Estimate Of Socioeconomic Status Research Articles

Socioeconomic status and psychological distress do not predict mortality risk in the island population of Vis, Croatia

Aims To investigate the association between socioeconomic status and psychological distress measured by the General health questionnaire (GHQ-30) with all-cause mortality, cardiovascular mortality and cancer mortality on the Croatian island of Vis. Methods This population-based cohort consisted of 1,025 subjects (426 men and 599 women), who were followed up for 18 years or a total of 5.8 million days. The causes of death were extracted from the Croatian National Institute of Public Health database. We calculated the adjusted hazard ratios, with subjective material status, years of schooling and a composite household material status used as estimates of socioeconomic status. Results There were 279 cases of death (27.2%). Socioeconomic status and psychological distress did not predict either the specific or the all-cause mortality risk. In addition, the interaction between socioeconomic variables and psychological distress also did not yield a significant hazard ratio in all three instances (all-cause, cardiovascular or tumour mortality). Conclusions These results confirm previous reports of the high level of social equality in the population of the island of Vis. Small and isolated communities may experience a lesser extent of social inequalities in health.

The state of enrollment on the National Health Insurance Scheme in rural Ghana after eight years of implementation

BackgroundIn 2004, Ghana implemented a national health insurance scheme (NHIS) as a step towards achieving universal health coverage. In this paper, we assessed the level of enrollment and factors associated with NHIS membership in two predominantly rural districts of northern Ghana after eight years of implementation, with focus on the poor and vulnerable populations.MethodsA cross-sectional survey was conducted from July 2012 to December 2012 among 11,175 randomly sampled households with their heads as respondents. Information on NHIS status, category of membership and socio-demographic characteristics of household members was obtained using a structured questionnaire. Principal component analysis was used to compute wealth index from household assets as estimates of socio-economic status (SES). The factors associated with NHIS enrollment were assessed using logistic regression models. The reasons behind enrollment decisions of each household member were further investigated against their SES.ResultsApproximately half of the sampled population of 39,262 were registered with a valid NHIS card; 53.2% of these were through voluntary subscriptions by payment of premium whilst the remaining (46.8%) comprising of children below the ages of 18 years, elderly 70 years and above, pregnant women and formal sector workers were exempt from premium payment. Despite an exemption policy to ameliorate the poor and vulnerable households against catastrophic health care expenditures, only 0.5% of NHIS membership representing 1.2% of total exemptions granted on accounts of poverty and other social vulnerabilities was applied for the poor. Yet, cost of premium was the main barrier to NHIS registration (92.6%) and non-renewal (78.8%), with members of the lowest SES being worst affected. Children below the ages of 18 years, females, urban residents and those with higher education and SES were significantly more likely to be enrolled with the scheme.ConclusionsDespite the introduction of policy exemptions as an equity measure, the poorest of the poor were rarely identified for exemption. The government must urgently resource the Department of Social Welfare to identify the poor for NHIS enrollment.

Racial and socioeconomic disparities in the selection of prostate brachytherapy

PurposeTo utilize the surveillance, epidemiology, and end results database to analyze whether there are racial or socioeconomic disparities associated with the selection of prostate brachytherapy.Material and methodsWe selected patients who were diagnosed with localized prostate cancer between 2004-2006 and who underwent treatment with radiation. Data regarding race and estimates of socioeconomic status were also obtained by analyzing the average reported cost of living adjusted income in the SEER county from which the patient was treated, and dividing these results into quartiles. Multivariate logistic regression analysis was used to determine whether there were any disparities associated with brachytherapy use.ResultsA total of 38 704 patients were included in the analysis. Most patients (57%) received EBRT alone, while the remaining 43% of patients had brachytherapy as a component of their treatment, either alone (30.2%) or in combination with EBRT (12.2%). On multivariate logistic regression, prostate brachytherapy use was less likely in African American patients with an odds ratio of 0.89 (95% CI: 0.84-0.95, p < 0.001), and was more likely to be used in those with higher socioeconomic status. Regarding socioeconomic status, the odds ratio for receiving brachytherapy was 1.65 (95% CI: 1.55-1.75) for the 25-50% quartile, 1.92 (95% CI: 1.81-2.04) for the 50-75% quartile, and 2.05 (95% CI: 1.93-2.18) for the 75-100% quartile, respectively (p < 0.001).ConclusionsThere do appear to be socioeconomic and racial disparities in the selection of prostate brachytherapy. These findings may have both significant equality of care as well as cost of care implications.

An Environment-Wide Association Study (EWAS) on Type 2 Diabetes Mellitus

BackgroundType 2 Diabetes (T2D) and other chronic diseases are caused by a complex combination of many genetic and environmental factors. Few methods are available to comprehensively associate specific physical environmental factors with disease. We conducted a pilot Environmental-Wide Association Study (EWAS), in which epidemiological data are comprehensively and systematically interpreted in a manner analogous to a Genome Wide Association Study (GWAS).Methods and FindingsWe performed multiple cross-sectional analyses associating 266 unique environmental factors with clinical status for T2D defined by fasting blood sugar (FBG) concentration ≥126 mg/dL. We utilized available Centers for Disease Control (CDC) National Health and Nutrition Examination Survey (NHANES) cohorts from years 1999 to 2006. Within cohort sample numbers ranged from 503 to 3,318. Logistic regression models were adjusted for age, sex, body mass index (BMI), ethnicity, and an estimate of socioeconomic status (SES). As in GWAS, multiple comparisons were controlled and significant findings were validated with other cohorts. We discovered significant associations for the pesticide-derivative heptachlor epoxide (adjusted OR in three combined cohorts of 1.7 for a 1 SD change in exposure amount; p<0.001), and the vitamin γ-tocopherol (adjusted OR 1.5; p<0.001). Higher concentrations of polychlorinated biphenyls (PCBs) such as PCB170 (adjusted OR 2.2; p<0.001) were also found. Protective factors associated with T2D included β-carotenes (adjusted OR 0.6; p<0.001).Conclusions and SignificanceDespite difficulty in ascertaining causality, the potential for novel factors of large effect associated with T2D justify the use of EWAS to create hypotheses regarding the broad contribution of the environment to disease. Even in this study based on prior collected epidemiological measures, environmental factors can be found with effect sizes comparable to the best loci yet found by GWAS.

Social Class Segregation and Its Relationship to Pupils' Examination Results in Scotland

In 1965 Scotland began to reorganize its secondary education along comprehensive lines by abolishing selective transfer to secondary school. Ten years later the process was substantially completed. This study describes the socioeconomic composition of Scotland's school towards the end of the 1970s and examines the relationship between school composition and pupils' grades and attainment in the Scottish Certificate of Education examinations. The study employs data from the 1981 Scottish School Leavers' Survey, which surveyed a large representative sample of pupils that left school in 1980. The analysis provides estimates of socioeconomic status (SES) segregation for each of Scotland's administrative divisions, and employs multilevel regression analyses to estimate the contextual effects of school mean SES on examination results. The findings show that there is large between-school variation in SES in most school divisions, and that much of this variation is associated with an unequal distribution of pupils from high-social-class backgrounds. The findings also suggest that there are substantial contextual effects of school mean SES on examination attainment, that they are more strongly related to the proportion of high-social-class pupils in a school than the proportion of low-social-class pupils, and that they are equally strong for pupils of high and low ability alike.