High Socioeconomic Areas Research Articles

Emergency department presentations and associated hospital admissions for low back pain in Australia.

ObjectiveTo determine factors associated with hospital admissions from ED presentations for low back pain (LBP).MethodsThis was a retrospective analysis of 147 ED centres in New South Wales (NSW), Australia, between 2005 and 2014. Data were accessed from the NSW Emergency Department Data Collection to determine patients who attended ED and whether or not they were admitted to hospital.ResultsThere were 1 388 078 ED visits for LBP across 147 different ED centres between 2005 and 2014. Between 2005 and 2013, hospital admission rates from ED visits for LBP increased annually by 5.1% (95% confidence interval [CI] 3.9–6.4) from 477 per 100 000 in 2005 to 730 per 100 000 in 2013. Patients who were under injured workers' insurance (i.e. workers compensation insurance) had significantly lower odds (odds ratio [OR] 0.42, 95% CI 0.40–0.43) of being admitted to hospital for LBP compared with those not on injured workers' insurance. Patients living in the highest socioeconomic areas were also more likely to be admitted to hospital from an ED visit, compared with those from the lowest socioeconomic areas (OR 1.26, 95% CI 1.24–1.29).ConclusionRates of hospitalisation following attendance to ED for LBP increased annually by 5% between 2005 and 2013. Hospital admission rates were lower among patients from the lowest socioeconomic areas or under injured workers' compensation insurance.

Availability and promotion of alcohol across different outlet typologies and under different area-level socioeconomic status.

We aimed to characterize the availability and promotion of alcohol at alcohol outlets in Madrid and to compare them according to type of outlet and area-level socioeconomic status. We used the OHCITIES instrument to characterise the alcohol outlets in 42 census tracts of Madrid in 2016. We specified alcohol availability as the density of alcohol outlets and the number of alcohol outlets with extended opening hours (12 or more). We registered any type of promotion associated to alcohol outlets that could be perceived from outside the outlet. We calculated and compared proportions of availability and promotion by alcohol outlet (on- and off-premise) using chi-squared and Fisher Exact tests. We estimated the availability and promotion of alcohol densities per census tract according to area-level socioeconomic status. To assess statistical significance, we used Kruskal-Wallis tests. We recorded 324 alcohol outlets, 241 on-premise and 83 off-premise. Most of the outlets had extended opening hours (73.77%) and at least one sign promoting alcohol (89.51%). More on-premise outlets had extended opening hours and higher presence of alcohol promotion than off-premise (p < 0.001). Higher density of alcohol outlets, extended opening hours and presence of alcohol promotion were found in higher socioeconomic areas (all p < 0.001). These results were also observed for on-premise alcohol outlets. Alcohol availability and promotion were associated with alcohol outlets in Madrid. Future alcohol policies regulating the availability and promotion of alcohol should consider outlet types and area-level socioeconomic status.

From street address to survival: Neighborhood socioeconomic status and pancreatic cancer outcomes

BackgroundNeighborhood factors may influence cancer care through physical, economic, and social means. This study assesses the impact of neighborhood socioeconomic status on diagnosis, treatment, and survival in pancreatic cancer. MethodsPatients with pancreatic adenocarcinoma were identified in the 2010–2016 Surveillance Epidemiology and End Results database. Neighborhood socioeconomic status (divided into tertiles) was based on an National Cancer Institute census tract-level composite score, including income, education, housing, and employment. Multivariate models predicted metastasis at time of diagnosis and receipt of surgery for early-stage disease. Overall survival compared via Kaplan-Meier and Cox proportional hazards. ResultsFifteen thousand four hundred and thirty-six patients (29.7%) lived in low neighborhood socioeconomic status, 17,509 (33.7%) in middle neighborhood socioeconomic status, and 19,010 (36.6%) in high neighborhood socioeconomic status areas. On multivariate analysis, neighborhood socioeconomic status was not associated with metastatic disease at diagnosis (low neighborhood socioeconomic status odds ratio 1.02, 95% confidence interval 0.97–1.07; ref: high neighborhood socioeconomic status). However, low neighborhood socioeconomic status was associated with decreased likelihood of surgery for localized/regional disease (odds ratio 0.60, 95% confidence interval 0.54–0.68; ref: high neighborhood socioeconomic status) and worse overall survival (low neighborhood socioeconomic status hazard ratio 1.18, 95% confidence interval 1.15–1.21; ref: high neighborhood socioeconomic status). ConclusionPatients from resource-poor neighborhoods are less likely to receive stage-appropriate therapy for pancreatic cancer and have an 18% higher risk of death.

Dental caries prevalence and severity in relation to residential factor among (6-9) years school age children in two different area in Baghdad city

The aim of this study is to estimate the prevalence and severity of dental caries among(6-9) years old children in two different socioeconomic background area in Baghdad city . Dental caries diagnosis was done according to criteria of WHO(1987). The total sample composed of 240 children (120 males and 120 females). Results showed that the prevalence of dental caries for the total sample was 100%, in another word caries free percentage was zero. Result showed that for the primary dentition dmfs and dmft values were higher for males aged 6-7 and 7-8 years in high socioeconomic class (7.8 &amp; 4.2 , 9.7 &amp; 4.7) than in low socioeconomic class (6.7 &amp; 3.9 ,7.2 &amp; 3.2) with statistically no significant differences ( p&gt; 0.05). For children aged 8-9 years in low socioeconomic area the values were higher compared with those in high socioeconomic area for both gender. For the permanent dentition the high social class showed higher prevalence of dental caries compared with their lower social class counter parts except females aged 8-9 years with low socioeconomic status recorded higher DMFS and DMFT values ( 2.66 &amp; 2.6) compared to those in high socioeconomic (2.6 &amp; 1.8), while the relation was not significant ( p&gt;0.05). Generally the present study showed that the prevalence and severity of dental caries for primary teeth was higher among children with low social class (dmfs &amp; dmft) than those with high social class, while the results were reversed for the permanent teeth.

Active use and perceptions of parks as urban assets for physical activity: A mixed-methods study.

Parks are potential key urban assets for improved population health; however, their use is not equal among all social groups. Individual and contextual factors could influence residents' perceptions of parks and how they interact with and, eventually, benefit from them. The use of complementary methodologies provides a deeper understanding of the relationship between park use, physical activity (PA), and residents' perceptions. Thus, we designed a mixed-methods study to analyze differences in park use and PA, and the perceptions of parks as urban assets for PA. We selected six parks from three neighborhoods in Madrid (Spain) with different neighborhood socioeconomic status (NSES) for systematic social observation. We registered park users by age, PA level (low, medium, and high), gender, and NSES using the System for Observing Play and Recreation in Communities (SOPARC) audit tool adapted for iOS software (iSOPARC). We also conducted 37 semi-structured interviews and 29 focus groups to analyze residents' perceptions of parks as urban assets for PA in the same neighborhoods. We adopted a convergent-parallel design to analyze both quantitative and qualitative data, and to describe the convergence and divergence areas between them. Parks within the high-NSES were more visited, showing a higher proportion of people performing high PA (11.9%) as compared to residents of the middle (9.3%) and low-NSES (3.2%). Female visitors showed lower PA levels compared to men, especially for parks within high-NSES. The following issues were reported as influence urban park use and perceptions: park maintenance and area perception, works constraints, insecurity and crime, differential perceptions by age, and the availability of organized activities in the parks. Residents from high-NSES reported fewer barriers to park use compared to residents from the other areas, who reported limitations such as less leisure time due to job constrains or perceived insecurity in parks. Senior participants reported that having parks with organized activities and a design oriented towards different age-groups are valuable. Our study shows consistency between the fewer and less intense use of parks registered in the middle and low-NSES neighborhoods, and the more barriers for PA reported in this areas during the qualitative analysis. Mixed-methods provided an insight of the potential causes leading to the differences in park use and PA within cities, which is essential in terms of environmental justice and health equity. Thus, a mixed-methods comprehensive approach to public health problems can help designing public policies addressing relevant factors related to urban health inequities.

Differences in healthiness perceptions of food and dietary patterns among the general public and nutrition experts: Across-sectional online survey.

Diet quality plays a vital role in the prevention of prevalent non-communicable diseases; however, misperceptions of healthiness of common foods and beverages may be undermining Australians' attempts to maintain a healthy diet. The current study aimed to assess the extent and nature of differences in public and expert opinion in the foods, beverages and dietary patterns that are considered healthy. A cross-sectional online survey of 1,097 Victorian adults aged 18-64 and 134 professional dietitians and nutritionists assessed healthiness perceptions of foods, beverages and dietary patterns, self-reported dietary patterns, and factors considered when making healthy choices. Differences in perceptions and dietary patterns between samples and by sex, socio-economic area and level of education were assessed using multivariable logistic regression. There were large discrepancies in which items the public and expert samples considered healthy. Females and those in high socio-economic areas tended to report healthiness perceptions that aligned with the expert sample to a greater degree than their counterparts. Personal judgement of products was important to both samples when making decisions about healthy choices. The public and expert samples differed greatly in healthiness perceptions with significant variation by demographics. SO WHAT?: Well-funded, sustained public health campaigns are needed to provide the public with evidence-based health and nutrition information and combat persuasive, misleading messaging from popular media and marketing.

Backyard benefits? A cross-sectional study of yard size and greenness and children\u2019s physical activity and outdoor play

BackgroundThe home environment is the most important location in young children’s lives, yet few studies have examined the relationship between the outdoor home environment and child physical activity levels, and even fewer have used objectively measured exposures and outcomes. This study examined relationships between objectively assessed home yard size and greenness, and child physical activity and outdoor play.MethodsData were drawn from the HealthNuts study, a longitudinal study of 5276 children in Melbourne, Australia. We used cross-sectional data from a sample at Wave 3 (2013–2016) when participants were aged 6 years (n = 1648). A sub-sample of 391 children had valid accelerometer data collected from Tri-axial GENEActive accelerometers worn on their non-dominant wrist for 8 consecutive days. Yard area and greenness were calculated using geographic information systems. Objective outcome measures were minutes/day in sedentary, light, and moderate-vigorous physical activity (weekday and weekend separately). Parent-reported outcome measures were minutes/day playing outdoors (weekend and weekday combined). Multi-level regression models (adjusted for child’s sex, mother’s age at the birth of child, neighbourhood socioeconomic index, maternal education, and maternal ethnicity) estimated effects of yard size and greenness on physical activity.ResultsData were available on outdoor play for 1648 children and usable accelerometer data for 391. Associations between yard size/greenness and components of physical activity were minimal. For example, during weekdays, yard size was not associated with daily minutes in sedentary behaviour (β: 2.4, 95% CI: − 6.2, 11.0), light physical activity (β: 1.4, 95% CI: − 5.7, 8.5) or MVPA (β: -2.4, 95% CI: − 6.5, 1.7), with similar patterns at weekends. There was no relationship between median annual yard greenness and physical activity or play.ConclusionIn our study of young children residing in higher socio-economic areas of Melbourne yard characteristics did not appear to have a major impact on children’s physical activity. Larger studies with greater variation in yard characteristics and identification of activity location are needed to better understand the importance of home outdoor spaces and guide sustainable city planning.

Implementation of school remote drop-off walking programs: Results from qualitative interviews

BackgroundRemote drop-off programs allow children living “unwalkable” distances from school to walk partway by being dropped off by personal vehicle or bus closer to the school, supporting physical activity and health. However, little evidence exists to guide implementation of such programs. MethodsSemi-structured interviews were conducted with key informants from 7 remote drop-off programs to capture descriptive information and qualitative content (e.g., barriers, facilitators, outcomes). Qualitative content was analyzed using inductive thematic analysis and identified themes were organized within implementation science frameworks. ResultsPrograms were from low and high socioeconomic areas (free/reduced price lunch range = 4%–92%) and initiated by various champions (school staff = 29%, parents = 29%, external = 42%). 29% of programs incorporated the yellow school bus, 43% involved >100 students, and 71% involved route distances ≥0.5 miles. Twenty themes were identified across 5 implementation science domains (Intervention Characteristics, Inner Setting, Outer Setting, Implementation Process, and Outcomes). Positive outcomes included physical activity, socialization, and improved focus for students; decreased traffic; and positive perceptions of the program by students, parents, and school staff/administrators. Barriers included traffic, weather, and student engagement. Facilitators included having a champion and support from school leaders and the community, conducting process improvements, and incentivizing participation. ConclusionsRemote drop-offs are feasible for supporting active school commuting but underutilized. Promising strategies for supporting uptake and implementation of such programs include communicating benefits, developing champions, engaging school and community leaders, and improving the neighborhood built environment.

Effect of socioeconomic status on survival in patients with head and neck cancer.

The aim of this study was to assess the survival outcomes of head and neck cancer (HNC) by socioeconomic status. A national retrospective population-based cohort of HNC patients diagnosed in Israel between 2000 and 2017 was conducted. Site of residence and socioeconomic status were correlated with overall survival (OS), controlling for prognostic factors that included tumor site, stage, age, sex, and ethnic group. Overall, 11 826 patients were identified. Patients from high socioeconomic areas had better overall 5-year survival than patients from low socioeconomic areas (p< 0.005). Patients in stage 3 from a high socioeconomic status had a longer median survival rate of 1.5 years than patients in the low-status group. In a cox proportional hazards analysis, we found age >65 (HR 2.91, 95% confidence interval [CI]: 2.75-3.09, p< 0.001) and low socioeconomic group (HR 1.25, 95% CI: 1.18-1.33, p< 0.001) to be correlated with inferior OS. Our findings show that patients with HNC living in low socioeconomic areas had worse OS.

Vaccination coverage estimates and utilization patterns of inactivated enterovirus 71 vaccine post vaccine introduction in Ningbo, China

BackgroundIn China, enterovirus 71 (EV71) is the major etiological agents of hand foot mouth disease that poses severe risks to children’s health. Since 2015, three inactivated EV71 vaccines have been approved for use. Previous studies indicated the high willingness of EV71 vaccination in eastern China. However, few studies have assessed coverage and utilization patterns of EV71 vaccine in China.MethodsChildren born during 2012–2018 were sampled and their records were abstracted from Ningbo childhood immunization information management system. Descriptive statistics characterized the study population and assessed coverage and timeliness for EV71 vaccination. Simultaneous administration patterns as well as type of EV71 vaccine used were also evaluated. Bivariate and multivariable analysis was used to examine the relationship of socio-demographic characteristics with vaccination coverage and timeliness.ResultsOf 716,178 children living in Ningbo. One hundred seventy-two thousand two hundred thirty-six received EV71 vaccine with a coverage rate of 24.05% and only 8.61% received vaccination timely. 21.97% of children received the complete two dose EV71 series but only 6.49% completed timely. Vaccination coverage and timeliness increased significantly from 2012 birth cohort to 2018 birth cohort. Relatively higher coverage and timeliness were observed in resident children, Inner districts, high socioeconomic areas and large-scaled immunization clinics. Of 329,569 doses of EV71 vaccine, only 5853(1.78%) doses were administered at the same day as other vaccines.ConclusionsThere is a need for increasing EV71 vaccination coverage and timeliness as well as eliminating disparities among different populations. Our study highlights the importance of simultaneous administration to increasing coverage and timeliness of EV71 vaccination.

Overview of In-Hospital Diabetes Management: Audit of Patients Attending a Rural Hospital in Queensland, Australia

Context: The Australian Institute of Health and Welfare (AIHW) health survey in 2018 demonstrated that mortality rates from diabetes in remote and very remote areas were twice as high compared to those in the urban regions. Moreover, diabetic patients in the lowest socioeconomic areas were more than twice as likely to die from the disease and its associated complications than those living in the highest socioeconomic areas (77 and 33 per 10,000 respectively) [1]. These health disparities prompted a closer look into the quality of local inpatient diabetes management in order to identify the changes required to improve diabetes care in a rural community. Methods: A retrospective audit assessing all adult patients (aged over 18) with diabetes between August and October 2019 who attended treatment in one rural health centre in Queensland, Australia was conducted. Information was obtained from paper based patient records, especially the state-wide insulin subcutaneous order and blood glucose chart. Results: There were 122 diabetic inpatients during the study period. 9 were excluded due to poor documentation on the details of diabetes or insulin management. Men comprised 62% (n = 75) of the patients and the chronicity of diabetes in the majority of the patients was either unknown or undocumented (n = 90). Type 2 diabetes represented 87% (n = 106) of the hospitalisations. There were 64 hospitalisations with diabetes or diabetic related complications as the principal diagnoses. Among these, 7% (n = 8) were due to diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS) or severe hyperglycaemia with ketosis, while 2 patients (1.7%) presented with hypoglycaemia. The majority (32%, n = 36) of the diabetic related complications were due to an underlying infection. Throughout inpatient stay, half (50.4%, n = 57) of the patients experienced one or more hyperglycaemic episodes and 14% (n = 16) experienced at least one hypoglycaemic events. The prevalence of inappropriate management of hyperglycaemia during this period was observed to be 21%. This was due to prescription errors i.e. usual insulin not prescribed (n = 7), erroneous insulin type (n = 3) and unsigned order (n = 4). Persistent hyperglycaemia, defined locally by blood glucose level (BGL) > 12 mmol/L was not managed ideally in 10 patients due to either lack of communication between staffs and physicians or failure to make changes when notifications were relayed. Patients were followed up until the discharge phase. Nearly half (41.8%, n = 51) of the patients were found to have no clearly documented follow up plans albeit the limitations of paper based clinical records should be taken into account. Conclusion: The management of diabetes in the rural communities can be challenging. Communication between the different layers of healthcare providers is imperative to ensure hyperglycaemia among hospitalised patients is not mismanaged. Clear documentation of insulin doses and BGL levels on paper records as well as regular education and shared clinical experience on insulin titration in response to abnormal BGL levels by clinicians are strategies to improve diabetes care. Reference: 1. Australian Institute of Health and Welfare. 2021. Diabetes, Type 2 Diabetes - Australian Institute Of Health And Welfare. [online] Available at: <https://www.aihw.gov.au/reports/diabetes/diabetes/contents/hospital-care-for-diabetes/type-2-diabetes> [Accessed 6 January 2021].

The relationship between air pollutants and maternal socioeconomic factors on preterm birth in California urban counties

BackgroundPreterm birth is the leading cause of perinatal morbidity and mortality in the U.S. and disparities among racial and ethnic groups persist. While etiologies of preterm birth have not been fully elucidated, it is probable that environmental and social factors play a role.ObjectiveWe hypothesized that there is an interactive association between exposure to fine particulate matter (PM2.5) or ozone (O3) and neighborhood socioeconomic factors that increase the risk of preterm birth.MethodsWe conducted a retrospective study using geocoded birth certificate data between 2007 and 2011, daily ambient air quality data on PM2.5 and O3, and American Community Survey (2007–2011 5-year estimates) data to assess census tract-level socioeconomic factors in California urban counties.ResultsOur study found a small positive association between maternal exposures to PM2.5 and O3 and preterm birth that varied by gestational exposure period. In mixed-effects models, we found an increase in the risk of preterm birth for a one-unit change in PM2.5 averaged across the entire pregnancy (AOR = 1.02, 95% CI: 1.01, 1.02) and O3 during 3-months pre-pregnancy (AOR = 1.03, 95% CI: 1.02, 1.04). Interaction between census tract-level factors and air pollutants showed an increase in the risk of preterm birth among mothers living in higher socioeconomic areas, though, a fixed cohort bias sensitivity analysis showed these associations were not significant.SignificanceThese findings substantiate previous studies that showed associations between air pollution and preterm birth, even as pollution levels have decreased. This study has important implications for policy decisions and may help inform research on potential mechanisms of preterm birth.

Differences of Salivary Ph, Feature, And Volume Of Children At Three Kindergartens With Different Socioeconomic Standard

Introduction: Saliva is the most important biological factor to protect against dental caries. When saliva flow is reduced, oral health problems such as dental caries and oral infections can develop. It was suggested that the effect of low salivary pH is more in plaque close to the area of susceptible tooth surface. The presence of saliva in pre-school age children is a significant indicator in oral health assessment oral health. There has been an association between salivary cortisol and socioeconomic variable. Descriptions above have encouraged us to examine the salivary pH, feature, and volume of pre-school-aged community. Thus, this study was aimed to describe the differences in salivary pH, feature, and volume of the children in the three pre-school with different location and socioeconomics aspect. Methods: Descriptive survey, with a population of preschool students in 3 different kindergartens with different socioeconomic environment. Inclusion criteria were the pre-school-aged community and got permission from parents. Exclusion criteria were a pre-school-aged community under medication treatment causes hyposalivation or hypersalivation and children who did not want to be involved in the study, with total sampling as the sampling technique, resulted in as much a 101 respondents as the study sample. The saliva was collected with unstimulated technique. Data analysis was performed using relative frequency distribution. Results: The salivary pH was slightly higher in male children than female by 0.1. The average pH value was 7.25. The salivary feature was mostly frothy bubbly, followed by thin and watery, and the sticky bubbly feature was found the least. The salivary volume of the pre-school-aged community was mostly in the very less category, followed by the less category, with no normal category was found. the p-values of salivary pH and salivary features were below 0.05 There are no significant differences between the salivary pH and salivary feature of children from the three studied kindergartens. However, there is a significant difference in the salivary volume found in children from kindergartens located in high socioeconomic standard and middle socioeconomic standard areas, which have a higher salivary volume than the children from kindergartens situated in areas with lower socioeconomic standard. Conclusion: since the reduced salivary volume was associated to children with lower socioeconomic standard, this association can justify the higher risk for caries described in the literature. KEYWORDS Salivary pH; Salivary feature; Salivary volume; Pre-school-aged children.

How long and how much? Wait times and costs for initial private child mental health appointments.

To determine: (i) wait times and out-of-pocket costs for children attending private specialists for initial mental health appointments; and (ii) whether these differed between specialists working in metropolitan versus rural areas and in low, medium and high socio-economic areas. Prospective secret shopper study whereby a researcher posed as a parent seeking an appointment for her child with anxiety or attention-deficit/hyperactivity disorder. We contacted 317 private paediatrician, psychiatrist and psychologist practices in Victoria and South Australia between 12 March and 5 May 2019. One third (29.8%) of private practices were closed to new referrals. The average wait times for paediatricians, psychiatrists, and psychologists were 44, 41 and 34 days, respectively. Average out-of-pocket costs quoted were AU$120 for paediatricians, AU$176 for psychiatrists and AU$85 for psychologists. Parents face extensive wait times and substantial out-of-pocket costs when seeking private mental health services for their child.

The affordability of a healthy and sustainable diet: an Australian case study

Background/AimsEAT–Lancet Commission’s Planetary Health Diet proposed a diet that integrates nutrition and sustainability considerations, however its affordability is unknown in many country-specific contexts, including Australia. The aim of this study is to develop a healthy and sustainable food basket modelled on the Planetary Health Diet to determine the affordability of the Planetary Health Diet basket across various socio-economic groups, and compare this affordability with a food basket modelled on the typical current diet, in an Australian setting.MethodsAn Australian-specific Planetary Health Diet basket was developed for a reference household (2 adults and 2 children) modelled on the Planetary Health Diet reference diet, and compared to a previously-developed Typical Australian Diet basket. The cost of each food basket was determined by online supermarket shopping surveys in low, medium and high socio-economic areas in each Australian state. Basket affordability was determined for the reference household by comparing the basket cost to disposable income in each socio-economic group in each state. Mann-Whitney U tests then determined if there were significant differences between the median costs and the median affordability of both baskets.ResultsThe Planetary Health Diet basket was shown to be less expensive and more affordable than the Typical Australian Diet basket nationally, in all metropolitan areas, in all socio-economic groups across Australia (median cost: Planetary Health Diet = AUD$188.21, Typical Australian Diet = AUD$224.36; median affordability: Planetary Health Diet = 13%, Typical Australian Diet = 16%; p = < 0.05).ConclusionsThis study showed the Planetary Health Diet to be more affordable than the Typical Australian Diet for metropolitan-dwelling Australians.ImplicationsThese results can help to inform public health and food policy aimed at achieving a healthy and sustainable future for all Australians, including reductions in overweight/obesity rates and increased food security.

Home and workplace neighborhood SES and behavior-related health: a within-individual analysis

Abstract Background Although the influence of individual and home neighborhood socioeconomic status (SES) on health-related behaviors has been widely studied, majority of the evidence is from cross-sectional studies. Moreover, studies on associations of workplace SES with health-related behaviors are almost non-existent. Objective To investigate associations between home and work neighborhood SES and behavior-related health in gainfully employed individuals. Methods Participants were from the Swedish Longitudinal Occupational Survey of Health with response to minimum two surveys between 2012 and 2018. We had 13163 individuals with complete data on exposure and covariates with total of 36925 observations. Neighborhood SES was determined as an index using mean income, education attainment, and unemployment rate within a 500 m buffer around home and workplace address. We used fixed effects method with conditional logistic regression to investigate longitudinal within-individual associations for home, workplace and their weighted summary neighborhood SES with self-reported obesity, physical activity, smoking, excessive alcohol consumption, sedentary lifestyle, and sleep problems. We included age, marital status, individuals' occupational position, presence of children, chronic disease, depressive symptoms, and work strain as covariates. Results The workers were more likely to consume alcohol excessively when their workplace was located in the highest SES area compared to time when their workplace was located in the lowest SES area (adjusted odds ratio 1.98; 95% confidence interval 1.12-3.49). Contrarily, socioeconomic status of home neighborhood was observed to be associated with low alcohol consumption. We observed no associations for other behavior-related health outcomes. Conclusions These within-individual comparisons suggest that having workplace in a high SES area may be favorable for excessive alcohol consumption. Key messages Workplace in a high socioeconomic area may be favorable of excessive alcohol consumption, while such association were not observed for home neighborhood. Consideration of work neighborhood SES along with home neighborhood SES and individual variables can enhance our understanding of the influence of environments on health behaviors.

Health inequalities: Harnessing data and data linkage to bridge the gaps

Abstract There is a complex interplay between health and welfare, where social factors such as an individual's education, employment, and relationships can impact their overall health, and vice versa. The Australian Institute of Health and Welfare (AIHW) is a national body that monitors the health of Australians including the social determinants and the distribution of health across populations. Where inequalities are observed, it investigates, where possible, the contributing factors. The AIHW is uniquely placed to address data gaps in inequalities, with a remit to monitor both health and welfare outcomes of Australians, access to a range of data and established relationships with national and jurisdictional governments. The AIHW reports against national frameworks such as the National Strategic Framework for Chronic Conditions. A variety of information sources are used. These include health surveys and administrative data on mortality and hospitalisations to estimate inequalities using standardised area based indices of socioeconomic status. The AIHW creates products to suit different audiences such as policy makers, researchers and the general public. These include reports, interactive web visualisations and fact sheets. AIHW research into mortality inequalities has consistently found that substantial mortality inequalities exist in the Australian population, particularly amongst those from areas of socioeconomic disadvantage. In 2016, if all Australians had the same cardiovascular disease (CVD) death rate as people in the highest socioeconomic areas, there would have been 8,600 fewer deaths. In recent times data linkage has increasingly been used to link health and social data to provide a broader understanding of the associations between social determinants and health and the health experiences of priority population groups. This presentation will give an overview of current monitoring efforts in Australia, and provide examples of methods used and current work in this area.

The impact of interventions addressing socioeconomic inequalities in cancer-related outcomes in high-income countries: A systematic review.

Background: High cancer mortality is a major source of burden. Population-wide programs have been developed to improve cancer outcomes, and although effective in improving outcomes overall, the socioeconomically disadvantaged population have disproportionately benefited. This systematic review evaluated interventions aimed at addressing inequalities in cancer-related outcomes between low and high socioeconomic groups within high-income countries.Materials and Methods: The Cochrane Register of Controlled Trials, EMBASE, and PubMed searches were completed in October 2018. Data extraction and quality appraisal were guided by established mechanisms. Impact of interventions, using odds ratios, with respective 95% confidence intervals were presented, where available.Results: Sixteen studies reporting on 19 interventions were included. Seven interventions (37%) reduced socioeconomic inequalities in cancer-related outcomes, focusing on participation in cancer screening. Interventions included pre-formulated implementation intentions; GP-endorsed screening invitations; enhanced reminder letters; text message reminders; and implementation of an organised screening program.Conclusions: This systematic review found limited evidence on the efficacy of existing interventions that aimed to reduce inequalities in cancer-related outcomes between people living in low and high socioeconomic areas among high-income countries. Future interventions should consider the specific needs of people living in socioeconomically disadvantaged areas to improve the efficacy of an intervention.Significance for public healthAustralia’s health system and public health programs have facilitated improvements in cancer outcomes over time. Disadvantaged populations have lower engagement with services and participation in programs, reflective in their worse outcomes and driving disparity between low and high socioeconomic groups. This is a trend in Australia and internationally. The study evaluated interventions aimed at reducing socioeconomic inequalities in cancer-related outcomes within highincome countries. All effective interventions focused on cancer screening participation and reported improvements, decreasing the risk of dying from screen-detected cancer. Lower uptake remained for low socioeconomic groups. The review demonstrated that interventions must be designed to meet the health literacy needs of the population and that they need to be engaged throughout the developmental phase for uptake to improve. Understanding the characteristics of successful and unsuccessful interventions is the first step in ensuring scalability, and therefore, is of public health importance to acknowledge well-planned interventions that have utilised resources effectively.

Cancers of the corpus uteri treated in South Australian public hospitals: Trends in clinical management and survival across three decades.

To investigate treatment and survival over three decades. Clinical registry data from three major public hospitals analysed using Kaplan-Meier product-limit estimates and multivariate proportional hazard regression to determine disease-specific survival. Five-year survival increased from 75% to 84%. The adjusted hazard ratio (HR, 95% CI) was 0.56 (0.41, 0.77) for 2010-2016 compared with 1984-1989 and was higher for: ages 80+ years; more advanced stages; poorly differentiated tumours; and complex mixed epithelial and mesenchymal tumours and sarcomas. Treatment was by surgery (92%), radiotherapy (33%), chemotherapy (12%) and hormone therapy (10%). Adjusted analyses showed radiotherapy and hormone therapy were less common from 1990 and chemotherapy more common for 2010-2016. Treatment likelihood was lower for ages ≥80years, mixed epithelial and mesenchymal tumours receiving surgery and chemotherapy, but higher for radiotherapy. Advanced cancers (FIGO stage IV) had less surgery but more non-surgical treatments. Marginal evidence presented of more hormone therapy for high socio-economic areas. Survival was equivalent to national figures for Australia and the United States, but potentially higher than for England and Wales. Cases aged 80+ years had less care and poorer survival. Findings illustrate the complementary roles of hospital and population-based registries in local service evaluation.

Food purchasing behaviour of shoppers from different South African socio-economic communities: results from grocery receipts, intercept surveys and in-supermarkets audits.

To identify factors associated with food purchasing decisions and expenditure of South African supermarket shoppers across income levels. Intercept surveys were conducted, grocery receipts collated and expenditure coded into categories, with each category calculated as percentage of the total expenditure. In-supermarket food quality audit and shelf space measurements of foods such as fruits and vegetables (F&V) (healthy foods), snacks and sugar-sweetened beverages (SSB) (unhealthy foods) were also assessed. Shoppers and supermarkets were classified by high-, middle- and low-income socio-economic areas (SEA) of residential area and location, respectively. Shoppers were also classified as "out-shoppers" (persons shopping outside their residential SEA) and "in-shoppers" (persons shopping in their residential SEA). Data were analysed using descriptive analysis and ANOVA. Supermarkets located in different SEA in urban Cape Town. Three hundred ninety-five shoppers from eleven purposively selected supermarkets. Shelf space ratio of total healthy foods v. unhealthy foods in all the supermarkets was low, with supermarkets located in high SEA having the lowest ratio but better quality of fresh F&V. The share expenditure on SSB and snacks was higher than F&V in all SEA. Food secure shoppers spent more on food, but food items purchased frequently did not differ from the food insecure shoppers. Socio-economic status and food security were associated with greater expenditure on food items in supermarkets but not with overall healthier food purchases. Urban supermarket shoppers in South Africa spent substantially more on unhealthy food items, which were also allocated greater shelf space, compared with healthier foods.