OBJECTIVES: Smoking-related mortality varies over different social, environmental, and policy contexts. However, spatial patterns, examined at a small area level, have been seldom considered. Therefore, the study provides a detailed analysis of socio-spatial inequalities in premature mortality related to smoking in the contemporary Czech adult population. DESIGN, SETTINGS, AND METHODS: We conducted a population-based, cross-sectional study to investigate the spatial pattern of the age-adjusted smoking-related mortality across Czechia. The spatial inequalities, as measured at the municipality level, were investigated using geostatistical modeling techniques. The ecological regression of the local mortality risk on socioeconomic composition of municipalities was also conducted. The target population was defined as permanent adult residents of Czechia aged 25-64 years in the period of 2011-2015. RESULTS: Among both sexes, a significant spatial gradient in the South-East (lower relative risk) - North-West (higher relative risk) axis was detected. The local mortality risk was significantly related to the level of relative deprivation of the municipalities (a composite index comprised from unemployment rate and level of education): adjusted RR among males (for an increase by 1 SD): 1.21 [95% CI: 1.158-1.256], p < 0.001; adjusted RR among females (for an increase by 1 SD): 1.14 [95% CI: 1.090-1.186], p < 0.001. Mortality among males was approximately twice as high as opposed to females. Regarding the spatial inequalities of the phenomena, however, only rather minor sex-specific patterns were identified. Contrasted to males, mortality among females was unrelated to unemployment rates. CONCLUSIONS: Consistent spatial patterns of the premature mortality were identified. The mortality risk was significantly related to socioeconomic composition of the Czech municipalities. The higher the level of local deprivation, the higher the local mortality risk. The results of the study can be found beneficial for planning of both socially and spatially integrated public health policy.
- Klíčová slova
- Ecological approach, Mortality, Small-area analysis, Smoking, Socioeconomic determinants, Spatial epidemiology,
- MeSH
- analýza malých oblastí MeSH
- dospělí MeSH
- kouření * MeSH
- lidé MeSH
- mortalita MeSH
- předčasná smrt * MeSH
- příčina smrti MeSH
- průřezové studie MeSH
- registrace MeSH
- rizikové faktory MeSH
- socioekonomické faktory MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
Czech Republic traditionally ranks among the countries with the highest alcohol, consumption. This paper examines both risk and protective factors for frequent of alcohol, consumption in the Czech population using multilevel analysis. Risk factors were measured at the, individual level and at the area level. The individual-level data were obtained from a survey for a, sample of 3526 respondents aged 18-64 years. The area-level data were obtained from the Czech, Statistical Office. The group most inclinable to risk alcohol consumption and binge drinking are mainly, men, who live as single, with low education and also unemployed. Only the variable for divorce rate, showed statistical significance at both levels, thus the individual and the aggregated one. No cross-level interactions were found to be statistically significant.
- MeSH
- alkoholismus epidemiologie MeSH
- analýza malých oblastí MeSH
- chudé oblasti * MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- logistické modely MeSH
- mladiství MeSH
- multivariační analýza MeSH
- pití alkoholu epidemiologie MeSH
- rizikové faktory MeSH
- společenská třída * MeSH
- zdravotnické přehledy MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
BACKGROUND: It has been observed that the prevalence of dental caries among children has declined in the last decade in Germany. However, despite of these improvements there is still a proportion of children suffering from dental decay. AIMS: The aims of this study were to evaluate if a social gradient in the prevalence of dental caries exists and, based on those findings, to develop a strategy to target those children with heightened risk to develop dental caries in order to assist oral health care professionals to refocus the current uniform school-based dental health programme to a caries preventive strategy based on a directed population approach. DESIGN: A representative, random sample of 12-year olds in Freiburg (Germany) was examined and dental caries was recorded using WHO criteria. Educational attainment of the child's parents was used as an indicator of socio-economic status and classified by use of the CASMIN Educational Classification. RESULTS: A total of 322 children participated. An examination of dental caries score revealed that its distribution was positively skewed. For this reason this study provides summary analyses based on medians and a non-parametric rank-sum test. The Kruskal-Wallis H-test showed a significant difference between median scores across the different educational levels (p-value = 0.015) which was due to lower dental caries levels in children with non-deprived social background. CONCLUSIONS: In order to reduce current social inequalities in child oral health the current uniform school-based dental health programme at secondary school level should be developed to a targeted school-based screening and prevention programme.
- MeSH
- analýza malých oblastí MeSH
- dítě MeSH
- DMF Index MeSH
- lidé MeSH
- prevalence MeSH
- školní zubní lékařství organizace a řízení MeSH
- společenská třída * MeSH
- zubní kaz epidemiologie prevence a kontrola MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Německo epidemiologie MeSH
OBJECTIVES: Air pollution has been linked to respiratory outcomes but controversy persists about its long-term effects. We used a novel technique to estimate the outdoor concentrations of sulphur dioxide (SO2) at small-area level to study the long-term effects on respiratory symptoms and disease in children. METHODS: As part of the international SAVIAH study, parents of 8,013 children aged 7-10 studied in Prague (Czech Republic) and Poznan (Poland) completed a questionnaire covering respiratory health, demographic and socio-economic factors and health behaviours (response rate 91%). This report is based on 6,959 children with complete data. Outdoor SO2 was measured by passive samplers at 80 sites in Poznan and 50 sites in Prague during 2-week campaigns. Concentrations of SO2 at each point (location) in the study areas were estimated from these data by modelling in a geographical information system. The mean of the estimated SO2 concentrations at children's homes and schools was used as an indicator of exposure to outdoor SO2. RESULTS: The prevalence of respiratory outcomes was similar in both cities. In the pooled data, 12% of children had experienced wheezing/whistling in the past 12 months; 28% had a lifetime prevalence of wheezing/whistling; 14% had a dry cough at night; and 3% had had asthma diagnosed by a doctor. The estimated mean exposure to outdoor SO2 was 80 (range 44-140) microg/m3 in Poznan and 84 (66-97) microg/m3 in Prague. After socio-economic characteristics and other covariates were controlled for, SO2 was associated with wheezing/whistling in the past 12 months (adjusted OR per 50 microg/m3 1.32, 95% CI 1.10-1.57), lifetime prevalence of wheezing/whistling (OR 1.13, 95% CI 0.99-1.30), and lifetime prevalence of asthma diagnosed by a doctor (OR 1.39, 95% CI 1.01-1.92). The association with dry cough at night did not reach statistical significance. CONCLUSIONS: In these two Central European cities with relatively high levels of air pollution, small-area based indicators of long-term outdoor winter concentrations of SO2 were associated with wheezing/whistling and with asthma diagnosed by a doctor.
- MeSH
- analýza malých oblastí MeSH
- bronchiální astma epidemiologie MeSH
- dítě MeSH
- kašel epidemiologie MeSH
- látky znečišťující vzduch škodlivé účinky analýza MeSH
- lidé MeSH
- oxid siřičitý škodlivé účinky analýza MeSH
- prevalence MeSH
- respirační zvuky * MeSH
- socioekonomické faktory MeSH
- zdravé chování MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
- Polsko epidemiologie MeSH
- Názvy látek
- látky znečišťující vzduch MeSH
- oxid siřičitý MeSH
Findings and procedures include in this article have been realized at Regional Public Health Office in Hradec Králové (Czech Republic) within the period from August 1999 to February 2000. The model sample used in this article dealed only with events of neoplasms incidence in men's population in the region of Eastern Bohemia within the period from 1986 to 1997. The original experimental part concerned to the use of procedures for demographical data standardization for target group of "small populations" including of their selection and spatial distribution. As the result of it, there are topical maps of spatial distribution of incidence (event. mortality) of selected diagnoses according to sex with target area units delimitated by methods of regional geography with around 120 km2 and total average number about 10000 inhabitants. Thanks to using of cluster analysis these maps include inside aggregated information about standardized ratio value, expression of its reliability rate. The original system has been tested thanks to software application and methodical procedures developed by author of this article in the connection with progressive information technology of geographical information system GIS SPANS which all allow quite easily to carry out the detection of another diagnoses spatial distribution within selected resolution and provided data. Mentioned above conclusions may be suggested as a basic descriptive method for the health risk assessment. Another analytical procedures can follow this original method in next phases. The method has brought essentially new view of the disease spatial distribution which has not been used in the Czech Republic in such a range and detail yet. There are being uncovered great possibilities that could in the end contribute to discovering of causal connections - mainly diseases with unfavourable development in time series. At the same time the introductory premise about spatial distribution of events to "skip" with the change of resolution has been confirmed.
- MeSH
- analýza malých oblastí MeSH
- dospělí MeSH
- epidemiologický výzkum - projekt * MeSH
- hodnocení rizik metody MeSH
- incidence MeSH
- lidé MeSH
- mladiství MeSH
- mortalita trendy MeSH
- shluková analýza MeSH
- veřejné zdravotnictví MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
The Czech Republic, together with Slovakia and Poland, forms a region within Central-Eastern Europe in which the values of life expectancy at birth have been increasing during the period of transformation. However, the tempo of mortality reduction has differed spatially within the territory of the Czech Republic, as have other outcomes of the transformation process. This paper discussed possible socio-economic explanations of regional differences in the tempos of mortality change between 1990/91 and 1995/96. Standardized mortality rates for males aged 0-64 years specified for the three most frequent causes of death were examined by means of the regression and correlation analysis.
- MeSH
- analýza malých oblastí MeSH
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mortalita trendy MeSH
- naděje dožití MeSH
- novorozenec MeSH
- politické systémy * MeSH
- politika MeSH
- předškolní dítě MeSH
- socioekonomické faktory MeSH
- zeměpis MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
Between 1983 and 1997 a total of 2029 children with CL/P (cleft lip, cleft lip and palate or cleft palate), who were born in the Bohemian districts of the Czech Republic and who underwent surgery and treatment at the Clinic of Plastic Surgery in Prague, were analysed. One possibility for decreasing the risk of delivery of a child with CL/P is to decrease or eliminate its prenatal exposure to embryotoxic factors. Detection of the embryotoxic factors acting at the individual level (e.g. elevated temperature, drug consumption, x-ray examination or infection) is easier than the detection of embryotoxic factors operating at the population level (e.g. water contamination, air pollution). When searching for the latter factors, we first have to reveal regional differences in CL/P incidence. The aim of the present paper was to determine significant differences in the mean incidence of newborns with CL/P in Bohemian districts during a 15 year period. The correlation between the incidence of CL/P and the birth rate in the different districts was also examined. The mean incidence of CL/P in all Bohemian districts was 1.86 per 1000 newborns (1.86/1000). Districts were divided into three groups, according to significant differences in the incidence of CL/P using a confidence interval. The lowest mean incidence of CL/P was detected in the Svitavy district (0.72/1000) and Louny (1.05/1000). The highest mean incidence was found in the Beroun district (2.86/1000). Besides Beroun, a high mean incidence of CL/P (more than 1.96/1000) was also found in Klatovy, Mĕlník, Tábor, Kolín, Semily, Ceská Lípa, Pardubice, Teplice, Ceský Krumlov, Sokolov, Chomutov, Praha-západ, Jicín, Rakovník, Kladno, Prachatice, Rokycany, Tachov, Liberec, Pelhrimov. Paradoxically, the districts with a higher or lower birth rate exhibited a lower (1.62/1000) or higher (1.92/1000) incidence of CL/P, respectively. Future studies should elucidate whether the significant regional differences in the incidence of CL/P can be related to differing exposure of pregnant women to harmful environmental embryotoxic factors.
- MeSH
- analýza malých oblastí MeSH
- charakteristiky bydlení MeSH
- hustota populace MeSH
- incidence MeSH
- lidé MeSH
- novorozenec MeSH
- porodnost MeSH
- rozštěp patra epidemiologie etiologie MeSH
- rozštěp rtu epidemiologie etiologie MeSH
- těhotenství MeSH
- vystavení vlivu životního prostředí škodlivé účinky MeSH
- zpožděný efekt prenatální expozice MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
Disease registries will often contain the addresses of cases included in the registry. If the registry includes information on all cases, or deaths, occurring in a defined geographical area and time period and if there is a postcode/zip code or map reference for each case it is possible to carry out a variety of different types of geographical analysis that may give clues to the aetiology of the disease. For such analyses it will usually also be necessary to have population data for the region covered by the registry and for separate sub-regions within it. In this paper we review types of analysis that may be applied to such data and give references to examples of applications and the statistical methods used. These include, first, methods of presenting incidence rates, and particularly the use of maps; of particular concern is the development of methods for presenting data that take into account the problems of rates calculated for small populations and which may therefore happen to be high or low simply by chance. Secondly, we consider, the analysis of "clustering" and "clusters" of cases of disease. These problems have been the subject of considerable methodological development in recent years. Analyses of clustering address the question of whether there is a general tendency for there to be aggregations of cases or areas of high incidence the analysis of clusters is concerned with problems of detecting specific locations where there are unusual aggregations of cases. The third type of problem considered here is whether there are, within the registry region, aetiological factors that vary geographically with consequent variations in disease incidence in different sub-regions. Where there is geographical variation it may be possible to use regression analysis to relate such variation to factors such as socio-economic status or levels of some environmental hazard. Finally we consider the problem of determining whether disease rates in certain areas may be related to distance from the source of some potential causative agent.
The primary objective of the SAVIAH, a multi-centre study funded by European Union, was to assess new methodology for study of small area health statistics and to implement it in epidemiological health statistics and geography. In Prague, the study has been conducted in two city districts with large variation in air pollution. Data at individual level (health symptoms and socio-economic circumstances of the family) were collected by questionnaires completed by parents of 3680 children aged 7-10 both resident and attending schools within the area (response rate 88%). Aggregated data for geographical areas were available from census and urban planning sources for 692 enumeration districts in the study area which were aggregated into 75 medium sized areas. Outdoor concentrations of nitrogen dioxide (NO2) were monitored by passive samplers. All these data were integrated into a geographic information system (GIS). Spatial distribution of air pollution was estimated by kriging and multiple regression modelling. These models explained about 80% of the variation in air pollution measured by passive samplers. GIS was then used to assign to individuals an exposure based on place of residence and school in order to conduct individual based analyses. Association between NO2 and life-time prevalence of wheezing and/or whistling, and wheezing/whistling in the last 12 months was studied by logistic regression. For both outcomes, school levels of NO2 were positively related to symptoms but home levels of NO2 showed a negative association. Logistic regression at individual level gives similar results as ecological analysis and multilevel modelling. Hierarchical model yielded somewhat wider confidence limits. Adjustment for parental behavioural and socio-economic factors did not affect these estimates substantially. This study demonstrated the power of the GIS methodology in studying the effects of complex environmental factors on respiratory health of children.
- MeSH
- analýza malých oblastí * MeSH
- dítě MeSH
- informační systémy * MeSH
- lidé MeSH
- logistické modely MeSH
- metoda nejmenších čtverců MeSH
- nemoci dýchací soustavy epidemiologie MeSH
- odds ratio MeSH
- oxid dusičitý škodlivé účinky analýza MeSH
- prevalence MeSH
- rizikové faktory MeSH
- socioekonomické faktory MeSH
- výfukové emise vozidel škodlivé účinky MeSH
- znečištění ovzduší škodlivé účinky analýza MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
- Názvy látek
- oxid dusičitý MeSH
- výfukové emise vozidel MeSH
