European Journal of Public Health

AimTo compare trends and undertake statistical analyses of differences in public health performance (confirmed cases and fatalities) of Nordic countries; Denmark, Finland, Norway and Sweden, and New Zealand, in response to the COVID-19 pandemic. MethodsPer capita trends in total cases and per capita fatalities were analysed and difference-in-difference statistical tests undertaken to assess whether differences in stringency of mandated social distancing (SD) measures, testing rates and border closures explain cross-country differences. ResultsSweden is a statistical outlier, relative to its Nordic neighbours, for both per capita cases and per capita fatalities associated with COVID-19 but not in terms of the reduction in economic growth. Swedens public health differences, compared to its Nordic neigbours, are partially explained by differences in terms of international border closures and the level of stringency of SD measures (including testing) implemented from early March to June 2020. ConclusionsWe find that: one, early imposition of full international travel restrictions combined with high levels of government-mandated stringency of SD reduced the per capita cases and per capita fatalities associated with COVID-19 in 2020 in the selected countries and, two, in Nordic countries, less stringent government-mandated SD is not associated with higher quarterly economic growth.

A gender perspective was used to analyze how socio-economic status and per capita public health expenditure are associated to perceived health among the Spanish population between the years 2014 and 2017. Using multilevel methodologies (looking at year, individual, and region) and linear specification, the longitudinal microdata files from the Survey on Living Conditions were analyzed. The results point at low educational levels being a factor for worse perceived health among women, while for the same group income appears to have a protective influence. On the other hand, women are not negatively affected by unemployment, unlike men. Regional per capita public health expenditure is not associated with perceived health in either men nor women.

BackgroundEpidemiological studies of COVID-19 with population based information may add to the knowledge needed to prioritise resources and advice on how restrictive measures should be targeted. This study provides admission rates to hospitals and intensive care units (ICU) in Norway, aiming to better understand the risk of severe COVID-19 infection. MethodsData from official reports from The Norwegian Institute of Public Health (NIPH) and the Norwegian Directorate of Health were used to calculate admission rates to hospitals and to ICU per 100 000 inhabitants. We compared rates of hospitalisation between the four health regions and provide separate rates for Oslo. We also assessed national admissions to ICU stratified by age. ResultsThe admission rate in the south-eastern region was 3.1 per 100 000, and the rate for Oslo was 5.8. Compared to the western region (reference), the Oslo rate was 4.0 times (confidence interval (CI) 3.0-5.5) higher. In Norway as a whole, the rate of ICU admissions was 3.9 per 100 000, and in the age groups 60-69 and 70-79, ICU rates were 10.3 and 11.5, respectively. These rates were 9.5 (CI 6.3-14.3) and 10.6 (CI 6.9-16.2) times higher compared to people younger than 50 years. ConclusionHospital admissions due to Covid-19 are much higher in Oslo than anywhere else in Norway, and in the country as a whole, ICU admissions are highest among people 60-79 years of age. These results and more detailed data could provide better advice on how restrictions can be safely lessened.

BackgroundHyperthyroidism during pregnancy is associated with maternal, obstetrical and fetal complications. Antithyroid drugs (ATD) including carbimazole (CMZ), methimazole (MMI) and propylthiouracil (PTU) are the main pharmacotherapy for hyperthyroidism. Exposure to CMZ and MMI during the first trimester was associated with birth defects, while PTU is assumed to be the safer alternative. ObjectiveTo calculate the prescription prevalences of ATD in women of childbearing age over time and to describe pregnancies occurring after or during ATD use. MethodsUsing the GePaRD database (claims data; 20% of the German population), we conducted year-wise cross-sectional studies for the period 2004-2020 to calculate prescription prevalences of CMZ, MMI and PTU in females aged 13-49 years. In longitudinal analyses, we included all women with any ATD dispensing between 2005 and 2020 aged 13- 49 years at the first dispensing. We identified pregnancies occurring in this cohort and described ATD use before and during pregnancy. ResultsThe age-standardized prescription prevalence of ATDs decreased by 32.1% between 2004 (2.71 per 1,000) and 2020 (1.84 per 1,000). This decrease was attributable to CMZ (2004: 1.40 per 1,000; 2020: 0.76 per 1,000; relative decrease: 45.7%) and MMI (2004: 1.25 per 1,000; 2020: 0.99 per 1,000; relative decrease: 20.8%). In the cohort including 9,723 women, 13,586 pregnancies were observed, of which 67% (n=9,140) occurred after ATD use. In 16.2% of the pregnancies (n=2,203), ATD use overlapped with pregnancy onset. The proportion exposed to CMZ/MMI at pregnancy onset decreased from 30.7% in 2005 to 10.9% in 2020. In 16.5% of pregnancies (n=2,243), ATD use was started during pregnancy. ConclusionThe prescription prevalence of ATD overall and specifically of CMZ/MMI in girls and women of childbearing age decreased between 2005 and 2020 in Germany. The decrease in exposure to CMZ/MMI at pregnancy onset indicate that physicians became increasingly aware of the potential risks of CMZ/MMI to the unborn child.

BackgroundDespite a well-funded healthcare system with universal insurance coverage, Switzerland has one of the highest neonatal and infant mortality rates among high-income countries. Identifying avoidable risk factors targeted by evidence-based policies is a public health priority. We describe neonatal and infant mortality in Switzerland from 2011-2018 and explore associations with neonatal and pregnancy-related variables, parental sociodemographic information, regional factors, and socioeconomic position (SEP) using data from a long-term nation-wide cohort study. MethodsWe included 680,077 live births--representing 99.3% of all infants born in Switzerland between January 2011 and December 2018. We deterministically linked the national live birth register with the mortality register and with census and survey data to create a longitudinal dataset of neonatal and pregnancy-related variables; parental sociodemographic information, such as civil status, age, religion, education, nationality; regional factors, such as urbanity, language region; and the Swiss neighbourhood index of SEP (Swiss-SEP index). Information on maternal education was available for a random subset of 242,949 infants. We investigated associations with neonatal and infant mortality by fitting multivariable Poisson regression models with robust standard errors. Several sensitivity analyses assessed the robustness of our findings. ResultsOverall, neonatal mortality rates between 2011 and 2018 were 3.0 per 1000 live births, varying regionally from 3.2 in German-speaking to 2.4 in French-speaking and 2.1 in Italian-speaking Switzerland. For infant mortality, respective rates were 3.7 per 1000 live births overall, varying from 3.9 to 3.3 and 2.9. Adjusting for sex, maternal age, multiple birth and birth rank, neonatal mortality remained significantly associated with language region [rate ratio (RR) 0.72, 95% confidence interval (CI): 0.64-0.80 for French-speaking and RR 0.66, 95% CI: 0.51-0.87 for Italian-speaking region], with marital status (RR 1.55, 95% CI: 1.40-1.71 for unmarried), nationality (RR 1.40, 95% CI: 1.21-1.62 for non-European Economic Area vs. Swiss), and the Swiss-SEP index (RR 1.17, 95% CI: 1.00-1.36 for lowest vs. highest SEP quintile). In the subset, we showed a possible association of neonatal mortality with maternal education (RR 1.24, 95% CI: 0.95-1.61 for compulsory vs tertiary education). ConclusionWe provide detailed evidence about the social patterning of neonatal and infant mortality in Switzerland and reveal important regional differences with about 30% lower risks in French-and Italian-speaking compared with German-speaking regions. Underlying causes for such regional differences, such as cultural, lifestyle, or healthcare-related factors, warrant further exploration to inform and provide an evidence base for public health policies.

BackgroundDespite universal health care, socioeconomic differences in health care utilization (HCU) persist in modern welfare states. The aim of this study is to assess income-based differences in utilization of primary- and specialized care in relation to mortality for the Swedish general population (>15 years old) between 2004 and 2017. Methods and FindingsUsing a repeated cross-sectional register-based study design, data on utilization of i) primary-ii) specialized outpatient- and iii) inpatient care, as well as iv) cause of death, were linked to family income and sociodemographic control variables. HCU and mortality for all-disease as well as for the five disease groups causing most deaths were compared for the lowest (Q1) and highest (Q5) income quintile using logistic regression. We also analysed income-related differences in the number of health care encounters [≤]5 years prior to death. In 2017, for all diseases combined, Q1 utilized marginally more primary- and specialized outpatient care than Q5 (adjusted odds ratio [OR] =1.07, 95% CI: 1.07, 1.08; OR 1.04, 95% CI: 1.04, 1.05, respectively), and considerably more inpatient care (OR=1.44, 95% CI: 1.43, 1.45). The largest relative inequality was observed for mortality (OR 1.78, 95% CI: 1.74, 1.82). This pattern was broadly reproduced for each of the five diseases. Time trends in HCU inequality varied by level of care. Each year, Q1 (vs. Q5) used more inpatient care and suffered increasing mortality rates. However, usage of primary- and specialized outpatient care increased more among Q5 than in Q1. Finally, Q1 and Q5 had similar number of encounters in primary- and inpatient care [≤]5 years prior to death, but Q1 had significantly fewer outpatient encounters. ConclusionsIncome-related differences in the utilization of primary and specialized outpatient care were considerably smaller than for mortality, and this discrepancy widened with time. Facilitating motivated use of primary- and outpatient care among low-income groups could help mitigate the growing health inequalities.

OO_SCPLOWBJECTIVESC_SCPLOWAssess the impact of the illness designated COVID-19 during the first year of pandemic outbreak in Spain through age/sex-specific death rates. SO_SCPLOWTUDYC_SCPLOWO_SCPCAP C_SCPCAPO_SCPLOWDESIGNC_SCPLOWAge/sex-specific weeekly deaths in Spain were retrieved from Eurostat. Spanish resident population was obtained from the National Statistics Office. MO_SCPLOWETHODSC_SCPLOWGeneralized linear Poisson regressions were used to compute the contrafactual expected rates after one year (52 weeks or 364 days) of the pandemic onset. From this one-year age/sex-specific and age/sex-adjusted mortality excess rates were deduced. RO_SCPLOWESULTSC_SCPLOWFor the past continued 13 years one-year age/sex-adjusted death rates had not been as high as the rate observed on February 28th, 2021. The excess death rate was estimated as 1.790x10-3 (95 % confidence interval, 1.773x10-3 to 1.808x10-3; P-score = 20.2 % and z-score = 11.4) with an unbiased standard deviation of the residuals equal to 157x10-6. This made 84 849 excess deaths (84 008 to 85 690). Sex disaggregation resulted in 44 887 (44 470 to 45 303) male excess deaths and 39 947 (39 524 to 40 371) female excess deaths. CO_SCPLOWONCLUSIONC_SCPLOWWith 73 571 COVID-19 deaths and 9772 COVID-19 suspected deaths that occurred in nursing homes during the spring of 2020 it is only 1496 excess deaths (1.8 %, a z-score of 0.2) that remains unattributed. The infection rate during the first year of the pandemic is estimated in 16 % of population after comparing the ENE-COVID seroprevalence, the excess deaths at the end of the spring 2020 and the excess deaths at the end of the first year of the pandemic.

ObjectivesNon-communicable diseases (NCDs) account for almost 90% of deaths in Europe, yet comparative estimates of the productivity costs associated with premature NCD mortality across diseases and countries remain limited. This study estimates and compares productivity losses attributable to cardiovascular disease (CVD) and cancer mortality among working-age populations across Europe. Population-based data were used to estimate productivity costs for CVD and cancer deaths across 30 European countries. Sex- and age-specific mortality data for 2021 were obtained from the World Health Organization Mortality Database. Economic data, including wages, unemployment rates, and labour force participation rates, were sourced from Eurostat. Productivity losses were valued using a human capital approach incorporating an age-transition lifecycle simulation model that adjusts for lifetime wage trajectories and labour market dynamics. Costs were discounted at 3.5%. Total productivity losses from cancer and CVD mortality in working-age populations were estimated at {euro}195.7 billion, equivalent to 1.24% of European GDP. Cancer accounted for 62.5% ({euro}122.2 billion) of total productivity losses, while CVD accounted for 37.5% ({euro}73.5 billion). Total CVD-related productivity costs exceeded cancer-related costs in Central and Eastern Europe, whereas cancer productivity costs were higher in Western, Northern, and Southern Europe. Mean productivity costs per death were higher for CVD ({euro}219,848; 95% CI 165,241-270,247) than for cancer ({euro}217,744; 95% CI 166,554-273,144). A larger gender gap was observed for CVD mortality, with a male-to-female cost ratio of 2.5 compared with 1.6 for cancer. Productivity losses associated with premature cancer and CVD mortality represent a substantial economic burden across Europe, with pronounced variation by disease, region, and sex. These findings provide comparative, cross-country estimates of the human capital costs associated with major NCD causes of death.

Using data from the Growing Up in Ireland Covid survey, this study examines the evolution of mental health as measured in December 2020, nine months into the pandemic, compared to observations pre pandemic for two cohorts of people. A deterioration in mental health was observed for both cohorts and particularly for younger women of the 1998 cohort. The increase in the rate of depression predominantly occurred due to an overall decline in mental health rather than being concentrated amongst those already vulnerable (in the sense of being near the depression threshold). There was little, if any, change in the socioeconomic gradient associated with mental health and virtually no gradient at all was observed pre or post pandemic for the 1998 cohort. Mobility analysis revealed that not only did females from the 1998 cohort show greater transitions into depression, they also appeared to transition into more extreme levels of depression. JEL CodesI14, I31. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. AbstractO_ST_ABSBackgroundC_ST_ABSThe Covid pandemic arrived in Ireland on February 29, 2020. In the following weeks various restrictions were introduced to stem the spread of the disease. Anxiety over the spread of the disease and over the restrictions introduced had an adverse effect upon mental health. This study examines the change in mental health for two groups: young adults aged around 23 at the time of onset of Covid (the 1998 cohort) and a sample of principal carers (PCs) of children who were aged 13 at the onset of Covid (the 2008 cohort). MethodsData were obtained from the two cohorts of the longitudinal Growing Up In Ireland (GUI) survey. The sample included 1953 young adults (from the 1998 cohort) and 3547 principal carers (from the 2008 cohort). Mental health as measured by the Centre for Epidemiological Studies Depression - 8 scale was obtained for the last pre-Covid wave and for the Covid wave (surveyed in December 2020). Observations for which CES-D8 was not available in either pre or post Covid waves were excluded. Post-Covid sampling weights were applied. ResultsRelative to the last pre-Covid survey, mental health, as measured by CES-D8 deteriorated for both the young adults of the 1998 cohort and the PCs of the 2008 cohort. For young adults, the deterioration was more pronounced for females. There was no observable socioeconomic gradient for poor mental health amongst young adults, both pre and post Covid. For mothers from the 2008 cohort, a gradient was observed pre-Covid with poorer mental health for lower-income, less well-educated mothers. This gradient was less pronounced post-Covid, the levelling-off arising from a greater deterioration in mental health for higher-income and better-educated PCs. ConclusionBoth observed cohorts showed a significant deterioration in mental health post Covid. For young adults the effect was more pronounced among females.

ObjectivesTo investigate the relationship between voting patterns, mortality, health, and disability across England, replicating and extending a BMJ study from 1996. DesignObservational study using data from the Office of National Statistics and the House of Commons Library, mapped to electoral constituencies. SettingEngland, UK. ParticipantsThe mortality, health and disability data come from the English population across multiple publicly available datasets and are cross tabulated against information on voting in the 2019 and 2024 UK General Election in constituencies in England. Main Outcome MeasuresAge-standardised mortality rate (ASMR) for 2021, as well as Health and Disability metrics from the UK Census of 2021. ResultsWhen observing the proportion of vote-share for Labour at the constituency level in both elections, there was a strong, positive correlation with ASMR. In the 2019 election, this was r=0.708 for males, and r=0.653 for females. For the 2024 election, this was r=0.540 for males, and r=0.539 for females. There are also correlations between Labour vote shares and measures of health, but far less substantially for measures of disability. The strongest correlations were almost unilaterally observed against the proportion of votes cast in a constituency. A marked deviation was in the 2019 election where there was also a small, but positive correlation with voting Conservative and poor health (r=0.035) and disability (r=0.081), but not for ASMR (r=-0.489 for females, r=-0545 for males). Strong, positive correlations were also observed between all covariates and vote share for the Brexit Party (2019) and Reform UK (2024). ConclusionsHealth and mortality inequalities across England remain high, with trends largely following previous political patterning. People needing to rely on state provisions likely vote for the political party they believe will be best placed to solve health and structural issues.

Several studies based on the Synthetic Control Method (SCM) link the many COVID-19 deaths in Sweden during the spring of 2020 to its decision not to lock down. These studies predominantly rely on a limited pre-intervention period and tend to focus on the very short run neglecting that Swedish health authorities emphasized that their public health strategy was designed for the long run. This paper handles these shortcomings expanding both the pre- and post-intervention period considerably using weekly mortality rates. I find no significant effect of the absence of lockdown on COVID-19 mortality neither in the short or long run. Using the timing of the winter holiday as a proxy for the extent/spread of COVID-19 in societies before lockdown - a variable which is unobservable due to limited testing - I suggest that the effect of lockdowns found in earlier studies using Sweden as a control are likely to be partially driven by unobserved variables rather than policies.

BackgroundThe UK 2024 general election manifestos publicly set out the political parties priorities for the eventuality that they are voted into government. We determined to evaluate whether already agreed, evidenced and promoted issues affecting womens health in the UK had been included in the major parties manifestos. MethodsWe curated a longlist of priorities and recommendations drawn from major womens health reports, white papers, national inquiries and health strategies published in the UK over the last 10 years which are publicly available and invited our public contributors to suggest additional topics. We selected the shortlist of womens health-related priorities - our top 15 asks -using a Delphi process. We then devised a scoring system whereby manifestos were marked against the 15 priorities with a maximum of 2 points for each priority. We tested inter-rater reliability on the 2019 Manifesto. ResultsOverall, the limited inclusion of prominent issues for womens health in party manifestos was disappointing across the board. There was little difference between most major parties coverage of womens health in their manifestos. All were limited. Most parties addressed two issues well: childcare and women returning to work after pregnancy; and violence against women and girls and the prosecution of perpetrators. Several other issues, including assurance that all policy is built in consultation with women; decriminalisation and access to abortion; and womens health hubs for reproductive, menopause and lifelong health, were considered by none or only one of the major parties. DiscussionWomens health remains a fringe issue in UK politics, despite the efforts of patients, advocates and healthcare professionals to highlight the suffering that many women live with every day, and at particularly vulnerable and high risk periods of their life such as in pregnancy and the postpartum. Our analysis highlights the importance of developing previous efforts in womens health to strengthen existing infrastructure, collaboration and innovation. The next government should build on the work in progress, such as delivering the Womens Health Strategy (2022) rather than starting afresh.

BackgroundCoronavirus disease 2019 (COVID-19) is an international emergency that has been addressed in many countries by changes in and restrictions on behaviour. These are often collectively labelled social distancing and lockdown. On the 23rd June 2020, Boris Johnson, the Prime Minister of the United Kingdom announced substantial easings of restrictions. This paper examines some of the data he presented. MethodsGeneralised additive models, with negative binomial errors and cyclic term representing day-of-week effects, were fitted to data on the daily numbers of new confirmed cases of COVID-19. Exponential rates for the epidemic were estimated for different periods, and then used to calculate R, the reproduction number, for the disease in different periods. ResultsAfter an initial stabilisation, the lockdown reduced R to around 0.81 (95% CI: 0.79, 0.82). This value increased to around 0.94 (95% CI 0.89, 0.996) for the fortnight from the 9th June 2020. ConclusionsOfficial UK data, presented as the easing of the lockdown was announced, shows that R was already more than half way back to 1 at that point. That suggests there was little scope for the announced changes to be implemented without restarting the spread of the disease.

BackgroundInternational sharing of cohort data for research is important and challenging. The LifeCycle project aimed to harmonise data across birth cohorts and develop methods for efficient federated analyses of early life stressors on offspring outcomes. AimTo explore feasibility of federated analyses of associations between four different types of pregnancy exposures (maternal education, area deprivation, proximity to green space and gestational diabetes) with offspring BMI from infancy to 17 years. MethodsWe used harmonised exposure and outcome data from 17 cohorts (n=200,650 mother-child pairs) from the EU Child Cohort Network. For each child, we derived BMI at five age periods: (i) 0-1 years, (ii) 2-3, (iii) 4-7, (iv) 8-13 and (v) 14-17 years. Associations were estimated using linear regression via one-stage individual participant data meta-analysis using the federated analysis platform DataSHIELD. ResultsAssociations between lower maternal education and higher child BMI emerged from age 4 years and increased with age (difference in BMI z-score comparing low with high education age 0-1 years = 0.02 [95% CI 0.00, 0.03], 2-3 years = 0.01 [CI -0.02, 0.04], 4-7 years = 0.14 [CI 0.13, 0.16], 8-13 years = 0.22 [CI 0.20, 0.24], 14-17 years = 0.20 [CI 0.16, 0.23]). A similar pattern was found for area deprivation. Gestational diabetes was positively associated with BMI from 8 years (8-13 years = 0.17 [CI 0.10, 0.24], 14-17 years = 0.012 [CI -0.13, 0.38]) but not at younger ages. The normalised difference vegetation index measure of maternal proximity to green space was weakly associated with higher BMI in the first year of life but not at older ages. ConclusionsAssociations between maternal education, area-based socioeconomic position and GDM with BMI increased with age. Maternal proximity to green space was not associated with offspring BMI, other than a weak association in infancy. Opportunities and challenges of cross-cohort federated analyses are discussed.

BackgroundThe mechanisms that influence the uptake of risky behaviours among immigrants are influenced by the interrelation between characteristics operating in different phases of their migratory experience. Characterizing their behavioural risk profile is needed to prioritize actions for prevention and health services organization. We therefore analysed health behaviours and their determinants among immigrants in Italy, jointly accounting for sociodemographic factors, migration pathways and integration indicators. MethodsData come from a national survey conducted in 2011-2012 on a sample of about 12000 households with at least one foreigner residing in Italy. The independent impact of a variety of sociodemographic, migratory and integration characteristics on obesity, smoking and daily alcohol consumption was assessed using multivariable Poisson models. ResultsThe survey involved more than 15,000 first generation immigrants. Unhealthy lifestyles are more common among men than among women and vary widely by ethnic group. There is a significant impact of employment status and family composition, while the educational level loses importance. Longer duration of residence and younger age at arrival are associated with an increased behavioural risk. Among women we also observed an independent impact of the integration indicators, less important for men. ConclusionsThe profile of the main unhealthy lifestyles among migrants is shaped by cultural, socioeconomic and migratory characteristics, which differ by gender. Understanding these factors can help to design tailored preventive messages, necessary to interrupt the deterioration of migrants health capital. Low levels of integration have an additional negative impact on health, so inclusion and integration policies should complement health promotion strategies.

INTRODUCTIONThe COVID-19 pandemic is an ongoing event disrupting lives, health systems, and economies worldwide. Clear data about the pandemics impact is lacking, namely regarding mortality. This work aims to study the impact of COVID-19 through the analysis of all-cause mortality data made available by different European countries, and to critique their mortality surveillance data. METHODSEuropean countries that had publicly available data about the number of deaths per day/week were selected (England and Wales, France, Italy, Netherlands and Portugal). Two different methods were selected to estimate the excess mortality due to COVID19: (DEV) deviation from the expected value from homologue periods, and (RSTS) remainder after seasonal time series decomposition. We estimate total, age- and gender-specific excess mortality. Furthermore, we compare different policy responses to COVID-19. RESULTSExcess mortality was found in all 5 countries, ranging from 10.6% in Portugal (DEV) to 98.5% in Italy (DEV). Furthermore, excess mortality is higher than COVID-attributed deaths in all 5 countries. DISCUSSIONThe impact of COVID-19 on mortality appears to be larger than officially attributed deaths, in varying degrees in different countries. Comparisons between countries would be useful, but large disparities in mortality surveillance data could not be overcome. Unreliable data, and even a lack of cause-specific mortality data undermine the understanding of the impact of policy choices on both direct and indirect deaths during COVID-19. European countries should invest more on mortality surveillance systems to improve the publicly available data.

BackgroundWe evaluated the impact on health care professionals workload and the long-term cost-effectiveness of a novel metabolomic risk score (MRS)-based health check compared with current practices in Finlands working-age population. MethodsA de novo individual-level microsimulation model was developed to estimate changes in labour time and cost-effectiveness of MRS-based health checks in detecting individuals at risk of cardiometabolic diseases (cardiovascular diseases; CVD or type 2 diabetes; T2D). The model used synthetic data on 256,372 Finnish individuals aged 50- 54 years without prior CVD or T2D. From a societal perspective, we assessed three scenarios: 1) replacing the standard health check with MRS-based health check, 2) replacing standard health check with MRS-based plus enhanced prevention, and 3) comparing enhanced standard check with MRS-based plus enhanced prevention. Outcomes included time required to identify at-risk individuals, incremental cost-effectiveness ratio per QALY gained, and cost-effectiveness acceptability curves. ResultsMRS-based health checks significantly reduced workload, saving 194,004 hours and 2902 hours for nurses and physicians over five years, respectively. The MRS-based approach was cost-saving across all scenarios, leading to discounted long-term savings ranging from {euro}26 million to {euro}298 million over the study period. In scenarios 1-2, it also improved QALYs, resulting in discounted gains ranging from 2017 to 8550 QALYs. In scenario 3, no QALY gains were observed, and minor losses occurred due to differences in baseline risk stratification. ConclusionsMRS-based health checks in primary and occupational care can reduce workload and are a cost-saving strategy with health outcome benefits for identifying individuals at risk for cardiometabolic diseases. FundingThis work was supported by Nightingale Health Plc.

BackgroundPrevious studies highlighted the relationships between socioeconomic inequalities and the populations risk to become disease or die during COVID-19 epidemic. In France, socioeconomic inequalities vary across metropolitan areas, but little is known if that could explain the spatial disparities observed in terms of incidence and testing rates. We assessed the impact of socioeconomic inequalities on testing and incidence rates of COVID-19 for each metropolitan area and wave. MethodsFor each of the 22 metropolitan areas, we relied on socioeconomic variables from census data to define socioeconomic profiles using classification on the principal components. We analysed associations between socioeconomic profiles, testing and incidence rates by epidemic wave from July-2020 to March-2023, using spatialised generalised additive mixed models. We performed meta-regressions to study the distribution of testing and incidence rate ratios (socially deprived vs privileged) across metropolitan areas, according to vaccination rates. ResultsSocially deprived metropolitan areas had lower testing rates than privileged, but during wave 4 (July-October-2021, extended health pass), testing rates increased in more deprived areas. Incidence rates were higher in deprived areas (waves 2-4, July-2020 to October-2021) but reversed between waves 6 to 9 (March-2022 to March-2023). Meta-regression analysis indicated that high vaccination coverage narrowed testing and incidence gaps between deprived and privileged. ConclusionsThe impact of social inequalities on the populations testing and incidence COVID-19 epidemic was driven by socioeconomic inequalities across metropolitan areas and varied across epidemic waves. Vaccination rates and the presence of health measures (lockdowns, health pass) seem to help reduce these disparities.

BackgroundKnowledge of the distribution, prevalence, and clustering of multiple health and lifestyle related behaviours (HLBs) among adolescents can inform the development of more effective health-promoting policies and interventions. We therefore assessed the clustering of multiple HLBs among 11, 13 and 15-year-old Swedish adolescents and examined the socioeconomic and demographic correlates of each cluster. MethodsWe used data from the 2017/2018 Swedish Health Behaviour in School-aged Children (HBSC) study to conduct sex and age-stratified latent class analysis (LCA). The LCA was based on five HLBs: eating behaviour and habits (EBH), physical activity (PA), tobacco usage (TU), alcohol consumption (AC) and sleeping habits and patterns (SHPs). Multinomial logistic regression models were used to assess the associations between the identified clusters and the socioeconomic and demographic characteristics of adolescents and their parents. ResultsHealth behaviours varied by age and sex. Four distinct clusters were identified based on sex: cluster 1 (Mixed eating behaviours and habits, physical activity and low alcohol consumption), cluster 2 Healthy lifestyle behaviours), cluster 3 (Unhealthy lifestyle behaviours), and cluster 4 (Breakfast, low alcohol consumption and tobacco usage). In the age-stratified analyses, three clusters were identified: cluster 1 (Unhealthy lifestyle behaviours), cluster 2 (Moderately healthy lifestyle behaviours) and cluster 3 (Healthy lifestyle behaviours). The multinomial analysis showed that sex, age, family situation and perceived family wealth were strong predictors of health behaviours. In particular, unhealthy behaviours showed the most frequent associations with socioeconomic disadvantage, having a migrant background and living in reconstructed families or single parent households. ConclusionsHealth behaviours vary significantly based on socioeconomic and demographic factors. Targeted policy and interventions programmes can effectively improve HLBs among vulnerable and at-risk adolescents.

We aimed to assess differences in the summer excess of mortality by COVID-19 history using data from the mortality and COVID-19 surveillances. We found 4% excess risk in 2022 summer, compared to 2015-2019. A mortality rate ratio of 1.59 (95%CI 1.39-1.82) for COVID-19 survivors compared to naive, was found. Both were higher in people aged [≥]75 years. During the July heat wave, the excess for COVID-19 survivors decreased and disappeared when excluding people living in nursing homes. Funding statementThis study was partially supported by the Italian Ministry of Health -CCM 2020 - "Sorveglianza epidemiologica e controllo del COVID-19 in aree urbane metropolitane e per il contenimento della circolazione del Sars-CoV-2 nella popolazione immigrata in Italia" and by the Ricerca Corrente 2023 HighlightsO_LIthe excess of mortality in COVID-19 survivors is not exacerbated by heatwaves C_LIO_LIan excess of mortality during the whole summer in COVID-19 survivors aged over 75 suggest that no harvesting effect is appreciable in the older population that survived COVID-19 C_LIO_LIFor COVID-19 survivors aged over 75, a lower mortality than the naive population was observed only during the July heat wave when we stratified by residency C_LI