Area-level SES Research Articles

Socioeconomic deprivation and tuberculosis in Germany: a longitudinal spatial analysis (2001–2022)

Abstract Background Socioeconomic conditions may affect tuberculosis (TB) dynamics. We analyzed the relation between area-level socioeconomic deprivation and TB incidence in Germany between 2001-2022. Methods Using nationally representative data at the level of 400 German districts, we fitted generalized linear mixed models to assess the effect of socioeconomic deprivation on TB incidence controlling for age, sex, share of non-nationals population, share of refugees, geographic effects, location and time. We estimated crude and adjusted risk ratios (RR) and corresponding 95% Confidence Intervals (95%-CI) for socioeconomic deprivation quintiles (Q1-Q5), ranging from least (Q1) to most deprived (Q5) districts. Results Preliminary findings show that crude TB incidence risk was 7% higher (RR = 1.07, 95%-CI=1.04-1.09) in least (Q1) compared to most deprived areas (Q5). Districts with medium-low (Q2), medium (Q3), and medium-high (Q4) socioeconomic deprivation showed 1% higher (1.01, 0.98-1.03), 4% lower (0.96, 0.94-0.99) and 3% lower (0.97 0.94-1.00) risk, respectively, compared to the most deprived districts (Q5). Fully adjusted incidence risk was 6% lower for Q1 compared to Q5 (0.94, 0.86-1.02), while districts classified in quintiles Q2-Q4 showed 8% (0.92, 0.86-0.99), 6% (0.94, 0.88-1.01) and 3% (0.97, 0.92-1.02) lower risk compared to Q5, respectively. Conclusions The adjusted effect of area-level socioeconomic deprivation on the risk of TB incidence has been low in Germany. Not considering the assumed confounders leads to over-estimation of the association between area-level SES and TB. Future studies should explore further area-level or individual factors in order to better understand the spatial variation of TB incidence in Germany. Key messages • Area-level socioeconomic deprivation has a low effect on the risk of TB incidence across German districts. • Further research is needed in order to better understand the spatial variation of TB incidence in Germany.

Socioeconomic disparities and green space associated with myopia among Chinese school-aged students: A population-based cohort study.

There is increasing evidence on the link between environmental factors and myopia in children and adolescents, yet with inconsistent conclusions. We investigated the associations between socioeconomic inequalities and green space with myopia in school-aged students participating in the Tianjin Child and Adolescent Research of Eye (TCARE) study. We obtained data from a population-based dynamic cohort study conducted in Tianjin, China, in 2021 and followed up in 2022. We included 1 245 271 participants from 16 districts with an average age of 11.6 years (standard deviation = 3.3) in our analysis. We synthesized their area-level SES through a prediction model that combined economic, educational, and health care variables and assessed the greenness levels surrounding the school using the Normalized Difference Vegetation Index (NDVI) based on data obtained through satellite remote sensing. We performed generalised linear mixed effects analyses for each myopia outcome separately, with adjustments for students' sex, years of education completed, and the school's geographical location. We observed that students living in low SES areas had the highest prevalence of myopia (60.7%) in the last screening in 2022, as well as a higher incidence of one-year myopia (26.4%) compared to those residing in middle SES areas (22.7%). With a 0.1 increase in the 250, 500, and 1000 m buffer NDVI, the prevalence of myopia dropped by 6.3% (odds ratio (OR) = 0.937; 95% confidence interval (CI) = 0.915, 0.960), 7.7% (OR = 0.923; 95% CI = 0.900, 0.946), and 8.7% (OR = 0.913; 95% CI = 0.889, 0.937), respectively. The interaction analysis showed that low SES and low greenness exacerbate the prevalence of myopia. Findings from longitudinal analyses consistently demonstrated a correlation between higher values of NDVI and a slower progression of myopia. These findings remained robust across sensitivity analyses, including for variables on parental myopia and students' behaviors. Exposure to green spaces could play a crucial role in slowing the progression of myopia among school-aged students. Myopia control policies should prioritise young populations residing in low SES areas with limited access to green spaces, as they face the highest potential risks.

Associations of neighbourhood attributes with depression in mid-age and older adults: the moderating role of traffic-related air pollution and neighbourhood socioeconomic status

ABSTRACT We aimed to examine whether features of the natural, built and socioeconomic neighbourhood environments were related to depressive symptoms in Australian mid-age and older adults; and whether traffic-related air pollution (TRAP) (NO2) and area-level SES moderated the associations. A total of 4141 of participants (M age = 61 years) were included in this cross-sectional study. Neighbourhood environmental characteristics included percentages of parkland, blue space and commercial land use, population density (persons/hectare), street intersection density (intersections/km2) within 1 km residential buffers. Annual mean concentrations of nitrogen dioxide (NO2) were included. In total-effect models, greater street intersection connectivity was associated with fewer depressive symptoms. Population density was positively associated with depressive symptoms in direct-effect models. Residents from disadvantaged areas with low levels of NO2 and with greater commercial land use coverage reported fewer depressive symptoms. In contrast, residents were more likely to report depressive symptoms with greater coverage of commercial land use in high SES neighbourhoods with low levels of NO2. Street connectivity and population density play a role in the maintenance of mental health in older adults. NO2 and area-level SES are moderators of commercial land use-depression associations, and this knowledge can better inform planning of commercial destinations and facilities in urban environments.

Greater temporal regularity of primary care visits was associated with reduced hospitalizations and mortality, even after controlling for continuity of care

BackgroundPrevious studies have shown that more temporally regular primary care visits are associated with improved patient outcomes.ObjectiveTo examine the association of temporal regularity (TR) of primary care with hospitalizations and mortality in patients with chronic illnesses. Also, to identify threshold values for TR for predicting outcomes.DesignRetrospective cohort study.ParticipantsWe used data from the electronic health record of a health maintenance organization in Israel to study primary care visits of 70,095 patients age 40 + with one of three chronic conditions (diabetes mellitus, heart failure, chronic obstructive pulmonary disease).Main measuresWe calculated TR for each patient during a two-year period (2016–2017), and divided patients into quintiles based on TR. Outcomes (hospitalization, death) were observed in 2018–2019. Covariates included the Bice-Boxerman continuity of care score, demographics, and comorbidities. We used multivariable logistic regression to examine TR’s association with hospitalization and death, controlling for covariates.Key resultsCompared to patients receiving the most regular care, patients receiving less regular care had increased odds of hospitalization and mortality, with a dose–response curve observed across quintiles (p for linear trend < 0.001). For example, patients with the least regular care had an adjusted odds ratio of 1.40 for all-cause mortality, compared to patients with the most regular care. Analyses stratified by age, sex, ethnic group, area-level SES, and certain comorbid conditions did not show strong differential associations of TR across groups.ConclusionsWe found an association between more temporally regular care in antecedent years and reduced hospitalization and mortality of patients with chronic illness in subsequent years, after controlling for covariates. There was no clear threshold value for temporal regularity; rather, more regular primary care appeared to be better across the entire range of the variable.

Associations of socioeconomic status with infectious diseases mediated by lifestyle, environmental pollution and chronic comorbidities: a comprehensive evaluation based on UK Biobank

BackgroundSocioeconomic status (SES) inequity was recognized as a driver of some certain infectious diseases. However, few studies evaluated the association between SES and the burden of overall infections, and even fewer identified preventable mediators. This study aimed to assess the association between SES and overall infectious diseases burden, and the potential roles of factors including lifestyle, environmental pollution, chronic disease history.MethodsWe included 401,009 participants from the UK Biobank (UKB) and defined the infection status for each participant according to their diagnosis records. Latent class analysis (LCA) was used to define SES for each participant. We further defined healthy lifestyle score, environment pollution score (EPS) and four types of chronic comorbidities. We used multivariate logistic regression to test the associations between the four above covariates and infectious diseases. Then, we performed the mediation and interaction analysis to explain the relationships between SES and other variables on infectious diseases. Finally, we employed seven types of sensitivity analyses, including considering the Townsend deprivation index as an area level SES variable, repeating our main analysis for some individual or composite factors and in some subgroups, as well as in an external data from the US National Health and Nutrition Examination Survey, to verify the main results.ResultsIn UKB, 60,771 (15.2%) participants were diagnosed with infectious diseases during follow-up. Lower SES [odds ratio (OR) = 1.5570] were associated with higher risk of overall infections. Lifestyle score mediated 2.9% of effects from SES, which ranged from 2.9 to 4.0% in different infection subtypes, while cardiovascular disease (CVD) mediated a proportion of 6.2% with a range from 2.1 to 6.8%. In addition, SES showed significant negative interaction with lifestyle score (OR = 0.8650) and a history of cancer (OR = 0.9096), while a significant synergy interaction was observed between SES and EPS (OR = 1.0024). In subgroup analysis, we found that males and African (AFR) with lower SES showed much higher infection risk. Results from sensitivity and validation analyses showed relative consistent with the main analysis.ConclusionsLow SES is shown to be an important risk factor for infectious disease, part of which may be mediated by poor lifestyle and chronic comorbidities. Efforts to enhance health education and improve the quality of living environment may help reduce burden of infectious disease, especially for people with low SES.

Socioeconomic disparities and dementia in China

ObjectivesThis study aimed to investigate the associations between individual-level SES, area-level SES, and their interaction with dementia in China. MethodsThis study used data from the Second China National Sample Survey on Disability and restricted our finalized analysis to 688,507 participants aged 50 years or older. Dementia was ascertained according to the International Statistical Classification of Diseases, Tenth Revision. Multilevel logistic regression models were fitted to examine the associations between individual-level SES, area-level SES, and their interaction with dementia. ResultsParticipants with higher individual SES were less likely to develop dementia; the risk of dementia decreased by 18% for each standard deviation increase in individual SES (OR=0.82, 95% CI=0.77, 0.88). Advantaged areas were associated with an increased risk of dementia in Chinese adults by 1.52 (95% CI=1.43, 1.62). Analysis of the combination between individual-level SES and area-level SES revealed that as the level of area SES increased, the risk of dementia in lower SES people was significantly higher than in higher SES people (OR=1.09, 95% CI=1.04,1.14). DiscussionThis study found that people with lower SES living in high-SES areas had a higher risk of dementia than people with lower SES living in low-SES areas. Significant socioeconomic differences in the risk of dementia exist in China, and more attention should be given to low-SES populations living in high-SES areas.

Leveraging open data to reconstruct the Singapore Housing Index and other building-level markers of socioeconomic status for health services research

BackgroundSocioeconomic status (SES) is an important determinant of health, and SES data is an important confounder to control for in epidemiology and health services research. Individual level SES measures are cumbersome to collect and susceptible to biases, while area level SES measures may have insufficient granularity. The ‘Singapore Housing Index’ (SHI) is a validated, building level SES measure that bridges individual and area level measures. However, determination of the SHI has previously required periodic data purchase and manual parsing. In this study, we describe a means of SHI determination for public housing buildings with open government data, and validate this against the previous SHI determination method.MethodsGovernment open data sources (e.g. data.gov.sg, Singapore Land Authority OneMAP API, Urban Redevelopment Authority API) were queried using custom Python scripts. Data on residential public housing block address and composition from the HDB Property Information dataset (data.gov.sg) was matched to postal code and geographical coordinates via OneMAP API calls. The SHI was calculated from open data, and compared to the original SHI dataset that was curated from non-open data sources in 2018.ResultsTen thousand seventy-seven unique residential buildings were identified from open data. OneMAP API calls generated valid geographical coordinates for all (100%) buildings, and valid postal code for 10,012 (99.36%) buildings. There was an overlap of 10,011 buildings between the open dataset and the original SHI dataset. Intraclass correlation coefficient was 0.999 for the two sources of SHI, indicating almost perfect agreement. A Bland-Altman plot analysis identified a small number of outliers, and this revealed 5 properties that had an incorrect SHI assigned by the original dataset. Information on recently transacted property prices was also obtained for 8599 (85.3%) of buildings.ConclusionSHI, a useful tool for health services research, can be accurately reconstructed using open datasets at no cost. This method is a convenient means for future researchers to obtain updated building-level markers of socioeconomic status for policy and research.

317Neighbourhood built and social environmental attributes associated with frailty among mid-to-older aged Australian adults

Abstract Background Little is known about to what extent neighbourhood built and social environmental factors are associated with frailty among community-dwelling mid-to-older aged adults. Methods Participants of our cross-sectional study were adults aged 50-74 years residing in Brisbane, Australia. Frailty was assessed by a frailty index (FI), consisting of 32 items. Five built environmental attributes (population density, density of 4-way intersections, area of retail land, area of park land, and area of land for recreational facilities) and three social environmental attributes (safety, cohesion, and socio-economic status [SES]) were included. We performed multilevel logistic regression analysis to examine the associations between those attributes and frailty. Results Of 4,176 eligible participants (56.8% women), we found that 437 (10.5%) were frail (FI ≥ 0.35). After adjusting for potential confounders, one standard deviation (SD) increment in intersection density and retail land area was associated 26% (95%CI: 1.12, 1.41) and 18% (95%CI: 1.07, 1.30) higher odds of being frail, respectively. One SD increment in safety and area-level SES was associated with 24% (95%CI: 0.69, 0.84) and 30% (95%CI: 0.62, 0.79) lower odds of being frail. Conclusions This study found that mid-to-older aged adults with frailty are more likely to live in areas with higher intersection density, greater area of retail land, poorer safety, and higher levels of deprivation. Key messages There is spatial heterogeneity in the distribution of frailty. Future research should investigate behavioural mechanism for the distribution.

Effects of long-term average temperature and temperature variability on cardiovascular disease hospitalizations in the US Medicare population

BACKGROUND AND AIM: Numerous studies have shown short-term exposure to extreme temperature is associated with increased mortality and morbidity. Less is known about effects of long-term exposure to warm or cold temperatures. Our aim was to evaluate associations of long-term temperature exposure and temperature variability with cardiovascular disease (CVD) hospitalizations. METHODS: We constructed an open cohort consisting of all fee-for-service Medicare beneficiaries, aged ≥65, living in the contiguous US from 2000 through 2016 (~63 million individuals). We used data from the 4km Gridded Surface Meteorological dataset to assess the annual (January-December), summer (June-August), and winter (December-February) average temperature and temperature variability (standard deviation) for each year for each zip code. Cox-equivalent Poisson models were used to estimate associations with first CVD, coronary heart disease (CHD) or cerebrovascular disease (CBV) hospitalization, after adjustment for potential confounders (including individual and area-level SES indicators). RESULTS:Higher annual average and summer average temperatures were associated with an increased risk of CVD, CHD and CBV hospitalization. Lower winter average temperatures were associated with an increased risk of CVD and CHD hospitalization, but a decreased risk of CBV hospitalization. For CVD hospitalization, we found a HR of 1.07 (95%CI: 1.06, 1.07) per IQR increase (8.1°C) for annual average temperature, a HR of 1.03 (95%CI: 1.03, 1.04) per IQR increase (5.2°C) for summer average temperature, and a HR of 0.97 (95%CI: 0.97, 0.98) per IQR increase (11.7°C) for winter average temperature. Higher annual and winter temperature variability and lower summer temperature variability were associated with an increased risk for all outcomes. Associations were modified by age, race, air pollution and greenness. CONCLUSIONS:Warmer annual and summer average temperatures and cooler winter average temperatures were associated with an increased risk of CVD hospitalizations. Higher annual and winter temperature variability and lower summer temperature variability were also associated with increased risk. KEYWORDS: temperature, temperature variability, Cardiovascular diseases

Oncotype DX Test Receipt among Latina/Hispanic Women with Early Invasive Breast Cancer in New Jersey: A Registry-Based Study.

Oncotype DX® (ODX) is a valid test of breast cancer (BC) recurrence risk and chemotherapy benefit. The purpose of this study was to examine prevalence of and factors associated with receipt of ODX testing among eligible Latinas/Hispanics diagnosed with BC. Sociodemographic and tumor data of BC cases diagnosed between 2008 and 2017 among Latina/Hispanic women (n = 5777) were from the New Jersey State Cancer Registry (NJSCR). Eligibility for ODX testing were based on National Comprehensive Cancer Network guidelines. Multivariable logistic regression models of ODX receipt among eligible women were used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) by demographic and clinicopathologic factors. One-third of Latinas/Hispanics diagnosed with BC were eligible for ODX testing. Among the eligible, 60.9% received ODX testing. Older age (AOR 0.08, 95% CI: 0.04, 0.14), low area-level SES (AOR 0.58, 95% CI: 0.42, 0.52), and being uninsured (AOR 0.58, 95% CI: 0.39, 0.86) were associated with lower odds of ODX testing. While there was relatively high ODX testing among eligible Latina/Hispanic women with BC in New Jersey, our findings suggest that age, insurance status, and area-level SES contribute to unequal access to genetic testing in this group, which might impact BC outcomes.

Living near greener spaces is associated with lower risk of diabetes-related mortality in Brussels, Belgium: a 13-year mortality follow-up study

Background/Aim: Living in greener areas has been related to a lower risk of diabetes disease, but few studies have explored its association with diabetes-related mortality. This study examined the relationship between objective and subjective indicators of residential urban green spaces (UGS) and diabetes-related mortality in Brussels.Methods: We used data from the 2001 Belgian census linked to migration and mortality register data during 2001-2014. We included objective indicators of UGS within 300m buffers from the residential address (surrounding greenness -NDVI-; surrounding green spaces -Urban Atlas-) and an area-level subjective indicator of perceived neighbourhood greenness. We considered the full causal chain of events leading to death, i.e. we included deaths from diabetes as both the original cause of death and as any cause of death (immediate, intermediate, original or additional). Cox proportional hazards models were conducted to obtain hazard ratios (HR) for diabetes-related mortality. Models were adjusted for age, gender, migrant background, education, housing tenure, PM2.5, night noise levels and area-level socioeconomic status (percentage of unemployed). Effect modification by gender, education and migrant background was assessed.Results: We included 734,806 individuals aged 16-80 in 2001. We observed 1,318 (1.5%) deaths from diabetes as the original cause and 5,268 (6.1%) deaths from diabetes as any cause. IQR increases of both surrounding and perceived neighbourhood greenness were inversely associated with diabetes-related mortality. Associations were stronger for diabetes as the original cause of death (e.g. with surrounding greenness: aHR:0.83, 95%CI:0.74-0.93). No associations were found for surrounding green spaces after adjusting by area-level SES. We observed a significant interaction between perceived neighbourhood greenness and gender with diabetes-related mortality: beneficial associations were stronger among women (for diabetes as original cause of death: aHR:0.80, 95%CI:0.69-0.94).Conclusions: Our findings suggest that living near UGS in Brussels might reduce diabetes-related mortality risk. The perception of neighbourhood greenness might be crucial among women.

Individual- and Area-Level SES in Diabetes Risk Prediction: The Multi-Ethnic Study of Atherosclerosis

The purpose of this study was to evaluate if adding SES to risk prediction models based upon traditional risk factors improves the prediction of diabetes. Risk prediction models without and with individual- and area-level SES predictors were compared using the prospective Multi-Ethnic Study of Atherosclerosis. Cox proportional hazards models were utilized to estimate hazard ratios for SES predictors and to generate 10-year predicted risks for 5,021 individuals without diabetes at baseline followed from 2000 to 2012. C-statistics were used to compare model discrimination, and the proportion of individuals reclassified into higher or lower risk categories with the addition of SES predictors was calculated. The accuracy of risk prediction by SES was assessed by comparing observed and predicted risks across tertiles of the SES variables. Statistical analyses were performed in 2015-2016. Over a median of 9.2 years of follow-up, 615 individuals developed diabetes. Individual- and area-level SES variables did not significantly improve model discrimination or reclassify substantial numbers of individuals across risk categories. Models without SES predictors generally underestimated risk for low-SES individuals or individuals residing in low-SES areas (underestimates ranging from 0.31% to 1.07%) and overestimated risk for high-SES individuals or individuals residing in high-SES areas (overestimates ranging from 0.70% to 1.30%), and the addition of SES variables largely mitigated these differences. Standard diabetes risk models may underestimate risk for low-SES individuals and overestimate risk for those of high SES. Adding SES predictors helps correct this systematic misestimation, but may not improve model discrimination.

Evaluation of individual and area-level factors as modifiers of the association between warm-season temperature and pediatric asthma morbidity in Atlanta, GA

IntroductionPrevious studies have found associations between respiratory morbidity and high temperatures; however, few studies have explored associations in potentially sensitive sub-populations. MethodsWe evaluated individual and area-level factors as modifiers of the association between warm-season (May-Sept.) temperature and pediatric respiratory morbidity in Atlanta. Emergency department (ED) visit data were obtained for children, 5–18 years old, with primary diagnoses of asthma or respiratory disease (diagnoses of upper respiratory infections, bronchiolitis, pneumonia, chronic obstructive pulmonary disease, asthma, or wheeze) in 20-county Atlanta during 1993–2012. Daily maximum temperature (Tmax) was acquired from the automated surface observing station at Atlanta Hartsfield International Airport. Poisson generalized linear models were used to estimate rate ratios (RR) between daily Tmax and asthma or respiratory disease ED visits, controlling for time and meteorology. Tmax effects were estimated for single-day lags of 0–6 days, for 3-, 5-, and 7-day moving averages and modeled with cubic terms to allow for non-linear relationships. Effect modification by individual factors (sex, race, insurance status) and area-level socioeconomic status (SES; ZIP code levels of poverty, education, and the neighborhood deprivation index) was examined via stratification. ResultsEstimated RRs for Tmax and pediatric asthma ED visits were positive and significant for lag days 1–5, with the strongest single day association observed on lag day 2 (RR=1.06, 95% CI: 1.03, 1.09) for a change in Tmax from 27°C to 32°C (25th to 75th percentile). For the moving average exposure periods, associations increased as moving average periods increased. We observed stronger RRs between Tmax and asthma among males compared to females, non-white children compared to white children, children with private insurance compared to children with Medicaid, and among children living in high compared to low SES areas. Associations between Tmax and respiratory disease ED visits were weak and non-significant (p-value>0.05). ConclusionsResults suggest socio-demographic factors (race/ethnicity, insurance status, and area-level SES) may confer vulnerability to temperature-related pediatric asthma morbidity. Our findings of weaker associations among children with Medicaid compared to other health insurance types and among children living in low compared to high SES areas run counter to our belief that children from disadvantaged households or ZIP codes would be more vulnerable to the respiratory effects of temperature. The potential reasons for these unexpected results are explored in the discussion.

Racial disparities in individual breast cancer outcomes by hormone-receptor subtype, area-level socio-economic status and healthcare resources.

The aim of the study is to determine the influence of area-level socio-economic status and healthcare access in addition to tumor hormone-receptor subtype on individual breast cancer stage, treatment, and mortality among Non-Hispanic (NH)-Black, NH-White, and Hispanic US adults. Analysis was based on 456,217 breast cancer patients in the SEER database from 2000 to 2010. Multilevel and multivariable-adjusted logistic and Cox proportional hazards regression analysis was conducted to account for clustering by SEER registry of diagnosis. NH-Black women had greater area-level access to healthcare resources compared with women of other races. For instance, the average numbers of oncology hospitals per million population in counties with NH-Black, NH-White, and Hispanic women were 8.1, 7.7, and 5.0 respectively; average numbers of medical doctors per million in counties with NH-Black, NH-White, and Hispanic women were 100.7, 854.0, and 866.3 respectively; and average number of Ob/Gyn in counties with NH-Black, NH-White, and Hispanic women was 155.6, 127.4, and 127.3, respectively (all p values <0.001). Regardless, NH-Black women (HR 1.39, 95% CI 1.36-1.43) and Hispanic women (HR 1.05, 95% CI 1.03-1.08) had significantly higher breast cancer mortality compared with NH-White women even after adjusting for hormone-receptor subtype, area-level socio-economic status, and area-level healthcare access. In addition, lower county-level socio-economic status and healthcare access measureswere significantly and independently associated with stage at presentation, surgery, and radiation treatment as well as mortality after adjusting for age, race/ethnicity, and HR subtype. Although breast cancer HR subtype is a strong, important, and consistent predictor of breast cancer outcomes, we still observed significant and independent influences of area-level SES and HCA on breast cancer outcomes that deserve further study and may be critical to eliminating breast cancer outcome disparities.

Abstract P083: Modest Association Between the Number of Fast Food Restaurants in a Neighborhood with Cardiovascular Disease Incidence

Background: In recent years, there has been an increasing interest in the association between neighbourhood environments and cardiovascular disease (CVD) outcomes. Applying advanced linkage techniques to existing databases enables new and more in-depth research in this field. Aim: To investigate the association between fast food restaurant (FFR) density and incident CVD. Methods: Through linkage with the Dutch Population Register, Hospital Discharge Register and Cause of Death Register we obtained a cohort of 35+ years adults who at 01-01-2009 had lived at the same address for 15 years and were not previously admitted for CVD during this period. We followed these persons for one year for incident CVD. Trough linkage with the Locatus database, a nationwide retail database, we obtained information about the number of FFR’s within 500m, 1000m and 3000m buffers from the exact address. Logistic regression analyses was used to investigate the association between FFR density and CVD incidence. We adjusted for age, gender, marital status, country of origin, area-level SES , comorbidity, and degree of urbanisation. Results: In total 3,146,469 adults (46% male), aged 59.2 ± 12 were included. After one year 72,811 (2.3%) persons suffered from an incident CVD. The association with the number of FFR and incident CVD in both 500m, 1000m and 3000m buffers were shown in table 1. Conclusion: There is a modest association between FFR and incident CVD. The association was stronger when FFR’s are within 500m from a person’s home address and when there is a high number of FFR’s. Table 1: The association (OR (95% confidence interval)) with the number of FFR and incident CVD in both 500m, 1000m and 3000m buffers. Adjusted for age, gender, marital status, country of origin, area-level SES , comorbidity, and degree of urbanisation.

Changes in Area-level Socioeconomic Status and Oral Health of Indigenous Australian Children.

Dental diseases have shown to be influenced by area-level socioeconomic status. This study aims to assess the effects of change in area-level SES on the oral health of Australian Indigenous children. Data were collected from a national surveillance survey for children's dental health at two points of time (2000-2002/2007-2010). The study examines caries experienced by area-level SES and whether changes in area-level SES (stable-high, upwardly-mobile, downwardly-mobile and stable low) affects caries experience. Dental caries in both the deciduous and permanent dentition increased significantly among Indigenous children during the study period. In stable low-SES areas, the experience of decayed, missing and overall dmft/DMFT in both dentitions was highest compared with other groups at both Time 1(2.15 vs 1.61, 1.77, 1.87 and 0.86 vs 0.55, 0.67, 0.70 respectively) and Time 2 (3.23 vs 2.08, 2.17, 2.02 and 1.49 vs 1.18, 1.21 respectively). A change in area-level SES was associated with experience of dental disease among Indigenous Australian children.

Contribution of health behaviors to the association between area-level socioeconomic status and cancer mortality

Cancer mortality is higher among residents of low-socioeconomic status (SES) areas than those of high-SES areas; however, the contribution of modifiable risk factors to this disparity is not known. We used data from 54,737 participants in the VITamins And Lifestyle (VITAL) Study, aged 50–76 with no history of cancer at baseline (2000–2002). Of these, 1488 died of cancer over an average of 7.7 years of follow-up. Data on modifiable risk factors including body mass index (BMI), physical activity, diet, alcohol, smoking and screening were taken from baseline questionnaires. We constructed a block group-level SES index using data from the 2000 United States Census and fit Cox proportional hazards models estimating the association between area-level SES and total cancer mortality with and without control for modifiable risk factors. All statistical tests are 2-sided. Cancer mortality was 77% (95% CI: 50%, 111%) higher in the lowest-SES areas compared with the highest. Modifiable risk factors accounted for 45% (95% CI: 34%, 62%) of this association. Smoking explained the greatest proportion (29%; 95% CI: 22%, 40%) of the observed association, followed by diet (11%; 95% CI: 7%, 17%), physical activity (10%; 95% CI: 7%, 16%), screening (9%; 6%, 13%), and BMI (5%; 95% CI: 1%, 10%). Results were similar in models controlling for individual education and income. The association between area-level SES and cancer mortality is partially explained by modifiable risk factors, which could suggest the appropriate targets to reduce socioeconomic disparities.

Levels and patterns of objectively-measured physical activity volume and intensity distribution in UK adolescents: the ROOTS study.

BackgroundFew studies have quantified levels of habitual physical activity across the entire intensity range. We aimed to describe variability in total and intensity-specific physical activity levels in UK adolescents across gender, socio-demographic, temporal and body composition strata.MethodsPhysical activity energy expenditure and minutes per day (min/d) spent sedentary and in light, moderate, and vigorous intensity physical activity were assessed in 825 adolescents from the ROOTS study (43.5% boys; mean age 15.0 ± 0.30 years), by 4 days of individually calibrated combined heart rate and movement sensing. Measurement days were classified as weekday or weekend and according to the three school terms: summer (April-July), autumn (September-December), and spring (January-March). Gender and age were self-reported and area-level SES determined by postcode data. Body composition was measured by anthropometry and bio-electrical impedance. Variability in physical activity and sedentary time was analysed by linear multilevel modelling, and logistic multilevel regression was used to determine factors associated with physical inactivity (<60 min moderate-to-vigorous intensity physical activity/d).ResultsDuring awake hours (15.8 ± 0.9 hrs/d), adolescents primarily engaged in light intensity physical activity (517 min/d) and sedentary time (364 min/d). Boys were consistently more physically active and less sedentary than girls, but gender differences were smaller at weekends, as activity levels in boys dropped more markedly when transitioning from weekday to weekend. Boys were more sedentary on both weekend days compared to during the week, whereas girls were more sedentary on Sunday but less sedentary on Saturday. In both genders light intensity physical activity was lower in spring, while moderate physical activity was lower in autumn and spring terms, compared to the summer term; sedentary time was also higher in spring than summer term. Adolescents with higher fatness engaged in less vigorous intensity physical activity. Factors associated with increased odds of physical inactivity were female gender, both weekend days in boys, and specifically Sunday in girls.ConclusionsPhysical activity components vary by gender, temporal factors and body composition in UK adolescents. The available data indicate that in adolescence, girls should be the primary targets of interventions designed to increase physical activity levels.

Comparison of individual-level versus area-level socioeconomic measures in assessing health outcomes of children in Olmsted County, Minnesota

BackgroundSocioeconomic status (SES) is an important determinant of health, but SES measures are frequently unavailable in commonly used datasets. Area-level SES measures are used as proxy measures of individual SES...

Socio-economic impact in CKD

BackgroundSocio-economic status (SES) may be conceptualized as an individual's position in society, as determined by their income, occupation, education, wealth, and housing situation. This review summarizes the current literature regarding associations of these markers of SES with both chronic kidney disease (CKD) and associated poor outcomes. MethodsLiterature searches were conducted in the US National Library of Medicine, National Institutes of Health, PubMed database using the search terms “chronic kidney disease” and “chronic renal insufficiency,” combined with “socio-economic status,” “income,” “occupation,” “employment,” “education,” “social class,” “wealth,” and “housing.” Articles not in the English language, using non-human subjects, or primarily concerning subjects with ESRD or acute kidney injury were excluded. ResultsIncome is the most-studied aspect of SES in relation to CKD, but there is increasing literature involving occupation and education as well. Additionally, the associations of CKD and its outcomes with area-level and life course SES are both burgeoning areas of research. There are several research areas that remain mostly unexplored, including the roles of wealth and housing in defining SES-related risk in CKD. Additionally, none have explored the relative utility of composite versus individual indicators of SES in predicting risk of CKD and outcomes. ConclusionGiven the overwhelming evidence that SES plays an important role in the development and progression of disease, the development and testing of more targeted interventions should be a top priority in CKD research. Continuing examination of these factors, with increased rigor and focus on potentially modifiable intermediate pathways, is needed.