Higher Income Levels Research Articles

Social Risk Profile and Cardiovascular-Kidney-Metabolic Syndrome in US Adults.

Poor cardiovascular-kidney-metabolic (CKM) health is associated with premature mortality and excess morbidity in the United States. Adverse social conditions have a prominent impact on cardiometabolic diseases during the life course. We aim to examine the association between social risk profile (SRP) and CKM multimorbidity among US adults. We used data from the National Health and Nutrition Examination Survey from 1999 to 2018. The definition of CKM syndrome is the coexistence of subclinical or clinical cardiovascular disease, chronic kidney disease, and metabolic disorders. We classified participants by 4 CKM stages according to the different clinical severity of different forms of CKM syndrome. We calculated the summed number of positive SRP measures, including employed, high-income level, food secure, high education attainment, private insurance, owning a house, and married, as SRP scores and classified them into 4 levels by quartiles: low (0-2), lower-middle (3-4), upper-middle (5-6), and high (7-8). A total of 18 373 US adults, aged 20 to 79 years, were included in our analyses. There were 2567 (9.4%) participants with low SRP score level. Most individual SRP measures and a combined SRP score were associated with CKM stages. Compared with high SRP score level, low SRP level was associated with higher odds of having CKM stage 1 (odds ratio [OR], 1.34 [95% CI, 1.06-1.70]), CKM stage 2 (OR, 2.03 [95% CI, 1.59-2.58]), CKM stage 3 (OR, 5.28 [95% CI, 3.29-8.47]), and CKM stage 4 (OR, 5.97 [95% CI, 4.20-8.49]). Cumulative social disadvantage, denoted by higher SRP burden, was associated with higher odds of CKM multimorbidity, independent of demographic and lifestyle factors.

The impact of street-scale built environments on urban park visitations: A case study in Wuhan

The COVID-19 pandemic has changed human life globally. Existing studies have revealed that citizens' visitations to urban parks varied before and after the COVID-19 outbreak. However, few studies have examined how street-scale built environments (SBEs) on routes affect visitations to urban parks at varying COVID-19 risk levels. In this study, a stated-preference survey was conducted to investigate 3,218 visitors' changes in urban park visitation under various COVID-19 risk levels. In addition to park visit influencing factors, including park features, neighborhood built environment, socio-demographic attributes, and travel distances, multiple SBE indexes on visitors' routes to parks were obtained from 34,780 Baidu Map street view images using a deep neural network (DeepLabv3+) method. The results suggest that a high GVI and high traffic congestion on the route from the visitor's home to the urban park led to an increased probability of visiting the urban park by 188.1% (p = 0.044, OR = 2.881) and a decreased probability by 32.3% (p = 0.049, OR = 0.677), respectively. The high probability of visitation was also associated with socio-demographic attributes (including male gender, high income, high and medium education levels, and the elderly) and short travel distances.

Energy-Dense and Low-Fiber Dietary Pattern May Be a Key Contributor to the Rising Obesity Rates in Brazil.

Hybrid methods are a suitable option for extracting dietary patterns associated with health outcomes. This study aimed to identify the dietary patterns of Brazilian adults (20-59 years old; n = 28,153) related to dietary components associated with the risk of obesity. Data from the 2017-2018 Brazilian National Dietary Survey were analyzed. Food consumption was obtained through 24 h recall. Dietary patterns were extracted using partial least squares regression, using energy density (ED), percentage of total fat (%TF), and fiber density (FD) as response variables. In addition, 32 food groups were established as predictor variables in the model. The first dietary pattern, named as energy-dense and low-fiber (ED-LF), included with the positive factor loadings solid fats, breads, added-sugar beverages, fast foods, sauces, pasta, and cheeses, and negative factor loadings rice, beans, vegetables, water, and fruits (≥|0.15|). Higher adherence to the ED-LF dietary pattern was observed for individuals >40 years old from urban areas, in the highest income level, who were not on a diet, reported away-from-home food consumption, and having ≥1 snack/day. The dietary pattern characterized by a low intake of fruits, vegetables, and staple foods and a high intake of fast foods and sugar-sweetened beverages may contribute to the obesity scenario in Brazil.

Attitudes Toward Using and Willingness to Use a Hypothetical Online Sex Communication Intervention for Parents of Sexual and Gender Minority Adolescents.

Although parents of sexual and gender minority (SGM) adolescents play a critical role in communicating about sexual health to their children, most parents have reported that they are unknowledgeable and uncomfortable talking about sexual health to their SGM adolescent. Because of the limited availability of sex education programs for parents of SGM adolescents, the study aimed to (1) describe the attitudes toward using and willingness to use a hypothetical online sex communication intervention for parents of SGM adolescents and (2) examine factors associated with willingness to use such an intervention. Parents of SGM adolescents from across the United States (N = 385) completed an online survey from March 10-16, 2023. Most participants were open to participating in a hypothetical online sex communication program and had positive attitudes toward it. Logistic regression results showed that participants who overall agreed a hypothetical online parent-based sex education intervention would be helpful and of interest had higher odds of being overall willing to participate in such a hypothetical intervention. Additionally, participants with higher income levels were also more likely to be willing to participate in a hypothetical program. Results from this exploratory study suggest that most parents of SGM adolescents have positive attitudes toward a hypothetical online parent-based sex education program and are willing to participate in it, highlighting a need to develop sex education programs tailored to the needs and preferences of parents of SGM adolescents. Additionally, equitable access to such programs is necessary especially regarding income level.

Factors related to complementary feeding practices during the COVID-19 pandemic in Indonesia

Introduction: Complementary feeding practice is critical for adequate growth and development in children. Appropriate practices should be maintained, especially during the COVID-19 pandemic. Methods: This cross-sectional study aimed to analyse complementary feeding practices and their related factors, including the impact of the COVID-19 pandemic on household economic aspects. Data were collected via online questionnaires involving 574 mothers of children aged 6–23 months in Indonesia from April to May 2022. Results: In total, 63.6%, 64.6%, 86.6%, and 57.7% of children met the criteria for timely introduction of complementary feeding (INTRO), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), respectively. Households that had no impact on their ability to provide food during the pandemic had higher odds of meeting MDD and MAD. Having a high household income level, high maternal education, and being a housewife increased the odds of INTRO. The odds of MDD increased in children who lived in Java, had older age, and whose mother had high education level. Older children had higher odds of having appropriate MMF. MAD was associated with mother’s high education level and being a housewife. Conclusion: Several factors during the pandemic, including economic aspects, influenced complementary feeding practices. To prevent child malnutrition, besides ensuring household food security, other strategies to increase complementary feeding quality are also needed.

Assessment of depression, anxiety, stress, and insomnia among government school teachers in the rural catchment areas of Nandyal district: A cross-sectional study

Background: Among the most demanding careers that many Indians choose is teaching. Teachers are under a lot of stress because of all the extra responsibilities and duties they have from the school, education boards, and institutions. This can be a fertile ground for psychological problems among teachers. Aim: To assess depression, anxiety, stress, and sleep disturbances among school teachers and to find out their correlates. Materials and Methods: A cross-sectional observational study was planned in 100 teachers working in the government schools of the rural catchment of Nandyal district, Andhra Pradesh. Teachers were assessed through a semistructured proforma containing sociodemographic information, information about job-related factors, and DASS 21 to assess depression, anxiety, and stress and Insomnia Severity Index to assess sleep disturbances. Results: The overall prevalence of depression, anxiety, and stress symptoms among teachers was found to be 28%, 61%, and 24%, respectively, and sleep disturbances were 38%. Depression was found to be independently associated with marital status (married > single, P < 0.001), position at workplace (secondary grade > primary grade, P < 0.001), mode of transport (public transport > personal, P = 0.001), source of income (single > family, P = 0.013), higher level of income (P < 0.001), stress (P < 0.001), and anxiety (P < 0.001). Anxiety was associated with migration for the job (P < 0.001), stress (P < 0.001), and depression (P < 0.001), while insomnia was associated with the type of family (nuclear > joint, P = 0.015), source of income (single > family, P = 0.039), no interaction with a colleague (P = 0.007), being dissatisfied with job (P = 0.002), and stress (P = 0.005). Conclusion: The significantly moderate proportion of depression, anxiety, stress, and insomnia among government schoolteachers is suggestive of the need for the necessary psychological aid and counseling for such teachers. Therefore, appropriate methods must be introduced to address the concerns of teachers, thereby reducing anxiety and stress among them.

Initiatives and exposures associated with food security in remote and isolated communities: a scoping review.

Chronic household food insecurity (HFI) and lack of food availability and accessibility in isolated communities are longstanding public health crises. This review aims to paint a more fulsome picture of food security initiatives in remote and isolated communities by examining programs across circumpolar countries, Australia, and Aotearoa New Zealand. This synthesis of research will contribute to an understanding of what types of initiatives exist and aid in the identification of best practices. The authors conducted a scoping review identifying articles that include either (1) an evaluation of an initiative with a quantitative food security outcome in remote and isolated communities, or (2) quantitative associations between exposure factors with food security outcomes. Inclusion criteria included English and French articles focused on remote and isolated communities in Canada, the US, Australia, New Zealand, Sweden, Norway, Finland, Greenland, and Russia from January 1997 to July 2022. The article search yielded 1882 results, of which 96 fulfilled the inclusion criteria, including 26 studies evaluating initiatives, 66 studies evaluating exposure factors, and four studies that included both initiatives and exposure factors. The majority of the studies included in this review were conducted in Canada and Australia. No initiative studies conducted in Russia, Greenland, Norway, Finland, or Sweden fulfilled the criteria for inclusion in this review. The most common types of initiatives evaluated included school-based programs, market subsidies, and education initiatives, though a small number (<5) of other programs were evaluated, including traditional food programs and greenhouses. Though multiple programs resulted in lower food costs or increases in healthy food consumption in remote regions, the cost of a healthy diet in these areas remained high, as do levels of HFI. Factors associated with improved food security outcomes included higher income level, access to adequate housing, higher education level, access to transportation for harvesting, and the level of remoteness of a community. The studies included in this review also stressed the importance of access to and affordability of harvesting traditional foods in these regions. Those living in remote and isolated communities are particularly vulnerable to food insecurity and lack of access and availability of healthy foods, which are compounded by a variety of socioeconomic factors. This study highlights the lack of quantitative evaluations of food security initiatives in remote and isolated communities, as well as the wide variety in measured outcomes. Authors of several of the included articles note that community-led initiatives, with strong partnerships and local champions, were recommended in these populations, given the culturally and geographically diverse groups living in remote and isolated areas.

INCOME INEQUALITY, ECONOMIC GROWTH, AND INSTITUTIONAL FACTORS: A COMPARATIVE ANALYSIS AT THE EUROPEAN UNION (EU) LEVEL

The rising income inequality around the world and its persistence represent a social phenomenon raising concerns at all levels (global, regional and country) for governments and pose huge challenges to master it and to identify effective solutions. The aim of the paper is to provide a comparative insight at the European Union (EU) level involving 25 Member States regarding the interplay between income inequality, economic growth, and institutional quality. Gini Index sourced from World Income Inequality Database, GDP per capita series extracted from the World Bank database, and institutional indicators collected from the World Governance Indicators database represent the examined variables over the period 1990-2022. Their dynamic is comparatively analysed and discussed. The clustering method is applied to identify similarities and differences between European Union countries in terms of the interplay between income inequality, economic growth and institutional factors and to draw relevant conclusions for future effective policy measures meant to reduce inequality and to boost economic growth. The clustering analysis based on the average growth rate of income inequality and per capita GDP revealed that European Union countries are differently facing the challenge of income inequality rising. Six groups of countries with similar paths regarding the income inequality and economic growth were identified. High-income countries face low levels of income inequality but with an upward trend. Economic growth is accompanied with high levels and increasing levels of income inequality. The institutional quality level may strength the capacity of a country to address the problem of rising income inequality, but it remains unclear the interplay of institutional quality dynamic in reducing income inequality. The implications of the paper’s findings are framed in the context of the European policies.

Examining the quality of life among pregnant women diagnosed with gestational diabetes mellitus: A systematic review and meta-analysis for women's health promotion.

Quality of life (QoL) of women with gestational diabetes mellitus (GDM) is one of the fundamental issues and public health challenges. This study examines the QoL among pregnant women with GDM through a systematic review and meta-analysis. A search was conducted in Scopus, PubMed, and the Web of Science databases for articles published until Jan 30, 2024. Manual searches of gray literature, Google Scholar, reference checks, and citation checks were conducted. The JBI's Critical Appraisal Checklist for Analytical Cross-Sectional Studies was utilized to assess the quality of the articles' reporting. The random model implemented in Stata software (version 16; Stata Corp.) was utilized to conduct the meta-analysis. Among the 516 studies obtained from the literature, only 15 were deemed suitable for inclusion. Most studies (73.3%) were conducted in nations with high-income levels. Additionally, general QoL was assessed in most studies (11 studies). The SF-36 and WHOQOLBREF questionnaires were the most often utilized. Based on the SF-36 measure, there was no statistically significant difference in the QoL of patients with GDM compared to the control group in most of dimensions. The WHOQOL-BREF instrument was utilized to estimate the QoL score at 49.69. The EQ-5D-5L tool revealed a difference in QoL scores between the GDM and control groups (MD=-7.40). The research findings were highly heterogeneous. The median evaluation score for the reporting quality of the articles was calculated to be 5, with a mean of 4.8 out of 7. The results of the present study showed that GDM reduces the QoL of pregnant women, especially in terms of mental and social health. Therefore, interventions and support programs should be designed and implemented to improve these women's QoL.

Determination of pregnant women’s exposure to thirdhand smoke, beliefs and affecting factors: a cross-sectional study from Turkey

ABSTRACT This study was conducted to determine pregnant women’s exposure to third-hand smoke, beliefs and influencing factors. The study included 400 pregnant women in a tertiary care obstetrics and gynecology hospital in Turkey. Data were collected using personal information form, Beliefs About Third-Hand Smoke Scale (BATHS-T) and Fagerström Test for Nicotine Dependence. 13.5% of the pregnant women smoked during pregnancy. However, 78.8% of the pregnant women were exposed to cigarette smoke at home. The mean score of BATHS-T scale and sub-scales increased in those whose spouses had university education or higher, and in pregnant women and their spouses who were public employees. The mean scores of BATHS-T scale and sub-scales were higher in pregnant women in the first trimester of pregnancy and in pregnant women with higher income levels. Community-based awareness of the effects of first, second and third-hand exposure to cigarette smoke on maternal and fetal health should be increased.

The Relationship Between Religious Attitudes and Xenophobia: Evidence from Türkiye

In this study, we examined whether religious attitudes have an effect on xenophobia, which we have witnessed to increase in recent years in Türkiye as well as in the world due to economic, socio-political and other factors, in terms of socio-demographic variables. In this context, our research was conducted to better understand the relationship between xenophobia and religious attitudes. Our sample group consists of 419 people aged between 18 and 56, residing in different provinces of Türkiye. These diverse demographic participants come from different socio-economic and cultural backgrounds. Data were collected online through Google Forms using the Personal Information Form, Religious Attitudes Scale and the Xenophobia Scale. These scales were used to assess participants' demographic information, religious attitudes and attitudes towards xenophobia. The findings of our study reveal that religious attitudes do not directly affect xenophobia in terms of variables such as age, gender, marital status and occupational status. That is, individuals' religious beliefs and the degree of these beliefs do not seem to be an important factor in determining their negative attitudes towards foreigners. Instead, other important factors behind xenophobia were analyzed. In the context of economic threat, remarkable results were obtained. Our research has documented that xenophobic attitudes are higher among individuals with low education and income levels compared to individuals with high income and education levels. This shows how important the impact of economic situation on xenophobia is. Especially in times of increased economic uncertainty and threats, individuals tend to develop negative attitudes towards foreigners. This suggests that economic insecurity may play a fundamental role in increasing xenophobia.

The interplay between urban expansion, human capital accumulation and innovation performance in Chinese cities

ABSTRACT The impact of spatial expansion on innovation performance has garnered widespread attention. This study establishes a two-sector equilibrium model to elucidate the transmission mechanism among urban expansion, human capital and innovation performance. Our findings indicate that the synergy between compact expansion and human capital enhances innovation performance. Drawing from a sample of 281 cities spanning 2005–2018, we observe that Chinese cities demonstrate compact expansion patterns, and human capital fosters the synergy effect of innovation. Furthermore, the synergistic effect of compact expansion and human capital formation is more pronounced in cities with larger populations, higher income levels and stronger regional status. These results offer both theoretical contributions and practical insights for shaping more effective urbanisation patterns and enhancing innovation capacity.

Animal source foods consumptions on complementary feeding during COVID-19 pandemic in Indonesia

PurposeComplementary feeding practices was more difficult during the COVID-19 pandemic due to economic instability, especially for animal source foods (ASFs) consumption. According to the problem, the purpose of this study was to determine the economic impact of COVID-19 pandemic on ASFs consumption and ASFs consumption related factors on complementary feeding in Indonesia.Design/methodology/approachThis cross-sectional study was targeted at mothers of children aged 6–23 months during pandemic. A total of 574 respondents were obtained through online questionnaire.FindingsThis study found that flesh food, including fish/seafood, organ meat, meat, poultry and processed meat, were associated with all economic impact of COVID-19 pandemic; in contrast, those economic impacts did not affect the dairy product and egg consumption. Multivariate analysis showed children with older age (AOR: 1.13, 95%CI: 1.04–3.26), meet minimum dietary diversity (AOR: 2.17, 95%CI: 1.56–5.44) and are from high income level household (AOR: 1.14, 95%CI: 1.09–2.10) contributed to ASFs consumption.Practical implicationsOther strategies aimed at enhancing food security to increase ASFs consumption on complementary feeding. The government may consider short-term emergency purchasing subsidies and macro-control of the ASFs market. Nutrition education is also required to improve knowledge related to importance of ASFs consumption for children.Originality/valueThis study reveals the association between each food group of ASFs consumption on complementary feeding and the economic impact of COVID-19 pandemic.

Factors associated with patient activation among patients with diabetes on hemodialysis: a multicenter cross-sectional study from a developing country

BackgroundDiabetes mellitus (DM) is a major public health concern with considerable morbidity and mortality. DM affects patients’ quality of life and can lead to multiple complications, including chronic kidney disease (CKD) and the need for dialysis. Higher patient activation can improve health outcomes in hemodialysis patients with DM. This study aimed to explore the factors associated with higher patient activation and health-related quality of life (HRQoL) among hemodialysis patients with DM.MethodsThis was a cross-sectional, questionnaire-based study conducted on hemodialysis patients with DM in Palestine. The quota sampling method was utilized to draw samples from six dialysis centers. The questionnaire consists of three sections. The first section includes demographic, socioeconomic and clinical questions. The second section utilizes the patient activation measure-13 (PAM-13) to measure patient activation, while the third section assesses HRQoL using the EQ-5D-5 L tool and the visual analog scale (VAS). Mann‒Whitney and Kruskal‒Wallis tests were employed to examine the relationships between variables at the bivariate level, and multiple regression analysis was employed at the multivariate level.ResultsOf the 200 patients who were approached, 158 were included. The median PAM, EQ-5D index, and VAS score were low at 51.0, 0.58, and 60.0, respectively. A higher PAM score was independently associated with a higher household income level and taking medications independently. A higher EQ-5D index was associated with taking more than eight medications, taking medications independently, living with fewer than three comorbid conditions, and having a higher PAM. A higher VAS score was associated with being married, and receiving less than 3.5 hours of hemodialysis.ConclusionsA higher patient activation level was associated with a higher income level and independence in taking medications. Interventions designed to improve patient activation, such as medication management programs, should address these factors among the target population. Longitudinal studies are needed to assess the time effect and direction of causation between health status and patient activation.

The Essence of Giving Food as The Spirit of Islam in The Book "الاءطعام روح الاءسلام " by Syeh Ali Bin Ali Bin Ibrahim U'dhobi

Social disparities are prevalent in our society. The imbalance in life and the terrifying contradictions among human lives continue to this day. These imbalances occur globally. We witness countries devastated by war, such as Palestine, Yemen, and Syria, where the inhabitants suffer from hunger and lack access to healthcare. Similarly, countries with high poverty rates like Cambodia, Myanmar, and Afghanistan experience hunger and poor sanitation. Conversely, there are many developed and prosperous countries with high income levels in other parts of the world. This study employs a literature review approach, examining verses from the Qur'an and hadiths of the Prophet Muhammad SAW concerning Ith’am as contained in the book "الاءطعام روح الاءسلام" by Syekh Ali bin Ali bin Ibrahim U’Dhobi. The book explains that Islam encourages people to help each other, have empathy, sympathy, and high social concern. As mentioned in Surah Adh-Dhariyat, verse 19: "And in their wealth, there is a right for those who ask and those who do not ask." Therefore, it is essential for Muslims to pay significant attention and care to convey and study the core teachings of Islam contained in Ith’am (charity by giving food). The five pillars of Islam (shahadah, prayer, fasting, zakat, and hajj) are the foundation of Islam and must be performed to be recognized as a Muslim. The pillars of Islam are closely related to Ith’am, making it a core teaching of Islam (the spirit of Islam).

Mendelian randomization analysis revealed that albuminuria is the key factor affecting socioeconomic status in CKD patients

Previous studies indicate a strong correlation between the incidence of chronic kidney disease (CKD) and lower economic status. However, these studies often struggle to delineate a clear cause–effect relationship, leaving healthcare providers uncertain about how to manage kidney disease in a way that improves patients’ financial outcomes. Our study aimed to explore and establish a causal relationship between CKD and socioeconomic status, identifying critical influencing factors. We utilized summary meta-analysis data from the CKDGen Consortium and UK Biobank. Genetic variants identified from these sources served as instrumental variables (IVs) to estimate the association between CKD and socioeconomic status. The presence or absence of CKD, estimated glomerular filtration rate (eGFR), and albuminuria were used as exposures, while income and regional deprivation were analyzed as outcomes. We employed the R packages ‘TwoSampleMR’ and ‘Mendelianrandomization’ to conduct both univariable and multivariable Mendelian randomization (MR) analyses, assessing for potential pleiotropy and heterogeneity. Our univariable MR analysis revealed a significant causal relationship between high levels of albuminuria and lower income (OR = 0.84, 95% CI: 0.73–0.96, p = 0.013), with no significant pleiotropy detected. In the multivariable MR analysis, both CKD (OR = 0.867, 95% CI: 0.786–0.957, p = 0.0045) and eGFR (OR = 0.065, 95% CI: 0.010–0.437, p = 0.0049) exhibited significant effects on income. This study underscores that higher albuminuria levels in CKD patients are associated with decreased income and emphasizes the importance of effective management and treatment of albuminuria in CKD patients to mitigate both social and personal economic burdens.

INVESTIGATION OF THE PREVALENCE OF EXPIRED AND UNUSED PHARMACEUTICALS IN THE ANKARA REGION

Objective: Due to the increase in the market share of pharmaceuticals and the unconscious use of medicines, unused or expired medicines are being discarded in a way that harms the environment. This study aims to examine which medicines are brought to collection points as household waste in order to reduce waste medicines from the source. Material and Method: The medicines collected in 12 spontaneously selected pharmacies operating in low and high income levels in the Ankara region were recorded at different periods during one year and the results were statistically evaluated. 4852 waste medicines were sorted and classified according to pharmaceutical dosage form and indication Result and Discussion: Unopened 521 medicines were discarded. In addition, it was seen which drug groups create waste in socio-economic terms. In addition to the damage to the environment, it has created a foresight to prevent drug waste that creates a deficit in the budget.

The relationship between fear of birth and feelings of security

Fear of childbirth is experienced in the pre-pregnancy period, during pregnancy and in the postpartum period, and the source of fear may vary in each period. It is stated that the experience and fear of childbirth during the birth process also have effects in the postnatal period and it is thought that it may affect feelings of security. This research was conducted in a descriptive and relationship-seeking manner to determine the relationship between fear of birth and feelings of postpartum security. Survey Form, Wijma Birth Expectation/Experience Scale Version B and Mothers’ Postpartum Sense of Security Scale were used to collect data. It was determined that there was a negative and significant relationship between birth expectation/experience and mothers’ feelings of postpartum security (β = − 0.423. p < .001). It has been established that fear of birth is related to mothers’ feelings of birth security, and as the fear of birth increases, the feeling of postpartum security decreases. As a result of the research, it was reported that mothers with high education levels, medium and high income levels, planned pregnancies, receiving prenatal care, and support from their relatives felt safer.

Race and ethnic inequalities

Abstract This article considers inequalities across racial and ethnic groups in the UK and finds that there is no single story of advantage or disadvantage. Racial and ethnic inequalities are complex and characterized simultaneously by continuity rooted in historical origins and conditions and rapid change fuelled by new and changing populations and opportunities. Continuity and change are also reflected in very different patterns of inequality across (and within) minority groups, generations and outcomes. Some groups are characterized by high levels of average qualifications, income and wealth, while others are persistently disadvantaged, faced with elevated levels of poverty and unemployment. Alongside different levels in outcomes are varied trajectories, both within and across generations. Within groups, there are less-explored, intersectional contours of difference, along the lines of gender, geography and class. Research and policy must acknowledge this diversity and complexity to inform effective policy prescriptions going forwards.

Attention-deficit/hyperactivity disorder and subsequent diagnoses of major psychiatric disorders: a nationwide population-based study.

We evaluated the risk of being diagnosed with various psychiatric disorders after an attention-deficit/hyperactivity disorder (ADHD) diagnosis using data from South Korea's National Health Insurance Service from 2002 to 2019, which covers approximately 97% of the country's population. ADHD and control groups were selected after propensity score matching was performed for individuals diagnosed with ADHD and their age- and sex-matched counterparts from the general population. Comorbid psychiatric disorders included depressive disorder, bipolar disorder, tic disorder, and schizophrenia. The incidence of newly diagnosed psychiatric disorders was compared between the groups. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated and adjusted for ADHD medication prescription. After matching, 353,898 individuals were assigned to each of the two groups. Compared to the control group, the ADHD group showed a significantly higher risk of being subsequently diagnosed with depressive disorder, bipolar disorder, schizophrenia, and tic disorder. The onset age of depressive disorder, bipolar disorder, and schizophrenia in the ADHD group was 16-17 years, approximately 5 years earlier than that in the control group. The risk for depression was the highest in individuals with high income levels, and that for schizophrenia was the highest among rural patients. The median length of the follow-up time until the diagnosis of each comorbid psychiatric disorder was 7.53, 8.43, 8.53, and 8.34 years for depressive disorder, bipolar disorder, schizophrenia, and tic disorder, respectively. Individuals with ADHD had an overall higher risk of being diagnosed with subsequent psychiatric disorders than did the controls. Hence, they should be carefully screened for other psychiatric symptoms from an early age and followed up for an extended duration, along with appropriate interventions for ADHD symptoms, including psychosocial treatments and educational approaches.