Effect Of Socioeconomic Inequalities Research Articles

Socioeconomic disparities in endometrial cancer survival in Germany: a survival analysis using population-based cancer registry data

PurposeArea-based socioeconomic deprivation has been established as an important indicator of health and a potential predictor of survival. In this study, we aimed to measure the effect of socioeconomic inequality on endometrial cancer survival.MethodsPopulation-based data on patients diagnosed with endometrial cancer between 2004 and 2014 were obtained from the German Centre for Cancer Registry Data. Socioeconomic inequality was defined by the German Index of Socioeconomic Deprivation. We investigated the association of deprivation and overall survival through Kaplan–Meier curves and Cox proportional regression models.ResultsA total of 21,602 women, with a mean age of 67.8 years, were included in our analysis. The observed 5-year overall survival time for endometrial cancer patients living in the most affluent districts (first quintile) was 78.6%. The overall survival rate decreased as the level of deprivation increased (77.2%, 73.9%, 76.1%, 74.7%, for patients in the second, third, fourth, and fifth quintile (most deprived patients), respectively). Cox regression models showed stage I patients living in the most deprived districts to have a higher hazard of overall mortality when compared to the cases living in the most affluent districts [Hazard ratio: 1.20; 95% Confidence interval (0.99–1.47)] after adjusting for age, tumor characteristics, and treatment.ConclusionOur results indicate differences in endometrial cancer survival according to socioeconomic deprivation among stage I patients. Considering data limitations, future studies with access to individual-level patient information should be conducted to examine the underlying causes for the observed disparity in cancer survival.

Effect of socioeconomic inequalities and vulnerabilities on health-system preparedness and response to COVID-19 in Brazil: a comprehensive analysis

BackgroundCOVID-19 spread rapidly in Brazil despite the country's well established health and social protection systems. Understanding the relationships between health-system preparedness, responses to COVID-19, and the pattern of spread of the epidemic is particularly important in a country marked by wide inequalities in socioeconomic characteristics (eg, housing and employment status) and other health risks (age structure and burden of chronic disease).MethodsFrom several publicly available sources in Brazil, we obtained data on health risk factors for severe COVID-19 (proportion of the population with chronic disease and proportion aged ≥60 years), socioeconomic vulnerability (proportions of the population with housing vulnerability or without formal work), health-system capacity (numbers of intensive care unit beds and physicians), coverage of health and social assistance, deaths from COVID-19, and state-level responses of government in terms of physical distancing policies. We also obtained data on the proportion of the population staying at home, based on locational data, as a measure of physical distancing adherence. We developed a socioeconomic vulnerability index (SVI) based on household characteristics and the Human Development Index. Data were analysed at the state and municipal levels. Descriptive statistics and correlations between state-level indicators were used to characterise the relationship between the availability of health-care resources and socioeconomic characteristics and the spread of the epidemic and the response of governments and populations in terms of new investments, legislation, and physical distancing. We used linear regressions on a municipality-by-month dataset from February to October, 2020, to characterise the dynamics of COVID-19 deaths and response to the epidemic across municipalities.FindingsThe initial spread of COVID-19 was mostly affected by patterns of socioeconomic vulnerability as measured by the SVI rather than population age structure and prevalence of health risk factors. The states with a high (greater than median) SVI were able to expand hospital capacity, to enact stringent COVID-19-related legislation, and to increase physical distancing adherence in the population, although not sufficiently to prevent higher COVID-19 mortality during the initial phase of the epidemic compared with states with a low SVI. Death rates accelerated until June, 2020, particularly in municipalities with the highest socioeconomic vulnerability. Throughout the following months, however, differences in policy response converged in municipalities with lower and higher SVIs, while physical distancing remained relatively higher and death rates became relatively lower in the municipalities with the highest SVIs compared with those with lower SVIs.InterpretationIn Brazil, existing socioeconomic inequalities, rather than age, health status, and other risk factors for COVID-19, have affected the course of the epidemic, with a disproportionate adverse burden on states and municipalities with high socioeconomic vulnerability. Local government responses and population behaviour in the states and municipalities with higher socioeconomic vulnerability have helped to contain the effects of the epidemic. Targeted policies and actions are needed to protect those with the greatest socioeconomic vulnerability. This experience could be relevant in other low-income and middle-income countries where socioeconomic vulnerability varies greatly.FundingNone.TranslationFor the Portuguese translation of the abstract see Supplementary Materials section.

The Material Context of Adolescent Identity Formation: A Family Economic Stress Approach

ABSTRACT Grounded in the family stress model and recent studies on cognitive effects of poverty, the current study examines how family material conditions relate to identity-relevant information processing among adolescents via family economic strain, family financial conflicts, and parenting behaviors. Data for the study come from the first wave of a longitudinal study on the development of adolescent goals in the context of socio-economic inequalities. The sample includes 1,268 adolescents (51.7% females; M = 14.87; SD = 0.39) attending 36 gymnasiums. Findings reveal that the family economic situation contributes to how adolescents process identity-relevant information, but these effects are primarily indirect. Specifically, better family material conditions are associated with more supportive parental engagement in their children’s identity-relevant decisions, which in turn is associated with higher levels of the information-oriented identity processing style. Poorer family material conditions, economic pressures, and conflicts are associated with parental interference and a lack of engagement, which in turn is associated with higher levels of diffuse-avoidant identity style. The identity styles themselves are known predictors for a wide array of outcomes. Therefore, our findings suggest that countering the adverse effects of socio-economic inequality may be crucial to break a self-perpetuation cycle of socio-economic adversity.

Effect of socioeconomic inequalities and contextual factors on induced abortion in Ghana: A Bayesian multilevel analysis.

There is a dearth of information on induced abortion in Ghana, possibly owing to the sensitive nature of the subject. In this study, we examine the effect of socioeconomic and contextual factors on induced abortion in Ghana. This study draws on data from the 2017 Ghana Maternal Health Survey. The study used a Bayesian multilevel logistic regression analysis to estimate both individual- and contextual-level factors affecting induced abortion levels in Ghana. The results show a total induced abortion prevalence of 19.6% coupled with considerable district-level disparities. Induced abortion is significantly associated with socioeconomic factors such as educational attainment, wealth status, and marital status at the individual-level. The risk of induced abortion is considerably higher among the educated, wealthy, and cohabiting women. The current age of women, age at first sex, religious affiliation, parity, and type of residence are the demographic factors having an association with induced abortion levels. At the contextual-level, district health insurance coverage and poverty rate have a significant association with induced abortion. Induced abortion appears to be prevalent in Ghana and is underpinned by both individual-level socioeconomic and aggregate-level factors. Addressing induced abortion levels in Ghana may require policies that take a multilevel approach by focusing on the socioeconomic status of women and district-level contextual factors.

The mediating role of social capital in the relationship between socioeconomic status and adolescent wellbeing: evidence from Ghana

BackgroundSocial capital is generally portrayed to be protective of adolescents’ health and wellbeing against the effects of socioeconomic inequalities. However, few empirical evidence exist on this protective role of social capital regarding adolescents’ wellbeing in the low-and middle-income country (LMIC) context. This study examines the potential for social capital to be a protective health resource by investigating whether social capital can mediate the relationship between socioeconomic status (SES) and wellbeing of Ghanaian adolescents. It also examines how SES and social capital relate to different dimensions of adolescents’ wellbeing in different social contexts.MethodsThe study employed a cross-sectional survey involving a randomly selected 2068 adolescents (13-18 years) from 15 schools (8 Senior and 7 Junior High Schools) in Ghana. Relationships were assessed using multivariate regression models.ResultsThree measures of familial social capital (family sense of belonging, family autonomy support, and family control) were found to be important protective factors of both adolescents’ life satisfaction and happiness against the effects of socioeconomic status. One measure of school social capital (school sense of belonging) was found to augment adolescents’ wellbeing but played no mediating role in the SES-wellbeing relationship. A proportion of about 69 and 42% of the total effect of SES on happiness and life satisfaction were mediated by social capital respectively. Moreover, there were variations in how SES and social capital related to the different dimensions of adolescents’ wellbeing.ConclusionSocial capital is a significant mechanism through which SES impacts the wellbeing of adolescents. Social capital is a potential protective health resource that can be utilised by public health policy to promote adolescents’ wellbeing irrespective of socioeconomic inequalities. Moreover, the role of the family (home) in promoting adolescents’ wellbeing is superior to that of school which prompts targeted policy interventions. For a holistic assessment of adolescents’ subjective wellbeing, both life evaluations (life satisfaction) and positive emotions (happiness) should be assessed concomitantly.

Effect of Socioeconomic Inequality on Overweight and Obesity in Children: A Review of Systematic Reviews

Background and objectivesObesity has become a global epidemic. Previous studies have reported a relationship between obesity in adults and socioeconomic factors, but the results regarding such relationship in the case of childhood obesity have been inconsistent. Therefore, this study aimed to determine the relationship between socioeconomic inequalities and overweight/obesity in children.MethodsAll meta-analysis, systematic and descriptive or correlational reviews on obesity in children and adolescents that have been published in English between January 2001 and January 2019 were included in the study. We performed the search for articles in the following databases: MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar. Each review article was subjected to qualitative evaluation using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.ResultsOf 46 articles that met the inclusion criteria, five systematic reviews were included after carefully reading the abstract and the full text of the articles. The prevalence of overweight and obesity in children differed in different socioeconomic groups. Ethnicity was a confounding factor that could change this relationship.ConclusionStrong evidence supports the relationship between socioeconomic status and overweight or obesity in children. Therefore, it is recommended to consider the socioeconomic status when planning for control and prevention of childhood obesity.

Effect of socioeconomic inequalities on cholecystectomy outcomes: a 10-year population-based analysis

BackgroundAlthough numerous epidemiological studies on cholecystectomy have been conducted worldwide, only a few have considered the effect of socioeconomic inequalities on cholecystectomy outcomes. Specifically, few studies have focused on the low-income population (LIP).MethodsA nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2003–2012. The International Classification of ICD-9-CM procedure codes 51.2 and 51.21–51.24 were identified as the inclusion criteria for cholecystectomy. Temporal trends were analyzed using a joinpoint regression, and the hierarchical linear modeling (HLM) method was used as an analytical strategy to evaluate the group-level and individual-level factors. Interactions between age, gender and SES were also tested in HLM model.ResultsAnalyses were conducted on 225,558 patients. The incidence rates were 167.81 (95% CI: 159.78–175.83) per 100,000 individuals per year for the LIP and 123.24 (95% CI: 116.37–130.12) per 100,000 individuals per year for the general population (GP). After cholecystectomy, LIP patients showed higher rates of 30-day mortality, in-hospital complications, and readmission for complications, but a lower rate of routine discharge than GP patients. The hospital costs and length of stay for LIP patients were higher than those for GP patients. The multilevel analysis using HLM revealed that adverse socioeconomic status significantly negatively affects the outcomes of patients undergoing cholecystectomy. Additionally, male sex, advanced age, and high Charlson Comorbidity Index (CCI) scores were associated with higher rates of in-hospital complications and 30-day mortality. We also observed that the 30-day mortality rates for patients who underwent cholecystectomy in regional hospitals and district hospitals were significantly higher than those of patients receiving care in a medical center.ConclusionPatients with a disadvantaged finance status appeared to be more vulnerable to cholecystectomy surgery. This result suggested that further interventions in the health care system are necessary to reduce this disparity.

Associations between social vulnerabilities and psychosocial problems in European children. Results from the IDEFICS study.

The effect of socioeconomic inequalities on children's mental health remains unclear. This study aims to explore the cross-sectional and longitudinal associations between social vulnerabilities and psychosocial problems, and the association between accumulation of vulnerabilities and psychosocial problems. 5987 children aged 2-9years from eight European countries were assessed at baseline and 2-year follow-up. Two different instruments were employed to assess children's psychosocial problems: the KINDL (Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents) was used to evaluate children's well-being and the Strengths and Difficulties Questionnaire (SDQ) was used to evaluate children's internalising problems. Vulnerable groups were defined as follows: children whose parents had minimal social networks, children from non-traditional families, children of migrant origin or children with unemployed parents. Logistic mixed-effects models were used to assess the associations between social vulnerabilities and psychosocial problems. After adjusting for classical socioeconomic and lifestyle indicators, children whose parents had minimal social networks were at greater risk of presenting internalising problems at baseline and follow-up (OR 1.53, 99% CI 1.11-2.11). The highest risk for psychosocial problems was found in children whose status changed from traditional families at T0 to non-traditional families at T1 (OR 1.60, 99% CI 1.07-2.39) and whose parents had minimal social networks at both time points (OR 1.97, 99% CI 1.26-3.08). Children with one or more vulnerabilities accumulated were at a higher risk of developing psychosocial problems at baseline and follow-up. Therefore, policy makers should implement measures to strengthen the social support for parents with a minimal social network.

Abstract TP195: Effect of Socioeconomic Inequality and Comorbidity on the Association Between Ambient Temperature and Ischemic Stroke

Background: Inconsistent findings have been reported regarding the effect of ambient temperature on ischemic stroke. Furthermore, little is known about how comorbidities and low socioeconomic status influence the association. We investigated the relationship between temperature and emergency department (ED) visits for ischemic stroke, and aimed to identify susceptible populations. Methods: Using medical claims data, we identified ED visits for ischemic stroke during 2005-2009 in Seoul, the Republic of Korea. We conducted piecewise linear regression analyses to find optimum temperature thresholds in summer and winter, and estimated the relative risks (RR) and 95% confidence intervals (CI) per 1°C change in temperature above/below the thresholds, adjusting for relative humidity, holidays, day of the week, and PM 10 and O 3 levels. Results: There were 63,564 ED visits for ischemic stroke during the study period. In summer, the risk of ED visits for ischemic stroke was not significant, with the threshold at 26.8°C. The RR of ischemic stroke visits was 1.055 (95% CI, 1.006-1.106) above 25.0°C in medical aid beneficiaries and 1.044 (1.007-1.082) above 25.8°C in patients with diabetes. In winter, the risk of ischemic stroke significantly increased as the temperature dropped below the threshold. The RRs were 0.618 (95% CI, 0.453-0.842) and 0.643 (0.501-0.824) for hypertensive and patients with diabetes, respectively. Conclusions: Temperature increases above a threshold were positively associated with ED visits for ischemic stroke in patients with diabetes and medical aid beneficiaries in summer. In winter, a decrease in temperature, to a point, significantly increased the risk of ischemic stroke visits.

Socioeconomic differentials and disease-free life expectancy of the elderly in Brazil

The objective of this study was to estimate life expectancy with and without a specific chronic disease among the Brazilian elderly population, by sex and socioeconomic factors, for the years 1998 and 2008. Life expectancy with and without hypertension, diabetes, bronchitis/asthma, and heart disease were calculated using the Sullivan method and prevalence estimates from data collected in the two years through the Brazilian National Household Survey (PNAD). Hypertension was the chronic disease with the largest effect on life expectancy. Among socioeconomic determinants, education proved more relevant than income. Having more years of education increased the average healthy time. Socioeconomic inequality negatively affected the health of women more than men. Despite the social changes in Brazil in recent decades with a reduction in inequality and poverty, the effect of socioeconomic inequality in the country on the health status of the elderly remains evident.

Effect of socio-economic factors in utilization of different healthcare services among older adult men and women in Ghana.

BackgroundThe older adult population is increasing all over the world. In sub-Saharan Africa, due to poverty and low policy coverage, older adults are not well catered for. The effect of socio-economic inequality in the use of healthcare services among older adult men and women in Ghana was investigated in this paper.MethodsThe data employed in the study were drawn from Global Ageing and Adult Health survey SAGE Wave 1 Ghana and was based on the design for the World Health Survey 2003, SAGE Wave 0, Ghana. The survey was conducted in 2007–2008 and collected data on socio-economic characteristics and other variables of the 5573 individuals interviewed.ResultsUsing generalized logit model, the study found that health status is a very strong determinant of the type of healthcare services preferred by older adults Ghanaians. Men with higher income preferred the private health facilities, while those who completed tertiary education, those with health insurance and those who self-rated their health as very bad, bad or moderate preferred public facility. Self-employed men and those in informal employment, preferred other health facilities outside the formal public health service. Women with primary and secondary education, preferred the private health facilities. Women with health insurance, those in middle and upper class income quintiles or those with self-rated bad and moderate health status or being relatively younger preferred the public facility to other health services. Self-employed women and those in informal employment preferred traditional treatment. In Ghana, there are important socio-economic gradients in the use of some healthcare services. In both sexes, those without insurance and rural residents preferred the pharmacy and traditional treatment.ConclusionThese differences may be due to socio-economic inequities but could also indicate that the existing health facilities are not always used in an optimal way. Patient factors may be equally important as supply factors in explaining the differential use of health services. The public health systems in Ghana still have a major role in improving the health of older adults. National commitments in providing basic essential infrastructure and personnel to health centres for the citizenry is imperative. Policy readjustment of the national health insurance scheme to make it truly accessible to the aged is essential.

The effects of socioeconomic inequalities on incidence of cognitive impairment among community-dwelling elderly in seoul

The effects of socioeconomic inequalities on incidence of cognitive impairment among community-dwelling elderly in seoul

Adolescent Binge Drinking as a Risk Factor for Depression/anxiety Disorders: Findings From a 4-year Follow-up Community Study

Introduction Binge drinking and mental health problems in the depression/anxiety spectrum often begin in adolescence as co-occurring phenomena. Objective and Aims To evaluate the mediating role of socioeconomic status in the association between binge drinking and adolescent depression/anxiety. Method A prospective cohort study of adolescents (n=3008), with 4 follow-up assessments between July 2006 and July 2010. Setting Family Panel, Institut d’Infancia i Mon Urba, Catalonia. Participants Adolescents and their parents. Measurements The presence or absence of a diagnosis of depression/anxiety was determined at T1 and at T4 in interviews with parents. Binge drinking, defined as 2 monthly binges or more, was assessed at T1, T2 and T3 through interviews with the adolescent study participants, and the responses recorded as variables (yes or no). Age, sex, income, parents’ level of education, number of friends, peer pressure, parental pressure, and risk-prone friends were included as variables in data analysis. Descriptive and inferential statistics and simple and multivariate logistics models were applied to study the long-term effect of alcohol consumption on depression/anxiety. Results Binge drinking is a risk factor for depression/anxiety in the last year of follow-up T3 (OR:1.7, IC 95%: 1.1-2.5). After adjusting for age and sex, the risk remains. The risk of depression decreases as household income increases (OR: 1.47, IC 95%: 0.9-2.4]. Conclusions Binge drinking increases the risk of depression and anxiety disorders mainly in adolescents from low-income families. Mental health interventions and treatment for addiction should be sensitive to the effect of socioeconomic inequalities in this age group.

The effects of socioeconomic inequalities of working life on health: implications for an ageing population

This study examines suggestions that inequalities in health related to socioeconomic status (SES) will increase in older age. A representative sample of the New Zealand population aged 55–70 years (N = 6662) responded to a postal questionnaire with measures of health (SF-36), SES, and health-related behaviours. Hierarchical multiple regressions supported predictions that the SES of working life will continue to influence physical and mental health in early old age. The strongest predictor was self-reported economic living standards. This subjective measure of SES is an important construct for future investigations of health and wellbeing among older people in an ageing population.

Social inequality and ethnic differences in smoking in New Zealand

This study tests a generalisation of the ‘Wilkinson’ thesis that the greater a nation's income inequality, the poorer the average national health status. We consider the effect of socio-economic inequality upon ethnic variations in smoking in New Zealand. Analysis of Maori and Pakeha (New Zealanders of European descent) smoking rates from the 1996 Census is conducted for 73 Territorial Local Authority areas in New Zealand, disaggregated by gender and rural–urban location. Partial correlation is used to control for absolute levels of deprivation and examine the independent effect of ethnic social inequality upon smoking rates. The level of social inequality between Maori and Pakeha has an independent effect on Maori smoking rates. Pakeha smoking rates by contrast are more sensitive to variations in absolute rather than relative deprivation. The effect of inequality is greatest for Maori women, especially among urban residents. By contrast, among Maori men the effects are greatest in rural areas. The results provide some qualified support for the Wilkinson thesis and suggest that policies which address fundamental issues of social inequality will play a small, but significant, role in helping to reduce high smoking rates amongst Maori.