Area-based Socioeconomic Indicators Research Articles

Temporal dynamics of socioeconomic inequalities in COVID-19 – a scoping review

Abstract Background International evidence shows a socially unequal burden of SARS-CoV-2 infections and COVID-19 outcomes across different socioeconomic groups. However, less is known about the temporal dynamics of socioeconomic inequalities in COVID-19 throughout the pandemic. We conducted a scoping review to systematically map and synthesize the available evidence. Methods We conducted a systematic literature search in Embase and Scopus with pre-defined eligibility criteria, including empirical research from 1 January 2020 to 24 August 2021. Additionally, several journals and the reference lists of all included articles were hand-searched to identify relevant studies. We used a standardized charting approach to extract relevant content and narratively synthesized the included evidence. The study follows the PRISMA guidelines for scoping reviews. Results From 8,011 identified records, we finally included 46 articles in the analysis. 50.0% of all included studies were conducted in the United States. The majority of all studies analyzed surveillance data (n = 44) and used area-based socioeconomic indicators on an ecological level (92.5%). The study results show temporal dynamics in COVID-19 inequalities, frequently initiated through higher outcome rates in more affluent populations and subsequent crossover dynamics to higher rates in more deprived populations (41.9%). Furthermore, 91.4% of the analyses show maintaining or worsening social inequalities in health with ongoing pandemic progression, which hit the most deprived populations the hardest. Conclusions The results show worsening social inequalities in COVID-19 over the course of the pandemic, with the most disadvantaged populations most affected during its progression. Targeted prevention and interventions, such as low-threshold testing and vaccination programs, infection protection for precarious jobs or living conditions, and targeted information are crucial to face socioeconomic inequalities throughout pandemics. Key messages

British Columbia’s Index of Multiple Deprivation for Community Health Service Areas

Area-based socio-economic indicators, such as the Canadian Index of Multiple Deprivation (CIMD), have been used in equity analyses to inform strategies to improve needs-based, timely, and effective patient care and public health services to communities. The CIMD comprises four dimensions of deprivation: residential instability, economic dependency, ethno-cultural composition, and situational vulnerability. Using the CIMD methodology, the British Columbia Index of Multiple Deprivation (BCIMD) was developed to create indexes at the Community Health Services Area (CHSA) level in British Columbia (BC). BCIMD indexes are reported by quintiles, where quintile 1 represents the least deprived (or ethno-culturally diverse), and quintile 5 is the most deprived (or diverse). Distinctive characteristics of a community can be captured using the BCIMD, where a given CHSA may have a high level of deprivation in one dimension and a low level of deprivation in another. The utility of this data as a surveillance tool to monitor population demography has been used to inform decision making in healthcare by stakeholders in the regional health authorities and governmental agencies. The data have also been linked to health care data, such as COVID-19 case incidence and vaccination coverage, to understand the epidemiology of disease burden through an equity lens.

Racial and ethnic differences in individual-level and area-based socioeconomic status and 12-month DSM-IV mental disorders

The purpose of this study was to: (1) examine the associations of individual-level objective socioeconomic status (OSS), subjective socioeconomic status (SSS), and area-based indicators of socioeconomic status, with 12-month DSM-IV mood, anxiety, alcohol use, and drug use disorders; and, (2) determine the extent of racial/ethnic differences in these associations across non-Latino White, non-Latino Black, Latino, and Asian participants. Data are from the Collaborative Psychiatric Epidemiology Studies dataset, a collection of three population-based surveys of mental disorders among U.S. residents aged 18 and older (n = 13,775). Among all indicators of socioeconomic status, SSS was most consistently associated with 12-month mental disorders. Income was negatively associated with mood and anxiety disorders; education was negatively associated with alcohol use and drug use disorders. Significant interactions with race/ethnicity were found for the associations of socioeconomic indicators with anxiety, alcohol use, and drug use disorders but not with mood disorders. SSS was not associated with any of the 12-month mental disorders among Blacks. Education had stronger associations with 12-month anxiety and alcohol use disorders among Whites than among other racial/ethnic groups. Among Asians, low income compared to high income was associated with a lower risk of anxiety disorders and less than high school completion compared to college or more was associated with a lower risk of alcohol use disorders. Finally, tract-level income inequality was associated with a greater risk of drug use disorders only among Blacks. The patterns and magnitudes of the associations of individual-level and area-based socioeconomic indicators differed by type of disorder and race/ethnicity.

Socioeconomic characteristics of neighborhoods where youth in out-of-home care reside

ABSTRACT In the U.S., little is known about the neighborhoods where youth in out-of-home care live prior to emancipation. This study describes the socioeconomic characteristics of such neighborhoods. Addresses for 229 youth aged 16–20 years and residing in out-of-home care in a single Midwest county were used. Addresses were geocoded and linked to U.S. Census’ data at the census tract level. Neighborhoods, or tracts, with youth in out-of-home care were significantly more disadvantaged across five area-based socioeconomic indicators. Findings suggest that youth in out-of-home care live in neighborhoods with disproportionately high rates of socioeconomic disadvantage.

Socioeconomic Inequalities in Total and Site-Specific Cancer Incidence in Germany: A Population-Based Registry Study.

Most chronic diseases follow a socioeconomic gradient with higher rates in lower socioeconomic groups. A growing body of research, however, reveals cancer to be a disease group with very diverse socioeconomic patterning, even demonstrating reverse socioeconomic gradients for certain cancers. To investigate this matter at the German national level for the first time, this study examined socioeconomic inequalities in cancer incidence in Germany, both for all cancers combined as well as for common site-specific cancers. Population-based data on primary cancers newly diagnosed in 2010–2013 was obtained from the German Centre for Cancer Registry Data. Socioeconomic position was assessed at the district level using the German Index of Socioeconomic Deprivation, which is a composite index of area-based socioeconomic indicators. Absolute and relative socioeconomic inequalities in total and site-specific cancer incidence were analyzed using multilevel Poisson regression models with the logarithm of the number of residents as an offset. Among men, socioeconomic inequalities in cancer incidence with higher rates in more deprived districts were found for all cancers combined and various site-specific cancers, most pronounced for cancers of the lung, oral and upper respiratory tract, stomach, kidney, and bladder. Among women, higher rates in more deprived districts were evident for kidney, bladder, stomach, cervical, and liver cancer as well as for lymphoid/hematopoietic neoplasms, but no inequalities were evident for all cancers combined. Reverse gradients with higher rates in less deprived districts were found for malignant melanoma and thyroid cancer in both sexes, and in women additionally for female breast and ovarian cancer. Whereas in men the vast majority of all incident cancers occurred at cancer sites showing higher incidence rates in more deprived districts and cancers with a reverse socioeconomic gradient were in a clear minority, the situation was more balanced for women. This is the first national study from Germany examining socioeconomic inequalities in total and site-specific cancer incidence. The findings demonstrate that the socioeconomic patterning of cancer is diverse and follows different directions depending on the cancer site. The area-based cancer inequalities found suggest potentials for population-based cancer prevention and can help develop local strategies for cancer prevention and control.

Socioeconomic Deprivation and Hospital Length of Stay

Socioeconomic deprivation is not easily measurable in hospital information systems. However, its identification is essential, as it is associated with morbidity and hospital length of stay (LOS). We aimed at studying the feasibility of using routinely recorded individual and area-based socioeconomic indicators, and assessing their relation with LOS. In a cross-sectional study we collected area-based socioeconomic deprivation indicators from French census databases and individual ones from the 2009 medical and administrative databases of a French referral maternity hospital. The principal outcome was the LOS for delivery. Individual level socioeconomic deprivation indicators included preferential insurance scheme (health insurance allocated to poor persons). Nine area-based socioeconomic deprivation indicators were aggregated at the census tract and commune levels. The relation between socioeconomic deprivation and LOS was studied using multilevel models. The well-documented relation between socioeconomic deprivation and preterm delivery was firstly studied in these models as a validation step. The linkage between aggregated and individual data was possible for the 3471 women included. The median LOS was 5 days. In multivariable analysis adjusted for age (P=0.02), twinning (P=0.0001), delivery mode (P<0.0001), drug addiction (P<0.0001), diagnosis-related group severity level (P<0.0001), and unemployment rate (P=0.002) were associated with an increased LOS. Identifying deprived patients in hospital databases using routinely collected area-based indicators is feasible. The relation of these latter with LOS is consistent with previous studies. Further multicenter investigations are needed to confirm the interest of using such indicators for cost and morbidity predictions.

Breast cancer stage at diagnosis and area-based socioeconomic status: a multicenter 10-year retrospective clinical epidemiological study in China

BackgroundAlthough socioeconomic status (SES) has been focused on as a key determinant of cancer stage at diagosis in western countries, there has been no systemic study on the relationship of SES and breast cancer stage at diagnosis in China.MethodsThe medical charts of 4,211 eligible breast cancer patients from 7 areas across China who were diagnosed between 1999 and 2008 were reviewed. Four area-based socioeconomic indicators were used to calculate area-based SES by cluster analysis. The associations between area-based SES and stage at diagnosis were analyzed by trend chi-square tests. Binary logistic regression was performed to estimate odds ratios for individual demographic characteristics' effects on cancer stages, stratified by area-based SES.ResultsThe individual demographic and pathologic characteristics of breast cancer cases were significantly different among the seven areas studied. More breast cancer cases in low SES areas (25.5%) were diagnosed later (stages III & IV) than those in high (20.4%) or highest (14.8%) SES areas (χ2 for trend = 80.79, P < 0.001). When area-based SES is controlled for, in high SES areas, cases with less education were more likely to be diagnosed at later stages compared with more educated cases. In low SES areas, working women appeared to be diagnosed at earlier breast cancer stages than were homemakers (OR: 0.18-0.26).ConclusionsIn China, women in low SES areas are more likely to be diagnosed at later breast cancer stages than those in high SES areas.

Reducing mortality in individuals at high risk for advanced melanoma through education and screening

Incidence and mortality rates of melanoma throughout most of the developed world have increased in the past 25 years. We propose that reduction of deaths from melanoma can be best enhanced by strong collaborations between experts in dermatology, primary care, oncology, cancer education and health systems research, epidemiologists, and behavioral scientists, among others. Public and professional educational campaigns should be guided by an understanding of 3 underlying but overlapping roots: epidemiology and preventable mortality (an understanding of who is most likely to be given the diagnosis of thick or late-stage melanoma), biology (an investigation of tumor types that are relatively common but potentially most lethal), and sociology (an analysis of the changes needed in social structures to improve access to those most in need of early detection programs). We review these major concepts, concentrating on the key risk factors for advanced melanoma.

Association of cutaneous melanoma incidence with area-based socioeconomic indicators–United States, 2004-2006

Socioeconomic status (SES) has been associated with melanoma incidence and outcomes. Examination of the relationship between melanoma and SES at the national level in the United States is limited. Expanding knowledge of this association is needed to improve early detection and eliminate disparities. We sought to provide a detailed description of cutaneous melanoma incidence and stage of disease in relationship to area-based socioeconomic measures including poverty level, education, income, and unemployment in the United States. Invasive cutaneous melanoma data reported by 44 population-based central cancer registries for 2004 to 2006 were merged with county-level SES estimates from the US Census Bureau. Age-adjusted incidence rates were calculated by gender, race/ethnicity, poverty, education, income, unemployment, and metro/urban/rural status using software. Poisson multilevel mixed models were fitted, and incidence density ratios were calculated by stage for area-based SES measures, controlling for age, gender, and state random effects. Counties with lower poverty, higher education, higher income, and lower unemployment had higher age-adjusted melanoma incidence rates for both early and late stage. In multivariate models, SES effects persisted for early-stage but not late-stage melanoma incidence. Individual-level measures of SES were unavailable, and estimates were based on county-level SES measures. Our findings show that melanoma incidence in the United States is associated with aggregate county-level measures of high SES. Analyses using finer-level SES measures, such as individual or census tract level, are needed to provide more precise estimates of these associations.

Inequalities in cancer survival and the NHS cancer plan: evidence of progress?

Inequalities in cancer survival and the NHS cancer plan: evidence of progress?

Poverty and childhood overweight in California Assembly districts

ObjectivesThe goal of the present study was to determine the association between childhood overweight and area-based socioeconomic indicators in California Assembly districts. DesignA cross-sectional ecologic study. ParticipantsCalifornia public school students. Main exposurePoverty and demographic data for California Assembly districts were based on the 2000 Census and obtained from the UCLA Center for Health Policy Research. Outcome measuresOverall and race- and ethnicity-specific rates of childhood overweight for California Assembly districts (n=80) were based on the 2004 statewide Fitnessgram evaluation of California public school students. ResultsPoverty was significantly associated with childhood overweight in California Assembly districts. At the Assembly district scale, childhood overweight was significantly associated with percent residents below poverty for the entire population (r=0.82), and with the race/ethnicity-specific overweight prevalence for African-American (r=0.43), Latino (r=0.61) and White (r=0.54) populations. There was also evidence that childhood overweight in California Assembly districts was spatially clustered. Linear regression models confirmed that percent of residents below poverty was an independent predictor of a higher prevalence of childhood overweight for the entire population. The results of race/ethnicity-specific models confirmed that the association between area poverty and childhood overweight was not explained by differences in the risk of overweight among specific race/ethnicity groups. ConclusionsArea-based measures of socioeconomic status can be used to identify problem areas and can be used for optimal targeting of public health prevention and intervention efforts.

Social inequalities in preterm birth in Scotland 1980–2003: findings from an area‐based measure of deprivation

The preterm birth rate in Scotland has been increasing in recent years. Although preterm birth rates show a social gradient, it is unclear how this gradient has been affected by the overall increase. We examined time trends in singleton live preterm birth rates in relation to area-based socio-economic indicators. Population-based retrospective cohort study. Scotland. All singleton live births delivered in Scottish hospitals between 1980 and 2003 (n= 1 423 993). Singleton live preterm birth rates in each deprivation quintile were derived. Subgroup analyses of those born moderately preterm (32-36 weeks), very preterm (28-31 weeks) and extremely preterm (24-27 weeks) were performed. The rate of singleton live preterm births increased from 49.7 per 1000 live births in the 5-year period 1980-84 to 56.1 per 1000 in the 4-year period 2000-03, a relative increase of 12.9%. A marked social gradient was apparent at all time periods: relative indices of inequality were 1.63 (95% CI 1.38-1.92) in 1980-84 and 1.55 (1.44-1.66) in 2000-03. Similar social gradients existed for all gestational age subgroups. Smoking status at first antenatal contact and increased obstetric intervention, possibly reflecting improvements in fetal monitoring and neonatal care, appeared to explain some but not all the social gradient. Social inequalities in preterm birth were apparent in Scotland between 1980 and 2003. In addition to helping pregnant women to stop smoking, other means to reduce social inequalities are required.

The usefulness of area-based socioeconomic measures to monitor social inequalities in health in Southern Europe

The study objective was to investigate the association between health outcomes and several small-area-based socioeconomic measures and also with individual socioeconomic measures as a check on external validity. Cross-sectional design based on the analysis of the Barcelona Health Interview Survey of 1992. A representative stratified sample of the non-institutionalised population resident in Barcelona city (Spain) was obtained. The present study refers to the 4171 respondents aged over 14. We studied perceived health status, presence of chronic conditions and smoking as health outcomes. Area socioeconomic measures (1991 census) were generated at census tract level and individual socioeconomic measures were educational level and social class obtained through the survey. With individual socioeconomic measures we observed that the lower the educational level or social class, the higher the probability of reporting a perceived health status of fair, poor or very poor and of presenting some chronic condition. With regard to smoking, among men this trend was similar [odds ratio (OR) = 1.5; 95% confidence interval (CI) = 1.2-1.9 in social classes IV-V with respect to social classes I-II], while among women it was reversed (OR = 0.7; 95% CI = 0.5-0.9). With the different area-based socioeconomic indicators differences were also observed in this sense, with the exception of smoking in women for which these indicators do not show any differences by socioeconomic level. With several census area-based socioeconomic measures similar effects on inequalities in health have been observed. In general, these inequalities were in the same sense as those obtained with individual-based measures. Small-area-based socioeconomic measures from the Spanish census could greatly enhance analysis of social inequalities in health, overcoming the absence of socioeconomic data in public health registries and in medical records.

Small area-based socio-economic indicators in the study of inequalities in health

To assess whether 2 area-level socioeconomic indicators (one single and the other composite) are able to detect social inequalities in health. We used the Health Interview Survey of Barcelona, 1992. Perceived health status, the presence of chronic conditions, smoking, pap test, educational level and social class were analyzed. As area-level indicators, the percentage of unemployment and a deprivation index at census tract level were obtained from the 1991 census. The associations between area-based socioeconomic indicators and individual-level socioeconomic position, as well as the associations among both types of socioeconomic indicator and health, were analyzed. A clear positive association was found between small area-based socioeconomic indicators and individual-level indicators. Similar effects were observed for different health outcomes among men as well as among women. For most of the outcomes analyzed, the differences were greater with the deprivation index than with unemployment. Thus, in men the age-adjusted odds ratio (ORa) of average, poor or very poor perceived health status was 2.0 (95% CI, 1.4-2.9) in the most disadvantaged unemployment quartile in relation to the least disadvantaged quartile while with the deprivation index the ORa was 2.7 (95% CI, 1.9-3.9). For women these ORa were 1.8 (95% CI, 1.4-2.4) and 2.4 (95% CI, 1.8-3.2), respectively. Area-based socioeconomic indicators, such as those available through the Spanish census, can be applied in all members of a population and are useful for detecting social inequalities in health.

Indicadores socioeconómicos de área pequeña en el estudio de las desigualdades en salud

ObjectiveTo assess whether 2 area-level socioeconomic indicators (one single and the other composite) are able to detect social inequalities in health. MethodsWe used the Health Interview Survey of Barcelona, 1992. Perceived health status, the presence of chronic conditions, smoking, pap test, educational level and social class were analyzed. As area-level indicators, the percentage of unemployment and a deprivation index at census tract level were obtained from the 1991 census. The associations between area-based socioeconomic indicators and individual-level socioeconomic position, as well as the associations among both types of socioeconomic indicator and health, were analyzed. ResultsA clear positive association was found between small area-based socioeconomic indicators and individuallevel indicators. Similar effects were observed for different health outcomes among men as well as among women. For most of the outcomes analyzed, the differences were greater with the deprivation index than with unemployment. Thus, in men the age-adjusted odds ratio (ORa) of average, poor or very poor perceived health status was 2.0 (95% CI, 1.4- 2.9) in the most disadvantaged unemployment quartile in relation to the least disadvantaged quartile while with the deprivation index the ORa was 2.7 (95% CI, 1.9-3.9). For women these ORa were 1.8 (95% CI, 1.4-2.4) and 2.4 (95% CI, 1.8- 3.2), respectively. ConclusionsArea-based socioeconomic indicators, such as those available through the Spanish census, can be applied in all members of a population and are useful for detecting social inequalities in health.

Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley Study.

OBJECTIVE: To investigate the associations of individual and area-based socioeconomic indicators with cardiovascular disease risk factors and mortality. DESIGN: Prospective study. SETTING: The towns of Renfrew and Paisley in the...