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المؤلفون: Maria Lindéus, Ali Kiadaliri, Aleksandra Turkiewicz, Martin Englund
المصدر: Arthritis Care & Research. 74:1704-1712
مصطلحات موضوعية: Sweden, medicine.medical_specialty, education.field_of_study, Proportional hazards model, business.industry, Public health, Relative index of inequality, Population, Cause specific mortality, Osteoarthritis, Middle Aged, medicine.disease, Socioeconomic Factors, Rheumatology, Cause of Death, Cohort, medicine, Educational Status, Humans, education, business, All cause mortality, Demography
الوصف: To assess the association between education and all-cause and cause-specific mortality among patients with osteoarthritis (OA) in comparison to an OA-free reference cohort.Using data from the Skåne Healthcare Register, we identified all residents age ≥45 years in the region of Skåne in southern Sweden with doctor-diagnosed OA of peripheral joints between 1998 and 2013 (n = 123,993). We created an age- and sex-matched reference cohort without OA diagnosis (n = 121,318). Subjects were followed until death, relocation outside Skåne, or the end of 2014. The relative index of inequality (RII) and the slope index of inequality (SII) were estimated by the Cox model and Aalen's additive hazard model, respectively.We found an inverse association between education and mortality. The magnitude of relative inequalities in all-cause mortality were comparable in the OA, with an RII of 1.53 (95% confidence interval [95% CI] 1.46, 1.61), and reference cohorts (RII 1.54 [95% CI 1.47, 1.62]). The absolute inequalities were smaller in the OA cohort (all-cause deaths per 100,000 person-years, SII 937 [95% CI 811, 1,063]) compared with the reference cohort (SII 1,265 [95% CI 1,109, 1,421]). Cardiovascular mortality contributed more to the absolute inequalities in the OA cohort than in the reference cohort (60.1% versus 48.1%) while the opposite was observed for cancer mortality (8.5% versus 22.3%).We found higher all-cause and cause-specific mortality in OA patients with lower education. The observed inequalities in the OA cohort reflect the inequalities in the population at large. The greater burden of cardiovascular diseases in OA patients suggests that proper management of cardiovascular risk factors in OA patients is important.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a105d442fd878bc9eafd4dd6014419a7Test
https://doi.org/10.1002/acr.24613Test -
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المؤلفون: Simone Battista, Ali Kiadaliri, Martin Englund, Thérése Jönsson, Kristin Gustafsson, Marco Testa, Andrea Dell'Isola
المصدر: Rheumatology. 62
مصطلحات موضوعية: Rheumatology, Pharmacology (medical)
الوصف: Background/Aims Osteoarthritis (OA) management programmes have been lately developed to tackle the osteoarthritis burden. Though beneficial, OA management programmes can be less effective on people in lower socioeconomic positions and widen the possible pre-existing inequalities gap (‘intervention-generated inequalities’). In Sweden, an OA management programme was implemented in the national healthcare system, including exercise and education. Its results are recorded in the ‘Better Management of People with Osteoarthritis’ (BOA) register, one of the most extensive OA datasets worldwide. Hence, this study investigated the influence of this Swedish osteoarthritis management programme on income-related inequality. Methods A register-based study with data from the BOA register. We calculated Erreygers’ and Wagstaff’s concentration indices and how they changed throughout time. We considered the variables ‘Pain intensity’, ‘Self-efficacy‘, ‘Use of NSAIDs’ and ‘Desire for surgery’ at three-time points (baseline, after three and twelve months from the beginning of the programme). Concentration indices’ values range from -1 to + 1. Zero indicates no income inequality. A positive (or negative) sign indicates an unequal concentration of the variables of interest among those with higher (or lower) income. We used bootstrapping (1000 replications) to compute 95% confidence intervals for changes in the concentration indices from baseline. Results A total of 115,403 people with knee and hip OA were identified. ‘Pain intensity’ and ‘Desire for surgery’ were disproportionately concentrated among those with lower income at the baseline, while the opposite happened for ‘Use of NSAIDs’ and ‘Self-efficacy’ (Table 1). Income inequalities for ‘Pain intensity’, ‘Self-efficacy’ and ‘Desire for surgery’ widened following the programme, though their magnitude was small. Conversely, income-related inequality in the ‘Use of NSAIDs’ narrowed after attending the programme. Conclusion Considering the concentration indices’ values, people with lower income were already experiencing higher levels of pain and desire for surgery and lower levels of self-efficacy than their higher counterparts. This trend got even worse after attending the abovementioned programme. Instead, people with higher income were keener on using NSAIDs but attending this programme narrowed this gap. These results highlighted ‘intervention-generated inequalities’ in the BOA data. OA management programmes should be structured to reduce inequalities among people with different incomes. Disclosure S. Battista: None. A. Kiadaliri: None. M. Englund: None. T. Jönsson: None. K. Gustafsson: None. M. Testa: None. A. Dell'Isola: None.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::29d4578054b4cac132a1ac4799738161Test
https://doi.org/10.1093/rheumatology/kead104.084Test -
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المصدر: BMC Musculoskeletal Disorders. 24
مصطلحات موضوعية: Rheumatology, Orthopedics and Sports Medicine
الوصف: Objective To investigate the trajectories of work and activity impairments among people participating in a digital self-management program for osteoarthritis (OA). Methods We conducted an observational longitudinal study using data for baseline, 3, 6, 9 and 12 months follow ups from people participating in a digital OA treatment between June 2018 and September 2021. The Work Productivity and Activity Impairment–Osteoarthritis (WPAI–OA) questionnaire was used to measure work and activity impairments. We applied linear mixed models and group-based trajectory modelling (GBTM) to assess the trajectories of work and activity impairments and their variability. Dominance analysis was performed to explore the relative importance of baseline characteristics in predicting the trajectory subgroup membership. Results A total of 14,676 participants with mean (± standard deviation) age 64.0 (± 9.1) years and 75.5% females were included. The adjusted mean improvements in work impairment from baseline were 5.8% (95% CI 5.3, 6.4) to 6.1% (95% CI 5.5, 6.8). The corresponding figures for activity impairment were 9.4% (95% CI 9.0, 9.7) to 11.3% (95% CI 10.8, 11.8). GBTM identified five (low baseline–declining, moderate baseline–declining, high baseline–declining, very high baseline–substantially declining, and very high baseline–persistent) and three (low baseline–declining, mild baseline–declining, high baseline–declining) subgroups with distinct trajectories of activity and work impairments. Dominance analysis showed that baseline pain was the most important predictor of membership in trajectory subgroups. Conclusion While participation in a digital self-management program for OA was, on average, associated with improvements in work and activity impairments, there were substantial variations among the participants. Baseline pain may provide useful insights to predict trajectories of work and activity impairments.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::90d2b6537b0eafb7f643ae56fb1c21d4Test
https://doi.org/10.1186/s12891-023-06322-zTest -
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المؤلفون: George Peat, Ali Kiadaliri, Dahai Yu
المصدر: Rheumatology.
مصطلحات موضوعية: Rheumatology, Pharmacology (medical)
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::cfa797e4d4d8cbc42df26d25edf70c1aTest
https://doi.org/10.1093/rheumatology/kead080Test -
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المصدر: Journal of Orthopaedic Surgery and Research. 18
مصطلحات موضوعية: Orthopedics and Sports Medicine, Surgery
الوصف: Objective Treatment adherence is suggested to be associated with greater improvement in patient outcomes. Despite the growing use of digital therapeutics in osteoarthritis management, there is limited evidence of person-level factors influencing adherence to these interventions in real-world settings. We aimed to determine the relative importance of factors influencing adherence to a digital self-management intervention for hip/knee osteoarthritis. Methods We obtained data from people participating in a digital OA treatment, known as Joint Academy, between January 2019 and September 2021. We collected data on the participants’ adherence, defined as the percentage of completed activities (exercises, lessons, and quizzes), at 3 (n = 14,610)- and 12-month (n = 2682) follow-up. We used dominance and relative weight analyses to assess the relative importance of sociodemographic (age, sex, place of residence, education, year of enrolment), lifestyle (body mass index, physical activity), general health (comorbidity, overall health, activity impairment, anxiety/depression), and osteoarthritis-related (index joint, fear of moving, walking difficulties, pain, physical function, wish for surgery, Patient Acceptable Symptom State) factors, measured at baseline, in explaining variations in adherence. We used bootstrap (1000 replications) to compute 95% confidence intervals. Results Mean (SD) adherences at 3 and 12 months were 86.3% (16.1) and 84.1% (16.7), with 75.1% and 70.4% of participants reporting an adherence ≥ 80%, respectively. The predictors included in the study explained only 5.6% (95% CI 5.1, 6.6) and 8.1% (7.3, 11.6) of variations in 3- and 12-month adherences, respectively. Sociodemographic factors were the most important predictors explaining more variations than other factors altogether. Among single factors, age with a nonlinear relationship with adherence, was the most important predictor explaining 2.3% (95% CI 1.9, 2.8) and 3.7% (2.4, 5.3) of variations in 3- and 12-month adherences, respectively. Conclusion Person-level factors could only modestly explain the variations in adherence with sociodemographic characteristics, mainly age, accounting for the greatest portion of this explained variance.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::2f016b8786473aa900435fae1324308cTest
https://doi.org/10.1186/s13018-023-03562-6Test -
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المؤلفون: Ali Kiadaliri, Tuhina Neogi, Martin Englund
المصدر: The Journal of Rheumatology. 49:731-739
مصطلحات موضوعية: Cohort Studies, Hospitalization, Gout, Rheumatology, Immunology, Ambulatory Care, Humans, Immunology and Allergy, Hospitals
الوصف: Objective.To investigate the risks and trajectories of hospital admission for ambulatory care–sensitive conditions (ACSCs) in gout.Methods.Among individuals aged 35 years to 85 years residing in Skåne, Sweden, in 2005, those with no doctor-diagnosed gout during 1998 to 2005 (n = 576,659) were followed from January 1, 2006, until a hospital admission for an ACSC, death, relocation outside Skåne, or December 31, 2016. Treating a new gout diagnosis (International Classification of Diseases, 10th revision, code M10) as a time-varying exposure, we used Cox proportional and additive hazard models to estimate the effects of gout on hospital admissions for ACSCs. We investigated the trajectory of hospital admissions for ACSCs from 3 years before to 3 years after gout diagnosis using generalized estimating equations and group-based trajectory modeling in an age-and sex-matched cohort study.Results.Gout was associated with a 41% increased rate of hospital admission for ACSCs (hazard ratio 1.41, 95% CI 1.35-1.47), corresponding to 121 (95% CI 104-138) more hospital admissions for ACSCs per 10,000 person-years compared with those without gout. Our trajectory analysis showed that higher rates of hospital admission for ACSCs among persons with gout were observed from 3 years before to 3 years after diagnosis, with the highest prevalence rate ratio (2.22, 95% CI 1.92-2.53) at the 3-month period after diagnosis. We identified 3 classes with distinct trajectories of hospital admissions for ACSCs among patients with gout: almost none (88.5%), low-rising (9.7%), and moderate-sharply rising (1.8%). The Charlson Comorbidity Index was the most important predictor of trajectory class membership.Conclusion.Increased risk of hospital admissions for ACSCs in gout highlights the need for better management of the disease through outpatient care, especially among foreign-born, older patients with comorbidities.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d59e67fadf963d7c264ff18e088b71edTest
https://doi.org/10.3899/jrheum.220038Test -
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المصدر: BMC Musculoskeletal Disorders
مصطلحات موضوعية: Rheumatology, Orthopedics and Sports Medicine
الوصف: Background Previous studies have reported an inverse association between educational attainment and different osteoarthritis (OA) outcomes. However, none of the previous studies have accounted for potential confounding by early-life environment and genetics. Thus, we aimed to examine the association between educational attainment and knee and hip OA surgery using twin data. Methods From the Swedish Twin Registry (STR), we identified dizygotic (DZ) and monozygotic (MZ) twins. All twins in the STR aged 35 to 64 years were followed from January the 1st 1987 or the date they turned 35 years until OA surgery, relocation outside Sweden, death or the end of 2016 (18,784 DZ and 8,657 MZ complete twin pairs). Associations between educational attainment and knee and hip OA surgery were estimated in models matched on twin pairs, using Weibull within-between (WB) shared frailty model. Results For knee OA surgery, the analysis matched on MZ twins yielded a within-estimate hazard ratio (HR) per 3 years of education, of 1.06 (95% CI: 0.81, 1.32), suggesting no association between the outcome and the individual´s education. Rather, there seemed to be a so called familial effect of education, with a between-pair estimate of HR = 0.71 (95% CI: 0.41, 1.01). For hip OA surgery, the within- and between-pair estimates for MZ twins were 0.92 (95% CI: 0.69, 1.14) and 1.15 (95% CI: 0.87, 1.42), respectively. Conclusions Our results suggest that the inverse associations between education and knee/hip OA surgery observed in cohort studies are potentially confounded by unobserved familial factors like genetics and/or early life exposures.
وصف الملف: application/pdf
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::deb038a1d9756f8e83b34050448b3e16Test
https://doi.org/10.1186/s12891-023-06163-wTest -
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المؤلفون: Firoozeh Bairami, Mohammad Hajizadeh, Ali Kiadaliri
المصدر: Injury Epidemiology. 10
مصطلحات موضوعية: General Medicine
الوصف: Background Injury deaths constitute a major avoidable cause of death affecting life expectancy to a different degree in men and women. This study quantified the contributions of injury deaths to the gender gap in life expectancy (GGLE) and life disparity (GGLD) in nine Eastern Mediterranean Region (EMR) countries. Methods We retrieved annual data on age-sex specific causes of death from the World Health Organization mortality database for EMR countries with at least 2-year consecutive data during 2010–2019. The injury-related deaths were categorized into five groups: transport accidents, other accidental injuries, intentional self-harm, assault and events of undetermined intent. Considering women as the reference, the GGLE and GGLD were decomposed by age and causes of death, using a continuous-change model. Results The largest and smallest GGLE were observed in Kuwait (5.2 years) and Qatar (− 1.2 years), respectively. Qatar (− 2.2 years) and Oman (0.2 years) had the highest and lowest GGLD. The highest contributions of injury deaths to the GGLE/GGLD were seen in Libya (1.8/− 1.2 years), followed by Iran (1.2/− 0.8 years). Among injury causes, transport accidents were the leading cause of GGLE in all countries but Libya and Morocco, with Iran having the greatest contributions (0.6 years). Injury deaths in men aged 15–29 years accounted for 33% [41%] (Kuwait) to 55% [65%] (Oman) of total GGLE [GGLD] attributable to injury deaths. Conclusions High injury deaths, particularly transport accidents, among young men contributed substantially to the GGLE and GGLD across nine EMR countries in this study. This highlights the need for implementing preventing policies to reduce the burden of injury deaths specifically in young men.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::3076914e460aedc7c92b45217ac0a646Test
https://doi.org/10.1186/s40621-023-00417-wTest -
9
المؤلفون: Ali Kiadaliri, Aleksandra Turkiewicz, Karin Magnusson, Fredrik Methi, Andrea Dell’Isola, Jos Runhaar, Sita Bierma-Zeinstra, Martin Englund
الوصف: Background: A wide range of response strategies have been implemented by different countries to slow the spread of the COVID-19 outbreak. While the effects of these strategies in the general population have been investigated, less is known about the effects of these strategies on those with pre-existing comorbid conditions including rheumatic and musculoskeletal diseases (RMDs). We aimed to quantify the impact of stringent lockdown restrictions in Norway compared to Sweden on COVID-19 hospitalization/death and all-cause mortality in persons with and without RMDs. Methods: Using ICD codes from register data, individuals aged ≥35 years residing in Norway and Skåne region (Sweden) on 31st December 2019 were divided into the RMD cohort (those with any diagnosis of RMDs during January 1, 2017–January 31, 2020), and the non-RMDs cohort. We obtained daily data on the outcomes for February–May, 2020 and applied difference-in-difference and event study to estimate the causal effect of lockdown. Results: Compared with Skåne, strict lockdown in Norway was, on average, associated with 18.0 (95% CI 8.6, 27.3), 2.7 (1.5, 3.9), and 2.9 (–4.0, 9.7) fewer daily COVID-19 hospitalizations, COVID-19 death, and all-cause mortality per million persons, respectively, among individuals with RMD. Corresponding reductions were 9.1 (95% CI 4.5, 13.7), 0.9 (0.4, 1.5), and 2.9 (–3.8, 9.7) among those without RMD. Event study showed that the effects on COVID-19 hospitalization and death were evident from 1-2 weeks after lockdown implementation and onward with generally greater effects in the RMDs than the non-RMDs cohort and in older than younger individuals. Conclusion: Strict lockdown was associated with reductions in COVID-19 hospitalizations and (to a lesser extent) COVID-19 death with no essential effect on all-cause mortality. Our findings confirm effect of strict lockdown in particular among those at higher risk of COVID-19 adverse outcomes such as older persons with RMDs.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::3f87558a7b3512003b251a39b6b43980Test
https://doi.org/10.21203/rs.3.rs-1584534/v1Test -
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المؤلفون: Kasim Allel, Mohammad Hajizadeh, Ali Kiadaliri
المصدر: International Journal for Equity in Health. 21
مصطلحات موضوعية: Male, Life Expectancy, Mortality, Premature, Cause of Death, Health Policy, Longevity, Public Health, Environmental and Occupational Health, Humans, Infant, Female, Iran, Mortality
الوصف: Background Healthcare system and intersectoral public health policies play a crucial role in improving population health and reducing health inequalities. This study aimed to quantify their impact, operationalized as avoidable deaths, on the gap in life expectancy (LE) and lifespan inequality (LI) between Iran and three neighbour countries viz., Turkey, Qatar, and Kuwait in 2015–2016. Methods Annual data on population and causes of deaths by age and sex for Iran and three neighbour countries were obtained from the World Health Organization mortality database for the period 2015–2016. A recently developed list by the OECD/Eurostat was used to identify avoidable causes of death (with an upper age limit of 75). The cross-country gaps in LE and LI (measured by standard deviation) were decomposed by age and cause of death using a continuous-change model. Results Iranian males and females had the second lowest and lowest LE, respectively, compared with their counterparts in the neighbour countries. On the other hand, the highest LIs in both sexes (by 2.3 to 4.5 years in males and 1.1 to 3.3 years in females) were observed in Iran. Avoidable causes contributed substantially to the LE and LI gap in both sexes with injuries and maternal/infant mortality represented the greatest contributions to the disadvantages in Iranian males and females, respectively. Conclusions Higher mortality rates in young Iranians led to a double burden of inequality –shorter LE and greater uncertainty at timing of death. Strengthening intersectoral public health policies and healthcare quality targeted at averting premature deaths, especially from injuries among younger people, can mitigate this double burden.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::204b8f4ff9ff01fc1dea50ece10defe4Test
https://doi.org/10.1186/s12939-022-01683-8Test
