Association Of Socioeconomic Factors Research Articles

Impact of the Affordable Care Act on Timeliness to Treatment for Patients With Multiple Myeloma.

To examine the impact of ACA and the association of socioeconomic factors on delay in initial treatment for multiple myeloma (MM). Patients diagnosed with MM between 2004-2016 were identified in the National Cancer Database (NCDB). Time-to-initial treatment (TTI) was defined as the number of days from diagnosis to initial therapy. Patients were classified into quartiles and those belonging to the fourth quartile for TTI constituted the delayed treatment group. Study period was divided into pre-ACA and post-ACA using 2010 as the cut-off. A total of 65,723 patients met the eligibility criteria. Median TTI was 13 (IQR=5-27) days. Racial-ethnic minorities were associated with delayed-TTI. Delayed treatment was more likely for Hispanics pre-ACA but not post-ACA, while non-Hispanic Blacks (NHB) were more likely to have delayed treatment both, pre- and post-ACA. While ACA has been shown to help mitigate healthcare disparities in certain cancer diagnoses, the study suggests that the effect is still limited among MM patients.

Systematic review: the impact of socioeconomic factors on Aedes aegypti mosquito distribution in the mainland United States.

Aedes aegypti mosquitoes are primary vectors of dengue, yellow fever, chikungunya and Zika viruses. Ae. aegypti is highly anthropophilic and relies nearly exclusively on human blood meals and habitats for reproduction. Socioeconomic factors may be associated with the spread of Ae. aegypti due to their close relationship with humans. This paper describes and summarizes the published literature on the association between socioeconomic variables and the distribution of Ae. aegypti mosquitoes in the mainland United States. A comprehensive search of PubMed/Medline, Scopus, Web of Science, and EBSCO Academic Search Complete through June 12, 2019 was used to retrieve all articles published in English on the association of socioeconomic factors and the distribution of Ae. aegypti mosquitoes. Additionally, a hand search of mosquito control association websites was conducted in an attempt to identify relevant grey literature. Articles were screened for eligibility using the process described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Initially, 3,493 articles were identified through the database searches and previously known literature. After checking for duplicates, 2,145 articles remained. 570 additional records were identified through the grey literature search for a total of 2,715 articles. These articles were screened for eligibility using their titles and abstracts, and 2,677 articles were excluded for not meeting the eligibility criteria. Finally, the full text for each of the remaining articles (n=38) was read to determine eligibility. Through this screening process, 11 articles were identified for inclusion in this review. The findings for these 11 studies revealed inconsistent relationships between the studied socioeconomic factors and the distribution and abundance of Ae. aegypti. The findings of this review suggest a gap in the literature and understanding of the association between anthropogenic factors and the distribution of Ae. aegypti that could hinder efforts to implement effective public health prevention and control strategies should a disease outbreak occur.

Associations of socioeconomic factors with cause-specific Mortality and burden of cardiovascular diseases: findings from the vital registration in urban Shanghai, China, during 1974\u20132015

BackgroundCardiovascular disease (CVD) is the leading cause of mortality worldwide. The effect of socioeconomic factors on cause-specific mortality and burden of CVD is rarely evaluated in low- and middle-income countries, especially in a rapidly changing society.MethodsOriginal data were derived from the vital registration system in Yangpu, a representative, population-stable district of urban Shanghai, China, during 1974–2015. Temporal trends for the mortality rates and burden of CVD during 1974–2015 were evaluated using Joinpoint Regression Software. The burden was evaluated using age-standardized person years of life loss per 100,000 persons (SPYLLs). Age-sex-specific CVD mortality rates were predicted by using age-period-cohort Poisson regression model.ResultsA total of 101,822 CVD death occurred during 1974–2015, accounting for 36.95% of total death. Hemorrhagic stroke, ischemic heart disease, and ischemic stroke were the 3 leading causes of CVD death. The age-standardized CVD mortality decreased from 144.5/100,000 to 100.7/100,000 in the residents (average annual percentage change [AAPC] -1.0, 95% confidence interval [CI] -1.7 to − 0.2), which was mainly contributed by women (AAPC -1.3, 95% CI − 2.0 to − 0.7), not by men. Hemorrhagic stroke, the major CVD death in the mid-aged population, decreased dramatically after 1991. The crude mortality of ischemic heart disease kept increasing but its age-adjusted mortality decreased continually after 1997. SPYLLs of CVD death increased from 1974 to 1986 (AAPC 2.1, 95% CI 0.4 to 3.8) and decreased after 1986 (AAPC 1.8, 95% CI − 2.3 to − 1.3). These changes were in concert with the implementation of policies including extended medical insurance coverage, pollution control, active prophylaxis of CVD including lifestyle promotion, and national health programs. The mortality of CVD increased in those born during 1937–1945, a period of the Japanese military occupation, and during 1958–1965, a period including the Chinese Famine. Sequelae of CVD and ischemic heart disease are predicted to be the leading causes of CVD death in 2029.ConclusionsExposure to serious malnutrition in early life might increase CVD mortality in later life. Improvements in medical services, pollution control, and lifestyle could decrease CVD death. New strategy is needed to prevent the aging-related CVD death and burden in the future.

The role of socioeconomic factors on discontinuation of insulin during pregnancy\u2014methodological challenges from a Swedish register-based study

AimContinuous use of antidiabetic medication, especially insulin, is crucial for diabetes management. In pregnancy, adherence to medication is generally low and may also be associated with lower socioeconomic status. However, little is known about discontinuation of insulin in pregnant women and the potential role of socioeconomic factors. Therefore, this study aims to measure the associations between socioeconomic factors and insulin discontinuation during pregnancy in women using insulin prior to the start of pregnancy in Sweden.Subjects and methodsThis cohort study identified pregnancies recorded in the Swedish Medical Birth Register from 2006 to 2016 in women receiving insulin prior to the start of pregnancy (N = 6029). Discontinuation of insulin was defined as not receiving a refill within 120 days from the previous refill. Associations between discontinuation and socioeconomic factors were investigated via logistic regression. Sensitivity analyses were performed using different definitions of discontinuation.ResultsWomen discontinued insulin use in 34.2% of pregnancies. The odds ratios (ORs) of discontinuation of insulin were 1.17 [95% confidence interval (CI): 1.01–1.37] for women with lower household disposable incomes and 1.14 (95% CI: 1.01–1.29) for women with lower educational levels. When testing a change in the maximum refill gap from 91 days to 180 days, women with lower educational levels and those born in non-Nordic countries showed greater associations with discontinuation.ConclusionThe definition of discontinuation affects the level of association of socioeconomic factors with discontinuation. Nevertheless, discontinuation of insulin is common in Sweden, especially in the lower socioeconomic groups. The socioeconomic inequality in insulin use behavior is worth noting.

Association of socioeconomic factors and prevalence of hypertension with sleep disorder among the elderly in rural southwest China

ObjectivesThis study examines the distribution of sleep disorder prevalence across socioeconomic status (SES) and investigates the relationship between sleep disorders and hypertension among southwest China's rural older adult population. MethodsA cross-sectional survey was conducted in rural Yunnan Province, China from 2017 to 2018, consisting of 4833 consenting participants aged ≥60 years. Each participant completed a structured interview and had their blood pressure measured. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Multivariate logistic regression was used to model variations in prevalence of sleep disorders and hypertension. ResultsIn the study population, the prevalence rates of sleep disorders and hypertension were 46.5% and 50.3%, respectively. Women had higher prevalence of both chronic illnesses (53.4% vs. 38.7%, 53.1% vs. 47.6%, P < 0.01). After adjusting for age, sex, and residential status, older adults of minority ethnicity had a higher prevalence of sleep disorders than the Han ethnic majority (P < 0.01). Attainment of higher levels of education and lower annual household income were also associated with a greater risk of sleep disorders (P < 0.01). Further, logistic regression analysis indicated that older adults with sleep disorders had a greater risk of being hypertensive (P < 0.01). ConclusionsSleep disorders are highly prevalent in rural southwest China. Future interventions to improve sleep quality would benefit from tailoring to address individual SES. Improving sleep quality profoundly reduces prevalence of hypertension.

A Scoping Review of Socioeconomic Inequalities in Distributions of Birth Outcomes: Through a Conceptual and Methodological Lens.

The extant literature has examined social inequalities in high-risk categories of birth weight and gestational age (i.e., low birth weight and preterm birth) with little attention given to their distributional nature. As such, a scoping review was conducted to understand how researchers have conceptualized and analyzed socioeconomic inequalities in entire distributions of these birth outcomes. Bibliographic databases were searched from their inception until August 2016 for articles from five similar, English-speaking, advanced capitalist democracies: Canada, United States, United Kingdom, Australia and New Zealand. Twenty-one studies were included in the review, all of which provided rationales for examining socioeconomic inequalities in the entire distribution of birth weight. Yet, only three studies examined non-uniform associations of socioeconomic factors across the distribution of birth weight using conditional quantile regression, while the majority focused on mean birth weight using descriptive analysis or linear regression to analyze inequalities. Nevertheless, study results indicated that socioeconomic inequalities exist throughout the distribution of birth weight, extending beyond the high-risk category of low birth weight. Although social inequalities in distributions of birth weight have been conceptualized, few studies have analytically engaged with this concept. As such, this review supports further investigation of distributional inequalities in birth outcomes using methodology which allows one to empirically quantify and explain differences in population risk distributions, rather than solely between infants born low birth weight or preterm birth, versus not.

Behavioural and socioeconomic factors associated with the simultaneous occurrence of periodontal disease and dental caries

Objective: The aim was to evaluate the association of behavioural and socioeconomic factors with the occurrence of periodontal disease and dental caries, paying special attention to the simultaneous occurrence of these diseases.Materials and methods: The study population consisted of 5255 dentate persons aged ≥30 years from a nationally representative survey. Caries and probing pocket depth were recorded by tooth and calculated in relation to the number of existing teeth. The groups were: non-affected (A), the two most affected quintiles for periodontal disease with little or no dental caries (B), the two most affected quintiles for dental caries with little or no periodontal disease (C) and the two most affected quintiles for both periodontal disease and dental caries (D). Presence of dental plaque was determined, and behavioural and socioeconomic factors were established.Results: Dental plaque, smoking, lack of regular dental check-ups, older age and a basic level of education were strongly associated with the simultaneous occurrence of periodontal disease and dental caries.Conclusions: There are many behavioural and socioeconomic factors that associate with the occurrence of both periodontal disease and dental caries. These factors also increase the risk of individuals having these diseases simultaneously.

Association of socioeconomic risk factors with under 5-year mortality in Zabol, Iran, during 2011-2015

Background: Under-5 mortality is an important health indicator of a country's development and every country is committed todecrease it. Children under-5 years are vulnerable to the imbalance of socioeconomic inequality and are dependent on the adults toremain healthy. The aim of this study was to determine the association of socioeconomic factors with under-5 mortality in Zabol. Methods: This descriptive cross sectional study was performed on 2001 children younger than 5 years who were under the coverageof Zabol University of Medical Sciences between 2011 and 2015. The data were collected using standard questionnaires on mortality ofinfant and children 1-59 months old, questionnaires determining socioeconomic condition, and health center data files. The analyseswere performed using SPSS software version 21, and significance level was set at 0.05 for all tests. Results: The most common causes of death under 5 years of age included immaturity, congenital defects, and respiratory diseases. Inthe logistic regression model, father's addiction, maternal literacy, socioeconomic level, and household family size were significantlyassociated with under-5 mortality (P<0.05). Moreover, there was a correlation between a congenital defect in the Zahak region andimmaturity in the Hamun region with under-5 mortality. Conclusion: Low socioeconomic status, parental addiction, and low education level were the most probable risk factors for under 5mortality.

Socioeconomic factors related to leprosy: an integrative literature review.

To investigate in the literature the relation of socioeconomic factors in the incidence of the disease and other outcomes related to leprosy. Integrative review conducted in Lilacs, Medline, Scopus databases and SciELO online library with studies from 2000 to 2016. 32 studies were included. Only studies that analyzed statistical associations of socioeconomic factors and outcomes related to leprosy were selected. Leprosy is greatly affected by the social context in which the patient is inserted, the chances of exposure to illness are the result of a set of not only individual aspects, but also of contexts or collective conditions. It is imperative for Nursing, as an essential part of the multiprofessional team entrusted with the care and surveillance of the disease, to recognize these factors to predict unfavorable outcomes and to develop new practices capable of reducing inequities.

Predictors of Routine Dental Check-up Among Male Adolescents in Saudi Arabia.

ObjectiveTo evaluate the association of socioeconomic factors and self-perceived oral conditions with routine dental check-up among male adolescents.MethodsThis cross-sectional study was conducted on male children (grade 10-12) from public schools in different cities of the Eastern province of Saudi Arabia. A multistage random sampling was used for the recruitment of study participants. A piloted questionnaire translated into the Arabic language was used for data collection.ResultsThere were 586 students with mean age 16.86±0.87 years. The prevalence of routine dental visit within last year was 18.9%. Half of the entire sample had dental cavities (50.5%) and tooth sensitivity (50%) followed by dental pain (42.2%). Bivariate analyses found that the children with dental cavities (OR 0.4, 95% CI 0.26, 0.61), dental pain (OR 0.63, 95% CI 0.41, 0.97), and malodor (OR 0.41, 95% CI 0.23, 0.71) had significantly lower odds of routine dental visits than those without these conditions. The final model of multivariable logistic regression showed that dental cavities (OR 0.42, 95% CI 0.27, 0.66) and malodor (OR 0.45, 95% CI 0.25, 0.78) were significantly associated with lower likelihood of visiting dental office for a regular dental check-up. No significant influence of socioeconomic factors on routine dental attendance was observed.ConclusionsA small proportion of children performed routine dental visits. The children with dental cavities and malodor were less likely to perform routine dental visits. The awareness about the importance of regular dental check-up should be raised to reduce the burden of oral diseases in schoolchildren.

Path Analysis and Correlation of Influential Socioeconomic Factors in the Production of Sugarcane

The analysis of the economic viability of agriculture and sugar cane is necessary to understand the techniques of measuring the financial return on the activities of rural establishments. The authors aimed to examine the direct and indirect associations of socioeconomic factors on the benefit/cost index in sugarcane activity and their significant correlations. The methodological approach of research was quantitative, applying statistical techniques of inferential and multivariate analysis (path analysis) under statistical significance (P&lt;0.05). A model of path diagram was developed that presented a structural adjustment of quality, obtaining relevant R2 (0.74). The analysis showed that the characteristics of the successors of the farms impact on the economic factors of the productive system of the sugar cane. There was a total association between the successor's vocation and the benefit/cost index, presenting a substantial path coefficient (-0.90), in which the direct and indirect effect (51% and 49%) was inversely proportional and had a significant impact (P&lt;0.05). A total association between the successor's practical ability and the benefit/cost index was obtained, which presented a strong and directly proportional path coefficient (0.70). In the dynamics of the socioeconomic factors of the sugarcane productive system, the influence of social variables on the economic result is expressive, and the indirect effects impact in a manner similar to the direct ones, as evidenced by the analysis of the benefit/cost, implying the adoption of actions that prepare the successors for agricultural management and for the management of agribusiness.

Socioeconomic determinants of leprosy new case detection in the 100 Million Brazilian Cohort: a population-based linkage study

SummaryBackgroundAlthough leprosy is recognised as a disease of poverty, there is little evidence on the specific socioeconomic factors associated with disease risk. To inform targeted strategies for disease elimination, we investigated socioeconomic markers of leprosy risk in Brazil.MethodsSocioeconomic data from the 100 Million Brazilian Cohort were linked to the Brazilian national disease registry (Sistema de Informação de Agravos de Notificação) for leprosy from Jan 1, 2007, to Dec 31, 2014. Using Poisson regression, we assessed the association of socioeconomic factors with risk of incident leprosy in the full cohort and in children (aged 0–15 years), by leprosy subtype and region of residence.FindingsIn an analysis of 23 899 942 individuals including 18 518 patients with leprosy, increased levels of deprivation were associated with an increased risk of leprosy in Brazil. Directions of effect were consistent in children younger than 15 years and across disease subtypes. Individuals residing in regions with the highest poverty in the country (central-west, north, and northeast regions) had a risk of leprosy incidence five-to-eight times greater than did other individuals. Decreased levels of income and education and factors reflecting unfavourable living conditions were associated with an up to two-times increase in leprosy incidence (incidence rate ratio 1·46, 95% CI 1·32–1·62, for lowest vs highest quartile of income per capita; 2·09, 95% CI 1·62–2·72, for lowest vs highest level of education).InterpretationWithin the poorest half of the Brazilian population, the most deprived individuals have the greatest risk of leprosy. Strategies focusing on early detection and treatment in the poorest populations could contribute substantially to global disease control.FundingMedical Research Council, Wellcome Trust, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Brazil), the Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa, Economic and Social Research Council, Biotechnology and Biological Sciences Research Council, Conselho Nacional de Desenvolvimento Científico e Tecnológico, and Fundação de Apoio à Pesquisa do Distrito Federal.

Self-Reported Oral Health Related Behaviour and Gum Bleeding of Adolescents in Slovakia in Relation to Socioeconomic Status of Their Parents: Cross-Sectional Study Based on Representative Data Collection.

Background: Oral health strongly affects overall health and is related to many factors. The aim of our study was to analyse oral health related behaviours (OHRBs) and gum bleeding among Slovak adolescents and assess the effect of socioeconomic factors on the outcomes. Methods: Data from the Health Behaviour in School-aged Children study (HBSC) were used (N = 8896, age range = 10–16 years, M = 13.4; SD = 1.4; 50.9% boys). Sociodemographic and socioeconomic indicators and frequency of OHRBs (dental hygiene, toothbrush changing, preventive check-up) and gum bleeding were collected. Effects of sociodemographic and socioeconomic variables on outcome variables were analysed by binary logistic regression. Results: We found that prevalence of OHRBs slightly decreases with age, and worse outcomes were reported by boys compared to girls (OHRB odds ratio range 0.45–0.75, (95% C.I. range 0.40–0.91), gum bleeding 1.38 (95% C.I. 1.19–1.61), p < 0.05). OHRBs were in most cases significantly associated with socioeconomic variables, lower affluence predicts worse outcomes (odds ratio range 0.76–0.88 (95% C.I. range 0.68–0.96), p < 0.05). Conclusion: Our study provides representative findings on ORHBs in Slovakia and shows important associations of socioeconomic factors related to adolescents’ oral health issues.

Association of socioeconomic risk factors with under 5-year mortality in Zabol, Iran, during 2011-2015

Background: Under-5 mortality is an important health indicator of a country’s development and every country is committed todecrease it. Children under-5 years are vulnerable to the imbalance of socioeconomic inequality and are dependent on the adults toremain healthy. The aim of this study was to determine the association of socioeconomic factors with under-5 mortality in Zabol. Methods: This descriptive cross sectional study was performed on 2001 children younger than 5 years who were under the coverageof Zabol University of Medical Sciences between 2011 and 2015. The data were collected using standard questionnaires on mortality ofinfant and children 1-59 months old, questionnaires determining socioeconomic condition, and health center data files. The analyseswere performed using SPSS software version 21, and significance level was set at 0.05 for all tests. Results: The most common causes of death under 5 years of age included immaturity, congenital defects, and respiratory diseases. Inthe logistic regression model, father's addiction, maternal literacy, socioeconomic level, and household family size were significantlyassociated with under-5 mortality (P<0.05). Moreover, there was a correlation between a congenital defect in the Zahak region andimmaturity in the Hamun region with under-5 mortality. Conclusion: Low socioeconomic status, parental addiction, and low education level were the most probable risk factors for under 5mortality.

Association of Poor Self-Perceived Health with Demographic, Socioeconomic and Lifestyle Factors in the Croatian Adult Population

The aim of this study was to analyse the association of poor self- -perceived health with demographic, socioeconomic and lifestyle factors using data from the European Health Interview Survey. When applying the multiple logistic regression model, two demographic (male sex, older age), all four socioeconomic (low education level, unemployed and retired, living in households with lowest income, poor social support) and only one lifestyle factor (no alcohol consumption) were revealed as associated with poor self-perceived health. The association of socioeconomic factors with self-perceived health among the adult population in Croatia is direct and not mediated exclusively through lifestyle factors.

Clinical and socioeconomic factors associated with delayed orchidopexy in cryptorchid boys in China: a retrospective study of 2423 cases.

We investigated the associations of clinical and socioeconomic factors with delayed orchidopexy for cryptorchidism in China. A retrospective study was conducted on cryptorchid boys who underwent orchidopexy at Children's Hospital at Chongqing Medical University in China from January 2012 to December 2017. Of 2423 patients, 410 (16.9%) received timely repair by 18 months of age, beyond which surgery was considered delayed. Univariate analysis suggested that the laterality of cryptorchidism (P = 0.001), comorbidities including inguinal hernia/scrotal hydrocele (P < 0.001) or urinary tract disease (P = 0.016), and whether patients lived in a poverty county (P < 0.001) could influence whether orchidopexy was timely or delayed. Logistic regression analysis suggested that the following factors were associated with delayed repair: unilateral rather than bilateral cryptorchidism (odds ratio [OR] = 1.752, P < 0.001), absence of inguinal hernia or hydrocele (OR = 2.027, P = 0.019), absence of urinary tract disease (OR = 3.712, P < 0.001), and living in a poverty county (OR = 2.005, P < 0.001). The duration of postoperative hospital stay and hospital costs increased with the patient's age at the time of surgery.

Socio-economic inequalities in mortality for Asian people: New Zealand Census-Mortality Study, 1996–2004

This study examines the association of socio-economic factors with mortality for the Asian population, and compares with those of the European/Other group. Conversely, it examines differences in mortality rates between the European/Other and Asian groups by levels of these socio-economic factors. Asian and European/Other 25–74 year olds on census night 1996 and 2001 were followed up for 3 years by record linkage with mortality data. Socio-economic position was measured using household income, highest educational qualification and a measure of neighbourhood deprivation. Poisson regression modelling was used to estimate the effect socio-economic variables and ethnicity on mortality rates. Asians with no qualifications had mortality rates 72% higher than those Asians with post-school qualifications whereas the corresponding figure for European/Others was 29%. Asian people living in areas of high deprivation had mortality rates 56% higher than those living in areas of low deprivation, with a similar result for the European/Other group. However, while there was no income-mortality gradient among Asian people, there was a significant effect of household income for the European/Other group where mortality rates decreased by 6% for each unit increase in income decile. Consequently, the protective effect on mortality from being Asian compared to European/Other) is more marked at higher levels of education or lower levels of income. Education is an important determinant of mortality among Asian people, but not income, perhaps reflecting the importance of education as a predictor of health status following migration, and sacrifices in income that migrants are prepared to make.

Associations of Socioeconomic Factors,Nutrients Intake,and Gut Microbiota of Healthy Pregnant Women in the Third Trimester with Gestational Weight Gain

Objective To investigate the associations of socioeconomic factors,nutrients intake,and gut microbiota of healthy pregnant women in the third trimester with gestational weight gain (GWG).Methods We recruited 98 pregnant women in the third trimester who had received antenatal care in the Department of Obstetrics Gynecology,Peking Union Medical College Hospital from October,2015 to May,2016. We collected socioeconomic information through a structured questionnaire covering age,ethnicity,height,pre-pregnancy weight,and education. Nutritional status of these pregnant women was assessed by a 24-hour dietary intake recall. The participants were provided with collective tubes for faecal sample collection at home;their weight before the delivery was recorded. The pre-pregnancy weight and GWG were classified according to World Health Organization body mass index (BMI) standard for adults and the Institute of Medicine GWG guidelines (2009),respectively. The gut microbiota of the participants were analyzed using a whole-metagenome shotgun sequencing method.Results Insufficient and excessive GWG accounted for 15.3% and 50.0% of the cohort,respectively. Appropriate GWG level was associated with intakes of fat (F=3.113,P=0.049),carbohydrates (F=3.750,P=0.027),and dietary fiber (F=4.499,P=0.014) but not with age (F=2.495,P=0.088),ethnicity (Χ 2=0.065,P=0.968),education (Χ 2=0.827,P=0.661),or pre-pregnancy BMI (F=0.121,P=0.887). Compared with the participants with appropriate GWG,those with excessive GWG had significantly higher abundance of Akkermansia muciniphila,Atopobium parvulum,and Alistipes indistinctus as well as lower abundance of Lactobacillus rhamnosus,Weissella unclassified,Eubacterium ventriosum,Ruminococcus torques,and Bacteroides uniformis. Compared with the participants with appropriate GWG,those with insufficient GWG had significantly higher abundance of Dialister invisus,Alistipes unclassified,Peptoniphilus harei,Escherichia unclassified,Parvimonas unclassified,Campylobacter ureolyticus,Lactobacillus crispatus,and Fusobacterium nucleatum and lower abundance of Eubacterium ventriosum.Conclusions Abnormal GWG is common in pregnant women. GWG is significantly associated with gut microbiota as well as with nutritional factors including fat,carbohydrate,and dietary fiber intake.

Does health insurance matter to the use of health services for the elderly in China? A multiyear, nationwide, cross-sectional study

BackgroundChina has a population that is rapidly ageing. This rapid growth raises many challenges such as financing and delivery of health care. The Urban Residents Basic Medical Insurance (URBMI) has provided financial protection for the urban elderly not covered by other health insurance schemes since 2007. We therefore aimed to do a national level assessment on the changes in perceived health needs and use of health services of the elderly enrolled in URBMI. MethodsWe extracted data from two waves (2008 and 2013) of the National Health Service Surveys. We included eligible individuals aged 60 years or over and enrolled in URBMI for analysis. Our primary measures were self-reported diagnosis of non-communicable diseases (NCDs), outpatient visits in the past 2 weeks, hospital admissions within the past year, and proportion of forgone necessary admissions referred, which were analysed by age groups (60–69 years, 70–79 years, and ≥80 years) and income levels (low, middle, and high). We used multivariate regression models to estimate associations of socioeconomic factors (age and income groups) and perceived health demand to the use of health services with control of demographic characters (sex, household size, marriage status, and education) and year of survey (2008 as base). The National Health Services Surveys were reviewed and approved by National Statistics Bureau and all participants gave oral consent to participate in the study. FindingsFrom June 1, 2008, to Sep 30, 2013, 7634 individuals were eligible for analysis, in whom self-reported prevalence rates of NCDs increased from 67·9% (553 of 815) to 77·8% (5305 of 6819). 89·1% (1792 of 2012) of individuals aged 70–79 years reported with NCDs in 2013, which is 9·0% higher than those aged 80 years or over and 17·6% higher in those aged 60–69 years. 80·1% (1821 of 2273) of the elderly from the middle-income group reported having NCDs, whereas 78·9% (1793 of 2273) from the high-income group and 75·4% (1714 of 2273) from the low-income group reported having NCDs in 2013. Between 2008 and 2013, outpatient visits increased from 23·7% (193 of 815) to 27·0% (1841 of 6819) and hospital admissions increased from 13·3% (108 of 815) to 16·6% (1132 of 6819). Outpatient visits increased from 24·8% to 32·1% for those aged 70–79 years and 19·7% to 26·7% for those aged 80 years or over, but remained at 24·5% for individuals aged 60–69 years. The high-income group had the highest increase from 23·0% to 31·1% whereas the low-income group had a decrease from 26·3% to 22·2%. Hospital admissions increased among all groups, with the 70–79 years' age group and the middle-income group having the largest increase. Proportion of forgone necessary admission reduced from 29·4% to 17·7%, and both low-income and middle-income groups had more than 20% reduction between 2008 and 2013. Age, income, and survey year significantly influenced outpatient visits whereas education, age, income, self-reported NCDs, and survey year were significant influential factors for hospital admission. InterpretationThe use of overall services increased and forgone necessary admission decreased after the implementation of URBMI, indicating the improvement of access to health services. However, outpatient use favoured those in the high-income group and calls for further attention on equity. Additionally, the prevalence rate of NCDs among the elderly in urban regions increased sustainably and action plans on health promotion and primary prevention of NCDs should be implemented. The benefit package of insurance should also support the care of NCDs. FundingNone.

Association of socioeconomic factors and the risk for unintentional injuries among children in Japan: a cross-sectional study

ObjectivesWhile Japan has socioeconomic issues, such as income inequality, little is known about the association between socioeconomic factors and the risk of unintentional childhood injuries. The purpose of the study...