Dataset Information

'The Healthy Migrant Effect' for Mental Health in England: Propensity-score Matched Analysis Using the EMPIRIC Survey.

ABSTRACT: Evidence has demonstrated that immigrants have a mental health advantage over the indigenous population of developed countries. However, much of the evidence-base demonstrating this mental health advantage is susceptible to confounding and inadequate adjustment across immigrant and non-immigrant groups preventing a rigorous assessment of a 'healthy migrant effect'. To compare the risk of common mental disorders in the immigrant population compared to the non-immigrant population in ethnic minority groups in England. A propensity-score matched analysis was carried out to adequately balance immigrant and non-immigrant groups for known confounders using the EMPIRIC national survey of Black-Caribbean, Indian, Pakistani and Bangladeshi groups. The mental health of participants was assessed using the validated Revised Clinical Interview Schedule tool. Immigrant participants were significantly less likely to have a common mental disorder than non-immigrant participants; OR = 0.47, (95% CI 0.40, 0.56). The results from this study demonstrate that a mental health advantage exists in ethnic minority immigrants compared to non-immigrants when balancing the two groups for confounding factors. This may be due to immigrants possessing certain personality traits, such as "psychological hardiness", that the migration process may select for.

SUBMITTER: Dhadda A

PROVIDER: S-EPMC6061089 | biostudies-other | 2018 Aug

REPOSITORIES: biostudies-other

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'The Healthy Migrant Effect' for Mental Health in England: Propensity-score Matched Analysis Using the EMPIRIC Survey.

Dhadda Amrit A Greene Giles G

Journal of immigrant and minority health 20180801 4

Evidence has demonstrated that immigrants have a mental health advantage over the indigenous population of developed countries. However, much of the evidence-base demonstrating this mental health advantage is susceptible to confounding and inadequate adjustment across immigrant and non-immigrant groups preventing a rigorous assessment of a 'healthy migrant effect'. To compare the risk of common mental disorders in the immigrant population compared to the non-immigrant population in ethnic minori ...[more]

PMID: 28389831

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Project description:BackgroundHospitalized patients with COVID-19 demonstrate a higher risk of developing thromboembolism. Anticoagulation (AC) has been proposed for high-risk patients, even without confirmed thromboembolism. However, benefits and risks of AC are not well assessed due to insufficient clinical data. We performed a retrospective analysis of outcomes from AC in a large population of COVID-19 patients.MethodsWe retrospectively reviewed 1189 patients hospitalized for COVID-19 between March 5 and May 15, 2020, with primary outcomes of mortality, invasive mechanical ventilation, and major bleeding. Patients who received therapeutic AC for known indications were excluded. Propensity score matching of baseline characteristics and admission parameters was performed to minimize bias between cohorts.ResultsThe analysis cohort included 973 patients. Forty-four patients who received therapeutic AC for confirmed thromboembolic events and atrial fibrillation were excluded. After propensity score matching, 133 patients received empiric therapeutic AC while 215 received low dose prophylactic AC. Overall, there was no difference in the rate of invasive mechanical ventilation (73.7% versus 65.6%, p = 0.133) or mortality (60.2% versus 60.9%, p = 0.885). However, among patients requiring invasive mechanical ventilation, empiric therapeutic AC was an independent predictor of lower mortality (hazard ratio [HR] 0.476, 95% confidence interval [CI] 0.345-0.657, p < 0.001) with longer median survival (14 days vs 8 days, p < 0.001), but these associations were not observed in the overall cohort (p = 0.063). Additionally, no significant difference in mortality was found between patients receiving empiric therapeutic AC versus prophylactic AC in various subgroups with different D-dimer level cutoffs. Patients who received therapeutic AC showed a higher incidence of major bleeding (13.8% vs 3.9%, p < 0.001). Furthermore, patients with a HAS-BLED score of ≥2 had a higher risk of mortality (HR 1.482, 95% CI 1.110-1.980, p = 0.008), while those with a score of ≥3 had a higher risk of major bleeding (Odds ratio: 1.883, CI: 1.114-3.729, p = 0.016).ConclusionEmpiric use of therapeutic AC conferred survival benefit to patients requiring invasive mechanical ventilation, but did not show benefit in non-critically ill patients hospitalized for COVID-19. Careful bleeding risk estimation should be pursued before considering escalation of AC intensity.

Project description:BACKGROUND:To reduce inequalities between individuals with and without mental health problems, a better understanding is required of triggers and success of quit attempts among the third of smokers with mental health problems. The aim was to assess whether there are differences by mental health status in (i) triggers for quit attempts, (ii) use of evidence-based support (iii) and quit success. METHODS:Monthly cross-sectional household surveys of representative samples of the adult population in England. In 2016/2017, 40,831 adults were surveyed; 1956 who had attempted to stop smoking cigarettes in the past year were included. Logistic regressions assessed associations between mental health (ever diagnosis, past-year treatment, past-month distress), triggers, support used and quit success, adjusting for sociodemographic and smoking characteristics. RESULTS:Concern about future health, current health problems and expense of smoking were the most common triggers overall. For respondents with an ever diagnosis, past-year treatment or serious past-month distress, quit attempts were more frequently triggered by current health problems. Non-evidence-based support and e-cigarettes were used most often, and this did not differ by mental health status. Respondents with an ever diagnosis and moderate or serious distress were less likely to have used non-prescription nicotine replacement therapy (NRT). Respondents with past-year treatment or serious distress were more likely to have used prescription medication/behavioural support. Quit success did not differ by mental health status. Compared with non-evidence-based support, non-prescription NRT conferred no benefit. There was some evidence that prescription medication/behavioural support was beneficial (depending on outcome and adjustment, ORs ranged from 1.46, 95% CI 0.92-2.31, to 1.69, 1.01-2.86). E-cigarettes were associated with higher success rates after adjustment for different indicators of mental health (ORs ranged from 2.21, 1.64-2.98, to 2.25, 1.59-3.18). CONCLUSIONS:Smokers with mental health problems were more likely to have attempted to quit because of health problems and were more likely to have used gold standard support (medication and behavioural support) than other smokers. E-cigarettes were strongly associated with increased success and were used similarly by those with and without mental health problems, indicating that improved uptake of e-cigarettes for smoking cessation among smokers with mental health problems could help address inequalities.

Project description:BackgroundMaternal and newborn mortality rates in Ethiopia are among the highest in sub-Saharan Africa. The majority of deaths take place during childbirth or within the following 48 h. Therefore, ensuring facility deliveries with emergency obstetric and newborn care services available and immediate postnatal follow-up are key strategies to increase survival. In early 2014, the Family Conversation was implemented in 115 rural districts in Ethiopia, covering about 17 million people. It aimed to reduce maternal and newborn mortality by promoting institutional delivery, early postnatal care and immediate newborn care practices. More than 6000 Health Extension Workers were trained to initiate home-based Family Conversations with pregnant women and key household decision-makers. These conversations included discussions on birth preparedness, postpartum and newborn care needs to engage key household stakeholders in supporting women during their pregnancy, labor and postpartum periods. This paper examines the effects of the Family Conversation strategy on maternal and neonatal care practices.MethodsWe used cross-sectional data from a representative sample of 4684 women with children aged 0-11 months from 115 districts collected between December 2014 and January 2015. We compared intrapartum and newborn care practices related to the most recent childbirth, between those who reported having participated in a Family Conversation during pregnancy, and those who had not. Propensity score matched analysis was used to estimate average treatment effects of the Family Conversation strategy on intrapartum and newborn care practices, including institutional delivery, early postnatal and immediate breastfeeding.ResultsAbout 17% of the respondents reported having had a Family Conversation during their last pregnancy. Average treatment effects of 7, 12, 9 and 16 percentage-points respectively were found for institutional deliveries, early postnatal care, clean cord care and thermal care of the newborn (p?<?0.05).ConclusionWe found evidence that Family Conversation, and specifically the involvement of household members who were major decision-makers, was associated with better intrapartum and newborn care practices. This study adds to the evidence base that involving husbands and mothers-in-law, as well as pregnant women, in behavior change communication interventions could be critical for improving maternal and newborn care and therewith lowering mortality rates.

Project description:BackgroundEpidemiological and other evidence strongly supports the hypothesis that problem drinking is causally related to the incidence of active tuberculosis and the worsening of the disease course. The presence of a large number of potential confounders, however, complicates the assessment of the actual size of this causal effect, leaving room for a substantial amount of bias. This study aims to contribute to the understanding of the role of confounding in the observed association between problem drinking and tuberculosis, assessing the effect of the adjustment for a relatively large number of potential confounders on the estimated prevalence odds ratio of tuberculosis among problem drinkers vs. moderate drinkers/abstainers in a cross-sectional, nationally representative sample of the South African adult population.MethodsA propensity score approach was used to match each problem drinker in the sample with a subset of moderate drinkers/abstainers with similar characteristics in respect to a set of potential confounders. The prevalence odds ratio of tuberculosis between the matched groups was then calculated using conditional logistic regression. Sensitivity analyses were conducted to assess the robustness of the results in respect to misspecification of the model.ResultsThe prevalence odds ratio of tuberculosis between problem drinkers and moderate drinkers/abstainers was 1.97 (95% CI: 1.40 to 2.77), and the result was robust with respect to the matching procedure as well as to incorrect adjustment for potential mediators and to the possible presence of unmeasured confounders. Sub-population analysis did not provide noteworthy evidence for the presence of interaction between problem drinking and the observed confounders.ConclusionIn a cross-sectional national survey of the adult population of a middle income country with high tuberculosis burden, problem drinking was associated with a two fold increase in the odds of past TB diagnosis after controlling for a large number of socio-economic and biological confounders. Within the limitations of a cross-sectional study design with self-reported tuberculosis status, these results adds to previous evidence of a causal link between problem drinking and tuberculosis, and suggest that the observed higher prevalence of tuberculosis among problem drinkers commonly found in population studies cannot be attributed to the confounding effect of the uneven distribution of other risk factors.

Project description:Background:Reducing inequality in maternal, neonatal and infant mortality are key targets in the Sustainable Development Goals. This study is the first to evaluate the impact of Indonesia's national health insurance scheme, Jaminan Kesehatan Nasional (JKN), on access to maternal health services by sociodemographic status. Methods:Using data from the 2017 Indonesia Demographic and Health Survey (IDHS) on women with live births in 2016-2017, we conducted propensity score matching (PSM) analysis to evaluate the association of JKN enrollment on the following maternal health care utilisation outcomes: (1) at least four antenatal care (ANC4+) visits; (2) ANC4+ visits and received essential components of ANC; (3) skilled birth attendance; (4) facility-based delivery; (5) post-natal care (PNC); and (6) PNC with skilled provider. Analyses were conducted at the national level and by economic subgroup and region of residence. Additionally, we investigated the potential negative impact of JKN on access to maternal health services among the uninsured population by looking at trends over time using data from the 2012 and 2017 IDHS. Results:Of the 5429 women who had recently given birth, 61% were insured by JKN in 2017. After matching treated and untreated women on key sociodemographic characteristics, enrollment in JKN was associated with a higher prevalence of receiving ANC4+ visits (7.4%, 95% confidence interval (CI)?=?4.8-9.39); ANC4+ visits and received essential components of ANC (5.6%, 95% CI?=?3.3-7.9); skilled birth attendance (3.0%, 95% CI?=?1.5-4.5; facility-based delivery (10.2%, 95% CI?=?7.5-12.7); PNC (4.0%, 95% CI?=?2.2-5.7); PNC with skilled provider (4.5%, 95% CI?=?2.6-6.5). Effect sizes were larger among the poor and those living in less-developed areas, such as Eastern Indonesia and Sulawesi, except for at least ANC4+ and received clinical components. Conclusions:Expansion of health insurance coverage was associated with reductions in sociodemographic inequalities in access to maternal health services in Indonesia. However, large differences in utilisation persist across regions and by economic subgroup. Accelerating progress toward universal health coverage may reduce health inequalities in other low and middle-income countries.

Dataset Information

'The Healthy Migrant Effect' for Mental Health in England: Propensity-score Matched Analysis Using the EMPIRIC Survey.

Publications

'The Healthy Migrant Effect' for Mental Health in England: Propensity-score Matched Analysis Using the EMPIRIC Survey.

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