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  • 101.
    Pujilestari, Cahya Utamie
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Association between changes in waist circumferences and disability among older adults: WHO-INDEPTH study on global ageing and adult health (SAGE) in Indonesia2019In: Obesity Research and Clinical Practice, ISSN 1871-403X, E-ISSN 1878-0318, Vol. 13, no 5, p. 462-468Article in journal (Refereed)
    Abstract [en]

    Background: There is a lack of evidence regarding the impact of changes in waist circumference on disability among older populations in low- and middle-income countries (LMICs). This research examines the association between changes in waist circumference with disability in the older populations of Indonesia, and whether the associations are dependent on wealth or baseline abdominal obesity levels.

    Methods: In 2007 the INDEPTH-WHO Study on global AGEing and adult health (SAGE) was conducted among 11,753 individuals aged 50 years and older in Purworejo District, Central Java Province, Indonesia. Of these, a total of 8,089 were followed up in 2010. On both occasions, individuals’ waist circumferences were measured and the 12-item version of the WHO Disability Assessment Schedule version 2 (WHODAS-II) was implemented to measure disability.

    Results: A significant positive association was observed between waist circumference and disability at the baseline (β = 0.066; p < 0.001), and between the increase in waist circumference and the level of disability during the three-year follow-up period (β = 0.094; p < 0.001) after adjusting for baseline variables. This association was also significant among the poor, non-obese men, as well as poor and rich obese women. Among the non-obese women, a decrease in waist circumference was associated with more disabilities.

    Conclusions: An increase in waist circumference is associated with increased disability among older people in Purworejo, Indonesia. Health promotion programmes aiming to prevent obesity could have positive effects in preventing and reducing disability among older adults.

  • 102.
    Pujilestari, Cahya Utamie
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Norberg, Margareta
    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.
    Waist circumference and all-cause mortality among older adults in rural Indonesia2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, article id 116Article in journal (Refereed)
    Abstract [en]

    Waist circumference, a measure of abdominal obesity, is associated with all-cause mortality in general adult population. However, the link between abdominal obesity with all-cause mortality in the studies of older adults is unclear. This study aims to determine the association between waist circumference and all-cause mortality in older adults in Indonesia. The association between waist circumference and all-cause mortality was examined in 10,997 men and women aged 50 years and older, in the World Health Organization (WHO) and International Network of field sites for continuous Demographic Evaluation of Populations and their Health in developing countries (INDEPTH) collaboration Study on global AGEing and adult health (SAGE) in Purworejo District Central Java, Indonesia during 2007–2010. Multivariate Cox regression analysis with restricted cubic splines was used to assess the non-linear association between waist circumference and all-cause mortality. During the 3-year follow-up, a total of 511 men and 470 women died. The hazard ratio plot shows a pattern of U-shape relationship between waist circumference and all-cause mortality among rich women, though the result was significant only for women in the lower end of waist circumference distribution (p < 0.05). Poor men with a low waist circumference (5th percentile) have a two times higher mortality risk (HR = 2.1; 95% CI = 1.3, 3.3) relative to those with a waist circumference of 90 cm. Poor women with a low waist circumference (25th percentile) have a 1.4 times higher mortality risk (HR = 1.4; 95% CI = 1.1, 1.8) relative to those with a waist circumference of 80 cm. This study shows a significant association between low waist circumference measure and mortality, particularly among poor men and women. Though the association between large waist circumference and mortality was not significant, we observed a trend of higher mortality risk particularly among rich women with large waist circumference measure. Public health intervention should include efforts to improve nutritional status among older people and promoting healthy lifestyle behaviours including healthy food and active lifestyle.

  • 103.
    Pujilestari, Cahya Utamie
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hakimi, Mohammad
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Socioeconomic inequality in abdominal obesity among older people in Purworejo District, Central Java, Indonesia: a decomposition analysis approach2017In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 16, no 1, article id 214Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Obesity has become a global health challenge as its prevalence has increased globally in recent decades. Studies in high-income countries have shown that obesity is more prevalent among the poor. In contrast, obesity is more prevalent among the rich in low- and middle-income countries, hence requiring different focal points to design public health policies in the latter contexts. We examined socioeconomic inequalities in abdominal obesity in Purworejo District, Central Java, Indonesia and identified factors contributing to the inequalities.

    METHODS: We utilised data from the WHO-INDEPTH Study on global AGEing and adult health (WHO-INDEPTH SAGE) conducted in the Purworejo Health and Demographic Surveillance System (HDSS) in Purworejo District, Indonesia in 2010. The study included 14,235 individuals aged 50 years and older. Inequalities in abdominal obesity across wealth groups were assessed separately for men and women using concentration indexes. Decomposition analysis was conducted to assess the determinants of socioeconomic inequalities in abdominal obesity.

    RESULTS: Abdominal obesity was five-fold more prevalent among women than in men (30% vs. 6.1%; p < 0.001). The concentration index (CI) analysis showed that socioeconomic inequalities in abdominal obesity were less prominent among women (CI = 0.26, SE = 0.02, p < 0.001) compared to men (CI = 0.49, SE = 0.04, p < 0.001). Decomposition analysis showed that physical labour was the major determinant of socioeconomic inequalities in abdominal obesity among men, explaining 47% of the inequalities, followed by poor socioeconomic status (31%), ≤ 6 years of education (15%) and current smoking (11%). The three major determinants of socioeconomic inequalities in abdominal obesity among women were poor socio-economic status (48%), physical labour (17%) and no formal education (16%).

    CONCLUSION: Abdominal obesity was more prevalent among older women in a rural Indonesian setting. Socioeconomic inequality in abdominal obesity exists and concentrates more among the rich population in both sexes. The inequality gap is less prominent among women, indicating a trend towards obesity being more common in poor women. Policies to address social determinants of health need to be developed to address the socioeconomic inequality gaps in obesity, with particular focus on addressing the existing burden of obesity among the better-off population group, while preventing the imminent burden of obesity among the worst-off group, particularly among women.

  • 104. Razzaque, Abdur
    et al.
    Nahar, Lutfun
    Van Minh, Hoang
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. India.
    Juvekar, Sanjay
    Ashraf, Ali
    Ahmed, Syed Masud
    Soonthornthada, Kusol
    Kanungsukkasem, Uraiwan
    Huu Bich, Tran
    Social factors and overweight: evidence from nine Asian INDEPTH Network sites2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Overweight/obesity increases the risk of morbidity and mortality from a number of chronic conditions, including heart disease, stroke, diabetes and some cancers. This study examined the distribution of body mass index (BMI) in nine Health and Demographic Surveillance System (HDSS) sites in five Asian countries and investigated the association between social factors and overweight.

    DATA AND METHODS: This cross-sectional study was conducted in nine HDSS sites in Bangladesh, India, Indonesia, Thailand and Vietnam. The methodology of the WHO STEPwise approach to Surveillance with core risk factors (Step 1) and physical measurements for weight, height and waist circumference (Step 2) were included. In each site, about 2,000 men and women aged 25-64 years were selected randomly using the HDSS database. Weight was measured using electronic scales, height was measured by portable stadiometers and waist circumference was measured by measuring tape. Overweight/obesity was assessed by BMI defined as the weight in kilograms divided by the square of the height in metres (kg/m(2)).

    RESULTS: At least 10% people were overweight (BMI >/= 25) in each site except for the two sites in Vietnam and WATCH HDSS in Bangladesh where few men and women were overweight. After controlling for all the variables in the model, overweight increases with age initially and then declines, with increasing education, and with gender with women being heavier than men. People who eat vegetables and fruits below the recommended level and those who do high level of physical activity are, on the whole, less heavy than those who eat more and do less physical activity.

    CONCLUSIONS: As the proportion of the population classified as being overweight is likely to increase in most sites and overweight varies by age, sex, and social and behavioural factors, behavioural interventions (physical exercise, healthy diet) should be developed for the whole population together with attention to policy around nutrition and the environment, in order to reduce the adverse effects of overweight on health.

  • 105. Rodriguez-Fernandez, Rodrigo
    et al.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Susilo, Dwidjo
    Prawira, John
    Bangs, Michael J.
    Amiya, Rachel M.
    The double burden of disease among mining workers in Papua, Indonesia: at the crossroads between Old and New health paradigms2016In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, article id 951Article in journal (Refereed)
    Abstract [en]

    Background: As the global shift toward non-communicable diseases overlaps with the unfinished agenda of confronting infectious diseases in low-and middle-income countries, epidemiological links across both burdens must be recognized. This study examined the non-communicable disease-infectious disease overlap in the specific comorbidity rates for key diseases in an occupational cohort in Papua, Indonesia. Methods: Diagnosed cases of ischaemic heart disease, stroke, hypertension, diabetes (types 1 and 2), chronic obstructive pulmonary disease, asthma, cancer, HIV and AIDS, tuberculosis, and malaria were extracted from 22,550 patient records (21,513 men, 1037 women) stored in identical electronic health information systems from two clinic sites in Papua, Indonesia. Data were collected as International Classification of Diseases, 10th Revision, entries from records spanning January-December 2013. A novel application of Circos software was used to visualize the interconnectedness between the disease burdens as overlapping prevalence estimates representing comorbidities. Results: Overall, NCDs represented 38 % of all disease cases, primarily in the form of type 2 diabetes (n = 1440) and hypertension (n = 1398). Malaria cases represented the largest single portion of the disease burden with 5310 recorded cases, followed by type 2 diabetes with 1400 cases. Tuberculosis occurred most frequently alongside malaria (29 %), followed by chronic obstructive pulmonary disease (19 %), asthma (17 %), and stroke (12 %). Hypertension-tuberculosis (4 %), tuberculosis-cancer (4 %), and asthma-tuberculosis (2 %) comorbidities were also observed. Conclusions: The high prevalence of multimorbidity, preponderance of non-communicable diseases, and extensive interweaving of non-communicable and infectious disease comorbidities highlighted in this cohort of mining workers in Papua, Indonesia reflect the markedly double disease burden increasingly plaguing Indonesia and other similar low-and middle-income countries - a challenge with which their over-stretched, under-resourced health systems are ill-equipped to cope. Integrated, person-centered treatment and control strategies rooted in the primary healthcare sector will be critical to reverse this trend.

  • 106.
    Salimi, Shabnam
    et al.
    Univ Maryland, Sch Med, Dept Epidemiol & Publ Hlth Gerontol, Baltimore, MD 21201 USA.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Seliger, Stephen L
    Univ Maryland, Sch Med, Div Nephrol, Baltimore, MD 21201 USA.
    Parsa, Afshin
    Univ Maryland, Sch Med, Div Nephrol, Baltimore, MD 21201 USA.
    Periodontal Disease, Renal Dysfunction and Heightened Leukocytosis.2014In: Nephron. Clinical practice, ISSN 1660-8151, E-ISSN 2235-3186, Vol. 128, no 1-2, p. 107-114Article in journal (Refereed)
    Abstract [en]

    Background:

    Leukocytosis is a powerful predictor of incident chronic kidney disease (CKD) and related outcomes. However, the association between periodontitis measures and increased leukocytosis in the context of CKD has not been well described. We sought to identify which individual measures of periodontal disease may best associate with reduced estimated glomerular filtration rate (eGFR) and albuminuria, and to test if these measures were associated with increased leukocytosis in subjects with established CKD.

    Methods:

    We estimated, among 13,270 participants in the National Health and Nutrition Examination Survey III study, the associations between case-based definition of periodontitis, clinical attachment loss (CAL) and pocket depth (PD) as individual measures of periodontal disease, with renal function measures and leukocytosis.

    Results:

    In adjusted multivariate analyses, case-based definition of severe periodontitis was associated with albuminuria (β = 0.003, p = 0.01) but not with eGFR. However, CAL and PD were all individually associated with both albuminuria (β = 0.08, p < 0.001 and β = 0.06, p < 0.001, respectively) and eGFR (β = -0.05, p < 0.001 and β = -0.03, p < 0.001, respectively). We found significant associations between elevated CAL and PD with leukocytosis. Lastly, we found a marked association between the joint presence of CKD and elevated CAL or PD with leukocytosis (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.4-7.5 and OR 3.2, 95% CI 1.1-9.7, respectively).

    Conclusion:

    Individual measures of periodontal disease are associated with renal function and heightened leukocytosis in CKD subjects. The significantly added inflammatory burden noted in CKD subjects with periodontal disease argue for targeting periodontitis treatment as part of our multifaceted approach to CKD patients. 

  • 107.
    San Sebastián, Miguel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Nursing I, University of Basque Country, Bilbao, Spain.
    Mosquera, Paola A
    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.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Health care on equal terms?: assessing horizontal equity in health care use in northern Sweden2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 4, p. 637-643Article in journal (Refereed)
    Abstract [en]

    Background: The Swedish health care system has successively moved toward increased market-orientation, which has raised concerns as to whether Sweden still offers health on equal terms. To explore this issue, this study aimed (i) to assess if the principles of horizontal equity (equal access for equal need regardless of socio-economic factors) are met in Northern Sweden 2006-14; and (ii) to explore the contribution of different factors to the inequalities in access along the same period. Data came from cross sectional surveys known in 2006, 2010 and 2014 targeting 16-84-year-old residents in the four northern-most counties in Sweden. The horizontal inequity index was calculated based on variables representing (i) the individual socioeconomic status, (ii) the health care needs, (iii) non-need factors as well as (iv) health care utilization: general practitioner (GP), specialist doctors, hospitalization. Decomposition analysis of the concentration index for need-standardized health care utilization was applied. Adjusting for needs, there was a higher use of GP services by rich people during the two last surveys, a roughly equal use of specialists, and hospitalization concentrated among the poor but with a clear time trend toward equality. The pro-rich inequalities in GP use were to a large part explained by the income gap. While health care utilization can be considered equitable regarding specialist and hospital use, the increasing pro-rich trend in the use of GP is a concern. Further studies are required to investigate the reasons and a constant monitoring of socioeconomic differences in health care access is recommended.

  • 108.
    Sandström, Glenn
    et al.
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Stockholm University Demography Unit (SUDA), Stockholm University, Stockholm, Sweden.
    Namatovu, Fredinah
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Ineland, Jens
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Larsson, Daniel
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Ng, Nawi
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Stattin, Mikael
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    The Persistence of High Levels of Living Alone Among Adults with Disabilities in Sweden, 1993–20112020In: Population: Research and Policy Review, ISSN 0167-5923, E-ISSN 1573-7829Article in journal (Refereed)
    Abstract [en]

    This study investigates how the probability to live alone has developed among working age individuals with and without disabilities in Sweden during the period 1993–2011 when extensive political reforms to improve the integration of disabled individuals in society were implemented. The results show that individuals with disabilities are approximately twice as likely to be living alone when compared to individuals without disabilities. People with disabilities were also more likely to report low life satisfaction, and this was especially true among individuals with disabilities living alone. Men and women with disabilities also tend to experience longer periods of living as a one-person household than non-disabled people. Over time we find no indications of reduced differences in family outcomes between disabled and non-disabled individuals but rather evidence to the contrary. These differences are interpreted as being the result of the disadvantage disabled individual’s experience in the partner market and that people with disabilities are less successful in forming partnerships that can lead to cohabitation and family formation. The results thus show how disabled individuals still face societal barriers that limit their possibilities to find and sustain relationships that result in stable cohabitation despite increased efforts to improve their inclusion in Swedish society.

  • 109.
    Santosa, Ailiana
    et al.
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Schröders, Julia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Vaezghasemi, Masoud
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    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).
    Inequality in disability-free life expectancies among older men and women in six countries with developing economies2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 9, p. 855-861Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 110.
    Santosa, Ailiana
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
    Hakimi, Mohammad
    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). Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
    Cross-sectional survey of sexual dysfunction and quality of life among older people in Indonesia2011In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 8, no 6, p. 1594-1602Article in journal (Refereed)
    Abstract [en]

    Introduction.  The burden of sexual dysfunction among older people in many low- and middle-income countries is not well known. Understanding sexual dysfunction among older people and its impact on quality of life is essential in the design of appropriate health promotion programs.

    Aims.  To assess levels of sexual function and their association with quality of life while controlling for different sociodemographic determinants and chronic diseases among men and women over 50 years of age in rural Indonesia.

    Methods.  A cross-sectional study was conducted in the Purworejo District, Central Java, Indonesia in 2007. The study involved 14,958 men and women over 50 years old. The association between sexual dysfunction and quality of life after controlling for potential confounders (e.g., sociodemographic determinants and self-reported chronic diseases) was analyzed by multivariable logistic regression.

    Main Outcome Measures.  Self-reported quality of life.

    Results.  Older men more commonly reported sexual activity, and sexual problems were more common among older women. The majority of older men and women reported their quality of life as good. Lack of sexual activity, dissatisfaction in sexual life, and presence of sexual problems were associated with poor self-reported quality of life in older men after adjustment for age, marital status, education, and history of chronic diseases. A presence of sexual problems was the only factor associated with poor self-reported quality of life in women. Being in a marital relationship might buffer the effect of sexual problems on quality of life in men and women.

    Conclusion.  Sexual dysfunction is associated with poor quality of life among older people in a rural Javanese setting. Therefore, promotion of sexual health should be an integral part of physical and mental health campaigns in older populations.

  • 111.
    Schröders, Julia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hakimi, Mohammad
    Dewi, Fatwa Sari Tetra
    Weinehall, Lars
    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).
    Nichter, Mark
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kusnanto, Hari
    Rahajeng, Ekowati
    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).
    How is Indonesia coping with its epidemic of chronic noncommunicable diseases?: A systematic review with meta-analysis2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 6, article id e0179186Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chronic noncommunicable diseases (NCDs) have emerged as a huge global health problem in low- and middle-income countries. The magnitude of the rise of NCDs is particularly visible in Southeast Asia where limited resources have been used to address this rising epidemic, as in the case of Indonesia. Robust evidence to measure growing NCD-related burdens at national and local levels and to aid national discussion on social determinants of health and intra-country inequalities is needed. The aim of this review is (i) to illustrate the burden of risk factors, morbidity, disability, and mortality related to NCDs; (ii) to identify existing policy and community interventions, including disease prevention and management strategies; and (iii) to investigate how and why an inequitable distribution of this burden can be explained in terms of the social determinants of health.

    METHODS: Our review followed the PRISMA guidelines for identifying, screening, and checking the eligibility and quality of relevant literature. We systematically searched electronic databases and gray literature for English- and Indonesian-language studies published between Jan 1, 2000 and October 1, 2015. We synthesized included studies in the form of a narrative synthesis and where possible meta-analyzed their data.

    RESULTS: On the basis of deductive qualitative content analysis, 130 included citations were grouped into seven topic areas: risk factors; morbidity; disability; mortality; disease management; interventions and prevention; and social determinants of health. A quantitative synthesis meta-analyzed a subset of studies related to the risk factors smoking, obesity, and hypertension.

    CONCLUSIONS: Our findings echo the urgent need to expand routine risk factor surveillance and outcome monitoring and to integrate these into one national health information system. There is a stringent necessity to reorient and enhance health system responses to offer effective, realistic, and affordable ways to prevent and control NCDs through cost-effective interventions and a more structured approach to the delivery of high-quality primary care and equitable prevention and treatment strategies. Research on social determinants of health and policy-relevant research need to be expanded and strengthened to the extent that a reduction of the total NCD burden and inequalities therein should be treated as related and mutually reinforcing priorities.

  • 112.
    Schröders, Julia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kusnanto, Hari
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Millennium Development Goal Four and Child Health Inequities in Indonesia: A Systematic Review of the Literature2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0123629Article, review/survey (Refereed)
    Abstract [en]

    Introduction Millennium Development Goal (MDG) 4 calls for reducing mortality of children under-five years by two-thirds by 2015. Indonesia is on track to officially meet the MDG 4 targets by 2015 but progress has been far from universal. It has been argued that national level statistics, on which MDG 4 relies, obscure persistent health inequities within the country. Particularly inequities in child health are a major global public health challenge both for achieving MDG 4 in 2015 and beyond. This review aims to map out the situation of MDG 4 with respect to disadvantaged populations in Indonesia applying the Social Determinants of Health (SDH) framework. The specific objectives are to answer: Who are the disadvantaged populations? Where do they live? And why and how is the inequitable distribution of health explained in terms of the SDH framework?

    Methods and Findings We retrieved studies through a systematic review of peer-reviewed and gray literature published in 1995-2014. The PRISMA-Equity 2012 statement was adapted to guide the methods of this review. The dependent variables were MDG 4-related indicators; the independent variable "disadvantaged populations" was defined by different categories of social differentiation using PROGRESS. Included texts were analyzed following the guidelines for deductive content analysis operationalized on the basis of the SDH framework. We identified 83 studies establishing evidence on more than 40 different determinants hindering an equitable distribution of child health in Indonesia. The most prominent determinants arise from the shortcomings within the rural health care system, the repercussions of food poverty coupled with low health literacy among parents, the impact of low household decision-making power of mothers, and the consequences of high persistent use of traditional birth attendants among ethnic minorities.

    Conclusion This review calls for enhanced understanding of the determinants and pathways that create, detain, and overcome inequities in child health in resource constraint settings like Indonesia and the promotion of actionable health policy recommendations and tailored investments.

  • 113. Septiono, Wahyu
    et al.
    Kuipers, Mirte A. G.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kunst, Anton E.
    Progress of smoke-free policy adoption at district level in Indonesia: A policy diffusion study2019In: International journal on drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 71, p. 93-102Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Even though Indonesia has not ratified the Framework Convention on Tobacco Control (FCTC), district and provincial stakeholders are increasingly adopting smoke-free policies (SFPs). This study aimed to 1) assess whether local SFP adoption in Indonesia followed a horizontal or vertical diffusion pattern and 2) identify district characteristics that are associated with the SFP adoption.

    METHODS: Policy documents enacted during 2004-2015 were compiled from 33 provinces and 510 districts in Indonesia. First, we described the geographical distributions of the policy adoption. Second, we ran logistic regression to assess the associations of district SFP adoption with having adjacent districts that had adopted SFPs (i.e. horizontal diffusion) and being situated in a province that had adopted SFPs (i.e. vertical diffusion). Third, the associations between district characteristics (population density, GDP, tobacco production) and SFP adoption were assessed using logistic regression.

    RESULTS: By 2015, a total of 17 provinces and 143 districts had adopted SFPs. Districts with SFPs were more concentrated in the western part of Indonesia. Adoption was more likely in districts of which adjacent districts had already adopted SFPs (OR: 2.02; 95%CI: 1.26-3.23), and less likely when the province had already adopted SFPs (OR: 0.19; 95%CI: 0.11 - 0.34). Adoption was more likely in districts with higher GDP (OR high vs low GDP: 3.28; 95%CI: 1.80-5.98) and higher population density (OR high vs low density: 6.57; 95%CI: 3.63-11.9). High tobacco production showed a strong inverse association with SPF adoption (OR high vs. no production: 0.36; 95%CI: 0.17-0.74).

    CONCLUSIONS: Smoke-free policy adoption in Indonesian districts followed a horizontal diffusion pattern, with poorer and rural districts lagging behind in their policy adoption. Our results indicate that local-level policy development is important for smoke-free policy adoption in countries with decentralised governments, but that effective advocacy is needed to counteract tobacco industry interference.

  • 114. Septiono, Wahyu
    et al.
    Kuipers, Mirte
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Kunst, Anton
    Social patterning in Indonesian adolescent smoking: A mediation analysis of family smoking, parental control, and parental permissiveness2019In: Tobacco Induced Diseases, ISSN 1617-9625, E-ISSN 1617-9625, Vol. 17, p. 38-39Article in journal (Other academic)
    Abstract [en]

    Objective: In poorer communities, smoking has demonstrated as an indicator of social inequalities in mortality. Adolescents from poor family are often exposed to smoking and are more vulnerable to smoke. This study quantified 1) the association between family characteristics and adolescent smoking in Indonesia and 2) the mediating role of the family smoking environment in this association.

    Methods: A cross-sectional survey was conducted in eight Indonesian cities among 2,661 students aged 13 to 18 years old. Multilevel logistic regression was used to estimate the association between family characteristics (parent’s educational attainment, wealth, and religion) and adolescent smoking. Mediation analysis using Generalized Structural Equation Modelling (GSEM) quantified how much the family smoking environment (family smoking status, parental control, and parental permissiveness of smoking) mediated these associations. Analyses were stratified by gender.

    Results: Smoking prevalence was 53.2% among boys and 7.7% among girls. The correlation between smoking and wealth were not significant in boys (wealthier vs poorer: OR 0.97, 95%CI 0.68-1.39), but was significant in girls (wealthier vs poorer: OR 0.49, 95%CI 0.27 – 0.89). Smoking was less favourable among Christian boys (OR 0.56, 95%CI 0.35-0.89) and Buddhist-Hindu girls (OR 0.23, 95%CI 0.05 – 0.97) compared to Muslims. Parental education was an insignificant predictor of smoking in boys and girls. Smoking environment significantly mediated the association between smoking in boys and parental education (moderate: 69.9%; low: 88.7%) and between smoking and religions in both genders (Christian boys: 46.9%; Buddhist-Hindu girls: 297%). Significant mediation indicates parental control and parental permissiveness as mediators.

    Conclusions: The current study demonstrates that social inequality in smoking remains high in girls and smoking environment is important in social patterning of adolescent smoking. Predictors of and mediation effect in smoking among girls and boys differed, hence, future tobacco control campaign targeting adolescents may not necessarily identical for both groups.

  • 115. Septiono, Wahyu
    et al.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Kuipers, Mirte
    Kunst, Anton
    Did local smoke free policy in Indonesia prevent youth from smoking?2018In: Tobacco Induced Diseases, ISSN 1617-9625, E-ISSN 1617-9625, Vol. 16, no 1, p. 55-56, article id A149Article in journal (Other academic)
    Abstract [en]

    Background: Although Indonesia has not ratified the WHO Framework Convention on Tobacco Control, it has developed a series of tobacco control policies at the local level. Strong presence of tobacco industry is marked with intensive marketing towards young people. This study assessed the impact of local smoke-free policy (SFP) on prevalence of daily and non-daily smoking among youth living in 33 provinces, 98 municipalities, and 412 regencies in Indonesia in 2007 and 2013.

    Methods: Data on 239,170 adolescents (12-17 years old) was derived from the 2007 and 2013 basic health survey (RISKESDAS) performed by Indonesia Ministry of Health. Information on local tobacco control policies was derived from official documents from 84 districts and 8 provinces. District SFP and provincial SFP were distinguished. A multilevel logistic regression analysis compared the odds of daily and non-daily smoking between areas with and without SFP.

    Results: Respondents who reported smoked daily was 4.6 % and non-daily was 4.4% in 2007. Smoking prevalence rates were high among males, in older adolescents, areas with high GDP per-capita, and rural areas. Different models consistently observed significantly reduction of daily smoking (OR:0.85; CI95%:0.79-0.90) and non-daily smoking (OR:0.92; CI95%:0.86-0.98) prevalence between 2007 and 2013. No difference in daily smoking and non-daily smoking was observed between districts with and without SFP. Intermediate compared with no provincial SFP was significantly associated to reduce the odds of non-daily (OR:0.82; CI95%:0.69-0.98) smoking, while no association was found between no provincial SFP and high group.

    Conclusions: Smoke-free policies at the municipal level seemed to have no effect to reduce smoking among youth in local settings of Indonesia while policies at the provincial level were associated with lower smoking rates. To have better result of the smoking prevention among youth in the future, we suggest enhancing provincial SFP and strengthening the implementation of local SFP as well.

  • 116. Septiono, Wahyu
    et al.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Kunst, Anton
    The development of local smoke free policy of Indonesia in 2004–20152018In: Tobacco Induced Diseases, ISSN 1617-9625, E-ISSN 1617-9625, Vol. 16, no 1, p. 57-58, article id A154Article in journal (Other academic)
    Abstract [en]

    Background: Many low-income countries develop tobacco control policies not only national levels, but also at local levels. The dynamics underlying the development of local-level policies are still poorly understood. This study aimed to map and understand the development of local-level policies regarding smoke-free area, as the main tobacco control strategy in Indonesia, in 2004-2015.

    Methods: We used an official government data base with data on smoke free policies for Indonesia's 33 provinces and 510 municipalities. The extent of smoke free policies was expressed in a summary scale derived from the Tobacco Control Scale (TCS) to map, and to relate these scores to provincial-level scores and to characteristics of municipalities.

    Results: By 2015, about 30 percent of the municipalities had smoke-free policies. Many municipalities enacted such policies before these were introduced at province. Municipalities with stronger policies clustered within specific parts of the Indonesian archipelago. Municipalities within provinces with high TCS score were more likely to have smoke-free policies (OR=1.91; CI95%: 1.09-3.35) but no difference was found between low and intermediate group. Smoke-free policies were more common in municipalities with high urbanization rate (OR=2.65; CI95%: 1.46-4.84), high population density (OR=4.35; CI95%: 2.29-8.22), and high GDP per-capita (OR=2.26; CI95%: 1.27-4.02).

    Conclusions: There was little evidence for a top-down development of tobacco control policy in Indonesia. Provincial tobacco control policy seemed to have stimulated local policies only if they were fully developed. Trends at local levels followed instead a diffusion pattern, with local tobacco control policies starting in clusters of areas with higher population density or economic development.

  • 117.
    Sjölander, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Prescription of lipid-lowering drugs increases following receipt of a pictorial representation of patients´carotid ultrasound examinations2019In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 15, no 12, p. E49-E49Article in journal (Other academic)
    Abstract [en]

    Background and objectives: We evaluated whether a pictorial representation of asymptomatic atherosclerosis based on carotid ultrasound examinations given to the participants and their physicians had an impact on the proportion of participants receiving prescriptions for lipid-lowering drugs during the following 465 days. The overall aim of the study was to optimize cardiovascular disease (CVD) prevention.

    Methods: This study was performed within a CVD screening and prevention program in Vasterbotten County, Sweden 2013-2016. 3532 par- € ticipants were randomly assigned 1:1 to receive or not receive a simplified picture of an ultrasound scan by mail plus a phone call including a health dialogue with a trained nurse. The picture indicated vascular age and the presence of plaques, and was also sent to participants’ physicians. The control group received no information about the ultrasound. Data on prescriptions was collected from the County Council database.

    Results: During the first 465 days, prescriptions of lipid-lowering drugs were higher in the intervention group compared with the control group among men (34.2% vs 21.3%, p<0.001) and women (25.8% vs 15.2% p<0.001). Corresponding proportions for first prescriptions were 19.2% vs 6.0% (p<0.001) and 16.6% vs 5.7% (p<0.001), respectively. Similar patterns were observed for participants with and without plaque, but with a higher proportion among those with plaque. Cholesterol level, diabetes, prescription of antihypertensives and previous myocardial infarction were in a multivariable logistic regression model associated with first prescriptions. Although prescriptions increased over the study period, 56% of participants with known plaque were not prescribed any lipid-lowering drug.

    Conclusion: Provision of pictorial information on vascular age and carotid plaque based on ultrasound examination increased physician prescriptions of lipid-lowering drugs within the following 465 days.

  • 118.
    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.

  • 119.
    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.

  • 120.
    Sörlin, Ann
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Lindholm, Lars
    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.
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Gender equality in couples and self-rated health: a survey study evaluating measurements of gender equality and its impact on health2011In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 10, no Art.nr. 37Article in journal (Refereed)
    Abstract [en]

    Background: Men and women have different patterns of health. These differences between the sexes present a challenge to the field of public health. The question why women experience more health problems than men despite their longevity has been discussed extensively, with both social and biological theories being offered as plausible explanations. In this article, we focus on how gender equality in a partnership might be associated with the respondents' perceptions of health.

    Methods: This study was a cross-sectional survey with 1400 respondents. We measured gender equality using two different measures: 1) a self-reported gender equality index, and 2) a self-perceived gender equality question. The aim of comparison of the self-reported gender equality index with the self-perceived gender equality question was to reveal possible disagreements between the normative discourse on gender equality and daily practice in couple relationships. We then evaluated the association with health, measured as self-rated health (SRH). With SRH dichotomized into 'good' and 'poor', logistic regression was used to assess factors associated with the outcome. For the comparison between the self-reported gender equality index and self-perceived gender equality, kappa statistics were used.

    Results: Associations between gender equality and health found in this study vary with the type of gender equality measurement. Overall, we found little agreement between the self-reported gender equality index and self-perceived gender equality. Further, the patterns of agreement between self-perceived and self-reported gender equality were quite different for men and women: men perceived greater gender equality than they reported in the index, while women perceived less gender equality than they reported. The associations to health were depending on gender equality measurement used.

    Conclusions: Men and women perceive and report gender equality differently. This means that it is necessary not only to be conscious of the methods and measurements used to quantify men's and women's opinions of gender equality, but also to be aware of the implications for health outcomes.

  • 121.
    Sörlin, Ann
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Öhman, Ann
    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.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Can the impact of gender equality on health be measured? a cross-sectional study comparing measures based on register data with individual survey-based data2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, no 1, p. 795-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to investigate potential associations between gender equality at work and self-rated health. METHODS: 2861 employees in 21 companies were invited to participate in a survey. The mean response rate was 49.2%. The questionnaire contained 65 questions, mainly on gender equality and health. Two logistic regression analyses were conducted to assess associations between (i) self-rated health and a register-based company gender equality index (OGGI), and (ii) self-rated health and self-rated gender equality at work. RESULTS: Even though no association was found between the OGGI and health, women who rated their company as "completely equal" or "quite equal" had higher odds of reporting "good health" compared to women who perceived their company as "not equal" (OR = 2.8, 95% confidence interval = 1.4 -- 5.5 and OR = 2.73, 95% CI = 1.6-4.6). Although not statistically significant, we observed the same trends in men. The results were adjusted for age, highest education level, income, full or part-time employment, and type of company based on the OGGI. CONCLUSIONS: No association was found between gender equality in companies, measured by register-based index (OGGI), and health. However, perceived gender equality at work positively affected women's self-rated health but not men's. Further investigations are necessary to determine whether the results are fully credible given the contemporary health patterns and positions in the labour market of women and men or whether the results are driven by selection patterns.

  • 122.
    Tesfaye, Fikru
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Van Minh, H
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Epidemiologi och folkhälsovetenskap.
    Berhane, Yemane
    Bonita, Ruth
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Epidemiologi och folkhälsovetenskap.
    Association between body mass index and blood pressure across three populations in Africa and Asia.2007In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 21, no 1, p. 28-37Article in journal (Refereed)
  • 123. Thomsen, Sarah
    et al.
    Biao, Xu
    Kusnanto, Hari
    Mavalankar, Dileep
    Malqvist, Mats
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Diwan, Vinod
    The world we want: focus on the most disadvantaged2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 20919-Article in journal (Other academic)
  • 124. Thomsen, Sarah
    et al.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Biao, Xu
    Bondjers, Goran
    Kusnanto, Hari
    Liem, Nguyen Tanh
    Mavalankar, Dileep
    Malqvist, Mats
    Diwan, Vinod
    Bringing evidence to policy to achieve health-related MDGs for all: justification and design of the EPI-4 project in China, India, Indonesia, and Vietnam2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Background: The Millennium Development Goals (MDGs) are monitored using national-level statistics, which have shown substantial improvements in many countries. These statistics may be misleading, however, and may divert resources from disadvantaged populations within the same countries that are showing progress. The purpose of this article is to set out the relevance and design of the "Evidence for Policy and Implementation project (EPI-4)". EPI-4 aims to contribute to the reduction of inequities in the achievement of health-related MDGs in China, India, Indonesia and Vietnam through the promotion of research-informed policymaking. Methods: Using a framework provided by the Commission on the Social Determinants of Health (CSDH), we compare national-level MDG targets and results, as well as their social and structural determinants, in China, India, Indonesia and Vietnam. Results: To understand country-level MDG achievements it is useful to analyze their social and structural determinants. This analysis is not sufficient, however, to understand within-country inequities. Specialized analyses are required for this purpose, as is discussion and debate of the results with policymakers, which is the aim of the EPI-4 project. Conclusion: Reducing health inequities requires sophisticated analyses to identify disadvantaged populations within and between countries, and to determine evidence-based solutions that will make a difference. The EPI-4 project hopes to contribute to this goal.

  • 125.
    Vaezghasemi, Masoud
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Eriksson, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Subramanian, S. V.
    Households, the omitted level in contextual analysis: disentangling the relative influence of households and districts on the variation of BMI about two decades in Indonesia2016In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 15, article id 102Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 126.
    Vaezghasemi, Masoud
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Razak, Fahad
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Subramanian, S.V.
    Inter-individual inequality in BMI: an analysis of Indonesian Family LifeSurveys (1993–2007)2016In: SSM - Population Health, ISSN 2352-8273, Vol. 2, p. 876-888Article in journal (Refereed)
    Abstract [en]

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

  • 127.
    Vaezghasemi, Masoud
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Eriksson, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hakimi, Mohammad
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kusnanto, Hari
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The effect of gender and social capital on the dual burden of malnutrition: a multilevel study in indonesia2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 8, p. e103849-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The paradoxical phenomenon of the coexistence of overweight and underweight individuals in the same household, referred to as the "dual burden of malnutrition", is a growing nutrition dilemma in low- and middle-income countries (LMICs).

    AIMS: The objectives of this study were (i) to examine the extent of the dual burden of malnutrition across different provinces in Indonesia and (ii) to determine how gender, community social capital, place of residency and other socio-economic factors affect the prevalence of the dual burden of malnutrition.

    METHODS: The current study utilized data from the fourth wave of the Indonesian Family Life Survey (IFLS) conducted between November 2007 and April 2008. The dataset contains information from 12,048 households and 45,306 individuals of all ages. This study focused on households with individuals over two years old. To account for the multilevel nature of the data, a multilevel multiple logistic regression was conducted.

    RESULTS: Approximately one-fifth of all households in Indonesia exhibited the dual burden of malnutrition, which was more prevalent among male-headed households, households with a high Socio-economic status (SES), and households in urban areas. Minimal variation in the dual burden of malnutrition was explained by the community level differences (<4%). Living in households with a higher SES resulted in higher odds of the dual burden of malnutrition but not among female-headed households and communities with the highest social capital.

    CONCLUSION: To improve household health and reduce the inequality across different SES groups, this study emphasizes the inclusion of women's empowerment and community social capital into intervention programs addressing the dual burden of malnutrition.

  • 128.
    Vaezghasemi, Masoud
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hakimi, Mohammad
    Eriksson, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Concerned and conscious, but defenceless: the intersection of gender and generation in child malnutrition in Indonesia: A qualitative grounded theory studyArticle in journal (Refereed)
  • 129. Van Minh, Hoang
    et al.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Patterns of subjective quality of life among older adults in rural Vietnam and Indonesia.2012In: Geriatrics & Gerontology International, ISSN 1444-1586, E-ISSN 1447-0594, Vol. 12, p. 397-404Article in journal (Refereed)
    Abstract [en]

    Aim:  This paper aims to assess the subjective quality of life (SQOL) and its correlates among older adults in rural communities of Vietnam and Indonesia.

    Methods:  The paper uses the data from the INDEPTH/WHO Study on global aging and adult health (SAGE). The study was carried out in the FilaBavi Health and Demographic Surveillance System (HDSS) site in Vietnam and in Purworejo HDSS in Indonesia. All people aged 50 years and over who lived in these two HDSS areas were surveyed. Face-to-face household interviews were carried out by trained surveyors using the standardized summary version of the INDEPTH/WHO SAGE questionnaire. The SQOL was assessed by asking the respondents “How would you rate your overall quality of life?” The response set was a five-point scale where 1 = Very good, 2 = Good, 3 = Moderate, 4 = Bad, 5 = Very bad.

    Results:  In both countries, the SQOL was reported to be higher among (i) men; (ii) people with higher education; (iii) people who were in a marital partnership; (iv) people who lived with other family members; and (v) those with higher economic status, compared with that in those of other category(ies) of the same characteristic. In Vietnam, people who belonged to the second to fifth economic quintiles and had more than 6 years of education were sevenfold more likely to report very good/good quality of life compared with those who belonged to the first economic quintile (poorest) and had no formal education. The corresponding figure was 2.7 for Indonesia.

    Conclusions:  The patterns of sociodemographic determinants of SQOL show that inequality in quality of life exists among older adults in the two study settings.

  • 130. Van Minh, Hoang
    et al.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Juvekar, Sanjay
    Razzaque, Abdur
    Ashraf, Ali
    Hadi, Abdullahel
    Soonthornthada, Kusol
    Kanungsukkasem, Uraiwan
    Bich, Tran Huu
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Self-reported prevalence of chronic diseases and their relation to selected sociodemographic variables:: a study in INDEPTH Asian sites, 2005.2008In: Preventing Chronic Disease, ISSN 1545-1151, E-ISSN 1545-1151, Vol. 5, no 3, p. A86-Article in journal (Refereed)
  • 131.
    Van Minh, Hoang
    et al.
    Hanoi Med Univ, Dept Hlth Econ, Hanoi, Vietnam.
    Pocock, Nicola Suyin
    London Sch Hyg & Trop Med, London WC1, England.
    Chaiyakunapruk, Nathorn
    Monash Univ Malaysia, Sch Pharm, Selangor, Malaysia; Naresuan Univ, Fac Pharmaceut Sci, Dept Pharm Practice, Ctr Pharmaceut Outcomes Res, Phitsanulok, Thailand; Univ Queensland, Sch Populat Hlth, Brisbane, Qld 4072, Australia.
    Chhorvann, Chhea
    Natl Inst Publ Hlth, Phnom Penh, Cambodia.
    Duc, Ha Anh
    Minist Hlth, Hanoi, Vietnam.
    Hanvoravongchai, Piya
    Chulalongkorn Univ, Fac Med, Bangkok 10330, Thailand.
    Lim, Jeremy
    Oliver Wyman, Hlth & Life Sci Practice, New York, NY USA.
    Lucero-Prisno, Don Eliseo
    Xian Jiaotong Liverpool Univ, Dept Publ Hlth, Suzhou, Peoples R China; Open Univ, Univ Philippines, Fac Management & Dev Studies, Los Banos, Philippines.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Phaholyothin, Natalie
    Rockefeller Fdn, Bangkok, Thailand.
    Phonvisay, Alay
    Natl Univ Laos, Viangchan, Laos.
    Soe, Kyaw Min
    Mahidol Univ, Fac Publ Hlth, Bangkok 10700, Thailand.
    Sychareun, Vanphanom
    Univ Hlth Sci, Viangchan, Laos.
    Progress toward universal health coverage in ASEAN2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25856Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Association of Southeast Asian Nations (ASEAN) is characterized by much diversity in terms of geography, society, economic development, and health outcomes. The health systems as well as healthcare structure and provisions vary considerably. Consequently, the progress toward Universal Health Coverage (UHC) in these countries also varies. This paper aims to describe the progress toward UHC in the ASEAN countries and discuss how regional integration could influence UHC.

    DESIGN: Data reported in this paper were obtained from published literature, reports, and gray literature available in the ASEAN countries. We used both online and manual search methods to gather the information and 'snowball' further data.

    RESULTS: We found that, in general, ASEAN countries have made good progress toward UHC, partly due to relatively sustained political commitments to endorse UHC in these countries. However, all the countries in ASEAN are facing several common barriers to achieving UHC, namely 1) financial constraints, including low levels of overall and government spending on health; 2) supply side constraints, including inadequate numbers and densities of health workers; and 3) the ongoing epidemiological transition at different stages characterized by increasing burdens of non-communicable diseases, persisting infectious diseases, and reemergence of potentially pandemic infectious diseases. The ASEAN Economic Community's (AEC) goal of regional economic integration and a single market by 2015 presents both opportunities and challenges for UHC. Healthcare services have become more available but health and healthcare inequities will likely worsen as better-off citizens of member states might receive more benefits from the liberalization of trade policy in health, either via regional outmigration of health workers or intra-country health worker movement toward private hospitals, which tend to be located in urban areas. For ASEAN countries, UHC should be explicitly considered to mitigate deleterious effects of economic integration. Political commitments to safeguard health budgets and increase health spending will be necessary given liberalization's risks to health equity as well as migration and population aging which will increase demand on health systems. There is potential to organize select health services regionally to improve further efficiency.

    CONCLUSIONS: We believe that ASEAN has significant potential to become a force for better health in the region. We hope that all ASEAN citizens can enjoy higher health and safety standards, comprehensive social protection, and improved health status. We believe economic and other integration efforts can further these aspirations.

  • 132. Van Minh, Hoang
    et al.
    Soonthornthada, Kusol
    Ng, Nawi
    Juvekar, Sanjay
    Razzaque, Abdur
    Ashraf, Ali
    Ahmed, Syed Masud
    Bich, Tran Huu
    Kanungsukkasem, Uraiwan
    Blood pressure in adult rural INDEPTH population in Asia2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, p. 60-67Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: High blood pressure (BP) is a well-known major risk factor for cardiovascular diseases and is a leading contributor to cardiovascular mortality and morbidity worldwide. Reliable population-based BP data from low-middle income countries are sparse.

    OBJECTIVE: This paper reports BP distributions among adults in nine rural populations in five Asian countries and examines the association between high BP and associated risk factors, including gender, age, education, and body mass index.

    METHODS: A multi-site cross-sectional study of the major non-communicable disease risk factors (tobacco and alcohol use, fruit and vegetable intake, physical activity patterns) was conducted in 2005 in nine Health and Demographic Surveillance System (HDSS) sites in five Asian countries, all part of the INDEPTH Network. In addition to the self-report questions on risk factors, height and weight, and BP were measured during household visits using standard protocols of the WHO STEPwise approach to Surveillance.

    RESULTS: In all the study sites (except among men and women in WATCH and among women in Chililab), the mean levels of systolic BP were greater than the optimal threshold (115 mmHg). A considerable proportion of the study populations - especially those in the HDSS in India, Indonesia, and Thailand - had high BP (systolic BP >/= 140 mmHg or diastolic BP >/= 90 mmHg or on treatment with BP medications). A more conservative definition of high BP (systolic BP >/= 160 mmHg or diastolic BP >/= 100 mmHg) substantially reduced the prevalence rate. The marked differences in the proportion of the populations on high BP medication (range between 0.6 and 10.8%) raised problems in comparing the prevalence of high BP across sites when using the commonly used definition of high BP as in this study. In the four HDSS in Bangladesh, women had a higher prevalence of high BP than men; the reverse was true in the other sites (Chililab, Filabavi in Vietnam; Kanchanaburi, Thailand; and Vadu, India) where men experienced higher prevalence than women. Overweight and obesity were significantly associated with high BP, with odds ratio ranging from two in Chililab to five in Filabavi (both in Vietnam HDSS).

    CONCLUSION: The patterns of BP in these nine cross-sectional surveys were complex, reflecting the fact that the Asian countries are at different stages of the epidemiological transition. Actions to prevent the rise of BP levels are urgently required. An emphasis should be placed on cost-effective interventions to reduce salt consumption in the population as an immediate priority.

  • 133. 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.

  • 134. Winkler, Volker
    et al.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Tesfaye, Fikru
    Becher, Heiko
    Predicting lung cancer deaths from smoking prevalence data2011In: Lung Cancer, ISSN 0169-5002, E-ISSN 1872-8332, Vol. 74, no 2, p. 170-177Article in journal (Refereed)
    Abstract [en]

    Reliable data on lung cancer burden is not available from most developing countries as cancer registration is lacking. In a previously proposed model to estimate lung cancer deaths in those countries using smoking prevalence data, we estimated the current yearly number of lung cancer deaths in Ethiopia as 3356, a figure far above the WHO estimate of 1343 and the GLOBOCAN of 748. Our aim was to further develop and validate our estimation procedure. We included additional data on risk estimates for lung cancer mortality of ex-smokers and an approximation of duration of smoking into our model and reanalysed study results on non-smoker mortality, thus building two improved models. For validation the number of lung cancer deaths in Germany (2006), the UK (2006), Canada (2004), and Utah, USA (2000) were estimated based on all three models and compared to the observed number of deaths in these countries. We found that the refined model with a modified estimate of lung cancer mortality rates in non-smokers and a more detailed incorporation of smoking dose categories estimates rather well the observed lung cancer deaths in the above countries. With this model, the updated estimate of yearly lung cancer deaths in Ethiopia is 2946 deaths, close to the previous reported estimate. If Ethiopian lung cancer mortality rates in never-smokers and smoking relative risks are the same as in industrialised countries, our models suggests that WHO lung cancer deaths may be underestimated in Ethiopia.

  • 135. Wu, Fan
    et al.
    Guo, Yanfei
    Chatterji, Somnath
    Zheng, Yang
    Naidoo, Nirmala
    Jiang, Yong
    Biritwum, Richard
    Yawson, Alfred
    Minicuci, Nadia
    Salinas-Rodriguez, Aaron
    Manrique-Espinoza, Betty
    Maximova, Tamara
    Peltzer, Karl
    Phaswanamafuya, Nancy
    Snodgrass, James J.
    Thiele, Elizabeth
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kowal, Paul
    Common risk factors for chronic non-communicable diseases among older adults in China, Ghana, Mexico, India, Russia and South Africa: the study on global AGEing and adult health (SAGE) wave 12015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 88Article in journal (Refereed)
    Abstract [en]

    Background: Behavioral risk factors such as tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol are known and modifiable contributors to a number of NCDs and health mediators. The purpose of this paper is to describe the distribution of main risk factors for NCDs by socioeconomic status (SES) among adults aged 50 years and older within a country and compare these risk factors across six lower- and upper-middle income countries. Methods: The study population in this paper draw from SAGE Wave 1 and consisted of adults aged 50-plus from China (N=13,157), Ghana (N=4,305), India (N=6,560), Mexico (N=2,318), the Russian Federation (N=3,938) and South Africa (N=3,836). Seven main common risk factors for NCDs were identified: daily tobacco use, frequent heavy drinking, low level physical activity, insufficient vegetable and fruit intake, high risk waist-hip ratio, obesity and hypertension. Multiple risk factors were also calculated by summing all these risk factors. Results: The prevalence of daily tobacco use ranged from 7.7% (Ghana) to 46.9% (India), frequent heavy drinker was the highest in China (6.3%) and lowest in India (0.2%), and the highest prevalence of low physical activity was in South Africa (59.7%). The highest prevalence of respondents with high waist-to-hip ratio risk was 84.5% in Mexico, and the prevalence of self-reported hypertension ranging from 33% (India) to 78% (South Africa). Obesity was more common in South Africa, the Russia Federation and Mexico (45.2%, 36% and 28.6%, respectively) compared with China, India and Ghana (15.3%, 9.7% and 6.4%, respectively). China, Ghana and India had a higher prevalence of respondents with multiple risk factors than Mexico, the Russia Federation and South Africa. The occurrence of three and four risk factors was more prevalent in Mexico, the Russia Federation and South Africa. Conclusion: There were substantial variations across countries and settings, even between upper-middle income countries and lower-middle income countries. The baseline information on the magnitude of the problem of risk factors provided by this study can help countries and health policymakers to set up interventions addressing the global non-communicable disease epidemic.

  • 136. Yuan, Beibei
    et al.
    Målqvist, Mats
    Trygg, Nadja
    Qian, Xu
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Thomsen, Sarah
    What interventions are effective on reducing inequalities in maternal and child health in low- and middle-income settings? A systematic review.2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, p. 634-Article, review/survey (Refereed)
    Abstract [en]

    Background: The deadline for achieving Millennium Development Goals 4 and 5 is approaching, but inequalities between disadvantaged and other populations is a significant barrier for progress towards achieving these goals. This systematic review aims to collect evidence about the differential effects of interventions on different sociodemographic groups in order to identify interventions that were effective in reducing maternal or child health inequalities.

    Methods: We searched the PubMed, EMBASE and other relevant databases. The reference lists of included reviews were also screened to find more eligible studies. We included experimental or observational studies that assessed the effects of interventions on maternal and child health, but only studies that report quantitative inequality outcomes were finally included for analysis.

    Results: 22 articles about the effectiveness of interventions on equity in maternal and child health were finally included. These studies covered five kinds of interventions: immunization campaigns, nutrition supplement programs, health care provision improvement interventions, demand side interventions, and mixed interventions. The outcome indicators covered all MDG 4 and three MDG 5 outcomes. None of the included studies looked at equity in maternal mortality, adolescent birth rate and unmet need for family planning. The included studies reported inequalities based on gender, income, education level or comprehensive socioeconomic status. Stronger or moderate evidence showed that all kinds of the included interventions may be more effective in improving maternal or child health for those from disadvantaged groups.

    Conclusion: Studies about the effectiveness of interventions on equity in maternal or child health are limited. The limited evidence showed that the interventions that were effective in reducing inequity included the improvement of health care delivery by outreach methods, using human resources in local areas or provided at the community level nearest to residents and the provision of financial or knowledge support to demand side.

  • 137. Zhang, Yue
    et al.
    Gu, Yi'an
    Wang, Na
    Zhao, Qi
    Ng, Nawi
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wang, Ruiping
    Zhou, Xiaoyan
    Jiang, Yonggen
    Wang, Weibing
    Zhao, Genming
    Association between anthropometric indicators of obesity and cardiovascular risk factors among adults in Shanghai, China2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, no 1, article id 1035Article in journal (Refereed)
    Abstract [en]

    Background: To determine the optimal cut-off values and evaluate the associations of body mass index (BMI), waist circumference (WC) and waist-height ratio (WHtR) with cardiovascular disease (CVD) risk factors. Methods: A large-scale cross-sectional survey was conducted among 35,256 adults aged 20-74 years in Shanghai between June 2016 and December 2017. Receiver operating characteristic (ROC) analyses were conducted to assess the optimal cut-off anthropometric indices of CVD risk factors including hypertension, diabetes, dyslipidemia and hyperuricemia. Multivariate Logistic regression models were preformed to evaluate the odds ratio of CVD risk factors. Results: The area under the curve (AUC) of WHtR was significantly greater than that of BMI or WC in the prediction of hypertension and diabetes, and AUCs were higher in women than men. The optimal cut-off values of WHtR were approximately 0.51 in both sexes, while the cut-off values of BMI and WC were higher for men compared with women. The optimal cutoff values of BMI and WC varied greatly across different age groups, but the difference in WHtR was relatively slight. Among women, the optimal threshold of anthropometric indices appeared to increase with age for hypertension and diabetes. The odds ratio between anthropometric indices and CVD risk factors were attenuated with age. WHtR had the greatest odds ratio for CVD risk factors among adults under 60 years old except for women with hypertension, while among 60-74 years, BMI yielded the greatest odds ratio in terms of all CVD outcomes except for women with diabetes. Conclusions: WHtR had the best performance for discriminating hypertension and diabetes and potentially be served as a standard screening tool in public health. The associations between three anthropometric indices and CVD risk factors differed by sex and decreased with age. These findings indicated a need to develop age- and gender-specific difference and make effective strategies for primary prevention of CVDs.

  • 138. Zhang, Yue
    et al.
    Santosa, Ailiana
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wang, Na
    Wang, Weibing
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Zhao, Qi
    Jiang, Yonggen
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Zhao, Genming
    Prevalence and the Association of Body Mass Index and Other Risk Factors with Prediabetes and Type 2 Diabetes Among 50,867 Adults in China and Sweden: A Cross-Sectional Study2019In: Diabetes Therapy, ISSN 1869-6953, E-ISSN 1869-6961, Vol. 10, no 6, p. 2061-2077Article in journal (Refereed)
    Abstract [en]

    Introduction: Understanding socioeconomic differences for prediabetes and type 2 diabetes (T2DM) can offer guidance for the most effective development of both prevention and intervention programmes in different settings. This study aims to determine the prevalence and risk factors for prediabetes and T2DM and to explore the effect of high body mass index (BMI) on the probability of T2DM being present among adults in China and Sweden.

    Methods: This study enrolled 25,356 adults (35–64 years old) from the Shanghai Survey in China and 25,511 adults (aged 40, 50, 60) from the Västerbotten Intervention Programme in Sweden. Data on haemoglobin A1c, capillary fasting plasma glucose, 2-h plasma glucose and self-reported diagnoses of T2DM were used in the analysis. Multinomial logistic regression was used to examine the determinants of prediabetes and T2DM. The average predicted probabilities of T2DM developing or presenting were determined for the different ages and levels of BMI in each population.

    Results: Chinese participants had a higher adjusted prevalence of T2DM (men 12.8% vs. 4.6%; women 10.6% vs. 3.1%) and prediabetes (men 12.4% vs. 12.2%; women 14.4% vs. 12.2%) than Swedish participants. Age, overweightedness/obesity, hypertension and a family history of diabetes were significant risk factors for prediabetes and T2DM. In both populations, the predicted probability of T2DM increased as the BMI increased in all age groups. At the same BMI level, Chinese participants were more likely to have T2DM compared to their Swedish counterparts. The average predicted probability of T2DM was less than 20% in nearly all age groups among Swedish women.

    Conclusions: Chinese adults had the higher prevalence of prediabetes and T2DM and a higher probability of T2DM at the same BMI level compared with Swedish adults. These results indicate the importance of addressing the ongoing obesity epidemic as a matter of urgency in order to curb what has become an apparent diabetes epidemic in both countries.

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