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Vaezghasemi, Masoud
Publications (10 of 14) Show all publications
Afshin, A., Sur, P. J., Fay, K. A., Cornaby, L., Ferrara, G., Salama, J. S., . . . Murray, C. J. L. (2019). Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 393(10184), 1958-1972
Open this publication in new window or tab >>Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
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2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10184, p. 1958-1972Article in journal (Refereed) Published
Abstract [en]

Background: Suboptimal diet is an important preventable risk factor for non-communicable diseases (NCDs); however, its impact on the burden of NCDs has not been systematically evaluated. This study aimed to evaluate the consumption of major foods and nutrients across 195 countries and to quantify the impact of their suboptimal intake on NCD mortality and morbidity.

Methods: By use of a comparative risk assessment approach, we estimated the proportion of disease-specific burden attributable to each dietary risk factor (also referred to as population attributable fraction) among adults aged 25 years or older. The main inputs to this analysis included the intake of each dietary factor, the effect size of the dietary factor on disease endpoint, and the level of intake associated with the lowest risk of mortality. Then, by use of diseasespecific population attributable fractions, mortality, and disability-adjusted life-years (DALYs), we calculated the number of deaths and DALYs attributable to diet for each disease outcome.

Findings: In 2017, 11 million (95% uncertainty interval [UI] 10-12) deaths and 255 million (234-274) DALYs were attributable to dietary risk factors. High intake of sodium (3 million [1-5] deaths and 70 million [34-118] DALYs), low intake of whole grains (3 million [2-4] deaths and 82 million [59-109] DALYs), and low intake of fruits (2 million [1-4] deaths and 65 million [41-92] DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries. Dietary data were from mixed sources and were not available for all countries, increasing the statistical uncertainty of our estimates.

Interpretation: This study provides a comprehensive picture of the potential impact of suboptimal diet on NCD mortality and morbidity, highlighting the need for improving diet across nations. Our findings will inform implementation of evidence-based dietary interventions and provide a platform for evaluation of their impact on human health annually.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-159602 (URN)10.1016/S0140-6736(19)30041-8 (DOI)000467698100031 ()30954305 (PubMedID)
Available from: 2019-06-17 Created: 2019-06-17 Last updated: 2019-06-17Bibliographically approved
Eurenius, E., Richter Sundberg, L., Vaezghasemi, M., Silfverdal, S.-A., Ivarsson, A. & Lindkvist, M. (2019). Social-emotional problems among three-year-olds differ based on the child's gender and custody arrangement. Acta Paediatrica, 108(6), 1087-1095
Open this publication in new window or tab >>Social-emotional problems among three-year-olds differ based on the child's gender and custody arrangement
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2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 6, p. 1087-1095Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this study was to investigate mental health with respect to social-emotional problems among three-year-olds in relation to their gender, custody arrangements and place of residence.

METHODS: A cross-sectional population-based design was used, encompassing 7,179 three-year-olds in northern Sweden during the period 2014-2017 from the regional Salut Register. Descriptive and comparative analyses were performed based on parents' responses on the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE), supplemented with items on gender, custody arrangement and place of residence.

RESULTS: Parental-reported social-emotional problems were found in almost 10% of the children. Boys were reported to have more problems (12.3%) than girls (5.6%) (p<0.001). Parents were most concerned about children's eating habits and interactions at mealtimes. Parents not living together reported more problems among their children than those living together (p<0.001). When stratifying by custody arrangement, girls in rural areas living alternately with each parent had more problems compared to those in urban areas (p<0.008).

CONCLUSION: Gender and custody arrangements appear to be important factors for social-emotional problems among three-year-olds. Thus, such conditions should receive attention during preschool age, preferably by a systematic preventive strategy within Child Health Care.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
ages and stages questionnaires, cross-sectional study, emotional and behavioural problems, mental health, preschool child
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-154007 (URN)10.1111/apa.14668 (DOI)000467867900018 ()30496622 (PubMedID)2-s2.0-85058852765 (Scopus ID)
Available from: 2018-12-11 Created: 2018-12-11 Last updated: 2019-06-19Bibliographically approved
Benebo, F. O., Schumann, B. & Vaezghasemi, M. (2018). Intimate partner violence against women in Nigeria: a multilevel study investigating the effect of women's status and community norms. BMC Women's Health, 18, Article ID 136.
Open this publication in new window or tab >>Intimate partner violence against women in Nigeria: a multilevel study investigating the effect of women's status and community norms
2018 (English)In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 18, article id 136Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Intimate partner violence (IPV) against women has been recognised as a public health problem with far-reaching consequences for the physical, reproductive, and mental health of women. The ecological framework portrays intimate partner violence as a multifaceted phenomenon, demonstrating the interplay of factors at different levels: individual, community, and the larger society. The present study examined the effect of individual- and community-level factors on IPV in Nigeria, with a focus on women's status and community-level norms among men.

METHODS: A cross-sectional study based on the latest Nigerian Demographic Health Survey (2013) was conducted involving 20,802 ever-partnered women aged 15-49 years. Several multilevel logistic regression models were calibrated to assess the association of individual- and community-level factors with IPV. Both measures of association (fixed effect) and measures of variations (random effect) were reported.

RESULTS: Almost one in four women in Nigeria reported having ever experienced intimate partner violence. Having adjusted for other relevant covariates, higher women's status reduced the odds of IPV (OR = 0.47; 95% CI = 0.32-0.71). However, community norms among men that justified IPV against women modified the observed protective effect of higher women's status against IPV and reversed the odds (OR = 1.89; 95% CI = 1.26-2.83).

CONCLUSIONS: Besides women's status, community norms towards IPV are an important factor for the occurrence of IPV. Thus, addressing intimate partner violence against women calls for community-wide approaches aimed at changing norms among men alongside improving women's status.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Community norms, Intimate partner violence, Multilevel analysis, Nigeria, women’s status
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150594 (URN)10.1186/s12905-018-0628-7 (DOI)000441123800001 ()30092785 (PubMedID)
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-12-13Bibliographically approved
Afshin, A., Forouzanfar, M. H., Reitsma, M. B., Sur, P., Estep, K., Lee, A., . . . Murray, C. J. L. (2017). Health Effects of Overweight and Obesity in 195 Countries over 25 Years. New England Journal of Medicine, 377(1), 13-27
Open this publication in new window or tab >>Health Effects of Overweight and Obesity in 195 Countries over 25 Years
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2017 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 377, no 1, p. 13-27Article in journal (Refereed) Published
Abstract [en]

BACKGROUND Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain. METHODS We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015. RESULTS In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease. CONCLUSIONS The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem. 

Place, publisher, year, edition, pages
MASSACHUSETTS MEDICAL SOC, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-138542 (URN)10.1056/NEJMoa1614362 (DOI)000404730000005 ()28604169 (PubMedID)
Available from: 2017-09-15 Created: 2017-09-15 Last updated: 2018-06-09Bibliographically approved
Vaezghasemi, M. (2017). Nutrition transition and the double burden of malnutrition in Indonesia: a mixed method approach exploring social and contextual determinants of malnutrition. (Doctoral dissertation). Umeå: Umeå Universitet
Open this publication in new window or tab >>Nutrition transition and the double burden of malnutrition in Indonesia: a mixed method approach exploring social and contextual determinants of malnutrition
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction

Nutrition transition concerns the broad changes in the human diet that have occurred over time and space. In low- to middle-income countries such as Indonesia, nutrient transition describes shifts from traditional diets high in cereal and fibre towards Western pattern diets high in sugars, fat, and animal-source foods. This causes a swift increase in the prevalence of overweight and obesity while undernutrition remains a great public health concern. Thus a double burden of malnutrition occurs in the population. The main aim of this investigation was to explore social and contextual determinants of malnutrition in Indonesia. The specific objectives were: (i) to examine body mass index (BMI) changes at the population level, and between and within socioeconomic groups; (ii) to estimate which context (i.e., household or district) has a greater effect on the variation of BMI; (iii) to assess the prevalence of double burden households (defined as the coexistence of underweight and overweight individuals residing in the same household) and its variation among communities as well as its determining factors; and (iv) to explore and understand what contributes to a double burden of malnutrition within a household by focusing on gender relations.

Methods

A mixed method approach was adopted in this study. For the quantitative analyses, nationally representative repeated cross-sectional survey data from four Indonesian Family Life Surveys (IFLS; 1993, 1997, 2000, 2007) were used. The IFLS contains information about individual-level, household-level and area-level characteristics. The analyses covered single and multilevel regressions. Data for the qualitative component were collected from sixteen focus group discussions conducted in Central Java and in the capital city Jakarta among 123 rural and urban men and women. Connell’s relational theory of gender and Charmaz’s constructive grounded theory were used to analyse the qualitative data.

Results

Greater increases in BMI were observed at higher percentiles compared to the segment of the population at lower percentiles. While inequalities in mean BMI decreased between socioeconomic groups, within group dispersion increased over time. Households were identified as an important social context in which the variation of BMI increased over time. Ignoring the household level did not change the relative variance contribution of districts on BMI in the contextual analysis. Approximately one-fifth of all households exhibited a double burden of malnutrition. Living in households with a higher socioeconomic status resulted in higher odds of double burden of malnutrition with the exception of women-headed households and communities with high social capital. The qualitative analysis resulted in the construction of three categories: capturing the significance of gendered power relations, the emerging obesogenic environment, and generational relations for child malnutrition.

Conclusion

At the population level, greater increases in within-group inequalities imply that growing inequalities in BMI were not merely driven by socioeconomic factors. This suggests that other under-recognised social and contextual factors may have a greater effect on the variation in BMI. At the contextual level, recognition of increased variation among households is important for creating strategies that respond to the differential needs of individuals within the same household. At the household level, women’s empowerment and community social capital should be promoted to reduce inequalities in the double burden of malnutrition across different socioeconomic groups. Ultimately community health and nutrition programmes will need to address gender empowerment and engage men in the fight against the emerging obesogenic environment and increased malnutrition that is evident within households, especially overweight and obesity among children.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2017. p. 100
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1873
Keywords
Double burden of malnutrition, Child obesity, Body Mass Index, Gender relations, Social capital, Multilevel modelling, Grounded theory, Indonesian Family Life Surveys, Indonesia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-130552 (URN)978-91-7601-637-4 (ISBN)
Public defence
2017-02-17, Sal 135 Allmänmedicin, Byggnad 9A, ingång X5, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2017-01-27 Created: 2017-01-23 Last updated: 2018-06-09Bibliographically approved
Vaezghasemi, M., Sundberg, L., Ivarsson, A., Eurenius, E., Silfverdal, S. A. & Lindkvist, M. (2017). Psychometric analysis of Age and Stages Questionnaire: Social-Emotional (ASQ:SE) among 3-year-olds. Paper presented at 10th European Public Health Conference Sustaining resilient and healthy communities Stockholm, Sweden 1–4 November 2017. European Journal of Public Health, 27(Suppl_3), 173-174
Open this publication in new window or tab >>Psychometric analysis of Age and Stages Questionnaire: Social-Emotional (ASQ:SE) among 3-year-olds
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2017 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 173-174Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Mental health is an urgent public health challenge, and for some individuals the problem starts already in pre-school age. Increased knowledge is needed to guide evidence-based health-promoting interventions and early identification for adequate parental support. Valid and reliable instruments to measure children’s mental health are called for. Our aim is to analyze psychometric properties of the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE) among 3-year-olds.

Methods: Within Child Health Care (CHC) in Västerbotten (Sweden) the 3-year-olds’ health check-up includes parent-rated socio-emotional health by scoring the ASQ:SE. This instrument has seven psychological domains (self-regulation, compliance, communication, adaptive functioning, autonomy, affect, and interaction); built up by 31 items, responded on a 3-point Likert scale with total scores 0-465. Item scores are combined into a total score with high values indicating social-emotional vulnerability. Most parents give informed consent for research and the study has ethical approval.

Results: During 2014-2016 we have ASQ:SE responses for 5434 children having had their 3-year health check-up (boys=2802, girls=2632), with total scores 0-215. Generally, boys scored higher (mean 31, SD 24; median 25) than girls (mean 25, SD 21; median 20), and 12% of boys, compared to 6% of girls, scored above the cut-off value (59). The internal consistency based on Cronbach’s alpha was 0.78. Confirmatory factor analysis was done and normative values were also reported for the ASQ:SE.

Conclusions: Our psychometric analyses of ASQ:SE among 3-year-olds indicates the relevance of an instrument for screening pre-school children’s social and emotional health. This is promising for future use of the instrument within ordinary CHC in Västerbotten and elsewhere.

Key messages:

  • The ASQ:SE instrument is a valuable asset within CHC to increase awareness about 3-year-olds social-emotional health.
  • The ASQ:SE instrument is a promising tool for low-cost screening of early social-emotional vulnerability.
Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-143146 (URN)10.1093/eurpub/ckx187.443 (DOI)000414389801209 ()
Conference
10th European Public Health Conference Sustaining resilient and healthy communities Stockholm, Sweden 1–4 November 2017
Available from: 2017-12-20 Created: 2017-12-20 Last updated: 2018-06-09Bibliographically approved
Wang, H., Vaezghasemi, M. & Murray, C. J. L. (2016). Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053)
Open this publication in new window or tab >>Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015
2016 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 388, no 10053Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time.

METHODS: Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age-sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).

FINDINGS: Globally, 5·8 million (95% uncertainty interval [UI] 5·7-6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7-53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3-43·6) to 2·6 million (2·6-2·7) neonatal deaths and 47·0% (35·1-57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6-3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone.

INTERPRETATION: Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030.

FUNDING: Bill & Melinda Gates Foundation.

Place, publisher, year, edition, pages
Elsevier, 2016
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-128178 (URN)10.1016/S0140-6736(16)31575-6 (DOI)000423462600001 ()27733285 (PubMedID)
Available from: 2016-11-28 Created: 2016-11-28 Last updated: 2018-06-09Bibliographically approved
Vaezghasemi, M., Ng, N., Eriksson, M. & Subramanian, S. V. (2016). Households, the omitted level in contextual analysis: disentangling the relative influence of households and districts on the variation of BMI about two decades in Indonesia. International Journal for Equity in Health, 15, Article ID 102.
Open this publication in new window or tab >>Households, the omitted level in contextual analysis: disentangling the relative influence of households and districts on the variation of BMI about two decades in Indonesia
2016 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 15, article id 102Article in journal (Refereed) Published
Abstract [en]

Background: Most of the research investigating the effect of social context on individual health outcomes has interpreted context in terms of the residential environment. In these studies, individuals are nested within their neighbourhoods or communities, disregarding the intermediate household level that lies between individuals and their residential environment. Households are an important determinant of health yet they are rarely included at the contextual level in research examining association between body mass index (BMI) and the social determinants of health. In this study, our main aim was to provide a methodological demonstration of multilevel analysis, which disentangles the simultaneous effects of households and districts as well as their associated predictors on BMI over time.

Methods: Using both two- and three-level multilevel analysis, we utilized data from all four cross-sections of the Indonesian Family life Survey (IFLS) 1993 to 2007-8.

Results: We found that: (i) the variation in BMI attributable to districts decreased from 4.3 % in 1993 to 1.5 % in 1997-98, and remained constant until 2007-08, while there was an alarming increase in the variation of BMI attributable to households, from 10 % in 2000 to 15 % in 2007-08; (ii) ignoring the household level did not change the relative variance contribution of districts on BMI, but ignoring the district level resulted in overestimation of household effects, and (iii) households' characteristics (socioeconomic status, size, and place of residence) did not attenuate the variation of BMI at the household-level.

Conclusions: Estimating the relative importance of multiple social settings allows us to better understand and unpack the variation in clustered or hieratical data in order to make valid and robust inferences. Our findings will help direct investment of limited public health resources to the appropriate context in order to reduce health risk (variation in BMI) and promote population health.

Keywords
Body mass index, Multilevel modelling, Omitted level, Contextual effect, Households, Indonesian family life survey
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-124508 (URN)10.1186/s12939-016-0388-7 (DOI)000380105800001 ()27388459 (PubMedID)
Available from: 2016-08-22 Created: 2016-08-15 Last updated: 2018-06-07Bibliographically approved
Santosa, A., Schröders, J., Vaezghasemi, M. & Ng, N. (2016). Inequality in disability-free life expectancies among older men and women in six countries with developing economies. Journal of Epidemiology and Community Health, 70(9), 855-861
Open this publication in new window or tab >>Inequality in disability-free life expectancies among older men and women in six countries with developing economies
2016 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 9, p. 855-861Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: It is unclear whether the increase in life expectancy (LE) globally is coupled with a postponement of morbidity and disability. Evidence on trends and determinants of disability-free life expectancies (DFLEs) are available in high-income countries but less in low and middle-income countries (LMICs). This study examines the levels of and inequalities in LE, disability and DFLE between men and women across different age groups aged 50 years and over in six countries with developing economies.

METHODS: This study utilised the cross-sectional data (n=32 724) from the WHO Study on global AGEing and adult health (SAGE) in China, Ghana, India, Mexico, the Russian Federation and South Africa in 2007-2010. Disability was measured with the activity of daily living (ADL) instrument. The DFLE was estimated using the Sullivan method based on the standard period life table and ADL-disability proportions.

RESULTS: The disability prevalence ranged from 13% in China to 54% in India. The prevalence of disability was highest and occurred at younger age in both sexes in India. Women were more disadvantaged with higher prevalence of disability across all age groups, and the situation was worst among older women in Mexico and the Russian Federation. Though women had higher LE, their proportion of remaining LE free from disability was lower than men.

CONCLUSIONS: There are inequalities in the levels of disability and DFLE among men and women in different age groups among people aged over 50 years in these six countries. Countermeasures to decrease intercountry and gender gaps in DFLE, including improvements in health promotion and healthcare distribution, with a gender equity focus, are needed.

Keywords
Health expectancy, population ageing, disability, health inequality, low-and middle-income countries
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-118872 (URN)10.1136/jech-2015-206640 (DOI)000383291100003 ()26994068 (PubMedID)
Funder
Swedish Research Council, Dnr: 2013-2056
Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2018-06-07Bibliographically approved
Vaezghasemi, M., Razak, F., Ng, N. & Subramanian, S. (2016). Inter-individual inequality in BMI: an analysis of Indonesian Family LifeSurveys (1993–2007). SSM - Population Health, 2, 876-888
Open this publication in new window or tab >>Inter-individual inequality in BMI: an analysis of Indonesian Family LifeSurveys (1993–2007)
2016 (English)In: SSM - Population Health, ISSN 2352-8273, Vol. 2, p. 876-888Article in journal (Refereed) Published
Abstract [en]

Widening inequalities in mean Body Mass Index (BMI) between social and economic groups are well documented. However, whether changes in mean BMI are followed by changes in dispersion (or variance) and whether these inequalities are also occurring within social groups or across individuals remain understudied. In addition, a substantial body of literature exists on the global increase in mean BMI and prevalence of overweight and obesity. However, whether this weight gain is shared proportionately across the whole spectrum of BMI distribution, also remains understudied. We examined changes in the distribution of BMI at the population level over time to understand how changes in the dispersion reflect between-group compared to within-group inequalities in weight gain. Moreover, we investigated the entire distribution of BMI to determine in which percentiles the most weight gain is occurring over time. Utilizing four waves (from 1993 to 2007) of Indonesian Family Life Surveys (IFLS), we estimated changes in the mean and the variance of BMI over time and across various socioeconomic groups based on education and households’ expenditure per capita in 53,648 men and women aged 20–50 years. An increase in mean and standard deviation was observed among men (by 4.3% and 25%, respectively) and women (by 7.3% and 20%, respectively) over time. Quantile-Quantile plots showed that higher percentiles had greater increases in BMI compared to the segment of the population at lower percentiles. While between socioeconomic group differences decreased over time, within-group differences increased and were more prominent among individuals with poor education and lower per capita expenditures. Population changes in BMI cannot be fully described by average trends or single parameters such as the mean BMI. Moreover, greater increases in within-group dispersion compared with between-group differences imply that growing inequalities are not merely driven by these socioeconomic factors at the population level.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Body mass index, Distributional change, Health inequalities Obesity, Socioeconomic status, Indonesian Family Life Survey
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-130558 (URN)10.1016/j.ssmph.2016.09.013 (DOI)
Available from: 2017-01-23 Created: 2017-01-23 Last updated: 2018-06-09Bibliographically approved
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