Albert Dalmau-Bueno

Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century

Aims/hypothesisThe aim of this study was to determine and quantify socioeconomic position (SEP) inequalities in diabetes mellitus in different areas of Europe, at the turn of the century, for men and women.MethodsWe analysed data from ten representative national health surveys and 13 mortality registers. For national health surveys the dependent variable was the presence of diabetes by self-report and for mortality registers it was death from diabetes. Educational level (SEP), age and sex were independent variables, and age-adjusted prevalence ratios (PRs) and risk ratios (RRs) were calculated.ResultsIn the overall study population, low SEP was related to a higher prevalence of diabetes, for example men who attained a level of education equivalent to lower secondary school or less had a PR of 1.6 (95% CI 1.4–1.9) compared with those who attained tertiary level education, whereas the corresponding value in women was 2.2 (95% CI 1.9–2.7). Moreover, in all countries, having a disadvantaged SEP is related to a higher rate of mortality from diabetes and a linear relationship is observed. Eastern European countries have higher relative inequalities in mortality by SEP. According to our data, the RR of dying from diabetes for women with low a SEP is 3.4 (95% CI 2.6–4.6), while in men it is 2.0 (95% CI 1.7–2.4).Conclusions/interpretationIn Europe, educational attainment and diabetes are inversely related, in terms of both morbidity and mortality rates. This underlines the importance of targeting interventions towards low SEP groups. Access and use of healthcare services by people with diabetes also need to be improved.

Green spaces and General Health: Roles of mental health status, social support, and physical activity.

Green spaces are associated with improved health, but little is known about mechanisms underlying such association. We aimed to assess the association between greenness exposure and subjective general health (SGH) and to evaluate mental health status, social support, and physical activity as mediators of this association. This cross-sectional study was based on a population-based sample of 3461 adults residing in Barcelona, Spain (2011). We characterized outcome and mediators using the Health Survey of Barcelona. Objective and subjective residential proximity to green spaces and residential surrounding greenness were used to characterize greenness exposure. We followed Baron and Kennys framework to establish the mediation roles and we further quantified the relative contribution of each mediator. Residential surrounding greenness and subjective residential proximity to green spaces were associated with better SGH. We found indications for mediation of these associations by mental health status, perceived social support, and to less extent, by physical activity. These mediators altogether could explain about half of the surrounding greenness association and one-third of the association for subjective proximity to green spaces. We observed indications that mental health and perceived social support might be more relevant for men and those younger than 65years. The results for objective residential proximity to green spaces were not conclusive. In conclusion, our observed association between SGH and greenness exposure was mediated, in part, by mental health status, enhanced social support, and physical activity. There might be age and sex variations in these mediation roles.

Urban green and grey space in relation to respiratory health in children

We assessed the effect of three different indices of urban built environment on allergic and respiratory conditions. This study involved 2472 children participating in the ongoing INMA birth cohort located in two bio-geographic regions (Euro-Siberian and Mediterranean) in Spain. Residential surrounding built environment was characterised as 1) residential surrounding greenness based on satellite-derived normalised difference vegetation index (NDVI), 2) residential proximity to green spaces and 3) residential surrounding greyness based on urban land use patterns. Information on wheezing, bronchitis, asthma and allergic rhinitis up to age 4 years was obtained from parent-completed questionnaires. Logistic regression and generalised estimating equation modelling were performed. Among children from the Euro-Siberian region, higher residential surrounding greenness and higher proximity to green spaces were negatively associated with wheezing. In the Mediterranean region, higher residential proximity to green spaces was associated with a reduced risk for bronchitis. A higher amount of residential surrounding greyness was found to increase the risk for bronchitis in this region. Associations between indices of urban residential greenness and greyness with respiratory diseases differ by region. The pathways underlying these associations require further exploration. Associations between respiratory health and urban residential greenness and greyness differ by geographic region http://ow.ly/pnGJ30bqBn1

Green spaces and spectacles use in schoolchildren in Barcelona.

Abstract Myopia is one of the major causes of low visual acuity during childhood, and hence of the need for spectacles. It is generally more prevalent in urban areas where children are often less exposed to green spaces than in rural areas. This study evaluated the association between exposure to green space and use of spectacles (as a surrogate measure for myopia) in a cohort of 2727 schoolchildren (7–10 years old) recruited from 39 primary schools in Barcelona (2012–2015). We assessed exposure to green spaces by characterizing outdoor surrounding greenness at home and school and during commuting using satellite data on greenness (Normalized Difference Vegetation Index). We also obtained data on the annual average time children spent playing in green spaces through questionnaires. Cross‐sectional analyses were conducted based on prevalent cases of spectacles use at baseline data collection campaign and longitudinal analyses based on incident cases of spectacles use during the three‐year period between the baseline and last data collection campaigns. An interquartile range (IQR) increase in exposure to green space at home (500 m buffer) and school and during commuting was associated with respectively 14% (95% CI: 2%, 26%), 27% (95% CI: 6%, 44%), and 20% (95% CI: 5%, 33%) decrease in spectacles use in cross‐sectional analyses. In longitudinal analyses, we observed a reduction of 23% (95% CI: 4%, 39%) and 34% (95% CI: 2%, 55%) associated with an IQR increase in greenness at home and school, respectively. Moreover, an IQR increase in time playing in green spaces was associated with a 28% (95% CI: 7%, 45%) reduction in the risk of spectacles use in the longitudinal analysis. Our observed reduced risk of spectacles use associated with higher contact with green space calls for more refined studies of the association between green spaces and refractive errors of visions. HighlightsThe cause(s) of rapid increase in the global prevalence of myopia is unclear.Myopia is consistently reported to be more prevalent in urban areas.Urban residents often have limited access to green spaces.Higher greenness exposure was associated with lower spectacles use in children.Our findings require further confirmation by more refined studies.

Trends in socioeconomic inequalities in mortality over a twenty-two-year period in the city of Barcelona (Spain)

OBJECTIVE To analyze the trend in socioeconomic inequalities in all-cause mortality in Barcelona from 1983 to 2004. METHODS We performed an ecological study of trends over 4 cross-sections (1983-1988, 1989-1994, 1995-1999 and 2000-2004), with the basic health area (BHA) as the unit of analysis. The study population consisted of men and women aged 20 years or more living in Barcelona. The information sources were the mortality registry, the municipal census and the census of inhabitants and dwellings. The age- and sex-specific mortality rate (ASMR) for all causes was used as the dependent variable. As the independent variable, a composite index of socioeconomic deprivation of the BHA was calculated; BHAs were grouped in quartiles according to the values on the index. Poisson models were adjusted to estimate the relative risk of mortality from all causes in the 4 groups of BHA, stratified by age groups and sex. RESULTS In all the study periods, inequalities in mortality were found, depending on the BHA of residence, both for men and for women: the ASMR of the most deprived BHAs were greater than those of less deprived BHA, and were greater among men than among women. Likewise, relative risks in the youngest age groups were higher than in the oldest age groups. However, from the second to fourth study periods, inequalities decreased in absolute and relative terms, especially among men. CONCLUSIONS Inequalities in mortality persist in BHA in Barcelona but have decreased over the last 2 decades. Public policies should take this information into account when tackling inequalities among BHA.

Spatial and temporal variability of personal environmental exposure to radio frequency electromagnetic fields in children in Europe

BACKGROUND Exposure to radiofrequency electromagnetic fields (RF-EMF) has rapidly increased and little is known about exposure levels in children. This study describes personal RF-EMF environmental exposure levels from handheld devices and fixed site transmitters in European children, the determinants of this, and the day-to-day and year-to-year repeatability of these exposure levels. METHODS Personal environmental RF-EMF exposure (μW/m2, power flux density) was measured in 529 children (ages 8-18 years) in Denmark, the Netherlands, Slovenia, Switzerland, and Spain using personal portable exposure meters for a period of up to three days between 2014 and 2016, and repeated in a subsample of 28 children one year later. The meters captured 16 frequency bands every 4 s and incorporated a GPS. Activity diaries and questionnaires were used to collect childrens location, use of handheld devices, and presence of indoor RF-EMF sources. Six general frequency bands were defined: total, digital enhanced cordless telecommunications (DECT), television and radio antennas (broadcast), mobile phones (uplink), mobile phone base stations (downlink), and Wireless Fidelity (WiFi). We used adjusted mixed effects models with region random effects to estimate associations of handheld device use habits and indoor RF-EMF sources with personal RF-EMF exposure. Day-to-day and year-to-year repeatability of personal RF-EMF exposure were calculated through intraclass correlations (ICC). RESULTS Median total personal RF-EMF exposure was 75.5 μW/m2. Downlink was the largest contributor to total exposure (median: 27.2 μW/m2) followed by broadcast (9.9 μW/m2). Exposure from uplink (4.7 μW/m2) was lower. WiFi and DECT contributed very little to exposure levels. Exposure was higher during day (94.2 μW/m2) than night (23.0 μW/m2), and slightly higher during weekends than weekdays, although varying across regions. Median exposures were highest while children were outside (157.0 μW/m2) or traveling (171.3 μW/m2), and much lower at home (33.0 μW/m2) or in school (35.1 μW/m2). Children living in urban environments had higher exposure than children in rural environments. Older children and users of mobile phones had higher uplink exposure but not total exposure, compared to younger children and those that did not use mobile phones. Day-to-day repeatability was moderate to high for most of the general frequency bands (ICCs between 0.43 and 0.85), as well as for total, broadcast, and downlink for the year-to-year repeatability (ICCs between 0.49 and 0.80) in a small subsample. CONCLUSION The largest contributors to total personal environmental RF-EMF exposure were downlink and broadcast, and these exposures showed high repeatability. Urbanicity was the most important determinant of total exposure and mobile phone use was the most important determinant of uplink exposure. It is important to continue evaluating RF-EMF exposure in children as device use habits, exposure levels, and main contributing sources may change.

Veintidós años de evolución de las desigualdades socioeconómicas en la mortalidad en la ciudad de Barcelona

OBJECTIVE To analyze the trend in socioeconomic inequalities in all-cause mortality in Barcelona from 1983 to 2004. METHODS We performed an ecological study of trends over 4 cross-sections (1983-1988, 1989-1994, 1995-1999 and 2000-2004), with the basic health area (BHA) as the unit of analysis. The study population consisted of men and women aged 20 years or more living in Barcelona. The information sources were the mortality registry, the municipal census and the census of inhabitants and dwellings. The age- and sex-specific mortality rate (ASMR) for all causes was used as the dependent variable. As the independent variable, a composite index of socioeconomic deprivation of the BHA was calculated; BHAs were grouped in quartiles according to the values on the index. Poisson models were adjusted to estimate the relative risk of mortality from all causes in the 4 groups of BHA, stratified by age groups and sex. RESULTS In all the study periods, inequalities in mortality were found, depending on the BHA of residence, both for men and for women: the ASMR of the most deprived BHAs were greater than those of less deprived BHA, and were greater among men than among women. Likewise, relative risks in the youngest age groups were higher than in the oldest age groups. However, from the second to fourth study periods, inequalities decreased in absolute and relative terms, especially among men. CONCLUSIONS Inequalities in mortality persist in BHA in Barcelona but have decreased over the last 2 decades. Public policies should take this information into account when tackling inequalities among BHA.

Traffic-related air pollution and spectacles use in schoolchildren

Purpose To investigate the association between exposure to traffic-related air pollution and use of spectacles (as a surrogate measure for myopia) in schoolchildren. Methods We analyzed the impact of exposure to NO2 and PM2.5 light absorbance at home (predicted by land-use regression models) and exposure to NO2 and black carbon (BC) at school (measured by monitoring campaigns) on the use of spectacles in a cohort of 2727 schoolchildren (7–10 years old) in Barcelona (2012–2015). We conducted cross-sectional analyses based on lifelong exposure to air pollution and prevalent cases of spectacles at baseline data collection campaign as well as longitudinal analyses based on incident cases of spectacles use and exposure to air pollution during the three-year period between the baseline and last data collection campaigns. Logistic regression models were developed to quantify the association between spectacles use and each of air pollutants adjusted for relevant covariates. Results An interquartile range increase in exposure to NO2 and PM2.5 absorbance at home was respectively associated with odds ratios (95% confidence intervals (CIs)) for spectacles use of 1.16 (1.03, 1.29) and 1.13 (0.99, 1.28) in cross-sectional analyses and 1.15 (1.00, 1.33) and 1.23 (1.03, 1.46) in longitudinal analyses. Similarly, odds ratio (95% CIs) of spectacles use associated with an interquartile range increase in exposures to NO2 and black carbon at school was respectively 1.32 (1.09, 1.59) and 1.13 (0.97, 1.32) in cross-sectional analyses and 1.12 (0.84, 1.50) and 1.27 (1.03, 1.56) in longitudinal analyses. These findings were robust to a range of sensitivity analyses that we conducted. Conclusion We observed increased risk of spectacles use associated with exposure to traffic-related air pollution. These findings require further confirmation by future studies applying more refined outcome measures such as quantified visual acuity and separating different types of refractive errors.

Lifelong residential exposure to green space and attention: A population-based prospective study

Background: Natural environments, including green spaces, may have beneficial impacts on brain development. However, longitudinal evidence of an association between long-term exposure to green spaces and cognitive development (including attention) in children is limited. Objectives: We evaluated the association between lifelong residential exposure to green space and attention during preschool and early primary school years. Methods: This longitudinal study was based on data from two well-established population-based birth cohorts in Spain. We assessed lifelong exposure to residential surrounding greenness and tree cover as the average of satellite-based normalized difference vegetation index and vegetation continuous fields, respectively, surrounding the child’s residential addresses at birth, 4–5 y, and 7 y. Attention was characterized using two computer-based tests: Conners’ Kiddie Continuous Performance Test (K-CPT) at 4–5 y (n=888) and Attentional Network Task (ANT) at 7 y (n=987). We used adjusted mixed effects models with cohort random effects to estimate associations between exposure to greenness and attention at ages 4–5 and 7 y. Results: Higher lifelong residential surrounding greenness was associated with fewer K-CPT omission errors and lower K-CPT hit reaction time-standard error (HRT-SE) at 4–5 y and lower ANT HRT-SE at 7 y, consistent with better attention. This exposure was not associated with K-CPT commission errors or with ANT omission or commission errors. Associations with residential surrounding tree cover also were close to the null, or were negative (for ANT HRT-SE) but not statistically significant. Conclusion: Exposure to residential surrounding greenness was associated with better scores on tests of attention at 4–5 y and 7 y of age in our longitudinal cohort. https://doi.org/10.1289/EHP694

Thyroid Function in Early Pregnancy, Child IQ, and Autistic Traits: a Meta-analysis of Individual-participant Data

Context Low maternal free T4 (FT4) has been associated with poor child neurodevelopment in some single-center studies. Evidence remains scarce for the potential adverse effects of high FT4 and whether associations differ in countries with different iodine status. Objective To assess the association of maternal thyroid function in early pregnancy with child neurodevelopment in countries with a different iodine status. Design, Setting, and Participants Meta-analysis of individual participant data from 9036 mother-child pairs from three prospective population-based birth cohorts: INMA [Infancia y Medio Ambiente (Environment and Childhood project) (Spain)], Generation R (Netherlands), and ALSPAC (Avon Longitudinal Study of Parents and Children, United Kingdom). The exclusion criteria were multiple pregnancies, fertility treatments, thyroid-interfering medication usage, and known thyroid disease. Main Outcomes Child nonverbal IQ at 5 to 8 years of age, verbal IQ at 1.5 to 8 years of age, and autistic traits within the clinical range at 5 to 8 years of age. Results FT4 <2.5th percentile was associated with a 3.9-point (95% CI, -5.7 to -2.2) lower nonverbal IQ and a 2.1-point (95% CI, -4.0 to -0.1) lower verbal IQ. A suggestive association of hypothyroxinemia with a greater risk of autistic traits was observed. FT4 >97.5th percentile was associated with a 1.9-fold (95% CI, 1.0 to 3.4) greater risk of autistic traits. No independent associations were found with TSH. Conclusions Low maternal FT4 was consistently associated with a lower IQ across the cohorts. Further studies are needed to replicate the findings of autistic traits and investigate the potential modifying role of maternal iodine status. FT4 seems a reliable marker of fetal thyroid state in early pregnancy, regardless of the type of immunoassay.