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Journal articleBaker P, Hone T, Reeves A, et al., 2018,
Does government expenditure reduce inequalities in infant mortality rates in low- and middle-income countries? A time-series, ecological analysis of 48 countries from 1993-2013, Health Economics, Policy and Law, Vol: 14, Pages: 249-273, ISSN: 1744-1331
IntroductionInequalities in infant mortality rates (IMR) are rising in some Low and Middle-Income Countries (LMICs) and falling in others, but the explanation for these divergent trends is unclear. We investigate whether government expenditures and redistribution are associated with reductions in inequalities in IMR.MethodsWe estimated country-level fixed-effects panel regressions for 48 LMICs (142 country-observations). Slope and Relative Indices of Inequality in IMR (SII and RII) were calculated from Demographic and Health Surveys between 1993-2013. RII and SII were regressed on government expenditure (total, health, and non-health) and redistribution, controlling for GDP, private health expenditures, a democracy indicator, country fixed effects, and time.ResultsMean SII and RII was 39.12 and 0.69. In multivariate models, a one percentage-point increase in total government expenditure (% of GDP) was associated with a decrease in SII of -2.468 (95% CIs: -4.190, -0.746) and RII of -0.026 (95% CIs: -0.048, -0.004). Lower inequalities were associated with higher non-health government expenditure, but not higher government health expenditure. Associations with inequalities were nonsignificant for GDP, government redistribution, and private healthexpenditure.DiscussionUnderstanding how non-health government expenditure reduces inequalities in IMR, and why health expenditures may not, will accelerate progress towards the Sustainable Development Goals.
Journal articleRasella D, Basu S, Hone TV, et al., 2018,
Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: a nationwide microsimulation study, PLoS Medicine, Vol: 15, ISSN: 1549-1277
Background.Since 2015, a major economic crisis in Brazil has led to increasing poverty and the implementation of long-term fiscal austerity measures which will substantially reduce expenditure on social welfare programmes as a percentage of the country's GDP over the next 20 years. The Bolsa Família Programme (BFP) - one of the largest conditional cash transfer programmes in the world - and the nationwide primary healthcare strategy (Estratégia Saúde da Família - ESF) are affected by fiscal austerity, despite being among the policy interventions with the strongest estimated impact on child mortality in the country. We compared how reduced coverage of BFP and ESF, or an alternative scenario where the level of social protection under these programmes is maintained, may affect the under-five mortality rate (U5MR) and socio-economic inequalities in child health in the country until 2030, the end date of the Sustainable Development Goals.Methods and Findings.We developed and validated a microsimulation model, creating a synthetic cohort of all 5,507 Brazilian municipalities for the period 2017-2030. This was based on the longitudinal dataset and effect estimates from a previously published study which evaluated the effects of poverty, BFP, and ESF on child health. We forecast the economic crisis and the effect of reductions in BFP and ESF coverage due to current fiscal austerity on U5MR, and compare with scenarios where these programmes maintain the levels of social protection by increasing or decreasing with the size of Brazil's vulnerable populations. We used fixed effects multivariate regression models including BFP and ESF coverage and accounting for secular trends, demographic and socioeconomic changes, and programme duration effects.With the maintenance of the levels of social protection provided by BFP and ESF, in the most likely economic scenario the U5MR is expected to be 8.57% (CI: 6.88%- 10.24%) lower in 2030 than under fiscal austerity - a cumulative 19,7
Journal articleRauber F, da Costa Louzada ML, Steele EM, et al., 2018,
Ultra-processed food consumption and chronic non-communicable diseases-related dietary nutrient profile in the UK (2008⁻2014), Nutrients, Vol: 10, ISSN: 2072-6643
We described the contribution of ultra-processed foods in the U.K. diet and its association with the overall dietary content of nutrients known to affect the risk of chronic non-communicable diseases (NCDs). Cross-sectional data from the U.K. National Diet and Nutrition Survey (2008⁻2014) were analysed. Food items collected using a four-day food diary were classified according to the NOVA system. The average energy intake was 1764 kcal/day, with 30.1% of calories coming from unprocessed or minimally processed foods, 4.2% from culinary ingredients, 8.8% from processed foods, and 56.8% from ultra-processed foods. As the ultra-processed food consumption increased, the dietary content of carbohydrates, free sugars, total fats, saturated fats, and sodium increased significantly while the content of protein, fibre, and potassium decreased. Increased ultra-processed food consumption had a remarkable effect on average content of free sugars, which increased from 9.9% to 15.4% of total energy from the first to the last quintile. The prevalence of people exceeding the upper limits recommended for free sugars and sodium increased by 85% and 55%, respectively, from the lowest to the highest ultra-processed food quintile. Decreasing the dietary share of ultra-processed foods may substantially improve the nutritional quality of diets and contribute to the prevention of diet-related NCDs.
Journal articleLaverty AA, Vamos EP, Filippidis F, 2018,
Introduction:Using nationally representative data this study examined experimentation with and regular use of e-cigarettes among children not using tobacco at age 11 years, followed up to age 14 years.Material and Methods:Data come from 10 982 children in the UK Millennium Cohort Study. Logistic regression assessed experimentation with and current use of e-cigarettes by age 14 years. We considered associations of sociodemographics at age 11 years with subsequent e-cigarette use, including data on family income, peer and caregiver smoking. Subsequent models were adjusted for current tobacco use to assess both the strength of the assocations between e-cigarette use and tobacco, and whether sociodemographics were associated with e-cigarettes independently of tobacco.Results:Among 10 982 children who reported never smoking at age 11 years, 13.9% (1525) had ever tried an e-cigarette by age 14 years, and of these 18.2% (278) reported being current users. Children in lower income households were more likely to have tried an e-cigarette than those in higher income households (Adjusted Odds Ratio, AOR 1.89, p=0.002). Children who reported friend (AOR 2.28, p<0.001) or caregiver smoking (AOR 1.77, p<0.001) at age 11 years were more likely to have tried an e-cigarette by age 14 years. After adjusting for current tobacco use, there was some attenuation of these associations, although associations of friend and caregiver smoking with e-cigarette use remained statistically significant.Conclusions:Children from lower income families were more likely to experiment with e-cigarettes by age 14 years, although this was heavily mediated by concurrent tobacco use. Caregiver and friend smoking are linked to trying e-cigarettes, although these relationships are less clear for regular e-cigarette use.
Journal articleLaverty AA, Webb E, Vamos EP, et al., 2018,
Associations of changes in public transport use with physical activity and adiposity in older adults, International Journal of Behavioral Nutrition and Physical Activity, Vol: 15, ISSN: 1479-5868
Background:We investigated predictors of two increases in older people’s public transport use: initiating public transport use among non-users; and increasing public transport use amongst users. We also investigated associations of these changes with physical activity, Body Mass Index (BMI) and waist circumference.Methods:Data come from the 2008 and 2012 English Longitudinal Study of Ageing (ELSA). Logistic regression assessed predictors of increases in public transport use among adults aged ≥50 years. Gender-stratified logistic and linear models assessed associations of increases in public transport use with changes in physical activity and adiposity.Results:Those becoming eligible for a free older person’s bus pass were more likely to both initiate and increase public transport use (e.g. for initiating public transport use Adjusted Odds Ratio (AORs) 1.77, 95% Confidence Interval 1.35; 2.33). Retiring from paid work was also associated with both initiating and increasing public transport use e.g. AOR 1.57 (1.29; 1.91) for initiating use.Women who increased public transport use had mean BMI 2.03 kg/m2 lower (− 2.84, − 1.21) at follow up than those who did not, although this was attenuated after adjusting for BMI at baseline (− 0.40 kg/m2, − 0.82, 0.01). After adjustment for baseline physical activity those initiating public transport use were more likely to undertake at least some physical activity in 2012 (e.g. AOR for women 1.67, 1.03; 2.72).Conclusions:Both initiating and increasing public transport use were associated with increased physical activity and may be associated with lower adiposity among women. These findings strengthen the case for considering public transport provision as an effective means of promoting healthier ageing.
Journal articleLaverty AA, Millett C, Webb E, 2018,
Take up and use of subsidised public transport: evidence from the English Longitudinal Study of Ageing, Journal of Transport and Health, Vol: 8, Pages: 179-182, ISSN: 2214-1405
BackgroundSince 2006 England has had a bus pass scheme which provides free bus travel for older people. The scheme is universal but there are questions over whether take up is equitable.MethodsData come from waves 6 and 7 of the English Longitudinal Study of Ageing collected in 2012 and 2014. Logistic regression assessed factors associated with take up of a free bus pass by 2014 among eligible people without a pass in 2012, and associations of this with public transport use in 2014.ResultsOf those eligible for a free bus pass in 2012, 16.1% did not have one. 18.8% of these people had taken up a bus pass by 2014. Take up was equitable according to wealth and other individual characteristics but was more common among people retiring from paid work (AOR 2.33, p = 0.025), and moving house (AOR 2.76, p = 0.014). People who took up a free bus pass were more likely to use public transport in 2014 (AOR 3.23, p < 0.001).DiscussionTake up of the free bus pass is equitable across groups, and is strongly linked to public transport use among older people.
Journal articleSum G, Hone T, Atun R, et al., 2018,
Background: Multimorbidity, the presence of two or more non-communicable diseases (NCD), is a costly and complex challenge for health systems globally. Patients with NCDs incur high levels of out-of-pocket expenditure (OOPE), often on medicines, but the literature on the association between OOPE on medicines and multimorbidity has not been examined systematically. Methods: A systematic review was conducted via searching medical and economics databases including Ovid Medline, EMBASE, EconLit, Cochrane Library and the WHO Global Health Library from year 2000 to 2016. Study quality was assessed using Newcastle-Ottawa Scale. PROSPERO: CRD42016053538. Findings: 14 articles met inclusion criteria. Findings indicated that multimorbidity was associated with higher OOPE on medicines. When number of NCDs increased from 0 to 1, 2 and ≥3, annual OOPE on medicines increased by an average of 2.7 times, 5.2 times and 10.1 times, respectively. When number of NCDs increased from 0 to 1, 2, ≥2 and ≥3, individuals spent a median of 0.36% (IQR 0.15%-0.51%), 1.15% (IQR 0.62%-1.64%), 1.41% (IQR 0.86%-2.15%), 2.42% (IQR 2.05%-2.64%) and 2.63% (IQR 1.56%-4.13%) of mean annual household net adjusted disposable income per capita, respectively, on annual OOPE on medicines. More multimorbidities were associated with higher OOPE on medicines as a proportion of total healthcare expenditures by patients. Some evidence suggested that the elderly and low-income groups were most vulnerable to higher OOPE on medicines. With the same number of NCDs, certain combinations of NCDs yielded higher medicine OOPE. Non-adherence to medicines was a coping strategy for OOPE on medicines. Conclusion: Multimorbidity of NCDs is increasingly costly to healthcare systems and OOPE on medicines can severely compromise financial protection and universal health coverage. It is crucial to recognise the need for better equity and financial protection, and policymakers should consider health system financial optio
Conference paperFilippidis F, Laverty A, Hone T, et al., 2018,
Journal articleFouad FM, Sparrow A, Tarakji A, et al., 2017,
Journal articleAgrawal S, Walia GK, Staines-Urias E, et al., 2017,
Journal articleBhan N, Millett C, Subramanian SV, et al., 2017,
Journal articleLaverty AA, Been JV, Millett C, et al., 2017,
A smoke-free world to protect child health., BMJ, Vol: 359, Pages: j4892-j4892
Journal articleFaber T, Kumar A, Mackenbach JP, et al., 2017,
Effect of tobacco control policies on perinatal and child health: a systematic review and meta-analysis., Lancet Public Health, Vol: 2, Pages: e420-e437, ISSN: 2468-2667
BACKGROUND: Tobacco smoking and smoke exposure during pregnancy and childhood cause considerable childhood morbidity and mortality. We did a systematic review and meta-analysis to investigate whether implementation of WHO's recommended tobacco control policies (MPOWER) was of benefit to perinatal and child health. METHODS: We searched 19 electronic databases, hand-searched references and citations, and consulted experts to identify studies assessing the association between implementation of MPOWER policies and child health. We did not apply any language restrictions, and searched the full time period available for each database, up to June 22, 2017. Our primary outcomes of interest were perinatal mortality, preterm birth, hospital attendance for asthma exacerbations, and hospital attendance for respiratory tract infections. Where possible and appropriate, we combined data from different studies in random-effects meta-analyses. This study is registered with PROSPERO, number CRD42015023448. FINDINGS: We identified 41 eligible studies (24 from North America, 16 from Europe, and one from China) that assessed combinations of the following MPOWER policies: smoke-free legislation (n=35), tobacco taxation (n=11), and smoking cessation services (n=3). Risk of bias was low in 23 studies, moderate in 16, and high in two. Implementation of smoke-free legislation was associated with reductions in rates of preterm birth (-3·77% [95% CI -6·37 to -1·16]; ten studies, 27 530 183 individuals), rates of hospital attendance for asthma exacerbations (-9·83% [-16·62 to -3·04]; five studies, 684 826 events), and rates of hospital attendance for all respiratory tract infections (-3·45% [-4·64 to -2·25]; two studies, 1 681 020 events) and for lower respiratory tract infections (-18·48% [-32·79 to -4·17]; three studies, 887 414 events). Associations appeared to be stronger when comprehensive smoke-free laws w
Journal articleAlshamsan R, Lee JT, Rana S, et al., 2017,
Journal articleGhosh A, Millett C, Subramanian SV, et al., 2017,
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