Our findings imply that an increased availability of green space within a municipality may contribute to a reduction in the number of antidepressant prescriptions dispensed. Green space is thus a central health and community asset, whilst a minimum level of 28% needs to be established for health gains. The highest effectiveness occurred at a municipality surface percentage higher than 79%. This inverse dose-dependent relation has important implications for setting future community-level health and planning policies.
Our study explores the association between individual and neighborhood socioeconomic position (SEP) and all-cancer and site-specific cancer mortality. Data on all Belgian residents are retrieved from a population-based dataset constructed from the 2001 census linked to register data on emigration and mortality for [2001][2002][2003][2004][2005][2006][2007][2008][2009][2010][2011]. The study population contains all men and women aged 40 years or older during follow-up. Individual SEP is measured using education, employment status and housing conditions. Neighborhood SEP is measured by a deprivation index (in quintiles). Directly age-standardized mortality rates and multilevel Poisson models are used to estimate the association between individual SEP and neighborhood deprivation and mortality from all-cancer and cancer of the lung, colon and rectum, pancreas, prostate and female breast. The potential confounding role of population density is assessed using multilevel models as well. Our findings show an increase in mortality from all-cancer and site-specific cancer by decreasing level of individual SEP for both men and women. In addition, individuals living in highly deprived neighborhoods experience significantly higher mortality from all-cancer, lung cancer, pancreatic cancer and female colorectal cancer after controlling for individual SEP. Male colorectal and prostate cancer and female breast cancer are not associated with neighborhood deprivation. Population density acts as a confounder for female lung cancer only. Our study indicates that deprivation at both the individual and neighborhood level is associated with all-cancer mortality and mortality from several cancer sites. More research into the role of life-style related and clinical factors is necessary to gain more insight into causal pathway.
Background: Neighbourhood social fragmentation and socioeconomic deprivation seem to be associated with suicide mortality. However, results are inconclusive, which might be because dynamics in the social context are not well-represented by administratively bounded neighbourhoods at baseline. We used individualized neighbourhoods to examine associations between suicide mortality, social fragmentation, and deprivation for the total population as well as by sex and age group.Methods: Using a nested case-control design, all suicides aged 18-64 years between 2007 and 2016 were selected from longitudinal Dutch register data and matched with 10 random controls. Indices for social fragmentation and deprivation were calculated annually for 300, 600, and 1,000 metre circular buffers around each subject's residential address.Results: Suicide mortality was significantly higher in neighbourhoods with high deprivation and social fragmentation. Accounting for individual characteristics largely attenuated these associations. Suicide mortality remained significantly higher for women living in highly fragmented neighbourhoods in the fully adjusted model. Age-stratified analyses indicate associations with neighbourhood fragmentation among women in older age groups (40-64 years) only. Among men, suicide risk was lower in fragmented neighbourhoods for 18-39-yearolds and for short-term residents. In deprived neighbourhoods, the suicide risk was lower for 40-64-year-old men and long-term residents. Associations between neighbourhood characteristics and suicide mortality were comparable across buffer sizes.Conclusion: Our findings suggest that next to individual characteristics, the social and economic context within which people live may both enhance and buffer the risk of suicide.
KeywordsSuicide mortality; social fragmentation; neighbourhood deprivation; individualized neighbourhoods; longitudinal register.
What is already known Most ecological studies reported higher suicide risk in deprived and fragmented neighbourhoods. Most European multilevel studies showed no associations between neighbourhood socioeconomic characteristics and suicide mortality Research on social fragmentation and deprivation based on administrative units at one point in time (i.e., at baseline) is prone to methodological limitations.
What this study adds Using longitudinal register data, this is the first study assessing associations between neighbourhood fragmentation, deprivation, and suicide using annual address-based individualized buffers. Associations between neighbourhood deprivation and fragmentation were attenuated after adjusting for individual characteristics. Fully adjusted models show a higher suicide risk among women and a lower suicide risk among men aged 18-39 in highly fragmented neighbourhoods. Suicide risk was lower among men aged 40-64 in highly deprived neighbourhoods. Associations between suicide risk and neighbourhood fragmentation and deprivation were comparable across buffer sizes but varied by years of residence.None declared....
Being a highly industrialized country with one of the highest male lung cancer mortality rates in Europe, Belgium is an interesting study area for lung cancer research. This study investigates geographical patterns in lung cancer mortality in Belgium. More specifically it probes into the contribution of individual as well as area-level characteristics to (sub-district patterns in) lung cancer mortality. Data from the 2001 census linked to register data from 2001–2011 are used, selecting all Belgian inhabitants aged 65+ at time of the census. Individual characteristics include education, housing status and home ownership. Urbanicity, unemployment rate, the percentage employed in mining and the percentage employed in other high-risk industries are included as sub-district characteristics. Regional variation in lung cancer mortality at sub-district level is estimated using directly age-standardized mortality rates. The association between lung cancer mortality and individual and area characteristics, and their impact on the variation of sub-district level is estimated using multilevel Poisson models. Significant sub-district variations in lung cancer mortality are observed. Individual characteristics explain a small share of this variation, while a large share is explained by sub-district characteristics. Individuals with a low socioeconomic status experience a higher lung cancer mortality risk. Among women, an association with lung cancer mortality is found for the sub-district characteristics urbanicity and unemployment rate, while for men lung cancer mortality was associated with the percentage employed in mining. Not just individual characteristics, but also area characteristics are thus important determinants of (regional differences in) lung cancer mortality.
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