Subjective evaluation of income (un)fairness: Contrasting principles of justice?

IntroductionPre-frailty provides an ideal opportunity to prevent physical frailty and promote healthy ageing. Excess adiposity has been associated with an increased risk of pre-frailty, but limited studies have explored whether the association between adiposity measures and pre-frailty varies by social position.MethodsWe used data from the seventh survey of the Tromsø Study (Tromsø7) conducted in 2015–2016. Our primary sample consisted of 2,945 women and 2,794 men aged ≥ 65 years. Pre-frailty was defined as the presence of one or two of the five frailty components: low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity. Adiposity was defined by body mass index (BMI), waist circumference (WC), fat mass index (FMI) and visceral adipose tissue (VAT) mass. Education and subjective social position were used as measures of social position. Poisson regression with robust variance was used to assess the association between adiposity measures and pre-frailty, and the interaction term between adiposity measures and social position measures were utilised to explore whether the association varied by social position.ResultsIn our sample, 28.7% of women and 25.5% of men were pre-frail. We found sub-multiplicative interaction of BMI-defined obesity with education in women and subjective social position in men with respect to development of pre-frailty. No other adiposity measures showed significant variation by education or subjective social position. Regardless of the levels of education or subjective social position, participants with excess adiposity (high BMI, high WC, high FMI and high VAT mass) had a higher risk of pre-frailty compared to those with low adiposity.ConclusionWe consistently observed that women and men with excess adiposity had a greater risk of pre-frailty than those with low adiposity, with only slight variation by social position. These results emphasize the importance of preventing excess adiposity to promote healthy ageing and prevent frailty among all older adults across social strata.

Purpose: To evaluate the association of county level characteristics with the incidence of invasive squamous cell carcinoma of the cervix among Hispanic women. Methods: The Surveillance, Epidemiology, and End Results (SEER) Program's 18 registries from 2000-2009 were queried and average annual age-adjusted incidence rates per 100,000 Hispanic women for invasive squamous cell carcinoma of the cervix (SCC) were calculated. Patients were stratified by residence in a county with high versus low percent language isolation, percent of Hispanics with less than a high school education and percent of Hispanic families below the poverty level. Results: Between 2000-2009, 5,534 Hispanic women were diagnosed with SCC in SEER. Incidence rates were highest among those living in counties with high levels of LI (8.9 v 10.7), or low levels of education (8.9 v 10.8) or income (8.7 v 11.0). The incidence of SCC was significantly less in women living in counties with higher levels of education and income and lower levels of LI than among those living in counties with lower levels of education and income and higher levels of LI (8.6 v. 11.3). Counties that have higher levels of income and education are less likely to be LI whereas counties with lower levels of income and education are more likely to be LI. Conclusions: Among Hispanic women, county level characteristics such as LI, education, and income have a complex interaction that appears to be associated with the incidence of SCC. Community level interventions need to be evaluated to decrease the high incidence of SCC in this population. Citation Format: Kristy K. Ward, Angelica M. Roncancio, Steven C. Plaxe. The association of county level characteristics with the incidence of squamous cell carcinoma of the cervix in Hispanic women. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A54.

This study investigated subjective social position in 21 European countries using data from the social inequality module of the International Social Survey Programme 2009. Subjective social position shows people’s self-location in a social hierarchy. Most studies on subjective social position have typically involved a few countries and neglected the role of national educational and occupational structures. We hypothesise that these characteristics, together with national-level economic factors, modify the effect of individual-level characteristics on subjective social location. Our expectations are based on extended reference group thesis, the big-fish-little-pond and stigmatisation arguments. The results of multi-level analysis indicated that the extent of educational and income inequalities in society as well as occupational structures influence the importance of individual incomes, education and occupations for estimating social position.

BackgroundThe relationship between subjective social position (SSP) and cognitive ageing unclear, especially in low-income settings. We aimed to investigate the relationship between SSP and cognitive function over time among older...

The study is an exploratory attempt to assess the relationship between individuals' objective class position and subjective social positions in the South African hierarchy. While objective class dynamics have received much attention in South Africa, less is known about the subjective social position individuals place themselves. The study aims to make use of the International Social Survey Program (ISSP) dataset and assess the relationship between objective and subjective class positions in South Africa. The results show considerable variation between objective and subjective class positions, with a strong middling tendency among all objective class groups in South Africa. The study also shows that this middling tendency has increased in the last decade in South Africa, predominantly due to individuals overestimating their social positions. With a large share of South Africans living close or below the poverty line, there is a clear biasedness of South Africans placing themselves in the middle of society, deviating from their lower objective position. The study further measures the variation between objective and subjective social positions to create a novel class scheme of inflated, deflated, and concordant class perceptions. These biased perceptions are then compared to socio-economic characteristics, showing that gender, race, and education are closely related to bias perceptions in South Africa. Furthermore, the increasing nature of high inequality and social unrest events in South Africa prompts the study also to assess the different social and political attitudes by varying objective and subjective class schemes. The results show that among the subjective class identification, individuals in higher perceived class positions tend to be less angered towards inequality, have lower redistribution preferences, and perceive a weaker conflict between the rich and the poor. These results confirm the impact perceived social positions and biased perceptions could have on social and political attitudes in South Africa. Attitudes that have been considered relevant in voting behavior and social policy formulation models. The results of the paper provides some vital information for policy makers on the dynamics behind subjective class and bias perceptions in South Africa.

ABSTRACT: The study is an exploratory attempt to assess the relationship between individuals' objective class position and subjective social positions in the South African hierarchy. While objective class dynamics have received much attention in South Africa, less is known about the subjective social position individuals place themselves. The study aims to make use of the International Social Survey Program (ISSP) dataset and assess the relationship between objective and subjective class positions in South Africa. The results show considerable variation between objective and subjective class positions, with a strong middling tendency among all objective class groups in South Africa. The study also shows that this middling tendency has increased in the last decade in South Africa, predominantly due to individuals overestimating their social positions. With a large share of South Africans living close or below the poverty line, there is a clear biasedness of South Africans placing themselves in the middle of society, deviating from their lower objective position. The study further measures the variation between objective and subjective social positions to create a novel class scheme of inflated, deflated, and concordant class perceptions. These biased perceptions are then compared to socio-economic characteristics, showing that gender, race, and education are closely related to bias perceptions in South Africa. Furthermore, the increasing nature of high inequality and social unrest events in South Africa prompts the study also to assess the different social and political attitudes by varying objective and subjective class schemes. The results show that among the subjective class identification, individuals in higher perceived class positions tend to be less angered towards inequality, have lower redistribution preferences, and perceive a weaker conflict between the rich and the poor. These results confirm the impact perceived social positions and biased perceptions could have on social and political attitudes in South Africa. Attitudes that have been considered relevant in voting behavior and social policy formulation models. The results of the paper provides some vital information for policy makers on the dynamics behind subjective class and bias perceptions in South Africa.

The COVID-19 pandemic is profoundly impacting mental health worldwide1-3. Wuhan, China has been the first city to experience the emergency of COVID-19 and its high hospitalization and casualty rates, as well as the mandatory curfews that were strictly enforced for infection control, with their significant mental health implications4. Although a large number of hospitalized COVID-19 patients recovered and met the clinical criteria for discharge, we hypothesized that mental health problems would occur as major sequelae among COVID-19 survivors. A total of 4,328 hospitalized COVID-19 patients who met relevant clinical criteria5 were discharged between January 18 and March 29, 2020 from five hospitals in Wuhan, China (Wuhan No.1 Hospital, Wuhan Wuchang Hospital, Hubei Provincial Hospital of Traditional Chinese Medicine, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, and Wuhan Pulmonary Hospital). All these COVID-19 survivors (median age: 59 years, interquartile range, IQR: 47-68 years; 54.1% female) were followed up and assessed by mental health care specialists. The evaluation period started on the date of hospital discharge and continued through July 28, 2020. Among the survivors, 156 (3.6%) dropped out at some point of the follow-up. The validated Chinese versions of the Patient Health Questionnaire-9 (PHQ-9)6 and the Generalized Anxiety Disorder-7 (GAD-7)7 were administered to evaluate post-discharge depression and anxiety. As a reference group, 1,500 randomly selected individuals from the general population of Hubei province were assessed using the same instruments during the same time frame. Chi-square tests were used to compare the prevalence of mild-to-severe mental health problems in the two samples. Among COVID-19 survivors with depression or anxiety, logistic regression analysis was applied to test whether several variables (including age, gender, education, income level, comorbid chronic physical diseases, and retesting positive for SARS-CoV-2) influenced the severity of the mental health condition. The study was approved by the institutional ethics board of Tongji Medical College, Huazhong University of Science and Technology. All participants provided their informed consent. The median duration of the follow-up period was 144.0 days (IQR: 135-157). During this period, 615 COVID-19 survivors (14.2%) were found to have clinically defined depression (i.e., a score of at least 5 on the PHQ-9) and 528 (12.2%) to have clinically defined anxiety (i.e., a score of at least 5 on the GAD-7). Four survivors attempted suicide. Compared to the reference group, the risk of both depression and anxiety in COVID-19 survivors was significantly higher (relative risk, RR=1.2, 95% CI: 1.1-1.4, p=0.002; and RR=1.4, 95% CI: 1.2-1.7, p=0.001, respectively). Among the 615 survivors with depression, the risk for a severe condition (i.e., a score of at least 10 on the PHQ-9) was significantly higher in individuals living alone (odds ratio, OR=5.2, 95% CI: 3.6-7.1, p<0.001), in females (OR=3.4, 95% CI: 2.8-5.3, p<0.001), in those with a low income level (OR=2.4, 95% CI: 1.8-3.5, p=0.012), in those with a comorbid chronic physical disease (OR=2.8, 95% CI: 2.1-3.7, p=0.032), and in those who retested positive for SARS-CoV-2 (OR=10.4, 95% CI: 8.3-12.5, p<0.001). Age did not significantly influence the severity of depression. Among the 528 COVID-19 survivors with anxiety, the risk for a severe condition (i.e., a score of at least 10 on the GAD-7) was significantly higher in individuals with a low educational level (OR=3.5, 95% CI: 3.1-4.2, p<0.001), in unmarried subjects (OR=1.7, 95% CI: 1.2-2.8, p=0.025), and in those who retested positive for SARS-CoV-2 (OR=4.7, 95% CI: 3.7-5.8, p<0.001). Age, gender and other social status indices did not influence the severity of anxiety. All the four COVID-19 survivors who attempted suicide were elderly, had retested positive for SARS-CoV-2, and had experienced severe levels of depression and anxiety. In summary, this follow-up study documents that mental health problems among COVID-19 survivors in Wuhan are significantly more common than in the general population of the Hubei province. Risk factors for more severe mental health problems include retesting positive for SARS-CoV-2, living alone, female gender, comorbid chronic physical diseases, and low education and income levels. Clinicians and policy makers should be aware of the risk of mental health sequelae in COVID-19 survivors and implement appropriate preventive and treatment measures.

BackgroundThe body image of patients with cancer can be negatively affected due to treatment toxicities. Changes in body image may cause patients to experience social appearance anxiety. This study aimed to evaluate the body image and social appearance anxiety of patients with cancer undergoing radiotherapy.MethodsThe cross-sectional study was conducted with 153 patients with cancer undergoing radiotherapy in a university hospital. The data were collected with a Patient Information Form, the Body Image Scale, and the Social Appearance Anxiety Scale and the Radiation Therapy Oncology Group Skin Toxicity Criteria.ResultsPatients’ mean body image score was 15.18 ± 8.26 (min = 0, max = 30), mean social appearance anxiety score was 45.29 ± 14.50 (min = 16, max = 80). Patients with low education levels and low-income levels had higher body image and social appearance anxiety scores (p < 0.01). Body image and social appearance anxiety scores were found to be higher in patients with advanced cancer, grade III-IV skin toxicity, pain, fatigue, and constipation (p < 0.05).ConclusionsRadiotherapy may negatively affect body image and social appearance anxiety. Assessments of body image and social appearance anxiety regularly before, during, and after treatment are essential. Psychosocial support should be provided to patients to reduce body image and social appearance anxiety and increase their well-being. Patients with cancer especially those who have low income and education levels, advanced cancer stage and skin toxicity, and suffer from pain, fatigue, constipation, etc. should be supported by methods such as counseling and social support groups.

Objective: To evaluate diabetes self-care practice and disease knowledge in type 2 diabetes mellitus (T2D) patients with respect to age, educational attainment, income class and antidiabetic treatments. Methods: A total of 583 patients with T2D (mean (SD) age: 57.3 (9.5) years, 55.9% females) were included in this cross-sectional study. Data on sociodemographic characteristics, diabetes characteristics (duration, current treatment), diabetes self-care practice [forgetting to take anti-diabetic medication, discontinuation of treatment due to side effects, self-monitoring of blood glucose (SMBG), diabetes education and regular exercise] and disease knowledge (definition and target levels of HbA1c, hypoglycemia symptoms and diabetes-related complications) were recorded. Results: Overall, HbA1c levels were &gt;8% in 53.2% of patients, 38.3% of patients reported that they had no diabetes education, while at least twice daily SMBG and regular exercise was reported by 27.4% and 19.7% of patients, respectively. Lack of knowledge on definition and target levels of HbA1c was noted in up to 65.5% of patients, while majority of patients reported that they know hypoglycemia symptoms (89.2%) and diabetes-related complications (86.4%). Illiteracy was associated with higher likelihood of treatment discontinuation (p&lt;0.001) and with lesser likelihood of performing regular exercise (10.3 vs. 32.8%, p&lt;0.001). Older patient age, lower educational attainment and lower income level were associated with lesser likelihood of knowing the definition or target levels of HbA1c (p&lt;0.001 for each) and sexual complications of diabetes (p&lt;0.001, p&lt;0.001 and p=0.028, respectively). Knowing diabetes-related complications were less common in those with lower educational attainment (p&lt;0.001) and lower income level (p=0.010), while insulin-naïve patients were less likely to know hypoglycemia symptoms (p=0.010). Conclusion: In conclusion, our findings revealed poor glycemic control, low level of knowledge on definition and targets of HbA1c and lack of diabetes education with suboptimal adherence to self-care practice in a considerable percentage of patients. Disease knowledge but not SMBG practice significantly differed with respect to patient age, educational attainment, income class and treatment. Our findings seem to indicate lower disease-related insight among older patients and those with lower educational and income levels, emphasizing the potential role of individualized diabetes education interventions tailored to needs of patients to improve disease knowledge and thus the adherence to self-care practice in T2D patients.

Workers whose jobs are affected by structural change and digitization are required to continuously adapt their vocational skills to the requirements of the labor market. This adaptation is also essential for the competitiveness of their employer firms. The German legislature addressed this issue with investive measures for unemployment insurance, one of which is the Qualification Opportunities Act (Qualifizierungschancengesetz). Funds taken from unemployment insurance can now be used to provide financial help for employers in a more direct way and on a broader scale than before. It became possible that not only unemployed individuals but also workers in companies receive state assistance. This paper analyses the extent to which citizens accept such public support programs for further training and which principles of justice they apply when assessing a just amount of training subsidies. We conducted two factorial surveys. First, we investigated the justice assessments of training subsidies for different types of firms. The results showed that citizens are inclined to subsidize companies by receiving social security funds for further training of their employees. However, when doing so, the principle of needs-based justice should be complied with. Second, we analyze whether citizens think it is just or unjust to provide training subsidies to different workers, as we present them with changing characteristics of workers. The findings confirmed that in addition to the principle of need, views on performance justice, as well as economic considerations are relevant in assessments of whether training subsidies co-financed by unemployment insurance are just.

Background:Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder.Aims:To identify demographic factors in patients with IBS.Subjects and Methods:One-hundred and fifty three IBS patients seen at Taleghani Hospital Gastroenterology Clinic and met the Rome III criteria and 163 peoples who did not meet IBS criteria were consecutively enrolled. Both groups were asked to complete a self-rating questionnaire containing information, which included questions about age, sex, monthly income, education level, marital status, height, weight, alcohol drinking and smoking habits. Student's t-test, Pearson's Chi-square and logistic regression were used to statistical analysis.Results:The mean (SD) age for IBS patients 36.3 (13.5) years and 33.1 (9.9) years in non-IBS group (P < 0.001). Frequency of IBS defined by Rome III criteria was higher in females and younger individuals. Univariate analysis showed that IBS in males was associated with a lower monthly income and educational level and in females younger age, single, lower monthly income and educational level, body mass index (BMI), and unemployment status. Multivariate logistic regression identified a low level of education in males (Odds ratio [OR] = 3.6, 95% Confidence interval [CI]: 1.4-9.6) and in females, lower education level (OR = 2.4, 95% CI: 1.1-5.2), lower BMI (OR = 0.94, 95% CI: 0.89-0.99), unemployed (OR = 0.31, 95% CI: 0.11-0.85) and smoking (OR = 6.2, 95% CI: 1.03-37.2).Conclusion:We identified demographic factors in IBS patients. Being single and having a lower educational level, income, lower BMI and being unemployed were the most important factors associated with IBS, particularly in females.

Vaccination against COVID-19 and socioeconomic inequalities: A cross-sectional study in Ecuador

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): 1. SHE Foundation and "la Caixa" 2. Fondo de Investigación Sanitaria - Instituto de Salud Carlos III. Background Family socioeconomic status (SES) impacts childhood health and could influence the effect of school-based health promotion interventions. Purpose This work aims to evaluate the impact of SES on the effects of the SI! Program randomized controlled trials for cardiovascular health promotion in preschoolers carried out in Colombia, Spain, and USA. Specifically, this work analyzed the effect of SES in the change of knowledge, attitudes and habits (KAH) and body mass index z-scores (zBMI) from baseline to immediately after the end of the health promotion intervention. Methods Children completed a KAH questionnaire (from 0 to 80 points) at baseline and immediate post-intervention. Families reported household income and education level through a dedicated questionnaire. Household income was categorized as low or high, and education level as low, intermediate, or high based on local census data. Adjusted baseline scores were calculated and stratified by SES using linear mixed models. The impact of the intervention was assessed by an individual participant-level meta-analysis using a random-effects model (DerSimonian-Laird method). Estimates of the difference between groups were derived from linear mixed models. Results A total of 3839 children were included in the analysis (48.9% girls, 4.0 (SD=0.8) years at baseline). Children of families with high education level and high household income tended to have a higher KAH score at baseline than those with low education level or low income (47.2 points [95%CI: 43.9; 50.5] vs. 45.7 points [95%CI: 42.4; 48.9]; 47.4 points [95%CI: 44.6; 50.2] vs. 45.8 points [95%CI: 43.0; 48.6], respectively) (Fig. 1A). Children from high education level and high income families had a lower zBMI at baseline than those from low education level and low income families (0.23 [95%CI: -0.20; 0.67] vs. 0.47 [95% CI: 0.03; 0.90]; 0.25 [95%CI: -0.15; 0.66] vs. 0.44 [95%CI: 0.04; 0.85], respectively) (Fig. 1B). The mean difference in KAH change between the intervention and control groups was 4.76 points (95%CI: 2.78; 6.74). The effect of the intervention on KAH score change was higher for children of families reporting high income or an intermediate/high education level than for those reporting low income or education level (Fig. 2A). The overall mean difference in zBMI change between groups was -0.06 (95%CI: -0.14; 0.02), and no significant differences were found in relation to SES indicators (Fig. 2B). Conclusions These results suggest that children from a low SES background benefit less from lifestyle interventions than those from high SES families. Health promotion interventions may implement strategies to counteract this effect and, consequently, avoid the potential risk of increasing health inequalities.

The Chinese government stresses healthcare reform to improve the health of all residents in urban and rural areas. However, much research showed that inequities still existed in health status and health services utilization in China, especially in economically disadvantaged areas. Southwest China's Yunnan Province is an ethnic frontier region with lagging economic development. This study analyzed health equity among rural residents with various socio-economic and demographic statuses in Yunnan Province. Research on this area concerns rural residents. Our study was based on a household study sample consisting of 27,395 participants from six counties in Yunnan. For all participants, data on demographic and socio-economic characteristics, and health status were collected. The chi-square test and logistic regression were used to analyze factors influencing health. The concentration index was used to evaluate health equity. For all respondents, the 2-week prevalence, the prevalence of chronic diseases, and the required hospitalization rate were 7.3, 12.8, and 9.2%, respectively. After adjusting the age proportion of the sixth population census of Yunnan Province, the 2-week prevalence was 7.1%, the prevalence of chronic disease was 10.7%, and the hospitalization rate was 8.4%. The concentration indexes (CIs) reflecting health equity among the respondents with different incomes and educational levels were negative. There was health inequity among respondents with different incomes and educational levels. The respondents with lower incomes and educational levels had worse health. The common influencing factors included gender, age, ethnicity, occupation, marriage status, and the number of family members. Females, the aged, ethnic minorities, farmers, and the divorced or widowed had worse health status than the control groups. Larger numbers of family members correlated with better health. The respondents with lower incomes or educational levels had higher chronic disease prevalences. The associations between the 2-week prevalence, required hospitalization rate, and age were U-shaped; the lowest age group and the highest age group had higher rates. In conclusion, more attention should be paid to females, the aged, ethnic minorities, farmers, the divorced or widowed, residents with low income and low educational level, and those with chronic diseases.

Rapid population aging in high absolute poverty settings, such as much of South Africa, demands new research on the social context factors that affect cognitive aging in these settings. We investigated the relationships between subjective social position within one’s village and cognitive function and impairment, with the rationale that psychosocial stress induced by low relative social position may affect cognitive aging outcomes independently of absolute socioeconomic conditions. Data were from the population-representative HAALSI study of 5,059 adults aged 40+ in rural Agincourt, South Africa. Subjective social position was assessed using the MacArthur Network social ladder, which asks respondents to indicate how high up a ladder they stand, relative to others, in their village. Cognitive function was a composite z-score of time orientation and word recall tests; scores ≤1.5 standard deviations (SD) below the mean indicated cognitive impairment. Twenty percent of those on the bottom rung had cognitive impairment, declining to 2% on the top rung. In regression models adjusted for age, sex, country of birth, education, literacy, marital status, employment, and asset-based household wealth, each ladder rung increase was associated with an 0.05 SD increase in cognitive z-score (95% CI: 0.04-0.06), and a 17% decrease in odds of cognitive impairment (OR=0.83; 95% CI: 0.79-0.88); these associations were greater in magnitude than those for years of education with these cognitive outcomes. Future work should examine if these relationships persist longitudinally, and investigate the mechanisms of these relationships, including village-level contextual factors that may contribute to subjective social position in this setting.