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Area-level deprivation is associated with multiple adverse birth outcomes. Few studies have examined the mediating pathways through which area-level deprivation affects these outcomes. The objective of this study was to investigate the association between area-level deprivation and preterm birth, and examine the mediating effects of maternal medical, behavioural, and psychosocial factors.
We conducted a retrospective cohort study using national, commercial health insurance claims data from 2011, obtained from the Health Care Cost Institute. Area-level deprivation was derived from principal components methods using ZIP code-level data. Multilevel structural equation modeling was used to examine mediating effects.
In total, 138,487 women with a live singleton birth residing in 14,577 ZIP codes throughout the United States were included. Overall, 5.7% of women had a preterm birth. In fully adjusted generalized estimation equation models, compared to women in the lowest quartile of area-level deprivation, odds of preterm birth increased by 9.6% among women in the second highest quartile (odds ratio (OR) 1.096; 95% confidence interval (CI) 1.021, 1.176), by 11.3% in the third highest quartile (OR 1.113; 95% CI 1.035, 1.195), and by 24.9% in the highest quartile (OR 1.249; 95% CI 1.165, 1.339). Hypertension and infection moderately mediated this association.
Even among commercially-insured women, area-level deprivation was associated with increased risk of preterm birth. Similar to individual socioeconomic status, area-level deprivation does not have a threshold effect. Implementation of policies to reduce area-level deprivation, and the screening and treatment of maternal mediators may be associated with a lower risk of preterm birth.
Commercially-insured, Area-level deprivation, Preterm birth, Mediating pathways
Area-level deprivation and preterm birth: results from a national, commercially-insured population
Renee Mehra,corresponding author1 Fatma M. Shebl,1,2 Shayna D. Cunningham,1 Urania Magriples,3 Eric Barrette,4,5 Carolina Herrera,6 Katy B. Kozhimannil,7 and Jeannette R. Ickovics1,8
As many as 47% of adults over age 50 discontinue treatment with antidepressants after redeeming only one prescription. The study aim was to assess the risk of suicide in adults aged 50+ who discontinue antidepressants at an early stage of treatment.
Case control study of all individuals aged 50+ living in Denmark and who initiated antidepressant treatment between July 1st 1995 and December 31st 2000 (N=217,123). Hazard ratios were calculated using Cox regression analyses, propensity score matching techniques, and marginal structural models.
During the study period, 78,594 men and 138,529 women aged 50+ began treatment with an antidepressant medication, of whom 309 men and 229 women died by suicide. Men aged 50+ who discontinued treatment early had a suicide rate of 167 per 100,000 compared with 175 per 100,000 in those who continued refilling prescriptions; hazard ratio = 0.98 [CI-95%: 0.78-1.23]. The suicide rate in women who discontinued treatment was 52 per 100,000 compared with 74 per 100,000 in those who continued refilling; hazard ratio = 0.72 [CI-95%: 0.55-0.94]. Although people with previous psychiatric hospitalizations had greater risk of suicide than those without past hospital admissions, the difference was not significant in the adjusted model.
Prescriptions redeemed at pharmacies is our only indicator of treatment adherence. Also, information on severity of depression was not available.
We did not find a lower suicide risk among people over age 50 who seemingly follow treatment in comparison with those who discontinued treatment with antidepressants at an early stage.
Suicide, Antidepressants, Non-Compliance, Aged, Denmark
Early discontinuation of antidepressant treatment and suicide risk among persons aged 50 and over: a population-based register study
Annette Erlangsen,a,b,* Esben Agerbo,a Keith Hawton,c and Yeates Conwelld
2010 Dec 1.
The association of animal-origin food consumption and cooking patterns with colorectal cancer (CRC) risk was evaluated in a cohort of 73,224 participants of the Shanghai Women’s Health Study. After a mean follow-up time of 7.4 years, 394 incident cases of CRC (colon=236; rectal=158) were diagnosed. Overall, no association was found between the risk of CRC and intake of total meat and total fish. Eel (P trend =0.01), shrimp (P trend =0.06), and shellfish (P trend =0.04) consumption were positively associated with CRC risk. High egg intake and high intake of total cholesterol were also related to risk of CRC (RR for the highest versus lowest quintiles of intake were 1.4 (95% CI: 1.1-2.0) for eggs and 1.6 (95% CI: 1.1-2.3) for cholesterol). Milk intake was inversely associated with the risk of colon cancer (P trend =0.05). Common Chinese cooking practices except the ‘smoked’ method of cooking were related to CRC risk. The latter was positively associated with colon cancer (RR =1.4 for ever versus never, 95% CI: 1.1-1.9). A possible role of cholesterol and environmental pollution in the etiology of CRC was suggested.
colorectal cancer, animal origin foods, cooking method
Animal origin foods and colorectal cancer risk: A report from the Shanghai Women’s Health Study
Sang-Ah Lee,1 Xiao Ou Shu,1 Gong Yang,1 Honglan Li,2 Yu-Tang Gao,2 and Wei Zheng1
2010 Jan 22.