umu.sePublications
Change search
Refine search result
1 - 42 of 42
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Ahangari, Alebtekin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Generational, Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
    Myléus, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Pain and alcohol consumption among older adults: findings from the World Health Organization Study on global AGEing and adult health, Wave 12016In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 21, no 10, p. 1282-1292Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate cross-sectional associations between self-reported recent pain and alcohol use/abstinence, and previous-day pain and previous-week alcohol consumption in adults aged 50 + in six low- and middle-income countries (LMICs). METHODS: The WHO Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010) in China, Ghana, India, Mexico, Russia and South Africa is the data source. Prevalence of alcohol use/abstinence is reported by previous-day and previous-month pain. Multinomial logistic regressions (crude and adjusted for sex and country) tested associations between recent pain and alcohol use in the pooled multicountry sample. RESULTS: Across the six SAGE countries, about one-third of respondents reported alcohol use, being highest in Russia (74%) and lowest in India (16%). Holding the effects of sex and country constant, compared with abstainers, people with previous-day pain were more likely to be previous-day or other users. With regard to the quantity and frequency of alcohol use, people with previous-day pain were more likely to be non-heavy drinkers. CONCLUSION: Overall, we found that, in this population of older adults in six LMICs, recent pain was associated with moderate use of alcohol, although there were differences between countries. The findings provide a platform for country-specific research to better understand bi-directional associations between pain and alcohol in older adults.

  • 2. Aldrich, Rosemary
    et al.
    Kemp, Lynn
    Williams, Jenny Stewart
    Harris, Elizabeth
    Simpson, Sarah
    Wilson, Amanda
    McGill, Katie
    Byles, Julie
    Lowe, Julia
    Jackson, Terri
    Using socioeconomic evidence in clinical practice guidelines.2003In: BMJ (Clinical research ed.), ISSN 1756-1833, Vol. 327, no 7426, p. 1283-5Article in journal (Refereed)
  • 3. Aldrich, Rosemary
    et al.
    Mahoney, Mary
    Harris, Elizabeth
    Simpson, Sarah
    Stewart-Williams, Jenny
    Newcastle Institute of Public health, University of Newcastle, New South Wales, Australia.
    Building an equity focus in health impact assessment2005In: New South Wales Public Health Bulletin, ISSN 1034-7674, Vol. 16, no 7-8, p. 118-119Article in journal (Refereed)
  • 4. Byles, Julie E
    et al.
    Dolja-Gore, Xenia
    Loxton, Deborah J
    Parkinson, Lynne
    Stewart Williams, Jennifer A
    Research Centre for Gender, Health & Ageing, Faculty of Health, University of Newcastle, Level 2 David Maddison Building, Callaghan NSW 2308, Australia.
    Women's uptake of Medicare Benefits Schedule mental health items for general practitioners, psychologists and other allied mental health professionals.2011In: The Medical journal of Australia, ISSN 1326-5377, Vol. 194, no 4, p. 175-179Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To quantify women's uptake of Medicare Benefits Schedule mental health items, compare characteristics of women by mental health service use, and investigate the impact on Medicare costs.

    DESIGN, SETTING AND PARTICIPANTS: Analysis of linked survey data and Medicare records (November 2006 - December 2007) of 14 911 consenting participants of the Australian Longitudinal Study on Women's Health (ALSWH) across three birth cohorts (1921-1926 ["older cohort"], 1946-1951 ["mid-age cohort"], and 1973-1978 ["younger cohort"]).

    MAIN OUTCOME MEASURES: Uptake of mental health items; 36-Item Short Form Health Survey (SF-36) Mental Health Index scores from ALSWH surveys; and patient (out-of-pocket) and benefit (government) costs from Medicare data.

    RESULTS: A large proportion of women who reported mental health problems made no mental health claims (on the most recent survey, 88%, 90% and 99% of the younger, mid-age and older cohorts, respectively). Socioeconomically disadvantaged women were less likely to use the services. SF-36 Mental Health Index scores among women in the younger and mid-age cohorts were lowest for women who had accessed mental health items or self-reported a recent mental health condition. Mental health items are associated with higher costs to women and government.

    CONCLUSION: Although there has been rapid uptake of mental health items, uptake by women with mental health needs is low and there is potential socioeconomic inequity.

  • 5.
    Fuller, Beth G
    et al.
    Research Centre for Gender, Health & Ageing, Faculty of Health, University of Newcastle, Level 2 David Maddison Building, Callaghan NSW 2308, Australia.
    Stewart Williams, Jennifer A
    Research Centre for Gender, Health & Ageing, Faculty of Health, University of Newcastle, Level 2 David Maddison Building, Callaghan NSW 2308, Australia.
    Byles, Julie E
    Research Centre for Gender, Health & Ageing, Faculty of Health, University of Newcastle, Level 2 David Maddison Building, Callaghan NSW 2308, Australia.
    Active living--the perception of older people with chronic conditions2010In: Chronic Illness, ISSN 1742-3953, E-ISSN 1745-9206, Vol. 6, no 4, p. 294-305Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe and understand factors which enhance and impede participation in physical activity for older adults with and without chronic illness and develop a framework of health behaviours for 'active living'.

    METHODS: A contrasting group framework was used to compare discussions in two sets of focus groups with relatively healthy and less healthy older adults. The thematic analysis was informed by the Transtheoretical Model, the Health Belief Model and Social Cognitive Theory.

    RESULTS: All participants affirmed the health benefits of physical activity and there was broad agreement that social support and conductive environments contributed to the promotion of opportunities for physical activity. However, perceptions of specific factors needed to maintain and promote good health differed between healthy and less healthy participants. Connection to community, sense of place and 'walkability' of neighbourhoods were identified as motivators for undertaking physical activity, whilst barriers were associated with health, the environment, family and attitudes to physical activity. DISCUSSIONs: The focus groups highlighted the importance of social, behavioural and contextual factors in promoting opportunities for physical activity in older adults with and without chronic illness. The findings were used to propose an Active Living Framework which is the subject of ongoing research.

  • 6.
    Gwatidzo, Shingai Douglas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Gender, Health and Ageing, Faculty of Health, University of Newcastle, New Lambton Heights, Newcastle NSW 2305, New South Wales, Australia.
    Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE)2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 14Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Expenditure on medications for highly prevalent chronic conditions such as diabetes mellitus (DM) can result in financial impoverishment. People in developing countries and in low socioeconomic status groups are particularly vulnerable. China and India currently hold the world's two largest DM populations. Both countries are ageing and undergoing rapid economic development, urbanisation and social change. This paper assesses the determinants of DM medication use and catastrophic expenditure on medications in older adults with DM in China and India.

    METHODS: Using national standardised data collected from adults aged 50 years and above with DM (self-reported) in China (N = 773) and India (N = 463), multivariable logistic regression describes: 1) association between respondents' socio-demographic and health behavioural characteristics and the dependent variable, DM medication use, and 2) association between DM medication use (independent variable) and household catastrophic expenditure on medications (dependent variable) (China: N = 630; India: N = 439). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010).

    RESULTS: Prevalence of DM medication use was 87% in China and 71% in India. Multivariable analysis indicates that people reporting lifestyle modification were more likely to use DM medications in China (OR = 6.22) and India (OR = 8.45). Women were more likely to use DM medications in China (OR = 1.56). Respondents in poorer wealth quintiles in China were more likely to use DM medications whereas the reverse was true in India. Almost 17% of people with DM in China experienced catastrophic healthcare expenditure on medications compared with 7% in India. Diabetes medication use was not a statistically significant predictor of catastrophic healthcare expenditure on medications in either country, although the odds were 33% higher among DM medications users in China (OR = 1.33).

    CONCLUSIONS: The country comparison reflects major public policy differences underpinned by divergent political and ideological frameworks. The DM epidemic poses huge public health challenges for China and India. Ensuring equitable and affordable access to medications for DM is fundamental for healthy ageing cohorts, and is consistent with the global agenda for universal healthcare coverage.

  • 7. Harris, Elizabeth
    et al.
    Simpson, Sarah J
    Aldrich, Rosemary
    Williams, Jenny Stewart
    Achieving equity in the Australian healthcare system.2004In: Medical Journal of Australia, ISSN 0025-729X, E-ISSN 1326-5377, Vol. 180, no 6, p. 308-Article in journal (Refereed)
  • 8. Hosseinpoor, Ahmad R
    et al.
    Stewart Williams, Jennifer A
    University of Newcastle, New South Wales, Australia.
    Gautam, Jeny
    Posarac, Aleksandra
    Officer, Alana
    Verdes, Emese
    Kostanjsek, Nenad
    Chatterji, Somnath
    Socioeconomic inequality in disability among adults: a multicountry study using the World Health Survey2013In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 103, no 7, p. 1278-1286Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We compared national prevalence and wealth-related inequality in disability across a large number of countries from all income groups.

    METHODS: Data on 218,737 respondents participating in the World Health Survey 2002-2004 were analyzed. A composite disability score (0-100) identified respondents who experienced significant disability in physical, mental, and social functioning irrespective of their underlying health condition. Disabled persons had disability composite scores above 40. Wealth was evaluated using an index of economic status in households based on ownership of selected assets. Socioeconomic inequalities were measured using the slope index of inequality and the relative index of inequality.

    RESULTS: Median age-standardized disability prevalence was higher in the low- and lower middle-income countries. In all the study countries, disability was more prevalent in the poorest than in the richest wealth quintiles. Pro-rich inequality was statistically significant in 43 of 49 countries, with disability prevalence higher among populations with lower wealth. Median relative inequality was higher in the high- and upper middle-income countries.

    CONCLUSIONS: Integrating equity components into the monitoring of disability trends would help ensure that interventions reach and benefit populations with greatest need.

  • 9. Hosseinpoor, Ahmad Reza
    et al.
    Stewart Williams, Jennifer
    Research Centre for Gender Health and Ageing, Faculty of Health, University of Newcastle, Newcastle, New South Wales, Australia.
    Amin, Avni
    Araujo de Carvalho, Islene
    Beard, John
    Boerma, Ties
    Kowal, Paul
    Naidoo, Nirmala
    Chatterji, Somnath
    Social determinants of self-reported health in women and men: understanding the role of gender in population health2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 4, p. e34799-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Women and men share similar health challenges yet women report poorer health. The study investigates the social determinants of self-reported health in women and men, and male-female differences in health.

    METHODS: Data on 103154 men and 125728 women were analysed from 57 countries in the World Health Survey 2002-2004. Item Response Theory was used to construct a composite measure of health. Associations between health and determinants were assessed using multivariate linear regression. Blinder-Oaxaca decomposition partitioned the inequality in health between women and men into an "explained" component that arises because men and women differ in social and economic characteristics, and an "unexplained" component due to the differential effects of these characteristics. Decomposition was repeated for 18 countries in the World Health Organization (WHO) African region and 19 countries in the WHO European region.

    RESULTS: Women's health was significantly lower than men's. Health was associated with education, household economic status, employment, and marital status after controlling for age. In the pooled analysis decomposition showed that 30% of the inequality was "explained", of which almost 75% came from employment, education, marital status. The differential effects of being in paid employment increased the inequality. When countries in Africa and Europe were compared, the "explained" component (31% and 39% respectively) was largely attributed to the social determinants in the African countries and to women's longevity in the European countries. Being in paid employment had a greater positive effect on the health of males in both regions.

    CONCLUSIONS: Ways in which age and the social determinants contribute to the poorer health status of women compared with men varies between groups of countries. This study highlights the need for action to address social structures, institutional discrimination and harmful gender norms and roles that differently influence health with ageing.

  • 10. Hosseinpoor, Ahmad Reza
    et al.
    Stewart Williams, Jennifer Anne
    Research Centre for Gender, Health & Ageing, University of Newcastle, Australia.
    Itani, Lynn
    Chatterji, Somnath
    Socioeconomic inequality in domains of health: results from the World Health Surveys2012In: BMC public health, ISSN 1471-2458, Vol. 12, p. 198-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In all countries people of lower socioeconomic status evaluate their health more poorly. Yet in reporting overall health, individuals consider multiple domains that comprise their perceived health state. Considered alone, overall measures of self-reported health mask differences in the domains of health. The aim of this study is to compare and assess socioeconomic inequalities in each of the individual health domains and in a separate measure of overall health.

    METHODS: Data on 247,037 adults aged 18 or older were analyzed from 57 countries, drawn from all national income groups, participating in the World Health Survey 2002-2004. The analysis was repeated for lower- and higher-income countries. Prevalence estimates of poor self-rated health (SRH) were calculated for each domain and for overall health according to wealth quintiles and education levels. Relative socioeconomic inequalities in SRH were measured for each of the eight health domains and for overall health, according to wealth quintiles and education levels, using the relative index of inequality (RII). A RII value greater than one indicated greater prevalence of self-reported poor health among populations of lower socioeconomic status, called pro-rich inequality.

    RESULTS: There was a descending gradient in the prevalence of poor health, moving from the poorest wealth quintile to the richest, and moving from the lowest to the highest educated groups. Inequalities which favor groups who are advantaged either with respect to wealth or education, were consistently statistically significant in each of the individual domains of health, and in health overall. However the size of these inequalities differed between health domains. The prevalence of reporting poor health was higher in the lower-income country group. Relative socioeconomic inequalities in the health domains and overall health were higher in the higher-income country group than the lower-income country group.

    CONCLUSIONS: Using a common measurement approach, inequalities in health, favoring the rich and the educated, were evident in overall health as well as in every health domain. Existent differences in averages and inequalities in health domains suggest that monitoring should not be limited only to overall health. This study carries important messages for policy-making in regard to tackling inequalities in specific domains of health. Targeting interventions towards individual domains of health such as mobility, self-care and vision, ought to be considered besides improving overall health.

  • 11. Hosseinpoor, Ahmad Reza
    et al.
    Stewart Williams, Jennifer
    Research Centre for Gender Health & Ageing, Faculty of Health, University of Newcastle.
    Jann, Ben
    Kowal, Paul
    Officer, Alana
    Posarac, Aleksandra
    Chatterji, Somnath
    Social determinants of sex differences in disability among older adults: a multi-country decomposition analysis using the World Health Survey2012In: International journal for equity in health, ISSN 1475-9276, Vol. 11, p. 52-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Women represent a growing proportion of older people and experience increasing disability in their longer lives. Using a universally agreed definition of disability based on the International Classification of Functioning, Disability and Health, this paper examines how, apart from age, social and economic factors contribute to disability differences between older men and women.

    METHODS: World Health Survey data were analyzed from 57 countries drawn from all income groups defined by the World Bank. The final sample comprises 63638 respondents aged 50 and older (28568 males and 35070 females). Item Response Theory was applied to derive a measure of disability which ensured cross country comparability. Individuals with scores at or above a threshold score were those who experienced significant difficulty in their everyday lives, irrespective of the underlying etiology. The population was then divided into "disabled" vs. "not disabled". We firstly computed disability prevalence for males and females by socio-demographic factors, secondly used multiple logistic regression to estimate the adjusted effects of each social determinant on disability for males and females, and thirdly used a variant of the Blinder-Oaxaca decomposition technique to partition the measured inequality in disability between males and females into the "explained" part that arises because of differences between males and females in terms of age and social and economic characteristics, and an "unexplained" part attributed to the differential effects of these characteristics.

    RESULTS: Prevalence of disability among women compared with men aged 50+ years was 40.1% vs. 23.8%. Lower levels of education and economic status are associated with disability in women and men. Approximately 45% of the sex inequality in disability can be attributed to differences in the distribution of socio-demographic factors. Approximately 55% of the inequality results from differences in the effects of the determinants.

    CONCLUSIONS: There is an urgent need for data and methodologies that can identify how social, biological and other factors separately contribute to the health decrements facing men and women as they age. This study highlights the need for action to address social structures and institutional practices that impact unfairly on the health of older men and women.

  • 12. Jeacocke, David
    et al.
    Heller, Richard
    Smith, Justine
    Anthony, Danielle
    Williams, Jenny Stewart
    Dugdale, Anni
    Combining quantitative and qualitative research to engage stakeholders in developing quality indicators in general practice.2002In: Australian health review : a publication of the Australian Hospital Association, ISSN 0156-5788, Vol. 25, no 4, p. 12-8Article in journal (Refereed)
    Abstract [en]

    In 2000, the Newcastle Institute of Public Health (NIPH) undertook a project that aimed to review, identify and where necessary, develop a range of indicators of quality service provision in general practice. We describe the way in which quantitative and qualitative research methods (including a Delphi style survey) were combined to investigate consensus amongst stakeholders in defining quality indicators. Over 500 general practice stakeholders were consulted. They included general practitioners (GPs) and their representative groups, academics, policy makers, and consumers. Several important lessons were learnt from the process, including the importance of involving a broad representative group of stakeholders, informing workshop participants in advance, providing adequate response times for the Delphi surveys and using videoconferencing technologies.

  • 13. Kailembo, Alexander
    et al.
    Preet, Raman
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. 2.Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle.
    Common risk factors and edentulism in adults, aged 50 years and over, in China, Ghana, India and South Africa: results from the WHO Study on global AGEing and adult health (SAGE)2016In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 17, article id 29Article in journal (Refereed)
    Abstract [en]

    Background: Edentulism (loss of all teeth) is a final marker of disease burden for oral health common among older adults and poorer populations. Yet most evidence is from high-income countries. Oral health has many of the same social and behavioural risk factors as other non-communicable diseases (NCDs) which are increasing rapidly in low- and middle-income countries with ageing populations. The "common risk factor approach" (CRFA) for oral health addresses risk factors shared with NCDs within the broader social and economic environment. Methods: The aim is to improve understanding of edentulism prevalence, and association between common risk factors and edentulism in adults aged 50 years and above using nationally representative samples from China (N = 11,692), Ghana (N = 4093), India (N = 6409) and South Africa (N = 2985). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010). Multivariable logistic regression describes association between edentulism and common risk factors reported in the literature. Results: Prevalence of edentulism: in China 8.9 %, Ghana 2.9 %, India 15.3 %, and South Africa 8.7 %. Multivariable analysis: in China, rural residents were more likely to be edentulous (OR 1.36; 95 % CI 1.09-1.69) but less likely to be edentulous in Ghana (OR 0.53; 95 % CI 0.31-0.91) and South Africa (OR 0.52; 95 % CI 0.30-0.90). Respondents with university education (OR 0.31; 95 % CI 0.18-0.53) and in the highest wealth quintile (OR 0.68; 95 % CI 0.52-0.90) in China were less likely to be edentulous. In South Africa respondents with secondary education were more likely to be edentulous (OR 2.82; 95 % CI 1.52-5.21) as were those in the highest wealth quintile (OR 2.78; 95 % CI 1.16-6.70). Edentulism was associated with former smokers in China (OR 1.57; 95 % CI 1.10-2.25) non-drinkers in India (OR 1.65; 95 % CI 1.11-2.46), angina in Ghana (OR 2.86; 95 % CI 1.19-6.84) and hypertension in South Africa (OR 2.75; 95 % CI 1.72-4.38). Edentulism was less likely in respondents with adequate nutrition in China (OR 0.68; 95 % CI 0.53-0.87). Adjusting for all other factors, compared with China, respondents in India were 50 % more likely to be edentulous. Conclusions: Strengthening the CRFA should include addressing common determinants of health to reduce health inequalities and improve both oral and overall health.

  • 14. Kailembo, Alexander
    et al.
    Preet, Raman
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, New Lambton Heights, Australia.
    Socioeconomic inequality in self-reported unmet need for oral health services in adults aged 50 years and over in China, Ghana, and India2018In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, article id 99Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The 2015 Global Burden of Disease Study estimated that oral conditions affect 3.5 billion people worldwide with a higher burden among older adults and those who are socially and economically disadvantaged. Studies of inequalities in the use of oral health services by those in need have been conducted in high-income countries but evidence from low- and middle-income countries (LMICs) is limited. This study measures and describes socioeconomic inequality in self-reported unmet need for oral health services in adults aged 50 years and over, in China, Ghana and India.

    METHODS: A cross-sectional analysis of national survey data from the WHO SAGE Wave 1 (2007-2010) was conducted. Study samples in China (n = 1591), Ghana (n = 425) and India (n = 1307) were conditioned on self-reported need for oral health services in the previous 12 months. The binary dependent variable, unmet need for oral health services, was derived from questions about self-reported need and service use. Prevalence was estimated by country. Unmet need was measured and compared in terms of relative levels of education and household wealth. The methods were logistic regression and the relative index of inequality (RII). Models were adjusted for age, sex, area of residence, marital status, work status and self-rated health.

    RESULTS: The prevalence of unmet need was 60, 80, and 62% in China, Ghana and India respectively. The adjusted RII for education was statistically significant for China (1.5, 95% CI:1.2-1.9), Ghana (1.4, 95% CI: 1.1-1.7), and India (1.5, 95% CI:1.2-2.0), whereas the adjusted RII for wealth was significant only in Ghana (1.3, 95% CI:1.1-1.6). Male sex was significantly associated with self-reported unmet need for oral health services in India.

    CONCLUSIONS: Given rapid population ageing, further evidence of socioeconomic inequalities in unmet need for oral health services by older adults in LMICs is needed to inform policies to mitigate inequalities in the availability of oral health services. Oral health is a universal public health issue requiring attention and action on multiple levels and across the public private divide.

  • 15. Kailembo, Alexander
    et al.
    Quiñonez, Carlos
    Lopez Mitnik, Gabriela V.
    Weintraub, Jane A.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia.
    Preet, Raman
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Iafolla, Timothy
    Dye, Bruce A.
    Income and wealth as correlates of socioeconomic disparity in dentist visits among adults aged 20 years and over in the United States, 2011–20142018In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 18, no 1, article id 147Article in journal (Refereed)
    Abstract [en]

    Background: Most studies in the United States (US) have used income and education as socioeconomic indicators but there is limited information on other indicators, such as wealth. We aimed to assess how two socioeconomic status measures, income and wealth, compare as correlates of socioeconomic disparity in dentist visits among adults in the US.

    Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 were used to calculate self-reported dental visit prevalence for adults aged 20 years and over living in the US. Prevalence ratios using Poisson regressions were conducted separately with income and wealth as independent variables. The dependent variable was not having a dentist visit in the past 12 months. Covariates included sociodemographic factors and untreated dental caries. Parsimonious models, including only statistically significant (p < 0.05) covariates, were derived. The Akaike Information Criterion (AIC) measured the relative statistical quality of the income and wealth models. Analyses were additionally stratified by race/ethnicity in response to statistically significant interactions.

    Results: The prevalence of not having a dentist visit in the past 12 months among adults aged 20 years and over was 39%. Prevalence was highest in the poorest (58%) and lowest wealth (57%) groups. In the parsimonious models, adults in the poorest and lowest wealth groups were close to twice as likely to not have a dentist visit (RR 1.69; 95%CI: 1.51–1.90) and (RR 1.68; 95%CI: 1.52–1.85) respectively. In the income model the risk of not having a dentist visit were 16% higher in the age group 20–44 years compared with the 65+ year age group (RR 1.16; 95%CI: 1.04–1.30) but age was not statistically significant in the wealth model. The AIC scores were lower (better) for the income model. After stratifying by race/ethnicity, age remained a significant indicator for dentist visits for non-Hispanic whites, blacks, and Asians whereas age was not associated with dentist visits in the wealth model.

    Conclusions: Income and wealth are both indicators of socioeconomic disparities in dentist visits in the US, but both do not have the same impact in some populations in the US.

  • 16.
    Kriit, Hedi Katre
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Health economic assessment of a scenario to promote bicycling as active transport in Stockholm, Sweden2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 9, article id e030466Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To conduct a health economic evaluation of a proposed investment in urban bicycle infrastructure in Stockholm County, Sweden.

    DESIGN: A cost-effectiveness analysis is undertaken from a healthcare perspective. Investment costs over a 50-year life cycle are offset by averted healthcare costs and compared with estimated long-term impacts on morbidity, quantified in disability-adjusted life years (DALYs). The results are re-calculated under different assumptions to model the effects of uncertainty.

    SETTING: The Municipality of Stockholm (population 2.27 million) committed funds for bicycle path infrastructure with the aim of achieving a 15% increase in the number of bicycle commuters by 2030. This work is based on a previously constructed scenario, in which individual registry data on home and work address and a transport model allocation to different modes of transport identified 111 487 individuals with the physical capacity to bicycle to work within 30 min but that currently drive a car to work.

    RESULTS: Morbidity impacts and healthcare costs attributed to increased physical activity, change in air pollution exposure and accident risk are quantified under the scenario. The largest reduction in healthcare costs is attributed to increased physical activity and the second largest to reduced air pollution exposure among the population of Greater Stockholm. The expected net benefit from the investment is 8.7% of the 2017 Stockholm County healthcare budget, and 3.7% after discounting. The economic evaluation estimates that the intervention is cost-effective and each DALY averted gives a surplus of €9933. The results remained robust under varied assumptions pertaining to reduced numbers of additional bicycle commuters.

    CONCLUSION: Investing in urban infrastructure to increase bicycling as active transport is cost-effective from a healthcare sector perspective.

  • 17.
    Kunna, Rasha
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Generational Health and Ageing Faculty of Health, University of Newcastle.
    Measurement and decomposition of socioeconomic inequality in single and multimorbidity in older adults in China and Ghana: results from the WHO study on global AGEing and adult health (SAGE)2017In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 16, no 1, article id 79Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Globally people are living longer and enduring non-communicable diseases (NCDs) many of which co-occur as multimorbidity. Demographic and socioeconomic factors are determinants of inequalities and inequities in health. There is a need for country-specific evidence of NCD inequalities in developing countries where populations are ageing rapidly amid economic and social change. The study measures and decomposes socioeconomic inequality in single and multiple NCD morbidity in adults aged 50 and over in China and Ghana.

    METHODS: The data source is the World Health Organization Study on Global AGEing and Adult Health (SAGE) Wave 1 (2007-2010). Nationally representative cross-sectional data collected from adults in China (n = 11,814) and Ghana (n = 4,050) are analysed. Country populations are ranked by a socioeconomic index based on ownership of household assets. The study uses a decomposed concentration index (CI) of single and multiple NCD morbidity (multimorbidity) covering arthritis, diabetes, angina, stroke, asthma, depression, chronic lung disease and hypertension. The CI quantifies the extent of overall inequality on each morbidity measure. The decomposition utilises a regression-based approach to examine individual contributions of demographic and socioeconomic factors, or determinants, to the overall inequality.

    RESULTS: In China, the prevalence of single and multiple NCD morbidity was 64.7% and 53.4%, compared with 65.9% and 55.5% respectively in Ghana. Inequalities were significant and more highly concentrated among the poor in China (single morbidity CI = -0.0365: 95% CI = -0.0689,-0.0040; multimorbidity CI = -0.0801: 95% CI = -0.1233,-0.0368;). In Ghana inequalities were significant and more highly concentrated among the rich (single morbidity CI = 0.1182; 95% CI = 0.0697, 0.1668; multimorbidity CI = 0.1453: 95% CI = 0.0794, 0.2083). In China, rural residence contributed most to inequality in single morbidity (36.4%) and the wealth quintiles contributed most to inequality in multimorbidity (39.0%). In Ghana, the wealth quintiles contributed 24.5% to inequality in single morbidity and body mass index contributed 16.2% to the inequality in multimorbidity.

    CONCLUSIONS: The country comparison reflects different stages of economic development and social change in China and Ghana. More studies of this type are needed to inform policy-makers about the patterning of socioeconomic inequalities in health, particularly in developing countries undergoing rapid epidemiological and demographic transitions.

  • 18.
    Lu, Sai San Moon
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. a Department of Preventive and Social Medicine, University of Medicine Mandalay, Mandalay, Myanmar.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, New Lambton Heights, NSW, Australia.
    Nilsson Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Inequalities in early childhood mortality in Myanmar: Association between parents' socioeconomic status and early childhood mortality2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1603516Article in journal (Refereed)
    Abstract [en]

    Background: Despite global achievements in reducing early childhood mortality, disparities remain. There have been empirical studies of inequalities conducted in low- and middle-income countries. However, there have been no epidemiological studies on socioeconomic inequalities and early childhood survival in Myanmar.

    Objective: To estimate associations between two measures of parental socioeconomic status - household wealth and education - and age-specific early childhood mortality in Myanmar.

    Methods: Using cross-sectional data obtained from the Myanmar Demographic Health Survey (2015-2016), univariate and multiple logistic regressions were performed to investigate associations between household wealth and highest attained parental education, and under-5, neonatal, post-neonatal and child mortality. Data for 10,081 children born to 5,932 married women (aged 15-49 years) 10 years prior to the survey, were analysed.

    Results: Mortality during the first five years was associated with household wealth. In multiple logistic models, wealth was protective for post-neonatal mortality. After adjusting for individual proximate determinants, the odds of post-neonatal mortality in the richest households were 85% lower (95% CI: 50-96%) than in the poorest households. However, significant association was not found between wealth and neonatal mortality. Parental education was important for early childhood mortality; the highest benefit from parental education was for child mortality in the one- to five-year age bracket. After adjusting for proximate determinants, children with a higher educated parent had 95% (95% CI 77-99%) lower odds of death in this age group compared with children whose parents' highest educational attainment was at primary level. The association between parental education and neonatal mortality was not significant.

    Conclusions: In Myanmar, household wealth and parental education are important for childhood survival before five years of age. This study identified nuanced age-related differences in associations. Health policy must take socioeconomic determinants into account in order to address unfair inequalities in early childhood mortality.

  • 19. Navin Cristina, Tina J
    et al.
    Stewart Williams, Jennifer A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Univ Newcastle, Res Ctr Gender Hlth & Ageing, Callaghan, NSW 2308, Australia.
    Parkinson, Lynne
    Sibbritt, David W
    Byles, Julie E
    Identification of diabetes, heart disease, hypertension and stroke in mid- and older-aged women: Comparing self-report and administrative hospital data records2016In: Geriatrics & Gerontology International, ISSN 1444-1586, E-ISSN 1447-0594, Vol. 16, no 1, p. 95-102Article in journal (Refereed)
    Abstract [en]

    AIM: To estimate the prevalence of diabetes, heart disease, hypertension and stroke in self-report and hospital data in two cohorts of women; measure sensitivity and agreement between data sources; and compare between cohorts.

    METHODS: Women born between 1946-1951 and 1921-1926 who participated in the Australian Longitudinal Study on Women's Health (ALSWH); were New South Wales residents; and admitted to hospital (2004-2008) were included in the present study. The prevalence of diabetes, heart disease, hypertension and stroke was estimated using self-report (case 1 at latest survey, case 2 across multiple surveys) and hospital records. Agreement (kappa) and sensitivity (%) were calculated. Logistic regression measured the association between patient characteristics and agreement.

    RESULTS: Hypertension had the highest prevalence and estimates were higher for older women: 32.5% case 1, 45.4% case 2, 12.8% in hospital data (1946-1951 cohort); 57.8% case 1, 73.2% case 2, 38.2% in hospital data (1921-1926 cohort). Agreement was substantial for diabetes: κ = 0.75 case 1, κ = 0.70 case 2 (1946-1951 cohort); κ = 0.77 case 1, κ = 0.80 case 2 (1921-1926 cohort), and lower for other conditions. The 1946-1951 cohort had 2.08 times the odds of agreement for hypertension (95% CI 1.56 to 2.78; P < 0.0001), and 6.25 times the odds of agreement for heart disease (95% CI 4.35 to 10.0; P < 0.0001), compared with the 1921-1926 cohort.

    CONCLUSION: Substantial agreement was found for diabetes, indicating accuracy of ascertainment using self-report or hospital data. Self-report data appears to be less accurate for heart disease and stroke. Hypertension was underestimated in hospital data. These findings have implications for epidemiological studies relying on self-report or administrative data. Geriatr Gerontol Int 2015

  • 20.
    Parkinson, Lynne
    et al.
    Research Centre for Gender, Health and Ageing, The University of Newcastle, Newcastle, Australia.
    Doljagore, Xenia
    Gibson, Richard
    Doran, Evan
    Notley, Lisa
    Stewart Williams, Jenny
    Research Centre for Gender, Health and Ageing, The University of Newcastle, Newcastle, Australia.
    Kowal, Paul
    Byles, Julie E
    An observational study of the discrediting of COX-2 NSAIDs in Australia: Vioxx or class effect?2011In: BMC public health, ISSN 1471-2458, Vol. 11, p. 892-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: When a medicine such as rofecoxib (Vioxx) is withdrawn, or a whole class of medicines discredited such as the selective COX-2 inhibitors (COX-2s), follow-up of impacts at consumer level can be difficult and costly. The Australian Longitudinal Study on Women's Health provides a rare opportunity to examine individual consumer medicine use following a major discrediting event, the withdrawal of rofecoxib and issuing of safety warnings on the COX-2 class of medicines. The overall objective of this paper was to examine the impact of this discrediting event on dispensing of the COX-2 class of medicines, by describing medicine switching behaviours of older Australian women using rofecoxib in September 2004; the uptake of other COX-2s; and the characteristics of women who continued using a COX-2.

    METHODS: Participants were concessional beneficiary status women from the Older cohort (born 1921-26) of the Australian Longitudinal Study on Women's Health who consented to linkage to Pharmaceutical Benefits Scheme data, with at least one rofecoxib prescription dispensed in the 12 months before rofecoxib withdrawal. A prescription was defined as one dispensing occasion. Women were grouped by rofecoxib pattern of use: continuous (nine or more prescriptions dispensed in the 12 months prior to rofecoxib withdrawal) or non-continuous (eight or less prescriptions dispensed in the 12 months prior to rofecoxib withdrawal) users. Incidence rate per 100,000 person days and incidence risk ratio described uptake of alternate medicines, following rofecoxib withdrawal. Kaplan-Meier curves described differences in uptake patterns by medicine and pattern of rofecoxib use. Patterns of use of COX-2s in the next 100 days after first COX-2 uptake were described.

    RESULTS: Medicine switches and pattern of medicines uptake differed significantly depending upon whether a woman was a continuous or non-continuous rofecoxib user prior to rofecoxib discrediting. Continuous rofecoxib users overwhelmingly switched to another COX-2 and remained continuing COX-2 users for at least 100 days post-switch.

    CONCLUSIONS: The typical switching behaviour of this group of women suggests that the issues leading to the discrediting of rofecoxib were not seen as a COX-2 class effect by prescribers to this high use group of consumers.

  • 21. Peltzer, Karl
    et al.
    Phaswana-Mafuya, Nancy
    Arokiasamy, Perianayagam
    Biritwum, Richard
    Yawson, Alfred
    Minicuci, Nadia
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Gender, Health and Ageing, Faculty of Health, University of Newcastle, Australia.
    Kowal, Paul
    Chatterji, Somnath
    Prevalence, circumstances and consequences of non-fatal road traffic injuries and other bodily injuries among older people in China, Ghana, India, Mexico, Russia and South Africa2015In: African Safety Promotion: A Journal of Injury and Violence Prevention, Vol. 13, no 2, p. 59-77Article in journal (Refereed)
    Abstract [en]

    Unintentional injuries are one of the main contributors to mortality and disability in elderly populations in low- and middle-income countries. The aim of this study was to examine the annual road traffic and other bodily (not including falls) injury prevalence and associated risk factors among older adults across six lower and upper middle-income countries. A cross-sectional survey involving face-to-face household interviews were conducted in China (n=13,177), Ghana (n=4305), India (n=6560), Mexico (n=2318), the Russian Federation (n=3938) and South Africa (n=3840), resulting in population-based cohorts of persons aged 50+ years. Measures included questions on injury, self-rated visual difficulties, alcohol use, depression treatment, sleeping problems, self-reported health status, and vision assessment using LogMAR (logarithm of Minimum Angle of Resolution) eye charts. It comprises rows of letters and is used to measure visual acuity. Results indicate that the overall annual non-fatal road traffic injury prevalence was 2.0% and for other bodily injury 2.1% (not including falls) across the six countries. The multivariate logistic regression analysis found that residing in a rural area, taking medications or other treatment for depression in the past 12 months and having a sleeping problem were associated with road traffic injury, while younger age, residing in a rural area, hazardous or harmful alcohol use and having a sleeping problem were associated with other bodily injury. Visual impairment was not associated with prevalence of road traffic injuries. This study provides the burden of non-fatal road traffic injury and other bodily injury and their associated risk factors across the six countries’ studies. The findings of this study improves the understanding of non-fatal road traffic injury and other bodily injury upon which policy makers, programme developers and researchers in public health can design strategic interventions to reduce these preventable injuries as well as improve safety associated with unintentional injuries.

  • 22.
    Peltzer, Karl
    et al.
    Human Sci Res Council, Pretoria, South Africa.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Gender, Health & Ageing, University of Newcastle, Newcastle, Australia.
    Kowal, Paul
    Univ Newcastle, Res Ctr Gender Hlth & Ageing, Newcastle, Australia.
    Negin, Joel
    Snodgrass, James Josh
    Univ Sydney, Sch Publ Hlth, Sydney, Australia.
    Yawson, Alfred
    Univ Ghana, Dept Community Hlth, Accra, Ghana.
    Minicuci, Nadia
    Univ Ghana, Dept Community Hlth, Accra, Ghana.
    Thiele, Liz
    Phaswana-Mafuya, Nancy
    Nelson Mandela Metropolitan Univ, Off Deputy Vice Chancellor, Port Elizabeth, South Africa.
    Biritwum, Richard Berko
    Univ Ghana, Dept Community Hlth, Accra, Ghana.
    Naidoo, Nirmala
    WHO, HIS HSI, CH-1211 Geneva, Switzerland.
    Chatterji, Somnath
    WHO, HIS HSI, CH-1211 Geneva, Switzerland.
    Universal health coverage in emerging economies: findings on health care utilization by older adults in China, Ghana, India, Mexico, the Russian Federation, and South Africa2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25314Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE:

    The achievement of universal health coverage (UHC) in emerging economies is a high priority within the global community. This timely study uses standardized national population data collected from adults aged 50 and older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. The objective is to describe health care utilization and measure association between inpatient and outpatient service use and patient characteristics in these six low- and middle-income countries.

    DESIGN:

    Secondary analysis of data from the World Health Organization's Study on global AGEing and adult health Wave 1 was undertaken. Country samples are compared by socio-demographic characteristics, type of health care, and reasons for use. Logistic regressions describe association between socio-demographic and health factors and inpatient and outpatient service use.

    RESULTS:

    In the pooled multi-country sample of over 26,000 adults aged 50-plus, who reported getting health care the last time it was needed, almost 80% of men and women received inpatient or outpatient care, or both. Roughly 30% of men and women in the Russian Federation used inpatient services in the previous 3 years and 90% of men and women in India used outpatient services in the past year. In China, public hospitals were the most frequently used service type for 52% of men and 51% of women. Multivariable regression showed that, compared with men, women were less likely to use inpatient services and more likely to use outpatient services. Respondents with two or more chronic conditions were almost three times as likely to use inpatient services and twice as likely to use outpatient services compared with respondents with no reported chronic conditions.

    CONCLUSIONS:

    This study provides a basis for further investigation of country-specific responses to UHC.

  • 23.
    Preet, Raman
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Khan, Nausheen
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Blomstedt, Yulia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Priority Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.
    Assessing dental professionals' understanding of tobacco prevention and control: a qualitative study in Västerbotten County, Sweden2016In: BDJ Open, ISSN 2056-807X, no 2, p. 1-6, article id 16009Article in journal (Refereed)
    Abstract [en]

    Aim: To assess dental professionals’ understanding of tobacco prevention and control.

    Materials and methods: In Sweden dental hygienists receive training in tobacco prevention and control. The study setting is Västerbotton County in the north of Sweden where a number of successful tobacco control initiatives have been established. A purposeful sample comprising five male and four female dental professionals and trainees was selected. Data were collected through in-depth semi-structured individual interviews and analysed using content analysis.

    Results: Informants acknowledged limited adherence to tobacco prevention. They were not confident of their knowledge of tobacco and non-communicable disease prevention and had limited awareness of global oral health policies. Reasons for poor adherence included professional fragmentation, lack of training, and the absence of reimbursement for time spent on prevention activities.

    Discussion: The success of efforts to reduce smoking in Västerbotton County is attributed to the network of local public health initiatives with very limited involvement by local dental professionals.

    Conclusions: The findings highlight the need to more actively engage the dental workforce in tobacco control and prevention. Moreover, it is important to recognise that dental professionals can be public health advocates for tobacco control and prevention at global, national and local levels.

  • 24. Simpson, Sarah
    et al.
    Mahoney, Mary
    Harris, Elisabeth
    Aldrich, Rosemary
    Stewart-Williams, Jenny
    Equity-focused health impact assessment: A tool to assist policy makers in addressing health inequalities2005In: Environmental impact assessment review, ISSN 0195-9255, E-ISSN 1873-6432, Vol. 25, p. 772-782Article in journal (Refereed)
  • 25.
    Stewart Williams, Jennifer
    Research Centre for Gender, Health and Ageing, Newcastle Institute of Public Health, University of Newcastle, Newcastle, Australia.
    Assessing the suitability of fractional polynomial methods in health services research: a perspective on the categorization epidemic2011In: Journal of Health Services Research and Policy, ISSN 1355-8196, E-ISSN 1758-1060, Vol. 16, no 3, p. 147-52Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To show how fractional polynomial methods can usefully replace the practice of arbitrarily categorizing data in epidemiology and health services research.

    METHODS: A health service setting is used to illustrate a structured and transparent way of representing non-linear data without arbitrary grouping.

    RESULTS: When age is a regressor its effects on an outcome will be interpreted differently depending upon the placing of cutpoints or the use of a polynomial transformation.

    CONCLUSIONS: Although it is common practice, categorization comes at a cost. Information is lost, and accuracy and statistical power reduced, leading to spurious statistical interpretation of the data. The fractional polynomial method is widely supported by statistical software programs, and deserves greater attention and use.

  • 26.
    Stewart Williams, Jennifer A
    et al.
    Research Centre for Gender, Health and Ageing, HMRI Building, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
    Wallick, Christopher J
    Research Centre for Gender, Health and Ageing, HMRI Building, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia .
    Byles, Julie E
    Research Centre for Gender, Health and Ageing, HMRI Building, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia .
    Doran, Christopher M
    Hunter Medical Research Institute, Hunter Valley Research Foundation, HMRI Building, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia .
    Assessing patterns of use of cardio-protective polypill component medicines in Australian women2013In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 30, no 3, p. 193-203Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A low-cost 'polypill' could theoretically be one way of improving medication affordability and compliance for secondary prevention of cardiovascular and cerebrovascular disease. The polypill has also been proposed as a primary prevention strategy. Yet many of the issues surrounding the polypill are still being debated and the underlying assumptions have not been proven. In this paper, we step back from the complexities of the debate and report upon the utilization of polypill component medicines in two population cohorts of Australian women who were aged 56-61 years and 81-86 years in 2007.

    OBJECTIVES: The aims of this study were firstly, to describe the association between the women's characteristics (health, illness, behavioural, demographic, socioeconomic) and their use of statins and antihypertensive medicines for the treatment of heart disease, and secondly, to discuss possible health and economic benefits for women with these characteristics that may be expected to result from the introduction of a cardio-protective polypill.

    METHODS: Survey records from the Australian Longitudinal Study on Women's Health (ALSWH) were linked to 2007 Pharmaceutical Benefits Scheme (PBS) claims for 7,116 mid-aged women and 4,526 older-aged women. Associations between women's characteristics (self-reported in ALSWH surveys) and their use of statins and antihypertensive medicines (measured through PBS claims in 2007) were analysed using Chi-square and multivariate regression techniques.

    RESULTS: Between 2002 and 2007, the use of statins in combination with antihypertensives by mid- and older-aged Australian women increased. A moderate yet increasing proportion of mid-aged women were taking statins without antihypertensives, and a high proportion of older-aged women were using antihypertensives without statins. A high proportion of women who were prescribed both statins and antihypertensives were in lower socioeconomic groups and reported difficulty managing on their incomes.

    CONCLUSION: These results suggest that a polypill may provide an easy-to-take, cheaper alternative for Australian women already taking multiple cardiovascular disease medications, with particular benefits for older women and women in lower socioeconomic groups. Future research is needed to quantify the potential social and economic benefits of the polypill.

  • 27.
    Stewart Williams, Jennifer Anne
    Research Centre for Gender, Health and Ageing and Hunter Medical Research Institute, University of Newcastle, New South Wales, Australia.
    Using non-linear decomposition to explain the discriminatory effects of male-female differentials in access to care: a cardiac rehabilitation case study2009In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 69, no 7, p. 1072-1079Article in journal (Refereed)
    Abstract [en]

    This paper demonstrates the use of non-linear decomposition for identifying discrimination in referral to a cardiac rehabilitation (CR) program. The application is important because the methods are not commonly applied in this context. A secondary data analysis was conducted on a cohort of 2375 patients eligible for referral (as defined) to an Australian hospital outpatient CR program (1 July 1996 to 31 December 2000) on the basis of inpatient discharge diagnosis codes. Data from a population-based disease register were linked to hospital inpatient statistics and CR program records. Cohort selection was established in accordance with first register recorded hospital separations having specified cardiac inpatient diagnoses for which CR was recommended. Using the existing literature as a guide, multivariate logistic regression methods tested the strength of statistical association between independent variables (or 'endowments') and CR referral. Compared with males, females had 40% fewer odds of being referred. Non-linear decomposition was performed as a post-logistic regression technique to show the extent to which the sex-based inequality in referral (as defined here) was due to group characteristics (the relative distribution of endowments) compared with other influences not adjusted for in the model. The results showed that approximately 18% of the male-female inequality in referral was not explained by group characteristics, and on this basis was 'discriminatory'. The extent to which individual endowments contributed to the explained part of the inequality was also of interest. The methods offer potentially useful tools for informing researchers, policy makers, clinicians and others about unfair discriminatory processes that influence access to health and social services.

  • 28.
    Stewart Williams, Jennifer
    et al.
    Research Centre for Gender Health & Ageing, Faculty of Health, University of Newcastle.
    Cunich, Michelle
    Byles, Julie
    The impact of socioeconomic status on changes in the general and mental health of women over time: evidence from a longitudinal study of Australian women2013In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 12, article id 25Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Generally, men and women of higher socioeconomic status (SES) have better health. Little is known about how socioeconomic factors are associated with changes in health as women progress through mid-life. This study uses data from six survey waves (1996 to 2010) of the Australian Longitudinal Study on Women's Health (ALSWH) to examine associations between SES and changes in the general health and mental health of a cohort of women progressing in years from 45-50 to 59-64.

    METHODS: Participants were 12,709 women (born 1946-51) in the ALSWH. Outcome measures were the general health and mental health subscales of the Medical Outcomes Study Short Form 36 Questionnaire (SF-36). The measure of SES was derived from factor analysis of responses to questions in the ALSWH baseline survey (1996) on school leaving age, highest qualifications, and current or last occupation. Multi-level random coefficient models, adjusted for socio-demographic factors and health behaviors, were used to analyze repeated measures of general health and mental health. Survey year accounted for changes in factors across time. In the first set of analyses we investigated associations between the SES index, used as a "continuous" variable, and general health and mental health changes over time. To illuminate the impact of different levels of SES on health, a second analysis was conducted in which SES scores were grouped into three approximately equal sized categories or "tertiles" as reported in an earlier ALSWH study. The least square means of general and mental health scores from the longitudinal models were plotted for the three SES tertiles.

    RESULTS: The longitudinal analysis showed that, after adjusting for the effects of time and possible confounders, the general (mental) health of this cohort of mid-aged women declined (increased) over time. Higher SES women reported better health than lower SES women, and SES significantly modified the effects of time on both general and mental health in favor of higher SES women.

    CONCLUSIONS: This study contributes to our current understanding of how socioeconomic and demographic factors, health behaviors and time impact on changes in the general and mental health of women progressing in years from 45-50 to 59-64.

  • 29.
    Stewart Williams, Jennifer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Gender, Health and Ageing, Faculty of Health, University of Newcastle, Newcastle, Australia.
    Kowal, Paul
    Hestekin, Heather
    O'Driscoll, Tristan
    Peltzer, Karl
    Yawson, Alfred
    Biritwum, Richard
    Maximova, Tamara
    Salinas Rodriguez, Aaron
    Manrique Espinoza, Betty
    Wu, Fan
    Arokiasamy, Perianayagam
    Chatterji, Somnath
    Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-income countries: results from the WHO Study on global AGEing and adult health (SAGE)2015In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 13, article id 147Article in journal (Refereed)
    Abstract [en]

    Background: In 2010 falls were responsible for approximately 80 % of disability stemming from unintentional injuries excluding traffic accidents in adults 50 years and over. Falls are becoming a major public health problem in low-and middle-income countries (LMICs) where populations are ageing rapidly. Methods: Nationally representative standardized data collected from adults aged 50 years and over participating in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, the Russian Federation and South Africa are analysed. The aims are to identify the prevalence of, and risk factors for, past-year fall-related injury and to assess associations between fall-related injury and disability. Regression methods are used to identify risk factors and association between fall-related injury and disability. Disability was measured using the WHO Disability Assessment Schedule Version 2.0 (WHODAS 2.0). Results: The prevalence of past-year fall-related injuries ranged from 6.6 % in India to 1.0 % in South Africa and was 4.0 % across the pooled countries. The proportion of all past-year injuries that were fall-related ranged from 73.3 % in the Russian Federation to 44.4 % in Ghana. Across the six countries this was 65.7 %. In the multivariable logistic regression, the odds of past-year fall-related injury were significantly higher for: women (OR: 1.27; 95 % CI: 0.99,1.62); respondents who lived in rural areas (OR: 1.36; 95 % CI: 1.06,1.75); those with depression (OR: 1.43; 95 % CI: 1.01,2.02); respondents who reported severe or extreme problems sleeping (OR: 1.54; 95 % CI: 1.15,2.08); and those who reported two or more (compared with no) chronic conditions (OR: 2.15; 95 % CI: 1.45,3.19). Poor cognition was also a significant risk factor for fall-related injury. The association between fall-related injury and the WHODAS measure of disability was highly significant (P<0.0001) with some attenuation after adjusting for confounders. Reporting two or more chronic conditions (compared with none) was significantly associated with disability (P<0.0001). Conclusions: The findings provide a platform for improving understanding of risk factors for falls in older adults in this group of LMICs. Clinicians and public health professionals in these countries must be made aware of the extent of this problem and the need to implement policies to reduce the risk of falls in older adults.

  • 30.
    Stewart Williams, Jennifer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Gender, Health and Ageing, University of Newcastle, Australia.
    Ling, Rod
    Searles, Andrew M
    Doran, Christopher M
    Byles, Julie
    Identification of higher hospital costs and more frequent admissions among mid-aged Australian women who self-report diabetes mellitus2016In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 90, p. 58-63Article in journal (Refereed)
    Abstract [en]

    Objective: To ascertain whether the hospital costs for mid-aged Australian women who self-reported diabetes mellitus (DM) and who had one or more hospital admission during an eight and a half year period were higher than the hospital costs for other similarly aged non-DM women. Methods: The sample comprised 2,392 mid-aged women, resident in New South Wales (NSW) Australia and participating in the Australian Longitudinal Study on Women’s Health (ALSWH), who had any NSW hospital admissions during the eight and a half year period 1 July 2000 to 31 December 2008. Analyses were conducted on linked data from ALSWH surveys and the NSW Admitted Patient Data Collection (APDC). Hospital costs were compared for the DM and non-DM cohorts of women. A generalized linear model measured the association between hospital costs and self-reported DM. Results: Eight and a half year hospital costs were 41% higher for women who self-reported DM in the ALSWH surveys (p < 0.0001). On average, women who self-reported DM had significantly (p < 0.0001) more hospital admissions (5.3) than women with no reported DM (3.4). The average hospital stay per admission was not significantly different between the two groups of women. Conclusions: Self-reported DM status in mid-aged Australian women is a predictor of higher hospital costs. This simple measure can be a useful indicator for public policy makers planning early-stage interventions that target people in the population at risk of DM.

  • 31.
    Stewart Williams, Jennifer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Univ Newcastle, Fac Hlth, Res Ctr Gender Hlth & Ageing, Newcastle, NSW 2300, Australia.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Peltzer, Karl
    Yawson, Alfred
    Biritwum, Richard
    Maximova, Tamara
    Wu, Fan
    Arokiasamy, Perianayagam
    Kowal, Paul
    Chatterji, Somnath
    Risk Factors and Disability Associated with Low Back Pain in Older Adults in Low- and Middle-Income Countries. Results from the WHO Study on Global AGEing and Adult Health (SAGE)2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 6, p. e0127880-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Back pain is a common disabling chronic condition that burdens individuals, families and societies. Epidemiological evidence, mainly from high-income countries, shows positive association between back pain prevalence and older age. There is an urgent need for accurate epidemiological data on back pain in adult populations in low- and middle-income countries (LMICs) where populations are ageing rapidly. The objectives of this study are to: measure the prevalence of back pain; identify risk factors and determinants associated with back pain, and describe association between back pain and disability in adults aged 50 years and older, in six LMICs from different regions of the world. The findings provide insights into country-level differences in self-reported back pain and disability in a group of socially, culturally, economically and geographically diverse LMICs.

    METHODS: Standardized national survey data collected from adults (50 years and older) participating in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) were analysed. The weighted sample (n = 30, 146) comprised respondents in China, Ghana, India, Mexico, South Africa and the Russian Federation. Multivariable regressions describe factors associated with back pain prevalence and intensity, and back pain as a determinant of disability.

    RESULTS: Prevalence was highest in the Russian Federation (56%) and lowest in China (22%). In the pooled multi-country analyses, female sex, lower education, lower wealth and multiple chronic morbidities were significant in association with past-month back pain (p<0.01). About 8% of respondents reported that they experienced intense back pain in the previous month.

    CONCLUSIONS: Evidence on back pain and its impact on disability is needed in developing countries so that governments can invest in cost-effective education and rehabilitation to reduce the growing social and economic burden imposed by this disabling condition.

  • 32.
    Stewart Williams, Jennifer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Disability and ageing in China and India – decomposing the effects of gender and residence: Results from the WHO study on global ageing and adult health (SAGE)2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 197Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: China and India are the world's two most populous countries. Although their populations are growing in number and life expectancies are extending they have different trajectories of economic growth, epidemiological transition and social change. Cross-country comparisons can allow national and global insights and provide evidence for policy and decision-making. The aim of this study is to measure and compare disability in men and women, and in urban and rural dwellers in China and India, and assess the extent to which social and other factors contribute to the inequalities.

    METHODS: National samples of adults aged 50 to 79 years in China (n = 11,694) and India (n = 6187) from the World Health Organization (WHO) longitudinal Study on global AGEing and adult health (SAGE) Wave 1 were analysed. Stratified multiple linear regressions were undertaken to assess disability differences by sex and residence, controlling for other biological and socioeconomic determinants of disability. Oaxaca-Blinder decomposition partitioned the two-group inequalities into explained and unexplained components.

    RESULTS: In both countries women and rural residents reported more disability. In India, the gender inequality is attributed to the distribution of the determinants (employment, education and chronic conditions) but in China about half the inequality is attributed to the same. In India, more than half of the urban rural inequality is attributed to the distribution of the determinants (education, household wealth) compared with under 20% in China.

    CONCLUSIONS: Education and employment were important drivers of these measured inequalities. Overall inequalities in disability among older adults in China and India were shaped by gender and residence, suggesting the need for policies that target women and rural residents. There is a need for further research, using both qualitative and quantitative methods, to question and challenge entrenched practices and institutions and grasp the implications of global economic and social changes that are impacting on population health and ageing in China and India.

  • 33.
    Stewart Williams, Jenny A
    et al.
    Newcastle Institute of Public Health, University of Newcastle, PO Box 664J, Newcastle, NSW, Australia.
    Lowe, Julia M
    Candlish, Paula M
    Using pilot studies to inform health services2005In: Australian health review : a publication of the Australian Hospital Association, ISSN 0156-5788, Vol. 29, no 4, p. 478-481Article in journal (Refereed)
    Abstract [en]

    A pilot study was conducted at the John Hunter Hospital, Newcastle, Australia in 1998-99 to inform a randomised controlled trial (RCT) for a cardiac rehabilitation intervention for patients with congestive heart failure (CHF). Although the RCT did not proceed, the pilot study results raised a number of issues. In this paper, the pilot is used to demonstrate how estimates of population benefit need to take into account patient eligibility, consent and adherence, and also how non-clinical data can inform the planning and development of health service interventions.

  • 34.
    Tarekegne, Fitsum Eyayu
    et al.
    Mailman School of Public Health, Centre for International Programs, Columbia University, Addis Ababa, Ethiopia.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Schröders, Julia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia.
    Sociodemographic and behavioral characteristics associated with self-reported diagnosed diabetes mellitus in adults aged 50+ years in Ghana and South Africa: results from the WHO-SAGE wave 12018In: BMJ Open Diabetes Research & Care, ISSN 2052-4897, Vol. 6, no 1, article id e000449Article in journal (Refereed)
    Abstract [en]

    Objective: The objective is to identify and describe thesociodemographic and behavioral characteristics of adults,aged 50 years and over, who self-reported having beendiagnosed and treated for diabetes mellitus (DM) in Ghanaand South Africa.

    Research design and methods: This is a cross-sectionalstudy based on the WHO Study on global AGEing and adulthealth (SAGE) wave 1. Information on sociodemographicfactors, health states, risk factors and chronic conditionsis captured from questionnaires administered in face-tofaceinterviews. Self-reported diagnosed and treated DM isconfirmed through a ‘yes’ response to questions regarding1having previously been diagnosed with DM, and2 havingtaken insulin or other blood sugar lowering medicines.Crude and adjusted logistic regressions test associationsbetween candidate variables and DM status. Analysesinclude survey sampling weights. The variance inflationfactor statistic tested for multicollinearity.

    Results: In this nationally representative sample ofadults aged 50 years and over in Ghana, after adjustingfor the effects of sex, residence, work status, bodymass index, waist-hip and waist-height ratios, smoking,alcohol, fruit and vegetable intake and householdwealth, WHO-SAGE survey respondents who were older,married, had higher education, very high-risk waistcircumference measurements and did not undertakehigh physical activity, were significantly more likelyto report diagnosed and treated DM. In South Africa,respondents who were older, lived in urban areas andhad high-risk waist circumference measurements weresignificantly more likely to report diagnosed andtreated DM.

    Conclusions: Countries in sub-Saharan Africa arechallenged by unprecedented ageing populations andtransition from communicable to non-communicablediseases such as DM. Information on those who arealready diagnosed and treated needs to be combinedwith estimates of those who are prediabetic or, as yet,undiagnosed. Multisectoral approaches that includesocioculturally appropriate strategies are needed toaddress diverse populations in SSA countries.

  • 35. Van Minh, Hoang
    et al.
    Oh, Juhwan
    Hoat, Luu Ngoc
    Lee, Jong-Koo
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Millennium Development Goals in Vietnam: Taking Multi-sectoral Action to Improve Health and Address the Social Determinants2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 31271Article in journal (Refereed)
  • 36. Williams, Jennifer
    Coordinating rural divisions: the workforce window.1997In: Australian health review : a publication of the Australian Hospital Association, ISSN 0156-5788, Vol. 20, no 4, p. 13-26Article in journal (Refereed)
    Abstract [en]

    Divisions of General Practice have been established to alleviate the professional isolation which general practitioners face by being excluded from involvement in other parts of the health care system. Divisions facilitate the development of local communication networks and cooperative activities which improve the integration of general practice with other elements of the health system. Coordination of communication is one of the strengths of divisions at the local level and Rural Divisions Co-ordinating Units at the State level. This strength is being effectively utilised to target general practice workface issues. Given the significant proportion of general practitioners in the medical workforce, particularly in rural and remote areas, this has implications for broader medical workforce issues. Australia faces a maldistribution in its general practitioner workforce, with an excess supply in urban areas and a significant shortfall in rural and remote areas. Since 1995-96, the General Practice Rural Incentives Program, which targets the recruitment and retention of rural doctors, has devolved funding to the Rural Divisions Co-ordination Units to coordinate the statewide provision of practical assistance to rural general practitioners, through their divisions, in relation to continuing medical education and the provision of locums. There is potential to build on the success of these initiatives and also to work with urban divisions through the state-based organisational structures which are currently being developed.

  • 37. Williams, Jennifer
    Understanding rural and remote divisions under a workforce framework.1998In: The Australian journal of rural health, ISSN 1038-5282, E-ISSN 1440-1584, Vol. 6, no 3, p. 156-60Article in journal (Refereed)
    Abstract [en]

    In Australia, divisions of general practice are the organisational structures for local networks of general practitioners. They facilitate communication across the profession and with other parts of the health system and are established in urban, rural and remote areas. Funding is provided contractually to divisions through the Federal Government's Divisions and Projects Grants Program. The under-supply of doctors and other health professionals in rural and remote areas of Australia is a serious problem that has far-reaching effects. The present paper argues that if the Divisions and Projects Grants Program is to be effective in achieving its aims and objectives, then the Program's policies must be responsive to the different needs, roles, constraints, expectations and capabilities of divisions and their members as well as the structural impediments imposed by the medical workforce.

  • 38. Williams, Jennifer A Stewart
    et al.
    Byles, Julie E
    Inder, Kerry J
    Equity of access to cardiac rehabilitation: the role of system factors.2010In: International journal for equity in health, ISSN 1475-9276, Vol. 9, p. 2-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: When patient selection processes determine who can and cannot use healthcare there can be inequalities and inequities in individuals' opportunities to benefit. This paper evaluates the influence of a hospital selection process on opportunities to access outpatient cardiac rehabilitation (CR).

    METHODS: A secondary data analysis was conducted on a cohort of inpatients (n = 2,375) who were all eligible for invitation to an Australian CR program. Eligibility was determined by hospital discharge diagnosis codes. Only invited patients could attend. Logistic regression analysis tested the extent to which individual patient characteristics were statistically significantly associated with the outcome 'invitation' after adjusting for cardiac disease and other factors.

    RESULTS: Less than half of the eligible patients were invited to the CR program. After allowing for known factors that may have justified not being selected, there was bias towards inviting males, younger patients, married patients, and patients who nominated English as their preferred language.

    CONCLUSIONS: Health service managers typically monitor service utilisation patterns as indicators of access but often pay little attention to ways in which locally determined system factors influence access to care. The paper shows how a hospital selection process can unreasonably influence patients' opportunities to benefit from an evidence-based healthcare program.

  • 39. Wilunda, Boniface
    et al.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Health and ageing in Nairobi's informal settlements-evidence from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH): a cross sectional study2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 1231Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Much of the focus on population ageing has been in high-income counties. Relatively less attention is given to the world's poorest region, Sub-Saharan Africa (SSA) where children and adolescents still comprise a high proportion of the population. Yet the number of adults aged 60-plus in SSA is already twice that in northern Europe. In addition, SSA is experiencing massive rural to urban migration with consequent expansion of informal urban settlements, or slums, whose health problems are usually unrecognised and not addressed. This study aims to improve understanding of functional health and well-being in older adult slum-dwellers in Nairobi (Kenya).

    METHODS: The study sample comprised men and women, aged 50 years and over, living in Korogocho and Viwandani, Nairobi, Kenya (n = 1,878). Data from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) and the WHO Study on global AGEing and adult health (SAGE Wave 1) were analysed. The prevalence of poor self-reported quality of life (QoL) and difficulties in domain-specific function is estimated by age and sex. Logistic regression investigates associations between difficulties in the domains of function and poor QoL, adjusting for age, sex and socio-demographic factors. Statistical significance is set at P<0.05.

    RESULTS: Women reported poorer QoL and greater functional difficulties than men in all domains except self-care. In the multivariable logistic regression the odds of poor QoL among respondents with problems or difficulties in relation to affect (OR = 7.0; 95%CI = 3.0-16.0), pain/discomfort (OR = 3.6; 95%CI = 2.3-5.8), cognition (OR = 1.8; 95 %CI = 1.2-2.9) and mobility (OR = 1.8; 95%CI = 1.1-2.8) were statistically significant.

    CONCLUSIONS: The findings underscore differences in the domains of functional health that encapsulate women and men's capacities to perform regular activities and the impact of poor functioning on QoL. Investing in the health and QoL of older people in SSA will be crucial in helping the region to realise key development goals and in opening opportunities for improved health outcomes and sustainable economic development.

  • 40. Yego, Faith
    et al.
    D'Este, Catherine
    Byles, Julie
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyongesa, Paul
    Risk factors for maternal mortality in a Tertiary Hospital in Kenya: a case control study2014In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, article id 38Article in journal (Refereed)
    Abstract [en]

    Background: Maternal mortality is high in Africa, especially in Kenya where there is evidence of insufficient progress towards Millennium Development Goal (MDG) Five, which is to reduce the global maternal mortality rate by three quarters and provide universal access to reproductive health by 2015. This study aims to identify risk factors associated with maternal mortality in a tertiary level hospital in Kenya. Methods: A manual review of records for 150 maternal deaths (cases) and 300 controls was undertaken using a standard audit form. The sample included pregnant women aged 15-49 years admitted to the Obstetric and Gynaecological wards at the Moi Teaching and Referral Hospital (MTRH) in Kenya from January 2004 and March 2011. Logistic regression analysis was used to assess risk factors for maternal mortality. Results: Factors significantly associated with maternal mortality included: having no education relative to secondary education (OR 3.3, 95% CI 1.1-10.4, p = 0.0284), history of underlying medical conditions (OR 3.9, 95% CI 1.7-9.2, p = 0.0016), doctor attendance at birth (OR 4.6, 95% CI 2.1-10.1, p = 0.0001), having no antenatal visits (OR 4.1, 95% CI 1.6-10.4, p = 0.0007), being admitted with eclampsia (OR 10.9, 95% CI 3.7-31.9, p < 0.0001), being admitted with comorbidities (OR 9.0, 95% CI 4.2-19.3, p < 0.0001), having an elevated pulse on admission (OR 10.7, 95% CI 2.7-43.4, p = 0.0002), and being referred to MTRH (OR 2.1, 95% CI 1.0-4.3, p = 0.0459). Conclusions: Antenatal care and maternal education are important risk factors for maternal mortality, even after adjusting for comorbidities and complications. Antenatal visits can provide opportunities for detecting risk factors for eclampsia, and other underlying illnesses but the visits need to be frequent and timely. Education enables access to information and helps empower women and their spouses to make appropriate decisions during pregnancy.

  • 41. Yego, Faith H
    et al.
    D Este, Catherine
    Byles, Julie
    Nyongesa, Paul
    Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Gender, Health and Ageing, University of Newcastle, Newcastle, Australia.
    A case-control study of risk factors for fetal and early neonatal deaths in a tertiary hospital in Kenya2014In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, p. 389-Article in journal (Refereed)
    Abstract [en]

    BackgroundIt is important to understand the risk factors for fetal and neonatal mortality which is a major contributor to high under five deaths globally. Fetal and neonatal mortality is a sensitive indicator of maternal health in society. This study aimed to examine the risk factors for fetal and early neonatal mortality at the Moi Teaching and Referral Hospital in Kenya.MethodsThis was a case-control study. Cases were fetal and early neonatal deaths (n¿=¿200). The controls were infants born alive immediately preceding and following the cases (n¿=¿400). Bivariate comparisons and multiple logistic regression analyses were undertaken.ResultsThe odds of having 0-1 antenatal visits relative to 2-3 visits were higher for cases than controls (AOR=4.5; 95% CI: 1.2-16.7; p=0.03). There were lower odds among cases of having a doctor rather than a midwife as a birth attendant (OR¿=¿0.2; 95% CI: 0.1-0.6; p¿<¿0.01). The odds of mothers having Premature Rupture of Membranes (OR¿=¿4.1; 95% CI: 1.4-12.1; p¿=¿0.01), haemorrhage (OR¿=¿4.8; 95% CI: 1.1-21.9; p¿=¿0.04) and dystocia (OR¿=¿3.6; 95% CI: 1.2-10.9; p¿=¿0.02) were higher for the cases compared with the controls. The odds of gestational age less than 37 weeks (OR¿=¿7.0; 95% CI 2.4-20.4) and above 42 weeks (OR¿=¿16.2; 95% CI 2.8-92.3) compared to 37-42 weeks, were higher for cases relative to controls (p¿<¿0.01). Cases had higher odds of being born with congenital malformations (OR¿=¿6.3; 95% CI: 1.2-31.6; p¿=¿0.04) and with Apgar scores of below six at five minutes (OR¿=¿26.4; 95% CI: 6.1-113.8; p¿<¿0.001).ConclusionInterventions that focus on educating mothers on antenatal attendance, screening, monitoring and management of maternal conditions during the antenatal period should be strengthened. Doctor attendance at each birth and for emergency admissions is important to ensure early neonatal survival and avert potential risk factors for mortality.

  • 42. Yego, Faith
    et al.
    Stewart Williams, Jennifer
    Research Centre for Gender, Health and Ageing, HMRI Building, University of Newcastle, University Drive, 2308, Callaghan, NSW, Australia.
    Byles, Julie
    Nyongesa, Paul
    Aruasa, Wilson
    D'Este, Catherine
    A retrospective analysis of maternal and neonatal mortality at a teaching and referral hospital in Kenya2013In: Reproductive health, ISSN 1742-4755, Vol. 10, p. 13-Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To measure the incidence of maternal and early neonatal mortality in women who gave birth at Moi Teaching and Referral Hospital (MTRH) in Kenya and describe clinical and other characteristics and circumstances associated with maternal and neonatal deaths following deliveries at MTRH.

    METHODS: A retrospective audit of maternal and neonatal records was conducted with detailed analysis of the most recent 150 maternal deaths and 200 neonatal deaths. Maternal mortality ratios and early neonatal mortality rates were calculated for each year from January 2004 to December 2011.

    RESULTS: Between 2004 and 2011, the overall maternal mortality ratio was 426 per 100,000 live births and the early neonatal mortality rate (<7 days) was 68 per 1000 live births. The Hospital record audit showed that half (51%) of the neonatal mortalities were for young mothers (15-24 years) and 64% of maternal deaths were in women between 25 and 45 years. Most maternal and early neonatal deaths occurred in multiparous women, in referred admissions, when the gestational age was under 37 weeks and in latent stage of labour. Indirect complications accounted for the majority of deaths. Where there were direct obstetric complications associated with the delivery, the leading cause of maternal death was eclampsia and the leading cause of early neonatal death was pre-mature rupture of membranes. Pre-term birth and asphyxia were leading causes of early neonatal deaths. In both sets of records the majority of deliveries were vaginal and performed by midwives.

    CONCLUSION: This study provides important information about maternal and early neonatal mortality in Kenya's second largest tertiary hospital. A range of socio demographic, clinical and health system factors are identified as possible contributors to Kenya's poor progress towards reducing maternal and early neonatal mortality.

1 - 42 of 42
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf