sant M, et al., 2017, The histology of ovarian cancer: worldwide distribution and implications for international survival comparisons (CONCORD-2), Gynecologic Oncology, Vol: 144, Pages: 405-413, ISSN: 0090-8258
OBJECTIVE: Ovarian cancers comprise several histologically distinct tumour groups with widely different prognosis. We aimed to describe the worldwide distribution of ovarian cancer histology and to understand what role this may play in international variation in survival. METHODS: The CONCORD programme is the largest population-based study of global trends in cancer survival. Data on 681,759 women diagnosed during 1995-2009 with cancer of the ovary, fallopian tube, peritoneum and retroperitonum in 51 countries were included. We categorised ovarian tumours into six histological groups, and explored the worldwide distribution of histology. RESULTS: During 2005-2009, type II epithelial tumours were the most common. The proportion was much higher in Oceania (73.1%), North America (73.0%) and Europe (72.6%) than in Central and South America (65.7%) and Asia (56.1%). By contrast, type I epithelial tumours were more common in Asia (32.5%), compared with only 19.4% in North America. From 1995 to 2009, the proportion of type II epithelial tumours increased from 68.6% to 71.1%, while the proportion of type I epithelial tumours fell from 23.8% to 21.2%. The proportions of germ cell tumours, sex cord-stromal tumours, other specific non-epithelial tumours and tumours of non-specific morphology all remained stable over time. CONCLUSIONS: The distribution of ovarian cancer histology varies widely worldwide. Type I epithelial, germ cell and sex cord-stromal tumours are generally associated with higher survival than type II tumours, so the proportion of these tumours may influence survival estimates for all ovarian cancers combined. The distribution of histological groups should be considered when comparing survival between countries and regions.
Sassi F, 2017, ADDRESSING SOCIAL AND ECONOMIC CONSEQUENCES OF CHILDHOOD OBESITY, Publisher: KARGER, Pages: 110-110, ISSN: 0250-6807
Devaux M, Sassi F, 2016, Social disparities in hazardous alcohol use: self-report bias may lead to incorrect estimates, EUROPEAN JOURNAL OF PUBLIC HEALTH, Vol: 26, Pages: 129-134, ISSN: 1101-1262
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- Citations: 79
Sassi F, 2016, Taxing sugar, BMJ-BRITISH MEDICAL JOURNAL, Vol: 352, ISSN: 0959-535X
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- Citations: 5
Damiani G, Basso D, Acampora A, et al., 2015, The impact of level of education on adherence to breast and cervical cancer screening: Evidence from a systematic review and meta-analysis, PREVENTIVE MEDICINE, Vol: 81, Pages: 281-289, ISSN: 0091-7435
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- Citations: 91
Cecchini M, Sassi F, 2015, Preventing Obesity in the USA: Impact on Health Service Utilization and Costs, PHARMACOECONOMICS, Vol: 33, Pages: 765-776, ISSN: 1170-7690
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- Citations: 14
Franco S, 2015, Tackling Harmful Alcohol Use Economics and Public Health Policy Economics and Public Health Policy, Publisher: OECD Publishing, ISBN: 9789264181069
There are, however, new dimensions to the problems engendered by harmful alcohol use throughout the history of humankind (drinking and driving is one example). Although alcohol consumption has declined in many OECD countries in ...
Allemani C, Weir HK, Carreira H, et al., 2015, Global surveillance of cancer survival 1995-2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2), LANCET, Vol: 385, Pages: 977-1010, ISSN: 0140-6736
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- Citations: 1623
Sassi F, Belloni A, Capobianco C, et al., 2015, Taxation and economic incentives, REGULATING LIFESTYLE RISKS: THE EU, ALCOHOL, TOBACCO AND UNHEALTHY DIETS, Editors: Alemanno, Garde, Publisher: CAMBRIDGE UNIV PRESS, Pages: 94-119
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- Citations: 4
Sassi F, Belloni A, 2014, Fiscal incentives, behavior change and health promotion: what place in the health-in-all-policies toolkit? (vol 29, pg i103, 2014, HEALTH PROMOTION INTERNATIONAL, Vol: 29, Pages: 794-794, ISSN: 0957-4824
Lorenzoni L, Belloni A, Sassi F, 2014, Health-care expenditure and health policy in the USA versus other high-spending OECD countries, The Lancet, Vol: 384, Pages: 83-92, ISSN: 0140-6736
The USA has exceptional levels of health-care expenditure, but growth has slowed dramatically in recent years, amidst major efforts to close the coverage gap with other countries of the Organisation for Economic Co-operation and Development (OECD). We reviewed expenditure trends and key policies since 2000 in the USA and five other high-spending OECD countries. Higher health-sector prices explain much of the difference between the USA and other high-spending countries, and price dynamics are largely responsible for the slowdown in expenditure growth. Other high-spending countries did not face the same coverage challenges, and could draw from a broader set of policies to keep expenditure under control, but expenditure growth was similar to the USA. Tightening Medicare and Medicaid price controls on plans and providers, and leveraging the scale of the public programmes to increase efficiency in financing and care delivery, might prevent a future economic recovery from offsetting the slowdown in health sector prices and expenditure growth.
Sassi F, Belloni A, 2014, Fiscal incentives, behavior change and health promotion: what place in the health-in-all-policies toolkit?, HEALTH PROMOTION INTERNATIONAL, Vol: 29, Pages: 103-112, ISSN: 0957-4824
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- Citations: 12
Herforth A, Frongillo EA, Sassi F, et al., 2014, Toward an integrated approach to nutritional quality, environmental sustainability, and economic viability: research and measurement gaps, GLOBAL RESEARCH AGENDA FOR NUTRITION SCIENCE, Vol: 1332, Pages: 1-21, ISSN: 0077-8923
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- Citations: 15
Devaux M, Sassi F, 2013, Social inequalities in obesity and overweight in 11 OECD countries, EUROPEAN JOURNAL OF PUBLIC HEALTH, Vol: 23, Pages: 464-469, ISSN: 1101-1262
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- Citations: 191
McCracken K, Sassi F, 2012, Alcohol Arrest Referral, Alcohol-Related Violence: Prevention and Treatment, Pages: 187-203, ISBN: 9781119952749
Cecchini M, Sassi F, 2012, Tackling obesity requires efficient government policies, Israel Journal of Health Policy Research, Vol: 1, Pages: 1-2, ISSN: 2045-4015
Changes in food supply and eating habits, combined with a dramatic fall in physical activity, have made obesity a global epidemic. Across OECD countries, one in two adults is currently overweight and one in six is obese. Children have not been spared, with up to one in three currently overweight. Obese people are more likely to develop diseases such as diabetes, cardiovascular disease, and cancer, and have a shorter life expectancy than people of normal weight. A prevention strategy combining health promotion campaigns, government regulation, counseling of individuals at risk in primary care, and paying special attention to the most vulnerable, would enhance population health at an affordable cost, with likely beneficial effects on health inequalities. Failure to implement such a strategy would impose heavy burdens on future generations. The new IJHPR paper by Ginsberg and Rosenberg illustrates how particular countries can assess alternative strategies for tackling obesity in a rigorous fashion.
Damiani G, Federico B, Basso D, et al., 2012, Socioeconomic disparities in the uptake of breast and cervical cancer screening in Italy: a cross sectional study, BMC Public Health, Vol: 12, Pages: 1-10, ISSN: 1471-2458
BackgroundBreast and cervical cancer screening are widely recognized as effective preventive procedures in reducing cancer mortality. The aim of this study was to evaluate the impact of socioeconomic disparities in the uptake of female screening in Italy, with a specific focus on different types of screening programs.MethodsA cross-sectional study was conducted using data from the 2004-2005 national health interview survey. A sample of 15, 486 women aged 50-69 years for mammography and one of 35, 349 women aged 25-64 years for Pap smear were analysed. Logistic regression models were used to estimate the association between socioeconomic factors and female screening utilization.ResultsEducation and occupation were positively associated with attendance to both screening. Women with higher levels of education were more likely to have a mammogram than those with a lower level (OR = 1.28; 95% CI = 1.10-1.49). Women of intermediate and high occupational classes were more likely to use breast cancer screening (OR = 1.77; 95% CI = 1.55-2.03, OR = 1.63; 95% CI = 1.40-1.91) compared to unemployed women. Women in the highest occupational class had a higher likelihood of cervical cancer screening compared to those in the lowest class (OR = 1.81; 95% CI = 1.63-2.01). Among women who attended screening, those with lower levels of education and lower occupational classes were more likely than more advantaged women to attend organized screening programs rather than being screened on the basis of their own initiative.ConclusionsInequalities in the uptake of female screening widely exist in Italy. Organized screening programs may have an important role in increasing screening attendance and tackling inequalities.
Devaux M, Sassi F, Church J, et al., 2011, Exploring the relationship between education and obesity, OECD Journal: Economic Studies, Pages: 121-159, ISSN: 1995-2848
An epidemic of obesity has been developing in virtually all OECD countries over the last 30 years. Existing evidence provides a strong suggestion that such an epidemic has affected certain social groups more than others. In particular, a better education appears to be associated with a lower likelihood of obesity, especially among women. This paper sheds light on the nature and the strength of the correlation between education and obesity. Analyses of health survey data from Australia, Canada, England, and Korea were undertaken with the aim of exploring this relationship. Social gradients in obesity were assessed across the entire education spectrum, overall and in different population sub-groups. Furthermore, investigations testing for mediation effects and for the causal nature of the links observed were undertaken to better understand the underlying mechanisms of the relationship between education and obesity. © OECD 2011.
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