Area-based Measure Of Socioeconomic Status Research Articles

Health poverty among people with type 2 diabetes mellitus (T2DM) in Malaysia

In the context of the escalating burden of diabetes in low and middle-income countries (LMICs), there is a pressing concern about the widening disparities in care and outcomes across socioeconomic groups. This paper estimates health poverty measures among individuals with type 2 diabetes mellitus (T2DM) in Malaysia. Using data from the National Diabetes Registry between 2009 and 2018, the study linked 932,855 people with T2DM aged 40–75 to death records. Cox proportional hazards models were used to estimate the 5-year survival probabilities for each patient, stratified by age and sex, while controlling for comorbidities and area-based indicators of socio-economic status (SES), such as district-level asset-based indices and night-time luminosity. Measures of health poverty, based on the Foster-Greer-Thorbecke (FGT) measures, were employed to capture excessive risk of premature mortality. Two poverty line thresholds were used, namely a 5% and 10% reduction in survival probability compared to age and sex-adjusted survival probability of the general population. Counterfactual simulations estimated the extent to which comorbidities contribute to health poverty. 43.5% of the sample experienced health poverty using the 5% threshold, and 8.9% were health poor using the 10% threshold. Comorbidities contribute 2.9% for males and 5.4% for females, at the 5% threshold. At the 10% threshold, they contribute 7.4% for males and 3.4% for females. If all patients lived in areas of highest night-light intensity, poverty would fall by 5.8% for males and 4.6% for females at the 5% threshold, and 4.1% for males and 0.8% for females at the 10% threshold. In Malaysia, there is a high incidence of health poverty among people with diabetes, and it is strongly associated with comorbidities and area-based measures of SES. Expanding the application of health poverty measurement, through a combination of clinical registries and open spatial data, can facilitate simulations for health poverty alleviation.

Socioeconomic status and diabetes technology use in youth with type 1 diabetes: a comparison of two funding models.

Technology use, including continuous glucose monitoring (CGM) and insulin pump therapy, is associated with improved outcomes in youth with type 1 diabetes (T1D). In 2017 CGM was universally funded for youth with T1D in Australia. In contrast, pump access is primarily accessed through private health insurance, self-funding or philanthropy. The study aim was to investigate the use of diabetes technology across different socioeconomic groups in Australian youth with T1D, in the setting of two contrasting funding models. A cross-sectional evaluation of 4957 youth with T1D aged <18 years in the national registry was performed to determine technology use. The Index of Relative Socio-Economic Disadvantage (IRSD) derived from Australian census data is an area-based measure of socioeconomic status (SES). Lower quintiles represent greater disadvantage. IRSD based on most recent postcode of residence was used as a marker of SES. A multivariable generalised linear model adjusting for age, diabetes duration, sex, remoteness classification, and location within Australia was used to determine the association between SES and device use. CGM use was lower in IRSD quintile 1 in comparison to quintiles 2 to 5 (p<0.001) where uptake across the quintiles was similar. A higher percentage of pump use was observed in the least disadvantaged IRSD quintiles. Compared to the most disadvantaged quintile 1, pump use progressively increased by 16% (95% CI: 4% to 31%) in quintile 2, 19% (6% to 33%) in quintile 3, 35% (21% to 50%) in quintile 4 and 51% (36% to 67%) in the least disadvantaged quintile 5. In this large national dataset, use of diabetes technologies was found to differ across socioeconomic groups. For nationally subsidised CGM, use was similar across socioeconomic groups with the exception of the most disadvantaged quintile, an important finding requiring further investigation into barriers to CGM use within a nationally subsidised model. User pays funding models for pump therapy result in lower use with socioeconomic disadvantage, highlighting inequities in this funding approach. For the full benefits of diabetes technology to be realised, equitable access to pump therapy needs to be a health policy priority.

Association between socioeconomic status with pregnancy and neonatal outcomes: An international multicenter cohort.

Previous evidence examining the association between socioeconomic status and pregnancy complications are conflicted and often limited to using area-based measures of socioeconomic status. In this study, we aimed to examine the association between individual-level socioeconomic factors and a wide range of adverse pregnancy and neonatal outcomes using data from the IMPROvED birth cohort conducted in Sweden, the Netherlands and Republic of Ireland. The study cohort consisted of women who participated in the IMPROvED birth cohort between 2013 and 2017. Data on socioeconomic factors were self-reported and obtained at 15 weeks' gestation, and included level of education, employment status, relationship status, and income. Data on pregnancy and neonatal outcomes included gestational hypertension, pre-eclampsia, gestational diabetes mellitus, emergency cesarean section, preterm birth, post term delivery, small for gestational age and Apgar score at 1 min. These data were obtained within 72 h following delivery and confirmed using medical records. Multivariable logistic regression examined the association between each socioeconomic variable and each outcome separately adjusting for maternal age, maternal body mass index, maternal smoking, maternal alcohol consumption and cohort center. We also examined the effect of exposure to any ≥2 risk factors compared to none. A total of 2879 participants were included. Adjusted results suggested that those with less than third level of education had an increased odds of gestational hypertension (OR: 1.74, 95% CI: 1.23-2.46), while those on a middle level of income had a reduced odds of emergency cesarean section (OR: 0.59, 95% CI: 0.42-0.84). No significant associations were observed between socioeconomic variables and neonatal outcomes. Exposure to any ≥2 socioeconomic risk factors was associated with an increased risk of preterm birth (OR: 1.75, 95% CI: 1.06-2.89). We did not find strong evidence of associations between individual-level socioeconomic factors and pregnancy and neonatal outcomes in high-income settings overall, with only few significant associations observed among pregnancy outcomes.

Assessment of Health Disparities and Barriers to Accessing Keratoconus and Crosslinking at a Tertiary Referral Center.

The aim of this study was to determine the barriers to accessing the crosslinking service in Auckland, New Zealand. This was a prospective 1-year study of patients at Auckland District Health Board. Studied parameters included age, sex, body mass index, ethnicity, New Zealand Deprivation (NZDep; an area-based measure of socioeconomic status, 1 = low deprivation-10 = high deprivation) score of residence, disease severity (maximum keratometry and thinnest corneal thickness), attendance, distance travelled, car ownership, employment status, and visual outcomes. Statistical analysis was performed using independent t tests, Pearson correlation, independent samples ANOVA, MANCOVA, and binomial logistic regression. Four hundred fifty-four patients with keratoconus were analyzed and had a mean age of 24.1 ± 0.8 years, mean body mass index of 33.0 ± 9.7 kg/m 2 , and 43% were female. Pacific Peoples consisted 40.2% of the population; Māori 27.2%; Europeans 21.2%; Asian 9.9%; and Middle Eastern, Latin American, and African (MELAA) 1.3%. The mean distance travelled was 12.5 ± 9.5 km, NZDep score was 6.8 ± 2.6, and attendance was 69.0 ± 42.5%. The lowest attendance was observed in Pacific Peoples (58.9%) and the highest was in Asians (90%) ( P = 0.019). The mean worst-eye visual acuity at attendance was 0.75 ± 0.47 logMAR (6/35). Unemployment was associated with worse best-eye visual acuity at FSA ( P = 0.01) and follow-up ( P < 0.05). Māori and Pacific Peoples had the highest NZDep ( P < 0.001), were younger at presentation ( P = 0.019), had higher disease severity ( P < 0.001), and worse visual acuity ( P < 0.001). Poor attendance was seen in this cohort. Pacific Peoples and Māori presented younger with worse disease severity and visual acuity but also had the highest nonattendance. These results suggest that deprivation, factors associated with ethnicity, and unemployment are potential barriers to attendance.

Association of Area-Based Socioeconomic Measures with Tuberculosis Incidence in California

We assessed the association of area-based socio-economic status (SES) measures with tuberculosis (TB) incidence in California. We used TB disease data for 2012–2016 (n = 9901), population estimates, and SES measures to calculate incidence rates, rate ratios, and 95% confidence intervals (95% CI) by SES and birth country. SES was measured by census tract and was categorized by quartiles for education, crowding, and the California Healthy Places Index (HPI)and by specific cutoffs for poverty. The lowest SES areas defined by education, crowding, poverty, and HPI had 39%, 40%, 41%, and 33% of TB cases respectively. SES level was inversely associated with TB incidence across all SES measures and birth countries. TB rates were 3.2 (95% CI 3.0–3.4), 2.1 (95% CI 1.9–2.2), 3.6 (95% CI 3.3–3.8), and 2.0 (95% CI 1.9–2.1) times higher in lowest SES areas vs. highest SES areas as defined by education, crowding, poverty and HPI respectively. Area-based SES measures are associated with TB incidence in California. This information could inform TB prevention efforts in terms of materials, partnerships, and prioritization.

Inequality in out of pocket fees, government funding and utilisation of maternal health services in Australia

This study aimed to assess the distribution of service utilisation, out-of-pocket fees and government funding for maternal health care in Australia by socioeconomic group. A large linked administrative dataset was utilised. Women were grouped into socioeconomic quintiles using an area-based measure of socioeconomic status. Descriptive statistics were used to quantify the distribution of number of services, out of pocket fees, and government funding by socioeconomic quintile. Needs-adjusted concentration indices (CINA) were utilised to quantify inequity.The mean out of pocket fees for women of least socioeconomic advantage was $1,026 and for women of most socioeconomic advantage the mean was $2,432 (CINA 0.093, 95% CI: 0.088 – 0.098). However, use of many services were higher for women of most socioeconomic advantage: private obstetrician (CINA: 0.035, 95% CI: 0.032 – 0.038), other specialist services (CINA: 0.089, 95%CI: 0.083 – 0.094), and diagnostic and pathology tests (CINA: 0.027, 95%CI: 0.025 – 0.030). Federal government funding through Medicare was distributed towards women of most socioeconomic advantage (CINA: 0.036, 95%CI: 0.033 – 0.039); whereas government public hospital funding was skewed towards women of least socioeconomic advantage (CINA: -0.05, 95%CI: -0.057 - -0.046). Future policy changes in Australia's healthcare system need to ensure that women of least socioeconomic advantage have adequate access to maternity and early childhood care, and out of pocket fees are not an access barrier.

Is place or person more important in determining higher rural cancer mortality? A data-linkage study to compare individual versus area-based measures of deprivation.

Data from Northeast Scotland for 11,803 cancer patients (diagnosed 2007-13) were linked to UK Censuses to explore relationships between hospital travel-time, timely-treatment and one-year-mortality, adjusting for both area and individual-level socioeconomic status (SES). Adjusting for area-based SES, those living >60 minutes from hospital received timely-treatment more often than those living <15 minutes. Substituting individual-level SES changed little. Adjusting for area-based SES those living >60 minutes from hospital died within one year more often than those living <15 minutes. Again, substituting individual-level SES changed little. In Northeast Scotland distance to services, rather than individual SES, likely explains poorer rural cancer survival.Background and objectiveThe Northeast and Aberdeen Scottish Cancer and Residence (NASCAR) study found rural-dwellers are treated quicker but more likely to die within a year of a cancer diagnosis. A potential confounder of the relationship between geography and cancer mortality is socioeconomic status (SES). We linked the original NASCAR cohort to the UK Censuses of 2001 and 2011, at an individual level, to explore the relationship between travel time to key healthcare facilities, timely cancer treatment and one-year mortality adjusting for both area and individual-level markers of socioeconomic status.MethodsA data linkage study of 11803 patients examined the association between travel times, timely treatment and one-year mortality with adjustment for area, and for individual-level, markers of socioeconomic status.ResultsFollowing adjustment for area-based SES measures those living more than 60 minutes from the cancer treatment centre were significantly more likely to be treated within 62 days of GP referral than those living within 15 minutes (Odds Ratio [OR]) 1.41; 95% (Confidence Interval [CI]) 1.23, 1.60]. Replacing area-based with individual-level SES measures from UK Censuses made little impact on the results [OR 1.39; 95% CI 1.22, 1.57].Following adjustment for area-based SES measures of socioeconomic status those living more than 60 minutes from the cancer treatment centre were significantly more likely to die within one year than those living closer by [OR 1.22; 95% CI 1.08, 1.38]. Again, replacing area-based with individual-level SES measures from UK Censuses made little impact on the result [OR 1.20; CI 1.06, 1.35].ConclusionsDistribution of individual measures of socioeconomic status did not differ significantly between rural and urban cancer patients. The relationship between distance to service, timely treatment and one-year survival were the same adjusting for both area-based and individual SES. Overall, it seems that distance to services, rather than personal characteristics, influences poorer rural cancer survival.

Area-Based Socioeconomic Disparities in Survival of Children with Newly Diagnosed Acute Myeloid Leukemia: A Report from the Children's Oncology Group

Introduction: Income, education, and health insurance coverage have been shown to influence access to appropriate oncology care, impacting detection and treatment. We sought to evaluate the role of area-based measures of socioeconomic status in contributing to outcome disparities on the two most recent Children's Oncology Group (COG) Phase 3 clinical trials for acute myeloid leukemia (AML), AAML0531 and AAML1031. We hypothesized that pediatric AML patients from low income and low education zip codes have inferior five-year overall survival (OS) and event-free survival (EFS) relative to patients from middle income and more educated zip codes. Methods: Patients enrolled on AAML0531 and AAML1031 were included. Patients with Down syndrome (n=5), FLT3/ITD high allelic ratio (n=264), in AAML1031 Arm D (n=332), and patients whose zip code was not able to be mapped to a US Census area were excluded (n=60). Patients were observed from enrollment on study through last available follow up. Zip code level median annual household income was the primary exposure and was categorized as follows: Poverty: &amp;lt;$24,250 (federal poverty line); Low: $24,250-56,516; Middle/High &amp;gt;$56,516. Secondary exposures of interest included zip code level educational attainment and insurance type (Medicaid Only vs other insurance) at AML diagnosis. Standard descriptive statistics were used to compare patient characteristics by levels of exposure; the Kaplan Meier method was used to estimate OS (defined as time from study entry to death) and EFS (time from study entry until failure to achieve CR during induction, relapse, or death). Cox proportional hazards models were used to estimate hazard ratios (HR) for OS and EFS. Measures of association were adjusted for known risk factors for mortality including cytogenetic/mutation risk group, gemtuzumab (GO) receipt, race, and age. Logistic regression analyses were used to estimate odds ratios (OR) for early mortality (defined as death during induction). Results: Of 2387 patients enrolled on AAML0531 and AAML1031, 1726 met inclusion criteria for the overall analysis. Due to missing covariate data, 1467 patients were included in the final model. Race/ethnicity differed significantly by area-based income, area-based education, and insurance type with a higher proportion of Black and Hispanic patients living in poverty, low income, and low education areas, and having Medicaid only insurance. Lower area-based income was associated with lower OS (43% in poverty vs. 61% in low income vs. 68% in middle/high income; p = 0.004) and EFS (34% in poverty vs. 46% in low income vs. 54% in middle/high income; p = 0.005), shown in Figure 1. Lower area-based educational attainment was also associated with lower OS (58% in Quartile 4 (lower education) vs. 70% in Quartile 1 (higher education); p = 0.005 across quartiles) and EFS (44% in Q4 vs. 54% in Q1; p = 0.03 across quartiles). Patients with Medicaid Only insurance had lower OS (59 ± 5% vs. 66 ± 3%: p = 0.01) but similar EFS (48 ± 5% vs. 50 ± 3%: p = 0.33). In a full multivariable model, differences in survival by area-based educational attainment and insurance type resolved suggesting that observed crude associations were explained by confounding by area-based income combined with established risk factors. Patients from middle/high income areas experienced 25% lower risk of mortality compared to patients from low income areas (OS: crude HR 0.74 95% CI 0.62, 0.89; adjusted HR 0.79 95% CI 0.63, 0.99) with similar differences in EFS (crude HR 0.79 95% CI 0.69, 0.92; adjusted HR 0.77 95% CI 0.65, 0.89). There was no meaningful confounding of the income-survival association detected as evidenced by unchanged magnitudes of association following adjustment for area-based education, insurance, and established risk factors. Area-based low income was associated with both higher risk of early death (crude OR: 2.43 95% CI 1.04, 5.69) and treatment-related mortality on therapy (11.1 ± 10.5% vs. 3.7 ± 2.5%, p = 0.03) compared to area-based middle/high income. Conclusions: Lower area-based income and education were associated with significantly inferior EFS and OS among patients with AML on the last two Phase 3 COG trials. Moreover, zip-code based low SES is an independent risk factor for mortality in pediatric AML. Additional studies to understand mechanisms of observed socioeconomic disparities in treatment outcomes will inform interventions that may mitigate these inequities. Disclosures Fisher: Pfizer: Research Funding; Astellas: Other: Data Safety Monitoring Board Chair for an antifungal study; Merck: Research Funding.

Socio-economic inequalities in fragility fracture outcomes: a systematic review and meta-analysis of prognostic observational studies.

Fragility fractures, especially of the hip, cause substantial excess mortality and impairment in health-related quality of life (HRQoL). This systematic review and meta-analysis aimed to investigate the association between socio-economic status (SES) and post-fracture mortality and HRQoL. PubMed, EMBASE and CINAHL databases were searched from inception to the last week of November 2018 for studies reporting an association between SES and post-fracture mortality and/or HRQoL among people aged ≥ 50years. Risk ratios (RRs) were meta-analyzed using a standard inverse-variance-weighted random effects model. Studies using individual-level and area-based SES measures were analyzed separately. A total of 24 studies from 15 different countries and involving more than one million patients with hip fractures were included. The overall risk of mortality within 1-year post-hip fracture in individuals with low SES was 24% higher than in individuals with high SES (RR 1.24, 95% CI 1.19 to 1.29) for individual-level SES measures, and 14% (RR 1.14, 95% CI 1.09 to 1.19) for area-based SES measures. The quality of the evidence for the outcome mortality was moderate. Using individual SES measures, we estimated the excess HRQoL loss to be 5% (95% CI - 1 to 10%) among hip fracture patients with low SES compared with high SES. We found a consistently increased risk of post-hip fracture mortality with low SES across SES measures and across countries with different political structures and different health and social care infrastructures. The impact of SES on post-fracture HRQoL remains uncertain due to sparse and low-quality evidence.

Impact of marginalization on tobacco use in individuals diagnosed with head and neck Cancer

BackgroundConsiderable evidence now indicates that individuals living in underprivileged neighbourhoods have higher rates of mortality and morbidity independent of individual-level characteristics. This study explored the impact of geographical marginalization on smoking cessation in a population of individuals with a diagnosis of head and neck cancer. The aims of this study were twofold: (1) assess the prevalence of smoking cessation in those with a previous diagnosis of head and neck cancer, (2) analyze the determinants of smoking alongside area-based measures of socioeconomic status.MethodsThis was a cross-sectional study. We administered a self-reported nicotine dependence package to participants between the ages of 20–90 with a previous mucosal head and neck cancer diagnosis and with a history of tobacco use. Using the Canadian Marginalization (CAN-Marg) Index tool based on 2006 Canada Census data we compared the degree of marginalization to the smoking status. For those individuals who were currently smoking, nicotine dependence and readiness to quit were assessed. A summative score of marginalization was compared to smoking status of individuals.ResultsThe results from this study indicate that the summative level of marginalization developed from the combined factors of residential instability, material deprivation, ethnic concentration and dependency may be important factors in smoking cessation.ConclusionsThis analysis of determinants of smoking alongside area-based measures of socioeconomic status may implicate the need for targeted population-based smoking cessation interventions.

Socioeconomic Differences and Lung Cancer Survival-Systematic Review and Meta-Analysis.

Background: The impact of socioeconomic differences on cancer survival has been investigated for several cancer types showing lower cancer survival in patients from lower socioeconomic groups. However, little is known about the relation between the strength of association and the level of adjustment and level of aggregation of the socioeconomic status measure. Here, we conduct the first systematic review and meta-analysis on the association of individual and area-based measures of socioeconomic status with lung cancer survival.Methods: In accordance with PRISMA guidelines, we searched for studies on socioeconomic differences in lung cancer survival in four electronic databases. A study was included if it reported a measure of survival in relation to education, income, occupation, or composite measures (indices). If possible, meta-analyses were conducted for studies reporting on individual and area-based socioeconomic measures.Results: We included 94 studies in the review, of which 23 measured socioeconomic status on an individual level and 71 on an area-based level. Seventeen studies were eligible to be included in the meta-analyses. The meta-analyses revealed a poorer prognosis for patients with low individual income (pooled hazard ratio: 1.13, 95 % confidence interval: 1.08–1.19, reference: high income), but not for individual education. Group comparisons for hazard ratios of area-based studies indicated a poorer prognosis for lower socioeconomic groups, irrespective of the socioeconomic measure. In most studies, reported 1-, 3-, and 5-year survival rates across socioeconomic status groups showed decreasing rates with decreasing socioeconomic status for both individual and area-based measures. We cannot confirm a consistent relationship between level of aggregation and effect size, however, comparability across studies was hampered by heterogeneous reporting of socioeconomic status and survival measures. Only eight studies considered smoking status in the analysis.Conclusions: Our findings suggest a weak positive association between individual income and lung cancer survival. Studies reporting on socioeconomic differences in lung cancer survival should consider including smoking status of the patients in their analysis and to stratify by relevant prognostic factors to further explore the reasons for socioeconomic differences. A common definition for socioeconomic status measures is desirable to further enhance comparisons between nations and across different levels of aggregation.

Widening socioeconomic inequalities in Australian suicide, despite recent declines in suicide rates.

This study aims to investigate trends in socioeconomic inequalities of suicide from 1979 to 2013 for Australian males and females aged 15-34years and 35-64years. Data on suicides and population were obtained from national registries. An area-based measure of socioeconomic status (SES) was used, and categorized into low, middle, and high SES areas. Suicide rates for each SES groups were estimated using a negative binomial regression model, adjusted for confounders. Socioeconomic inequalities in suicide were assessed using absolute and relative risk of low-to-high SES areas. Secular changes in socioeconomic inequalities were assessed using trend tests for relative risk. For young males, there was an increase in socioeconomic inequality driven by a significant decrease in suicide rates in high SES areas. For older males, inequality in suicide increased by 29%, which was related to a marked increase in suicide rates in low SES areas. Inequalities in both young and older female suicides also increased. These increases occurred when corresponding suicide rates in high SES areas decreased. Recent widening socioeconomic inequalities in Australian suicide have been primarily associated with declines in suicide rates in high SES areas. However, an increasing inequality in older male suicide is linked with low SES. Efforts targeting people from poor areas, especially older males, should be considered when developing suicide prevention strategy.

Cancer survival in New South Wales, Australia: socioeconomic disparities remain despite overall improvements.

BackgroundDisparities in cancer survival by socioeconomic status have been reported previously in Australia. We investigated whether those disparities have changed over time.MethodsWe used population-based cancer registry data for 377,493 patients diagnosed with one of 10 major cancers in New South Wales (NSW), Australia. Patients were assigned to an area-based measure of socioeconomic status. Five-year relative survival was estimated for each socioeconomic quintile in each ‘at risk’ period (1996–2000 and 2004–2008) for the 10 individual cancers. Poisson-regression modelling was used to adjust for several prognostic factors. The relative excess risk of death by socioeconomic quintile derived from this modelling was compared over time.ResultsAlthough survival increased over time for most individual cancers, Poisson-regression models indicated that socioeconomic disparities continued to exist in the recent period. Significant socioeconomic disparities were observed for stomach, colorectal, liver, lung, breast and prostate cancer in 1996–2000 and remained so for 2004–2008, while significant disparities emerged for cervical and uterus cancer in 2004–2008 (although the interaction between period and socioeconomic status was not significant). About 13.4 % of deaths attributable to a diagnosis of cancer could have been postponed if this socioeconomic disparity was eliminated.ConclusionWhile recent health and social policies in NSW have accompanied an increase in cancer survival overall, they have not been associated with a reduction in socioeconomic inequalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2065-z) contains supplementary material, which is available to authorized users.

Emerging Infections Program Efforts to Address Health Equity.

The Emerging Infections Program (EIP), a collaboration between (currently) 10 state health departments, their academic center partners, and the Centers for Disease Control and Prevention, was established in 1995. The EIP performs active, population-based surveillance for important infectious diseases, addresses new problems as they arise, emphasizes projects that lead to prevention, and develops and evaluates public health practices. The EIP has increasingly addressed the health equity challenges posed by Healthy People 2020. These challenges include objectives to increase the proportion of Healthy People-specified conditions for which national data are available by race/ethnicity and socioeconomic status as a step toward first recognizing and subsequently eliminating health inequities. EIP has made substantial progress in moving from an initial focus on monitoring social determinants exclusively through collecting and analyzing data by race/ethnicity to identifying and piloting ways to conduct population-based surveillance by using area-based socioeconomic status measures.

Energy density of the Scottish diet estimated from food purchase data: relationship with socio-economic position and dietary targets.

Frequent consumption of energy-dense foods has been strongly implicated in the global increase of obesity. The World Cancer Research Fund suggests a population-level energy density (ED) goal for diets of 523 kJ/100 g (125 kcal/100 g) as desirable for reducing weight gain and related co-morbidities. However, there is limited information about the ED of diets of contemporary populations. The aims of the present study were to (1) estimate the mean ED of the Scottish diet, (2) assess differences in ED over time by socio-economic position, by household (HH) composition and for HH meeting dietary targets for fat and fruit and vegetables, and (3) assess the relationship between ED and the consumption of foods and nutrients, which are indicative of diet quality. ED of the diet was estimated from food (including milk) from UK food purchase survey data. The average ED of the Scottish diet was estimated as 718 kJ/100 g with no change between the survey periods 2001 and 2009. Individuals living in the most deprived areas had a higher mean ED than those living in the least deprived areas (737 v. 696 kJ/100 g). Single-parent HH had the highest mean ED (765 kJ/100 g) of all the HH surveyed. The mean ED of HH achieving dietary targets for fat and fruit and vegetables was 576 kJ/100 g compared with 731 kJ/100 g for non-achievers. HH within the lowest quintile of ED were, on average, closest to meeting most dietary guidelines. Food purchase data can be used to monitor the quality of the diet in terms of dietary ED of the population and subgroups defined by an area-based measure of socio-economic status.

Area-based socioeconomic status, type 2 diabetes and cardiovascular mortality in Scotland

The aim of this study was to explore the relationships between type 2 diabetes mellitus, area-based socioeconomic status (SES) and cardiovascular disease mortality in Scotland. We used an area-based measure of SES, Scottish national diabetes register data linked to mortality records, and general population cause-specific mortality data to investigate the relationships between SES, type 2 diabetes and mortality from ischaemic heart disease (IHD) and cerebrovascular disease (CbVD), for 2001-2007. We used negative binomial regression to obtain age-adjusted RRs of mortality (by sex), comparing people with type 2 diabetes with the non-diabetic population. Among 216,652 people aged 40 years or older with type 2 diabetes (980,687 person-years), there were 10,554 IHD deaths and 4,378 CbVD deaths. Age-standardised mortality increased with increasing deprivation, and was higher among men. IHD mortality RRs were highest among the least deprived quintile and lowest in the most deprived quintile (men: least deprived, RR 1.94 [95% CI 1.61, 2.33]; most deprived, RR 1.46 [95% CI 1.23, 1.74]) and were higher in women than men (women: least deprived, RR 2.84 [95% CI 2.12, 3.80]; most deprived, RR 2.04 [95% CI 1.55, 2.69]). A similar, weaker, pattern was observed for cerebrovascular mortality. Absolute risk of cardiovascular mortality is higher in people with diabetes than in the non-diabetic population and increases with increasing deprivation. The relative impact of diabetes on cardiovascular mortality differs by SES, and further efforts to reduce cardiovascular risk both in deprived groups and people with diabetes are required. Prevention of diabetes may reduce socioeconomic health inequalities.

Development of the Canadian Marginalization Index: a new tool for the study of inequality.

Area-based measures of socio-economic status are increasingly used in population health research. Based on previous research and theory, the Canadian Marginalization Index (CAN-Marg) was created to reflect four dimensions of marginalization: residential instability, material deprivation, dependency and ethnic concentration. The objective of this paper was threefold: to describe CAN-Marg; to illustrate its stability across geographic area and time; and to describe its association with health and behavioural problems. CAN-Marg was created at the dissemination area (DA) and census tract level for census years 2001 and 2006, using factor analysis. Descriptions of 18 health and behavioural problems were selected using individual-level data from the Canadian Community Health Survey (CCHS) 3.1 and 2007/08. CAN-Marg quintiles created at the DA level (2006) were assigned to individual CCHS records. Multilevel logistic regression modeling was conducted to examine associations between marginalization and CCHS health and behavioural problems. The index demonstrated marked stability across time and geographic area. Each of the four dimensions showed strong and significant associations with the selected health and behavioural problems, and these associations differed depending on which of the dimensions of marginalization was examined. CAN-Marg is a census-based, empirically derived and theoretically informed tool designed to reflect a broader conceptualization of Canadian marginalization.

Customising fetal weight by ethnicity may ignore confounding with socio-economic status in a UK population

IntroductionCustomised antenatal growth charts (CAGCs) adjust expectations of estimated fetal weight (EFW) based on the assumed effects of maternal characteristics on potential birthweight (Gardosi et al 1992). Previous studies have...

HOMICIDE AND SCHIZOPHRENIA

This study aimed to assess the distribution of service utilisation, out-of-pocket fees and government funding for maternal health care in Australia by socioeconomic group. A large linked administrative dataset was utilised. Women were grouped into socioeconomic quintiles using an area-based measure of socioeconomic status. Descriptive statistics were used to quantify the distribution of number of services, out of pocket fees, and government funding by socioeconomic quintile. Needs-adjusted concentration indices (CINA) were utilised to quantify inequity.The mean out of pocket fees for women of least socioeconomic advantage was $1,026 and for women of most socioeconomic advantage the mean was $2,432 (CINA 0.093, 95% CI: 0.088 – 0.098). However, use of many services were higher for women of most socioeconomic advantage: private obstetrician (CINA: 0.035, 95% CI: 0.032 – 0.038), other specialist services (CINA: 0.089, 95%CI: 0.083 – 0.094), and diagnostic and pathology tests (CINA: 0.027, 95%CI: 0.025 – 0.030). Federal government funding through Medicare was distributed towards women of most socioeconomic advantage (CINA: 0.036, 95%CI: 0.033 – 0.039); whereas government public hospital funding was skewed towards women of least socioeconomic advantage (CINA: -0.05, 95%CI: -0.057 - -0.046). Future policy changes in Australia's healthcare system need to ensure that women of least socioeconomic advantage have adequate access to maternity and early childhood care, and out of pocket fees are not an access barrier.

C-C3-03: Using Area-Based Measures in the Absence of Individual-Level Measures to Target Enrollment into a Study

Background Targeting enrollment into studies on participant characteristics is increasingly possible within HMOs given improved computerized collection of individual characteristics. Some gaps remain – particularly with respect to socioeconomic status (SES). In the absence of individual-level SES data, selecting participants on area-based SES measures may be more efficient than selecting participants on simple random samples. We describe the use of an area-based measure of formal education for targeting enrollment of adults into an intervention to design and evaluate oral and print health literacy.