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Policy Points The erosion of electoral democracy in the United States in recent decades may have contributed to the high and rising working‐age mortality rates, which predate the COVID‐19 pandemic. Eroding electoral democracy in a US state was associated with higher working‐age mortality from homicide, suicide, and especially from drug poisoning and infectious disease. State and federal efforts to strengthen electoral democracy, such as banning partisan gerrymandering, improving voter enfranchisement, and reforming campaign finance laws, could potentially avert thousands of deaths each year among working‐age adults. Context Working‐age mortality rates are high and rising in the United States, an alarming fact that predates the COVID‐19 pandemic. Although several reasons for the high and rising rates have been hypothesized, the potential role of democratic erosion has been overlooked. This study examined the association between electoral democracy and working‐age mortality and assessed how economic, behavioral, and social factors may have contributed to it. Methods We used the State Democracy Index (SDI), an annual summary of each state's electoral democracy from 2000 to 2018. We merged the SDI with annual age‐adjusted mortality rates for adults 25–64 years in each state. Models estimated the association between the SDI and working‐age mortality (from all causes and six specific causes) within states, adjusting for political party control, safety net generosity, union coverage, immigrant population, and stable characteristics of states. We assessed whether economic (income, unemployment), behavioral (alcohol consumption, sleep), and social (marriage, violent crime, incarceration) factors accounted for the association. Findings Increasing electoral democracy in a state from a moderate level (defined as the third quintile of the SDI distribution) to a high level (defined as the fifth quintile) was associated with an estimated 3.2% and 2.7% lower mortality rate among working‐age men and women, respectively, over the next year. Increasing electoral democracy in all states from the third to the fifth quintile of the SDI distribution may have resulted in 20,408 fewer working‐age deaths in 2019. The democracy–mortality association mainly reflected social factors and, to a lesser extent, health behaviors. Increasing electoral democracy in a state was mostly strongly associated with lower mortality from drug poisoning and infectious diseases, followed by reductions in homicide and suicide. Conclusions Erosion of electoral democracy is a threat to population health. This study adds to growing evidence that electoral democracy and population health are inextricably linked.

On 28 April 2011, China's state statistics bureau released its first report on the country's 2010 population census. The report states that the total population of mainland China reached 1.3397 billion in 2010, with an annual average population growth rate of 0.57% during the previous 10 years. The share of the total population aged 0 to 14 declined from 22.9% in 2000 to 16.6% in 2010, whereas the proportion aged 65 and above grew from 7.0% to 8.9% during the same period. This indicates that China's population is aging rapidly. The report also shows that China is urbanizing, with nearly half of the population—665.57 million people, or 49.7%—living in urban areas, an increase of 13 percentage points over the 2000 figure. Moreover, about 260 million Chinese people are living away from where they are formally registered, and the overwhelming majority of them (about 220 million) are rural migrants living and working in urban areas but without formal urban household registration status. China is at a demographic turning point: It is changing from an agricultural society into an urban one, from a young society to an old one, and from a society attached to the land to one that is very much on the move.

A decrease in the working-age population in aging societies causes a shortage of employees in workplaces due to long-term care (LTC) leave for family and relatives as well as longer working hours or overwork among those remaining in the workplace. We collected and analyzed literature and guidelines regarding social-support policies on LTC in workplaces in seven countries (Canada, France, Germany, Japan, Sweden, the UK, and the USA) to propose an effective way of occupational health support for those in need. Our analysis indicated the existence of a system that incorporates the public-assistance mechanism of providing unused paid leave to those in need. Additionally, recipients of informal care provided by employees tended to expand to non-family members under the current occupational health system. On the other hand, the health management of employees as informal caregivers remained neglected. Likewise, salary compensation and financial support for LTC-related leave need to be improved. In order to monitor and evaluate the progress and achievement of current legal occupational health systems and programs related to the social support of LTC among employees, the available national and/or state-based quantitative data should be comparable at the international level.

BACKGROUND Ageing is central in the European Union (EU) policy debate, with all member states being concerned about implications of growing shares of older people and declining shares of working-age populations for the sustainability of welfare and health systems. Beyond this general context, ageing patterns differ largely across EU territories because of distinctive demographic and spatial dynamics. OBJECTIVE We study the relative contribution of cohort turnover and migration flows in shaping the demographic evolution of the working-age population at the local level. METHODS Using Eurostat data, we decompose the changes that have occurred in the working-age population into cohort turnover and net migration effects for the 2015-2019 period, at territorial (NUTS3 and urban-intermediate-rural) levels. RESULTS The majority (63%) of European (NUTS3) territories experienced negative cohort turnover effects alongside positive net migration effects during the 2015-2019 period. However, in only 27% of these territories, net migration counterbalanced the deficit in the working-age population due to cohort turnover. CONCLUSIONS In 2015-2019, migration was the underlying force in the evolution of the working-age population, partially compensating for the loss of population due to the cohort turnover. This effect was particularly pronounced in urban areas. CONTRIBUTION Our contribution is twofold. First, we map EU NUTS3 territories where the working-age population is declining rapidly. Second, we give an assessment of the varied role of migration in mitigating the effect of ageing and shrinking working-age populations across EU urban, intermediate, and rural areas.

BackgroundIn England between 2010 and 2013, just over one million recipients of the main out-of-work disability benefit had their eligibility reassessed using a new functional checklist—the Work Capability Assessment. Doctors and disability rights organisations have raised concerns that this has had an adverse effect on the mental health of claimants, but there are no population level studies exploring the health effects of this or similar policies.MethodWe used multivariable regression to investigate whether variation in the trend in reassessments in each of 149 local authorities in England was associated with differences in local trends in suicides, self-reported mental health problems and antidepressant prescribing rates, while adjusting for baseline conditions and trends in other factors known to influence mental ill-health.ResultsEach additional 10 000 people reassessed in each area was associated with an additional 6 suicides (95% CI 2 to 9), 2700 cases of reported mental health problems (95% CI 548 to 4840), and the prescribing of an additional 7020 antidepressant items (95% CI 3930 to 10100). The reassessment process was associated with the greatest increases in these adverse mental health outcomes in the most deprived areas of the country, widening health inequalities.ConclusionsThe programme of reassessing people on disability benefits using the Work Capability Assessment was independently associated with an increase in suicides, self-reported mental health problems and antidepressant prescribing. This policy may have had serious adverse consequences for mental health in England, which could outweigh any benefits that arise from moving people off disability benefits.

Background and Objectives: Self-medication with over-the-counter (OTC) medicines is becoming an increasingly popular practice around the world. The global prevalence rate of self-medication ranges from 11.2% to 93.7%, depending on the target population and country. However, there is a lack of data on the prevalence and practices of self-medication among the working-age population, particularly in Thailand metropolitan areas. The current study describes the prevalence of self-medication practices, adverse drug reactions and severity, reasons for self-medication, and basic medication knowledge among people of working age in metropolitan areas in Thailand. Methods: We conducted an online cross-sectional study between December 2020 and January 2021. Descriptive statistics were used to analyze self-medication data. A chi-square test was used to assess the association between self-medication and sociodemographic characteristics. Results: This study found high prevalence of self-medication among the working-age population in metropolitan areas of Thailand (88.2%). The most commonly used drug groups were NSAIDs (34.8%) and antibiotics (30.2%). Minor illness and easy access to pharmacies were the most common reasons for self-medication. Almost half of the participants' illnesses (42.6%) for which they self-medicated were not always completely cured, necessitating treatment at a hospital or clinic. Although only a small number of participants (ranged from 0.6 to 6.6%) experienced adverse drug reactions as a result of self-medication, some had severe symptoms that disrupted their daily lives or required hospitalization. In terms of basic medication knowledge, we discovered that study participants misunderstood some antibiotic drug concepts. Conclusions: According to the study findings, it is recommended that more information about the risks of self-medication, drug adverse reactions, antibiotic stewardship, more supervision of the prohibition of over-the-counter drugs and selling practices, and adequate facilities for peoples access to medical services be provided at the policy level.

Osteoarthritis (OA) is a chronic degenerative joint disease with an increasing global burden, particularly among the working-age population. This study aims to analyze the temporal trends in OA burden by age and sex globally from 1990 to 2021, focusing on incidence, prevalence, and disability-adjusted life years (DALYs) rates, and to predict future trends. Using data from the Global Burden of Disease (GBD) database, which includes 204 countries and regions, we stratified the findings by the sociodemographic index (SDI). Age-standardized rates were used to calculate the estimated annual percentage change (EAPC) with corresponding 95% confidence intervals (95% CI). Additionally, a Bayesian Age-Period-Cohort (BAPC) model was employed to project future OA trends up to 2040.The results revealed a consistent increase in the global OA burden over the study period. Between 1990 and 2021, the number of OA cases in the working-age population increased from 16,420,160 to 35,494,218, representing a growth rate of 116.16%. Over the same period, prevalence and DALYs rose by 123.11% and 125%, respectively. Global age-standardized incidence rate (ASIR), prevalence rate (ASPR), and DALYs rate (ASDR) exhibited continuous upward trends, with annual percentage changes of 0.387%, 0.431%, and 0.46%, respectively. Notably, East Asia demonstrated the highest EAPC, reflecting a rapid rise in OA burden, while high-income North America exhibited minimal changes, indicating a relatively stable trend. Countries such as Equatorial Guinea, Mongolia, and Armenia also experienced significant increases in EAPC, underscoring emerging regional challenges.Further socioeconomic analysis highlighted disparities in OA burden. A significant positive correlation was observed between ASIR, ASPR, ASDR, and SDI. While low-SDI countries exhibited lower OA burdens, metrics were substantially higher in high-SDI countries. From 1990 to 2021, the gap between countries with the highest and lowest SDIs widened, underscoring growing global health inequalities. Projections based on the BAPC model suggest that by 2040, the incidence and prevalence of OA will continue to rise, with the number of cases expected to reach 38,800,395, particularly driven by notable increases among women.These findings highlight the urgent need for developing targeted public health strategies to mitigate the effect of OA on the working-age population and promote global health equity.

The world is currently in the midst of the greatest demographic upheaval in human history. Dramatic reductions in mortality, followed (but with a lag) by equally marked reductions in fertility, resulted in a doubling of world population between 1960 and 2000. A further increase of 2 to 4.5 billion is projected for the current half-century, with the increase concentrated in the world's least developed countries. Despite alarmist predictions, historical increases in population have not been economically catastrophic. Moreover, changes in population age structure have opened the door to increased prosperity. Demographic changes have had and will continue to have profound repercussions for human well-being and progress, with some possibilities for mediating those repercussions through policy intervention.

Background Periodontal diseases among working-age individuals (15–69 years) represent a significant global health challenge, impacting oral health, quality of life, and economic productivity. Defined according to the 2021 Global Burden of Disease (GBD) framework, periodontal disease in this study encompasses symptoms such as halitosis, altered taste sensation, and occasional gingival bleeding that do not impair daily activities. Despite their prevalence, comprehensive analyses of the global burden of periodontal diseases specifically within this demographic remain limited. Methods We analyzed data from the GBD 2021 study, examining periodontal disease burden among individuals aged 15–69 years across 204 countries and territories from 1990 to 2021. Age-standardized rates of prevalence, incidence, and disability-adjusted life years (DALYs) were calculated. We employed joinpoint regression analysis to assess temporal trends, decomposition analysis to examine contributing factors, and frontier analysis to evaluate the relationship between disease burden and sociodemographic development. Findings. In 2021, global periodontal disease cases reached 951.3 million (95% UI: 729.0–1,183.3 million), with an age-standardized prevalence rate (ASPR: 17,011.6 per 100,000 persons) and 80.3 million new cases (ASIR: 1,464.7 per 100,000). The burden accounted for 6.2 million DALYs globally (age-standardized DALY rate: 110.8 per 100,000). Asia demonstrated the highest age-standardized rates across all metrics, while Low-middle SDI regions showed the highest ASPR (20,920.5 per 100,000) and ASIR (1,627.9 per 100,000). At the national level, Sierra Leone, Gambia, and Cabo Verde had the highest disease burden. Males consistently showed higher prevalence rates than females, with peak rates observed in the 50–59 age group. Joinpoint regression analysis revealed an overall increasing trend from 1990 to 2021 (AAPC: 0.04, 95% UI: 0.01–0.06), with notable variations across different time periods. While some countries like Qatar, UAE, and Jordan experienced over 500% increase in prevalence since 1990, Pacific island nations like Tonga and Tokelau achieved reductions exceeding 70%. Decomposition analysis identified population growth (74.56%) and aging (23.00%) as primary drivers of increased disease burden. Interpretation. Our analysis reveals significant global disparities in periodontal disease burden among the working-age population, with concerning increases in many regions from 1990 to 2021. The disproportionate burden in Low-middle SDI regions and South Asia, coupled with the substantial impact of population growth and aging, highlights the urgent need for targeted interventions. While some countries have achieved remarkable reductions in disease burden, the dramatic increases in others underscore the importance of strengthening preventive oral healthcare systems and addressing socioeconomic determinants. These findings emphasize the need for country-specific strategies, particularly in regions with rising burden, and can inform evidence-based policy making to reduce the impact of periodontal diseases on the global workforce.

This study presents new evidence on the effects of minimum age regulations obtained from a natural experiment. In 1998, a constitutional reform in Brazil changed the minimum working age from 14 to 16. The reform was the legislative counterpart of a broad set of measures taken by a government strongly committed to eliminating child labor. This article investigates the role of the minimum working age in this context. The setting allows for improvements upon past approaches based on comparing employment rates of children at different ages. A discontinuity in treatment is exploited, namely the fact that only children who turned 14 after the enactment date (mid-December 1998) are banned from work. According to regression discontinuity and difference-in-discontinuity designs, the null hypothesis of no overall effect of the ban cannot be rejected. Throughout the methods and specifications, an employment effect in a confidence interval of [−0.06,0.03] (in percentage points) is found. A detailed heterogeneity analysis is performed and provides suggestive evidence of diminishing child labor trends in regions characterized by higher labor inspection intensity, which is interpreted as a trace of there being a law. However, contrary to what has been claimed in recent studies, the law seems not to have produced sizeable effects overall, at least in the short run. Power calculations and extensive sensitivity checks support these conclusions.