High Deprivation Research Articles

Metabolic syndrome and spatial disparities: The role of socioeconomic deprivation and medical resource availability in the Cijin district, Taiwan.

Metabolic syndrome (MetS) is a global health concern with spatial disparities, especially in disadvantaged neighborhoods. This study aimed to examine the association between area-level socioeconomic deprivation, the availability of medical resources in disadvantaged areas such as the Cijin district, and the prevalence of MetS in Taiwan. We used two representative secondary cross-sectional datasets, including physical examinations and lifestyle surveys from 2016 to 2020, sourced from the Taiwan Biobank and the Cijin District Adult Lifestyle and Health Survey. Our findings indicate that residing in the Cijin district, characterized by socioeconomic deprivation and limited medical resources, is associated with significantly higher odds of MetS (aOR = 1.45, 95% CI = 1.28-1.64, p <0.001). Additionally, living in areas with medium (aOR = 1.12, 95% CI = 1.07-1.17, p <0.001) and high area-level socioeconomic deprivation indexes (aOR = 1.13, 95% CI = 1.01-1.25, p <0.001) is linked to a higher likelihood of MetS. Conversely, residing in high medical resource availability index areas is associated with a lower risk of MetS (aOR = 0.92, 95% CI = 0.86-0.99, p = 0.026). We found a link between socioeconomic deprivation and limited medical resources, especially in disadvantaged areas such as the Cijin district, contributing to a higher MetS risk. Residents in these areas often struggle to access healthcare and preventive care. Addressing these disparities requires comprehensive public health initiatives and targeted policy interventions to improve residents' well-being.

OGC SO32 - Propensity score analysis of the impact of deprivation and the COVID-19 pandemic on Upper Gastro Intestinal (UGI) cancer surgery outcomes

Abstract Background Deprivation is a complex, multifaceted concept, not synonymous with poverty, but with the potential to widen health inequalities. This study aimed to explore demographic disparities in patients undergoing UGI cancer surgery in a UK regional cancer network during the COVID-19 pandemic. Method Consecutive 881 patients were studied prospectively (median age 67 (24 - 89) yr., 703 m, 178 f; 518 oesophageal, 363 gastric; 837 Adeno-, 44 SCC) over 13 years. The COVID-19 pandemic was defined as the 24-month period from February 1, 2020 to January 31, 2022, during which 118 patients were treated. The demographic profile of the pandemic cohort was compared with that of the 763 patients treated outside this period incorporating a propensity score analysis. Primary outcomes were operative morbidity, mortality, and one-year survival. Wales’ Index of Multiple Deprivation was used to assess deprivation disparity. Results A 24% reduction in the number of cancer operations was observed during the first pandemic year. No difference was observed in age, gender, histology, tumour site, ASA grade, or oncological treatment. During COVID-19 the proportion of patients from the two most deprived quartiles receiving potentially curative surgery fell from 53.2% to 40.7% (p=0.012). No difference was observed in severe morbidity (Clavien-Dindo &amp;gt;3, 22.2% vs. 19.8%, p=0.897), 30-day mortality (2.5% vs. 2.4%, p=0.886), or one-year survival (82.4% vs. 78.8%, p=0.374). Conclusion UGI cancer surgery safely continued during COVID-19, but patients from areas of high deprivation were over 20% less likely to access curative surgical treatment compared with before and after COVID-19. This emphasises the need for bespoke strategies to mitigate the disproportionate impact of any future pandemic on patients living in deprived geographical areas.

Do sociodemographic and health predictors affect the non-insulin-based insulin resistance index? A cross-sectional study.

Insulin resistance (IR) is considered a risk factor for cardiovascular diseases (CVD). Therefore, early diagnosis of IR is clinically significant for primary and secondary CVD prevention initiatives. In addition, non-insulin metabolic indices may be useful for diagnosing IR. The first objective was to estimate the triglyceride and glucose (TyG) index and the metabolic score for insulin resistance (METS-IR) index values in a local community with high social deprivation and increased cardiovascular risk according to the Systematic Coronary Risk Evaluation scale. The second objective was to identify significant sociodemographic and health predictors for the TyG index and METS-IR index. This cross-sectional study was conducted in the local community of Janów district in eastern Poland and consisted of 2 stages. The 1st stage involved basic research (n = 4,040), while the 2nd stage involved enhanced diagnostics (n = 2,657). Data from the 2nd stage was used for the analyses. Anthropometric and physiological measurements were taken, blood was drawn for laboratory tests, selected sociodemographic and health variables were evaluated, and the TyG index and METS-IR index were calculated. The mean TyG index score in the study group was 8.65 (±0.58), and the mean METS-IR index score was 41.45 (±9.02). Both indices were significantly associated with age, male sex, smoking, and systolic blood pressure (SBP) in a multivariable model. In addition, alcohol consumption and body mass index (BMI) were significantly correlated with the TyG index, whereas education was significantly associated with the METS-IR index. Our results show the association between IR and sociodemographic and health variables in a group with a high social deprivation rate and increased cardiovascular risk. Early detection of cardiometabolic risk is important for both primary and secondary CVD prevention. In primary healthcare, this can be accomplished through surrogate markers of IR.

Abstract 4135352: Neighborhood-level Determinants and Disparities in Incident Type 2 Diabetes in a Population-Based Cohort, 2015–2020

Introduction: Living in an area with high Area Deprivation Index (ADI) is linked to worse cardiovascular disease (CVD) outcomes. However, the association of ADI with type 2 diabetes (T2D), a major CVD risk factor, is incompletely described. This knowledge may guide primary CVD prevention. Method: Rochester Epidemiology Project is a medical record linkage system of persons in southeast Minnesota and southwest Wisconsin. We identified 253,890 persons (aged 4–98 yrs on July 1, 2015) in 9 counties with &gt;90% population coverage. ADI scores, from 2015 home addresses, were grouped into quartiles of low (Q1) to high (Q4) deprivation. We excluded persons with type 1 diabetes (T1D) or history of T2D and identified new T2D cases (2015-2020) using ICD codes, HbA1c and medications. We examined the association between ADI quartile and risk of incident T2D using Cox regression with persons right censored at death, T2D, T1D or last visit. Models were adjusted for age and gender, and reported adjusted hazard ratios (aHR [95% confidence interval]). Results: Age, gender, and race statistically differed across ADI quartiles (Table). Age × ADI interaction was significant ( P &lt;.001). T2D incidence ranged from 6.3 (Q1) to 9.0 (Q4) per 1000 person-years ( P &lt;.001). Women vs. men/non-binary persons (combined due to limited non-binary persons) had 30% lower risk of incident T2D (aHR 0.70 [0.67–0.72]). Risk of incident T2D was higher in persons from higher ADI areas. At median age of 48.6 yrs, the risk was 30% higher in Q2 (aHR 1.3 [1.22–1.38]), 38% higher in Q3 (aHR 1.38 [1.30–1.47]) and 53% higher in Q4 (aHR 1.53 [1.43–1.62]) vs. Q1. Higher ADI was associated with higher incident T2D in younger persons, with risk attenuation with increasing age (Figure). Conclusion: In this population cohort, persons, particularly of younger age, living in more deprived areas had a higher risk of incident T2D. ADI may help identify areas for targeted T2D screening, with implications for CVD screening and prevention.

Impact of Socioeconomic Deprivation on Care Quality and Surgical Outcomes for Early-Stage Non-Small Cell Lung Cancer in United States Veterans

Background: Socioeconomic deprivation has been associated with higher lung cancer risk and mortality in non-Veteran populations. However, the impact of socioeconomic deprivation on outcomes for non-small cell lung cancer (NSCLC) in an integrated and equal-access healthcare system, such as the Veterans Health Administration (VHA), remains unclear. Hence, we investigated the impact of area-level socioeconomic deprivation on access to care and postoperative outcomes for early-stage NSCLC in United States Veterans. Methods: We conducted a retrospective cohort study of patients with clinical stage I NSCLC receiving surgical treatment in the VHA between 1 October 2006 and 30 September 2016. A total of 9704 Veterans were included in the study and assigned an area deprivation index (ADI) score, a measure of socioeconomic deprivation incorporating multiple poverty, education, housing, and employment indicators. We used multivariable analyses to evaluate the relationship between ADI and postoperative outcomes as well as adherence to guideline-concordant care quality measures (QMs) for stage I NSCLC in the preoperative (positron emission tomography [PET] imaging, appropriate smoking management, pulmonary function testing [PFT], and timely surgery [≤12 weeks after diagnosis]) and postoperative periods (appropriate surveillance imaging, smoking management, and oncology referral). Results: Compared to Veterans with low socioeconomic deprivation (ADI ≤ 50), those residing in areas with high socioeconomic deprivation (ADI &gt; 75) were less likely to have timely surgery (multivariable-adjusted odds ratio [aOR] 0.832, 95% confidence interval [CI] 0.732–0.945) and receive PET imaging (aOR 0.592, 95% CI 0.502–0.698) and PFT (aOR 0.816, 95% CI 0.694–0.959) prior to surgery. In the postoperative period, Veterans with high socioeconomic deprivation had an increased risk of 30-day readmission (aOR 1.380, 95% CI 1.103–1.726) and decreased odds of meeting all postoperative care QMs (aOR 0.856, 95% CI 0.750–0.978) compared to those with low socioeconomic deprivation. There was no association between ADI and overall survival (adjusted hazard ratio [aHR] 0.984, 95% CI 0.911–1.062) or cumulative incidence of cancer recurrence (aHR 1.047, 95% CI 0.930–1.179). Conclusions: Our results suggest that Veterans with high socioeconomic deprivation have suboptimal adherence to care QMs for stage I NSCLC yet do not have inferior long-term outcomes after curative-intent resection. Collectively, these findings demonstrate the efficacy of an integrated, equal-access healthcare system in mitigating disparities in lung cancer survival that are frequently present in other populations. Future VHA policies should continue to target increasing adherence to QMs and reducing postoperative readmission for socioeconomically disadvantaged Veterans with early-stage NSCLC.

EPID-12. NEIGHBORHOOD SOCIOECONOMIC STATUS PREDICTS SURVIVAL IN GLIOBLASTOMA: A SINGLE CENTER COHORT STUDY

Abstract BACKGROUND Glioblastoma (GBM) is the most common primary brain malignancy. Despite recent progress in treatments, prognosis for patients remain poor. Recent literature has suggested the association of GBM outcomes and socioeconomic status. However, there is limited evidence regarding the association of neighborhood-level socioeconomic status on GBM outcomes. OBJECTIVE To investigate the impact of neighborhood-level socioeconomic status on GBM outcomes. METHODS We retrospectively reviewed all adult GBM patients at a single institution from 2008 to 2023. Patient addresses underwent geospatial analysis and Area Deprivation Index (ADI) was extracted. Univariable and multivariable survival analyses were performed. A Cox proportional hazards model was used to assess the effect of ADI and other socioeconomic variables while controlling for a priori selected clinical variables with known relevance to survival. RESULTS In total, 1492 patients met inclusion criteria. The average age at diagnosis was 62±14.2 years with a median overall survival of 12.1 [Interquartile Range (IQR) 5-22] months. The median ADI was 66 (IQR 46-84). Patients with high socioeconomic deprivation (ADI&amp;gt;75) were less likely to receive chemotherapy (92% vs 96%, p=.03), and had worse overall survival compared to patients with low socioeconomic deprivation (10 vs 13 months, p=.001). In the multivariable model, patients with high ADI had worse overall survival (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.16-1.73, p&amp;lt;.001). To account for changes in WHO guidelines, we implemented the model on patients diagnosed between 2017-2023 and findings were consistent (HR 1.34, 95%CI 1.07-1.68, p=.011). CONCLUSIONS We present the largest study reporting the effect of neighborhood-level socioeconomic status on overall survival of GBM patients. Neighborhood-level socioeconomic status provides the most accurate capture of the patient-level socioeconomic determinants of health. Patients with higher ADI have worse overall survival after controlling for other socioeconomic and clinical variables. These results suggest significant association between neighborhood-level socioeconomic status and overall survival in GBM patients.

Neighborhood Disadvantage Predicts Delay in Care in Bilateral Breast Reduction.

The Area Deprivation Index (ADI) is a validated quantifiable measure of neighborhood disadvantage and social determinants of health (SDoH). Higher percentiles in ADI correlate with the most disadvantaged neighborhoods: lower income, lower education, and less access to transportation. Using ADI, we aimed to investigate the impact of SDoH on bilateral breast reduction (BBR) complication rates. A retrospective study of BBR patients from 2015 to 2021 was conducted. Patient addresses were matched to ADI percentiles and grouped into most (top 80% ADI) and least disadvantaged. Multivariable regressions were used to compare postoperative treatment between groups and adjust for confounders. In total, 568 patients were analyzed and 47% were high ADI. Time-to-event analysis revealed a 155% (β = 2.55; CI, 1.87-3.48; P < 0.001) increase in time to presentation for treatment of wound-related complications among higher-deprivation patients compared to their lower-deprivation counterparts. This difference in time to presentation equated to approximately 3 days overall when comparing higher to lower deprivation patients; however, this difference between the groups increased to 12 days when comparing those who experienced wound-related complications beyond day 30. High deprivation was associated with increased delays to treatment after complications. More research is needed to determine the factors that impact postoperative courses among high ADI patients.

Neighborhood Socioeconomic Deprivation is Associated with Worse Outcomes in Pediatric Kidney Transplant Recipients.

Social determinants of health shape a child's transplant course. We describe the association between neighborhood socioeconomic deprivation, transplant characteristics, and graft survival in US pediatric kidney transplant recipients. US recipients <18 years of age at listing transplanted January 1st, 2010, to May 31st, 2022 (N=9,178) were included from the Scientific Registry of Transplant Recipients. Recipients were stratified into three groups according to Material Community Deprivation Index score, with greater score representing higher neighborhood socioeconomic deprivation. Outcomes were modeled using multivariable logistic regression and Cox proportional hazards models. Twenty-four percent (N=110) of recipients from neighborhoods of high socioeconomic deprivation identified as being of Black race, versus 12% (N=383) of recipients from neighborhoods of low socioeconomic deprivation. Neighborhoods of high socioeconomic deprivation had a much greater proportion of recipients identifying as being of Hispanic ethnicity (67%, N=311), versus neighborhoods of low socioeconomic deprivation (17%, N=562). The hazard of graft loss was 55% higher (aHR 1.55, 95% CI: 1.24, 1.94) for recipients from neighborhoods of high versus recipients from low socioeconomic deprivation neighborhoods when adjusted for base covariates, race and ethnicity, and insurance status, with 59% lower odds (aOR 0.41, 95% CI: 0.30, 0.56) of living donor transplantation and, although not statistically significant, 8% lower odds (aOR 0.92, 95% CI: 0.72, 1.19) of preemptive transplantation. The hazard of graft loss was 41% higher (aHR 1.41, 95% CI: 1.25, 1.60) for recipients from neighborhoods of intermediate versus recipients from low socioeconomic deprivation neighborhoods when adjusted for base covariates, race and ethnicity, and insurance status, with 27% lower odds (aOR 0.73, 95% CI: 0.66, 0.81) of living donor transplantation and 11% lower odds (aOR 0.89, 95% CI: 0.80, 0.99) of preemptive transplantation. Children from neighborhoods of high socioeconomic deprivation have worse graft survival and lower utilization of preemptive and living donor transplantation. These findings demonstrate inequities in pediatric kidney transplantation that warrant further intervention.

Estimated lifetime impact of a school-based intervention for mental health: A microsimulation study

Abstract Background The prevalence of childhood mental health problems is increasing. School-based interventions have the potential to reduce poor mental health and mental health inequalities. Our aim was to estimate the long-term costs and benefits of the Incredible Years Teacher® Classroom Management (IY-TCM) intervention in primary schools compared to no intervention. Methods LifeSim, an existing microsimulation model, was used to estimate the lifetime costs and benefits of IY-TCM by linking short-term changes in SDQ based on a previous trial in primary schools (Cluster RCT: 2075 children aged 4-9 years with a 30-month follow-up) to long-term health, social, economic and wellbeing outcomes. Benefits were measured in quality adjusted life years and wellbeing adjusted life years. We examined subgroup based on deprivation, conduct scores and parental depression. Results Microsimulation modelling estimated small gains in lifetime outcomes including reduced conduct disorder in adolescence and depression in adulthood. Estimates indicate IY-TCM could be cost-effective with a large amount of uncertainty (Net monetary benefit (NMB)=£21, Estimated CI = -£195, £240). IY-TCM was estimated to be more cost-effective for those with high deprivation (NMB = £231, Estimation CI - -£99, £231) and high conduct problem scores (NMB=£315, Estimated CI = £45, £483). Total net social benefit for a typical year size group was estimated to be £111m. Conclusions IY-TCM could be cost-effective compared to no intervention with a large estimated social benefit supporting wider implementation of IY-TCM, but results indicate a large amount of uncertainty. Greater benefits and higher certainty of cost-effectiveness for children with conduct problems and those living in a deprived area suggest IY-TCM has the potential to reduce mental health inequalities and may be more cost-effective for schools with higher deprivation and/or a high prevalence of conduct problems. Key messages • The Incredible Years Teacher Classroom Management intervention for mental health in primary schools could be considered cost-effective but there is a large amount of uncertainty. • Greater benefits for children with conduct problems and those living in a deprived area indicates the intervention has the potential to reduce mental health inequalities.

Luton, a Marmot town – using a whole-system approach to tackle health equity

Abstract Issue Luton has high deprivation and health inequalities. We have a borough-wide vision that no one should live in poverty by 2040, and have become a health equity town - committed to Marmot policy objectives and recommendations across all we do. Description Luton is 70th most deprived local authority in England, with stark health inequalities. To deliver the 2040 ambition, 5 pillars have been established, including tackling health inequalities. Luton has become the first Marmot Town in the UK, working with the Institute of Health Equity to develop recommendations and actions relating to the Marmot Policy objectives. Cross-sector system partnership has been key -NHS, businesses, housing, voluntary sector, university. Year 1: we mapped the Marmot recommendations to existing workstreams; completed a mixed-methods evaluation to understand system views of the approach and establish our impact measures. We established steering groups: Children and young people; Housing; Employment and skills; Net zero, they continue to embed recommendations using logic models. We have an overarching strategic approach, alongside smaller scale programmes, to create a movement. Including: grant funding; regular newsletter; training; case studies repository and annual celebration event. Results We have established 15 impact measures across Marmot policy areas to review annually. Qualitative evaluation findings built into work plans include: improved governance and accountability; workforce development across the system; use of logic models; Learning from best practice; sharing knowledge and learning. Lessons The wider agenda of Luton 2040 has enabled health inequalities to be embedded into strategic discussions; improved evidence base and clear narrative to support priorities is helpful; clear focused recommendations helps move work forwards; shared understanding of how we will measure long term impact is vital, communicating to the system is key, and long-term ism challenging. Speakers/Panelists Lee Watson East of England Public Health Training Programme, Luton, UK Ramya Ravindrane East of England Public Health Training Programme, Luton, UK Chimeme Egbutah Luton Borough Council, Luton, UK Nasreen Ali University of Bedfordshire, Luton, UK

Targeted initiatives to tackle health inequalities, integrating the Leeds Health and Care Workforce

Abstract Deprivation and poor health are significant challenges in Leeds, with the poverty gap growing in parts of the city. The Leeds One Workforce approach to narrowing inequalities (NI) was co-designed in 2021 building on the innovative partnership approach already visible in the city. Its phased approach has seen interventions put in place to boost the opportunities for people from marginalised communities to develop their skills and remove barriers to careers in health and care and has global relevance for other localities experiencing high deprivation. The overall NI approach is supported by a long-term and wide-reaching evaluation plan which mobilises our partner organisations and intends to amplify best practice in getting people into careers and supporting this group to develop within the health and care workforce. We will present findings from embedded evaluations of initiatives across the city, and individual case studies, from those who have accessed NI interventions in Leeds. These will explore the relationships and contributions of partnership organisations and presence of any unexpected barriers or facilitators to these interventions. Linking with third-sector organisations and creating accessible pre-employment opportunities to develop core working skills is a vital part of the Leeds approach to recruiting people from priority wards. Additionally, supporting people into careers in health and care which suit their values, interests and personal circumstances, in addition to employing organisations with flexibility and openness towards their employees at their core is a strong factor in recruiting and retaining from areas of deprivation. Partnership working is essential to tackling health inequalities in places of high deprivation to address individual and systemic barriers to securing employment, ensure the best chance of success for community outreach programmes, and maximise efficiencies by combining the efforts of local organisations. Key messages • Leeds, UK is transforming approaches to narrowing health inequalities through partnership working across health and social care education and employment. • Current and future best practice will be explored to demonstrate transferable NI approaches.

The role of sociodemographic factors on herpes zoster vaccine uptake among hard-to-reach populations

Abstract Background The anti-Herpes Zoster (HZ) vaccination program was expanded with the adjuvated recombinant vaccine (HZR) in the Lazio Region, Italy, in 2022, restricting its use only to certain categories at risk due to pathological conditions, such as dialysis patients or immunocompromised individuals. This study focuses on the role of clinical and socio-demographic factors on HZR vaccine uptake within the fragile resident population of the Local Health Authority Rome 2 (ASL RM2). Methods This population-based, retrospective cohort study leveraged data from various registries and databases. The study population comprised 835,779 individuals aged ≥18 years who were both RM2 residents and registered with an RM2 general practitioner (GP). Among these, 143,242 individuals with at least one chronic condition were assessed for vaccination uptake using a multivariate logistic model, exploring associations with gender, age, nationality, marital status, household size, and level of deprivation. Results At the conclusion of the study period, a small fraction (1.5%) of the fragile subjects had received at least one dose of the HZR vaccine, and a majority (78%) completed the vaccination course of two doses. The analysis indicated that vaccine adherence was significantly higher in males (OR = 1.15) and individuals aged 65 + (OR = 1.13) while lower among residents in areas of medium (OR = 0.61) and high deprivation (OR = 0.44) and with specific living arrangements - widowed people living alone (OR = 0.66) and families ≥ 6 people (OR = 0.63). Conclusions The ASL RM2 vaccination strategy for hard-to-reach individuals includes an integrated approach, with the engagement of local healthcare facilities and hospitals. Despite these efforts, lower adherence in socioeconomically disadvantaged fragile patients suggests a pressing need for targeted communication strategies and interventions to ensure equitable access to the HZ vaccine, as these groups are more vulnerable to developing chronic diseases. Key messages • Socio-demographic factors significantly influence Herpes Zoster vaccine uptake in hard-to-reach populations, with lower adherence in socially deprived groups. • Tailored, equity-driven approaches are essential for enhancing vaccine coverage among hard-to-reach fragile individuals, mitigating the higher disease risks in these communities.

Inequalities in preterm birth by deprivation and ethnicity: A national cohort study in England

Abstract Background Preterm birth has decreased in the UK; however, the extent of inequalities remains unclear. This study aimed to quantify socioeconomic and ethnic inequalities in preterm birth rates using routinely collected maternity data in England. Methods Retrospective analysis of cohort data from the NHS England Hospital Episode Statistics (HES). All women aged 13-55 with a singleton livebirth (April 2018 to March 2021) at 24-42 weeks were included. Multivariate Poisson regression was used to estimate the rate of preterm birth (livebirth between 24 + 0 and 36 + 6 weeks’) for each ethnic and deprivation postcode group, these were compared to white women from the least deprived 20% of areas. We iteratively developed the model, adjusting for covariates associated with preterm birth. A post-hoc calculation identified the rate of preterm birth for each ethnic group at each level of deprivation. Results We identified 1,111,045 livebirths between April 2018 and March 2021. The rate of preterm birth increased with socioeconomic deprivation and was highest at 7.1% per 100 livebirths (95%CI:7.00-7.20) in women living in the 20% most deprived areas, compared to 5.6% (95%CI:5.50-5.74) in women in the 20% least deprived areas. White women had the lowest preterm birth rate at 6.5% (95%CI:6.47-6.58) and South Asian women had the highest rate at 6.9% (95%CI:6.76-7.04) (Table 2). The rate of preterm birth increased according to increased area-level deprivation across all ethnic groups. In areas of high deprivation, the preterm birth rate was similar across ethnic groups. Whereas in less deprived areas, there were marked inequalities between ethnic groups. Conclusions Inequalities in preterm birth remain, despite overall decreases in preterm birth. We found area deprivation and individual ethnicity interact to increase the risk of preterm birth in marginalized communities. Interventions need to holistically consider the structural and socioenvironmental determinants of preterm birth. Key messages • Area deprivation and ethnicity remain key drivers of inequalities in preterm birth, despite overall decreases in preterm birth. • To reduce inequalities tailored prevention strategies are needed to address socioenvironmental and structural determinants of preterm birth in high deprivation areas and minoritized ethnicity groups.

The association between trajectories of structural disadvantage and mental wellbeing for Māori youth

Abstract Background Youth mental health is a major global concern with substantial inequities for Indigenous and other young people from minoritised ethnic groups. In New Zealand, Māori, the Indigenous people, experience poorer mental health than other young people, especially those living in high deprivation. Cultural connectedness is related to positive mental wellbeing, however, its potential to buffer against the harms of structural disadvantage for young Māori mental health has not been investigated. Methods We used data from 1224 Māori young people in the longitudinal Growing Up in New Zealand study. Structural disadvantage measures included material hardship, deprivation, employment, residential mobility. We conducted Latent Class Analysis and Social Sequence Analysis to identify clusters and longitudinal patterns of structural disadvantage. Cultural connectedness and mental wellbeing (depression &amp; anxiety symptoms, quality of life) were measured at age 12. Linear regression analysis was used to determine associations between structural disadvantage, cultural connectedness and mental health. Results We identified 3 trajectories of structural disadvantage for Māori youth: 21% experienced persistent high structural disadvantage, 35% intermittent high structural disadvantage and 44% persistent relatively low structural disadvantage. Few differences in mental health were found between groups. Cultural connectedness was independently associated with positive mental wellbeing, yet there was mixed evidence it might buffer the impacts of structural disadvantage on mental health. Conclusions Our results highlight the importance of policies that uphold Indigenous rights to health and address structural disadvantage as a persistent threat to Indigenous wellbeing. Our findings call for holistic, early-life, family-centred strategies and to reduce barriers to accessing support. We highlight the need for policies that enable young people to flourish in their identity and culture. Key messages • Many Māori young people experience pervasive structural disadvantage starting before they are born, persisting throughout childhood and adolescence which is an omnipresent threat to their wellbeing. • Supporting cultural connectedness for Indigenous youth is important but cannot substitute for policies addressing structural disadvantages that contribute to health inequities.

Cardiovascular disease risk in people with diabetes in the era of universal diabetes screening

Abstract Background/Introduction Traditionally, most people with diabetes have been considered at high cardiovascular disease (CVD) risk and CVD preventive treatment has been recommended for almost all patients after diagnosis. However, guidelines are increasingly recommending a more stratified approach to preventive treatment informed by predicted CVD risk. In the early 2000’s, New Zealand initiated the world-first national diabetes screening programme, as a component of a national CVD risk assessment programme, and by 2016, approximately 90% of eligible New Zealand adults had been screened. We hypothesised that in the era of universal diabetes screening, many recently diagnosed patients will be at low CVD risk and that contemporary CVD risk prediction equations would be required to accurately assess their risk. Purpose We aimed to develop sex-specific 5-year CVD risk prediction models in people with diabetes in New Zealand using a contemporary natural-population based cohort, and to characterise the distribution of CVD risk. Methods De-identified individual-level linkage of multiple health administrative datasets was undertaken to establish a cohort of almost all adults with diabetes in the northern region of New Zealand (one-third of the national population), without CVD or heart failure, and aged 30–74 years on January 1, 2014, with follow-up linkage to hospitalisations and mortality until December 31, 2018. Sex-specific models were developed to estimate the 5-year risk of CVD hospitalisation or death, with 15 pre-defined predictors, including sociodemographic variables, diabetes-related and renal function measures. Results 64,645 participants (median age: 57 years [IQR: 49–65]) were included in the final cohort, of whom 4,992 had first CVD events during 301,272 person-years follow-up. Models calibrated well in both women and men (Figure 1). Overall, increasing age; high deprivation level; smoking-related hospitalisations or use of smoking cessation medications; history of atrial fibrillation; high levels of haemoglobin A1c, total cholesterol to HDL cholesterol ratio, and albumin-to-creatinine ratio; use of blood pressure-lowering medications and insulin were associated with elevated CVD risk. Median 5-year CVD risks were 4.9% (IQR: 2.9%–8.1%) in women and 7.7% (4.8%–12.0%) in men. There was a wide range of predicted 5-year CVD risk, with 51% of women and 27% of men having a predicted risk below 5%, and 6% of women and 16% of men having a risk of 15% or above (Figure 2). Conclusions This study demonstrated marked heterogeneity in predicted CVD risk in people with diabetes in an era of universal diabetes screening. As diabetes screening is increasingly undertaken as part of a routine CVD risk assessment, these findings will have important clinical implications for accurately targeting new but expensive CVD preventive medications to the highest risk patients.

Lunchbox content and dietary outcomes of Dutch primary school children explored by sociodemographics

Abstract Background Most children fail to meet recommended guidelines for a healthy diet. Children living in low socioeconomic areas are less likely to have healthy eating behaviours. In this study we investigated the food Dutch primary school children bring from home, and their dietary, health and school related outcomes explored by sociodemographics. Methods 5 primary schools, with high deprivation scores and a high percentage of overweight, have been included in this study (ClinicalTrials.gov NCT06058325). With observations in September 2023 we mapped the content of lunchboxes, including snacks, of children. Questionnaires for all parents and children in grade 5-8 focused on dietary and health outcomes of children and perceived class factors. Preliminary baseline data were analysed using descriptive statistics. Exploratory analyses will be conducted to show differences by sociodemographics (e.g. age, sex, parental financial stress). Results 297 lunchboxes were observed, 98.7% contained sandwiches, half being brown bread. Most children brought fruit from home for either lunch or morning snack, 13.8% not at all. 21.9% brought vegetables. 135 children completed the questionnaire: 43.0% boys, mean age 9.3 years old (SD 1.12). Children ate fruit and vegetables on an average of 5.9 (SD 1.69) and 4.9 (SD 2.23) days a week. Whereas 80% of children eats fruit every day at school, only 20% of children eats vegetables every day at school. Most children perceived their health as good (89.3%) and felt happy (89.6%). On a scale of 1 (low) to 5 (high), they rated concentration, social climate and comfort in class an average of 3.8 (SD 1.05), 4.3 (SD 1.07) and 4.3 (SD 0.92) respectively. Conclusions Lunchboxes of Dutch primary school children mainly contain sandwiches. Whereas most children eat fruit at school, the majority of children do not eat vegetables at school. A healthy school lunch might increase vegetable consumption of children and could affect health and school related outcomes. Key messages • Most Dutch primary school children eat sandwiches during lunch at school, but in half of the cases this is not brown bread as recommended by nutritional guidelines. • Most Dutch primary school children bring fruit to eat as snack or lunch, but no vegetables to eat at school. The majority also self-reported the lack of eating vegetables at school on a daily basis.

Multimorbidity and Person-Centred care in a socioeconomically deprived community: a qualitative study.

Multimorbidity (>2 long-term conditions) has poorer outcomes in areas of high socioeconomic deprivation (SED). High-quality Person-Centred Care (PCC) is important in multimorbidity but socially vulnerable populations have not informed current PCC models. To explore how wider community factors influence management of multimorbidity in the context of high SED, how high-quality PCC is defined by patients, and whether this influences healthcare management. Ethnographically informed case study in community experiencing high SED in Scotland. Participant observation (hours = 142) within 4 community groups who also took part in 2 participatory workshops. 25 in-depth interviews with people with multimorbidity, recruited from local General Practices; emerging findings discussed with interviewees in one focus group. Field notes/transcripts analysed using inductive thematic analysis. Key aspects of PCC were "patient as person", "therapeutic relationship", "co-ordination" and "power-sharing"; power sharing was particularly enabling but rarely happened (barriers often unseen by practitioners). Shared community experiences of "being known", "stigma" and "none of the systems working" influenced how people approached health services, and healthcare decisions. High quality PCC may have been particularly effective in this setting because of its influence on ameliorating wider shared negative community experiences. In a high SED setting PCC is important and can enhance engagement. Wider community factors have a critical influence on engagement with healthcare in areas of high SED and PCC may be particularly important in this context because of its influence ameliorating these. Policy makers should prioritise and resource PCC.

The effects of neighborhood disadvantage and adverse childhood experiences on conditioned pain modulation in adults with chronic low back pain

Chronic low back pain (cLBP) remains a major health crisis worldwide. Current conceptualizations of cLBP utilize the biopsychosocial model, yet research on social factors remains limited. Adverse childhood experiences (ACEs) are a risk factor for a variety of chronic health problems, including cLBP. However, the extent to which socioeconomic context might influence associations between ACEs and cLBP remains unclear. Socioeconomic factors such as healthcare access and living conditions, which cluster at the neighborhood level, may affect how ACEs relate to cLBP in adulthood. This study examined (1) the relationship between ACEs and conditioned pain modulation (CPM), and (2) the moderating effect of area-level deprivation index (ADI) in a sample of community-dwelling adults with cLBP. 183 adults with cLBP (53% female, 62.8% non-Hispanic Black) reported on ACEs, ADI, sociodemographics, and completed experimental testing of conditioned pain modulation (CPM). Greater ACEs were associated with a less efficient CPM response for individuals residing in low neighborhood deprivation (p < 0.01). ACEs were not significantly associated with CPM for those residing in average (p = 0.31) or high deprivation (p = 0.15). Our findings suggest that a history of ACEs is associated with diminished ability to inhibit pain, especially among individuals living in less deprived neighborhoods. The association between ACEs and CPM was weakest for the portion of our sample residing in neighborhoods with the most deprivation. People from disadvantaged backgrounds may experience numerous psychosocial stressors that hinder CPM, making it difficult to assess the specific impact of ACEs on CPM. Trial registrationThis study utilized baseline data collected as part of a parent trial titled “Examining Racial and SocioEconomic Disparities in Chronic Low Back Pain” (ERASED - ClinicalTrials.gov ID: NCT03338192). PerspectiveThis study demonstrates that early life adversity is associated with abnormal endogenous pain modulation, particularly for participants who live in neighborhoods characterized by less deprivation.

Implementing creative dance activities for primary school children to improve health and wellbeing: a qualitative study in the North East England.

Evidence suggests that group arts activities with children build resilience and positive mental wellbeing. However, insufficient attention has been paid to how such activities can be implemented in practice across different contexts, particularly in socio-economically disadvantaged areas. Therefore, we explored the implementation of a dance-based intervention in two primary schools situated in an area of high economic deprivation in North East England. Our study explored Year 1 (age 5-6) and Year 5 (age 9-10) children, their parents, teachers and dance artists' views of a creative dance intervention (South Tees Arts project; STAR) in two schools in North East England, using interviews and focus groups, combined with innovative data capture activities (i.e. movement activities, graffiti walls, songs and Vox Pops). Children felt that STAR contributed positively to their emotional wellbeing and physical health. Teachers noticed improved confidence, engagement, literacy, and social and motor skills and less disruptive behaviour in class. Benefits continued beyond school, with children exercising at home to practice their dance moves. Several implementation barriers were identified ranging from limited time, large classes, dealing with challenging behaviours, the impact of COVID-19, stigma and anxiety. In response to these challenges, several solutions were developed during project delivery, such as artists and children working in pairs and role modelling by teachers and dance artists. We found three underlying mechanisms for successful implementation: (1) constant communication between teachers, dance artists and parents was essential to managing challenging behaviours, building personal relationships with children, and helping parents to get involved and support their children at home. (2) Linking dance activities to the school curriculum (using narratives from existing reading schemes) helped to support skill gaps. (3) A strong ethos of partnership between school, dance and arts providers and researchers ensured the adaptability and flexibility of projects.

A cross-sectional study of the relative availability and prominence of shelf space allocated to healthy and unhealthy foods in supermarkets in urban Ireland, by area-level deprivation

BackgroundDiet-related noncommunicable diseases (NCDs) are a leading cause of ill-health and death across Europe. In Ireland, dietary intakes of saturated fat, free sugar and salt exceed World Health Organization recommendations, and excess consumption follows a social gradient increasing population risk of diet-related NCDs. The retail food environment can influence consumer food choice and subsequent dietary intakes. In high income countries, supermarkets are an increasingly influential actor in consumer food availability, choice, purchase, and subsequent food intake. This study aims to assess the relative availability and prominence of healthy and unhealthy foods in Irish supermarkets, by area-level deprivation.MethodsThis study used a cross-sectional study design, and applied a validated measure, as described in the INFORMAS Protocol: Food Retail – Food availability in supermarkets. Between October 2021 and February 2022, shelf space (m2) (height or depth (cm) × length (cm)) and prominence (visibility), of foods, classified as healthy and unhealthy and represented by a proxy indicator, were collected in supermarkets (n = 36) in County Dublin, Ireland. Overall the proportion of mean relative shelf space (m2), allocated to healthy and unhealthy foods, and its prominence, by area-level deprivation, and retailer, were determined. We used t-tests and one-way ANOVA to analyse possible differences between the proportion of relative shelf space available to healthy and unhealthy foods, and its prominence, by area-level deprivation and retailer.ResultsThe study found the proportion of shelf space measured allocated to unhealthy food was 68.0% (SD 10.6). Unhealthy foods were more likely to be in areas of high prominence. Overall, there was no statistically significant difference between the proportion of relative shelf space available to unhealthy foods in areas of high and low deprivation. A statistically significant difference in the proportion of relative shelf space allocated to healthy and unhealthy food by area level deprivation was found in one retailer.ConclusionUnhealthy foods had a higher proportion of shelf space and were more prominent than healthy foods in supermarkets in County Dublin, Ireland. The current availability and prominence of foods in supermarkets does not align with Food Based Dietary Guideline recommendations and does not support consumers to make healthier food choices. There is a need for supermarkets in Ireland to improve the availability and prominence of healthy foods to support consumers to make healthier food choices.