AimTo map and compare site-specific cancer mortality for Belgians and five of the largest immigrant groups in Belgium, and to look into the role of socio-economic position (SEP) and urbanisation.
ResultsThere is marked diversity in cancer mortality levels by migrant background, with oft-lower levels for FG Moroccan and Turkish immigrants, and levels usually closer to those of Belgians for European immigrants. Small increases are commonly observed by generation, although less clearly so for stomach and liver cancer. SEP plays an important role in the patterning of cancer mortality by migrant background.
ConclusionMigrant background is associated with differences in site-specific cancer mortality levels in Belgium.The observed role of SEP warrants special attention to the most vulnerable socio-economic groups.
BackgroundCountry averages for health outcomes hide important within-country variations. This paper probes into the geographic Belgian pattern of all-cause mortality and wishes to investigate the contribution of individual and area socio-economic characteristics to geographic mortality differences in men aged 45–64 during the period 2001–2011.MethodsData originate from a linkage between the Belgian census of 2001 and register data on mortality and emigration during the period 2001–2011. Mortality rate ratios (MRRs) are estimated for districts and sub-districts compared to the Belgian average mortality level using Poisson regression modelling. Individual socio-economic position (SEP) indicators are added to examine the impact of these characteristics on the observed geographic pattern. In order to scrutinize the contribution of area-level socio-economic characteristics, random intercepts Poisson modelling is performed with predictors at the individual and the sub-district level. Random intercepts and slopes models are fitted to explore variability of individual-level SEP effects.ResultsAll-cause MRRs for middle-aged Belgian men are higher in the geographic areas of the Walloon region and the Brussels-Capital Region (BCR) compared to those in the Flemish region. The highest MRRs are observed in the inner city of the BCR and in several Walloon cities. Their disadvantage can partially be explained by the lower individual SEP of men living in these areas. Similarly, the relatively low MRRs observed in the districts of Halle-Vilvoorde, Arlon and Virton can be related to the higher individual SEP. Among the area-level characteristics, both the percentage of men employed and the percentage of labourers in a sub-district have a protective effect on the individual MRR, regardless of individual SEP. Variability in individual-level SEP effects is limited.ConclusionsIndividual SEP partly explains the observed mortality gap in Belgium for some areas. The percentage of men employed and the percentage of labourers in a sub-district have an additional effect on the individual MRR aside from that of individual SEP. However, these socio-economic factors cannot explain all of the observed differences. Other mechanisms such as public health policy, cultural habits and environmental influences contribute to the observed geographic pattern in all-cause mortality among middle-aged men.Electronic supplementary materialThe online version of this article (doi:10.1186/s13690-016-0135-y) contains supplementary material, which is available to authorized users.
Introduction: Cross-national comparison suggests that the timing of the obesity epidemic differs across
socio-economic groups (SEGs). Similar to the smoking epidemic, these differences might be described by
the diffusion of innovations theory, which states that health behaviours diffuse from higher to lower
SEGs. However, the applicability of the diffusion of innovations theory to long-term time trends in
obesity by SEG is unknown. We studied long-term trends in the obesity prevalence by socio-economic
group in England, France, Finland, Italy, Norway, and the USA and examined whether trends are
described by the diffusion of innovations theory.
Methods: Obesity prevalence from 1978 to 2019 by educational level, sex, and age group (25+) from
health surveys were harmonised, age-standardised, Loess-smoothed, and visualised. Prevalence rate
differences were calculated and segmented regression was performed to obtain annual percentage
changes, which were compared over time and across SEGs.
Results: Obesity prevalence among lower educated has exceeded that of higher educated groups,
except among USA men, in all countries throughout the study period. A comparable increase across
educational levels was observed until approximately 2000. Recently, obesity prevalence stagnated
among higher educated groups in Finland, France, Italy, and Norway, and lower educated groups in
England and the USA.
Discussion: Recent trends in obesity prevalence by SEG are mostly in line with the diffusion of
innovations theory, however, no diffusion from higher to lower SEGs at the start of the epidemic was
found. The stagnation among higher SEGs but not lower SEGs suggests that the latter will likely
experience the greatest future burden.
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