Higher Socioeconomic Groups Research Articles

New national alcohol guidelines in the UK: public awareness, understanding and behavioural intentions

BackgroundAlcohol consumption places a significant burden on the NHS and is an important risk factor for cancer, associated with 12 800 UK cases/year. New alcohol guidelines were published in 2016, taking into account the increasing evidence of the health harms of alcohol.MethodsA survey of the UK drinker population (n = 972) was conducted 1 week before and 1 month after the release of the guidelines to capture drinking habits, guideline awareness and intended behaviour change.ResultsOverall, 71% were aware of the new alcohol guidelines, however, just 8% knew what the recommended limits were. Higher socioeconomic groups were more likely to know these limits (ABC1 = 9% versus C2DE = 4%, P = 0.009). Participants who recognized the message that alcohol causes cancer were more likely to correctly identify the new guidelines (message recognition = 12% versus no recognition = 6%, P = 0.004); and were more likely to self-report an intention to reduce their alcohol consumption (message recognition = 10% versus no recognition = 6%, P = 0.01).ConclusionThe majority of the population knew the guidelines had been updated, however, communication of the new limits needs to be improved. Raising awareness of the links between alcohol and cancer may improve understanding of alcohol guidelines and could prompt behaviour change for those motivated to reduce their alcohol consumption.

Disparities in Breast Cancer: Private Patients Have Better Outcomes Than Public Patients.

Different outcomes in breast cancer have been reported for low and high socio-economic groups. We present data quantifying disparities between South African public and private patients. Records of 240 consecutive patients treated in 2008 in a public versus 97 patients in a private health facility were reviewed for demographic and oncologic data. The average of patients was 56.2 versus 51.9years (p=0.032). Stage at presentation was 0 in 0.83 versus 25.8%, I in 4.5 versus 15.5%, II in 41.3 versus 37.1%, III in 37.1 versus 18.6% and IV in 16.3 versus 3.1% public versus private patients. Seventy-three percent of patients were symptomatic versus 57.7%. Of patients with stage 0-III disease, 17.9 versus 20% had simple tumour excision and 7.5 versus 14%, oncoplastic tumour excision. The mastectomy rate was similar (52 vs. 60%), but immediate reconstruction was performed in 10 versus 63%. Public patients were less likely to have radiotherapy. The pathology was similar, 27.2 versus 20, 54 versus 52, 87 versus 61% of patients with stage I, II and III disease, respectively, had chemotherapy. Hormonal therapy for premenopausal patients in private was a LHRH agonist in 9.3%, ovarian ablation/BSO in 11.7% of public patients; biologicals were given in 7.2 versus 0% of patients. Overall survival for public versus private was 66 versus 80% (p<0.001) months. Better per stage survival of private patients 100 versus 100, 72.7 versus 93.3, 84.8 versus 88.9, 57.3 versus 77.8 and 33 versus 33% for stages 0, I, II, III and IV, did not reach statistical significance. The greatest impact on outcome was stage at presentation, but more aggressive therapy for each stage resulted in a trend to better outcome for private patients.

The financial crisis in Europe: Impact on satisfaction with life.

The 2008 financial crisis in Europe came abruptly and surprisingly. Many countries also suffered a second recession during the period 2010-2012. We examined the impact of the crisis on life satisfaction (LS) by country and individual socioeconomic level. We used a representative sample from the European Social Survey (2002-2014) with data from 26 countries ( N = 294,407). LS was measured with a single question with 11 response alternatives. Time from start of crisis (either 2008 or 2010-2012) was determined separately for each interview. Data were analyzed by multilevel analysis Results: There was a sharp decrease in LS in the beginning of the crisis in 2008, and another, but not so severe, decline in 2011, each of them of short duration. However, there was also a slight and progressive yearly decrease in LS that continued one to at least 3 years after either financial crisis that was independent of the effect of being unemployed. Associations varied considerably between countries. A negative decline after the financial crisis was especially evident among those in the most educated groups, and in those in the higher occupational levels. The 2008 financial crisis had a double effect on LS: (1) a sharp short-term decrease consistent with the Easterlin paradox; (2) a slighter long-term progressive decrease that was over and above the strong negative relationship with unemployment that lasted several years. The long-term decline in LS after the start of the financial crisis tended to occur especially in the higher socioeconomic groups.

Socioeconomic Differences in and Predictors of Home-Based Palliative Care Health Service Use in Ontario, Canada.

The use of health services may vary across people with different socioeconomic statuses, and may be determined by many factors. The purposes of this study were (i) to examine the socioeconomic differences in the propensity and intensity of use for three main home-based health services, that is, home-based palliative care physician visits, nurse visits and personal support worker (PSW) hours; and (ii) to explore the determinants of the use of home-based palliative care services. A prospective cohort study was employed. A total of 181 caregivers were interviewed biweekly over the course of the palliative care trajectory, yielding a total of 994 interviews. The propensity and intensity of health service use were examined using logistic regression and negative binomial regression, respectively. The results demonstrated that both the propensity and intensity of home-based nurse and PSW visits fell with socioeconomic status. The use of home-based palliative care services was not concentrated in high socioeconomic status groups. The common predictors of health service use in the three service categories were patient age, the Palliative Performance Scale (PPS) score and place of death. These findings may assist health service planners in the appropriate allocation of resources and service packages to meet the complex needs of palliative care populations.

Contribution of cognitive performance and cognitive decline to associations between socioeconomic factors and dementia: A cohort study.

BackgroundSocioeconomic disadvantage is a risk factor for dementia, but longitudinal studies suggest that it does not affect the rate of cognitive decline. Our objective is to understand the manner in which socioeconomic disadvantage shapes dementia risk by examining its associations with midlife cognitive performance and cognitive decline from midlife to old age, including cognitive decline trajectories in those with dementia.Methods and findingsData are drawn from the Whitehall II study (N = 10,308 at study recruitment in 1985), with cognitive function assessed at 4 waves (1997, 2002, 2007, and 2012). Sociodemographic, behavioural, and cardiometabolic risk factors from 1985 and chronic conditions until the end of follow-up in 2015 (N dementia/total = 320/9,938) allowed the use of inverse probability weighting to take into account data missing because of loss to follow-up between the study recruitment in 1985 and the introduction of cognitive tests to the study in 1997. Generalized estimating equations and Cox regression were used to assess associations of socioeconomic markers (height, education, and midlife occupation categorized as low, intermediate, and high to represent hierarchy in the socioeconomic marker) with cognitive performance, cognitive decline, and dementia (N dementia/total = 195/7,499). In those with dementia, we examined whether retrospective trajectories of cognitive decline (backward timescale) over 18 years prior to diagnosis differed as a function of socioeconomic markers. Socioeconomic disadvantage was associated with poorer cognitive performance (all p < 0.001). Using point estimates for the effect of age, the differences between the high and low socioeconomic groups corresponded to an age effect of 4, 15, and 26 years, for height, education, and midlife occupation, respectively. There was no evidence of faster cognitive decline in socioeconomically disadvantaged groups. Low occupation, but not height or education, was associated with risk of dementia (hazard ratio [HR] = 2.03 [95% confidence interval (CI) 1.23–3.36]) in an analysis adjusted for sociodemographic factors; the excess risk was unchanged after adjustment for cognitive decline but was completely attenuated after adjustment for cognitive performance. In further analyses restricted to those with dementia, retrospective cognitive trajectories over 18 years prior to dementia diagnosis showed faster cognitive decline in the high education (p = 0.006) and occupation (p = 0.001) groups such that large differences in cognitive performance in midlife were attenuated at dementia diagnosis. A major limitation of our study is the use of electronic health records rather than comprehensive dementia ascertainment.ConclusionsOur results support the passive or threshold cognitive reserve hypothesis, in that high cognitive reserve is associated with lower risk for dementia because of its association with cognitive performance, which provides a buffer against clinical expression of dementia.

Clinical profile of patients with atrophic rhinitis: descriptive study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Atrophic rhinitis is a chronic nasal disease, characterized by a triad of symptoms, namely foul odour, atrophy of nasal mucosa and crusts formation. The understanding of the pathophysiology and the management of atrophic rhinitis has long been a vexing problem for the treating clinician&lt;span lang="EN-IN"&gt;. Hence some authors have recommended adopting a capsular dissection technique in order to avoid these complications. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This present study was conducted in the Department of E.N.T, in which all the cases diagnosed as primary atrophic rhinitis and who were willing to undergo this surgery during the study period were taken for the study. Totally 20 patients were included for the study. Patients with secondary atrophic rhinitis were excluded&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study foul smelling nasal discharge and falling of crusts were the most commonest presenting symptoms which were present in all 20 patients (100%). The other presenting complaints were loss of sense of smell in 19 patients (95%), nasal obstruction in 16 patients (80%), bleeding from nose in 9 patients (45%), headache in 9 patients (45%) and maggots in 2 patients (10%)&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The incidence of atrophic rhinitis is more in low, less in middle and nil in high socio economic status group of patients and smelling nasal discharge and falling of crusts were the most commonest presenting symptoms&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Socioeconomic and demographic differences in walking and cycling in the Netherlands: How do these translate into differences in health benefits?

Walking and cycling are effective means to increase people's daily physical activity. Since little is known about how differences in walking and cycling translate into inequalities in health benefits on the population level, this study quantified these health benefits for demographic and socioeconomic groups in the Netherlands. Population-representative data on walking and cycling among adults (aged 20–90 years) for the period 2010–2014 were analyzed with the Health Economic Assessment Tool (HEAT). Results showed pronounced differences between subgroups, with women, senior citizens (50–79 years), higher socioeconomic groups, and native-Dutch people walking and cycling more than others. Given the relatively high mortality rates and high levels of walking and cycling among senior citizens, it was found that a large number of deaths were prevented in that age group. In lower socioeconomic groups, despite their lower walking and cycling levels, it was found that even more deaths were prevented, given their large population size and higher mortality rates. The proportion of health benefits was found to be greater among the native Dutch because their walking and cycling levels as well as their population size were higher than among non-native groups. The study suggests that policies to increase walking and cycling among lower socioeconomic groups could induce further health benefits in the aggregate and thus help mitigate socioeconomic health inequalities.

A study on the Relationship of the weight pattern with the socioeconomic status among adolescents school going children in an Indian Metropolitan City

Objective: The last two decades have witnessed an increase in health care costs due to obesity and related issues among children and adolescents. Childhood obesity is a global phenomenon affecting all socio-economic groups, irrespective of age, sex or ethnicity. The study was done to find the the prevalence of obesity and overweight and their association with socioeconomic status (SES) and the risk factors. Materials and Methods: School based cross sectional study carried out over a period of 4 months in three schools of East Delhi. The study was carried out in 629 school children of 10–18 years of age and belonging to different socioeconomic statuses in schools in East Delhi. The obesity and overweight were considered using an updated body mass index reference. A pre-tested questionnaire was used to determine the Socio-economic status and life style factors. Results: The prevalence of overweight among children was higher in middle socioeconomic status groups as compared to high socioeconomic class in both boys and girls whereas the prevalence of obesity was higher in high Socio economic status group as compared to middle socioeconomic group. The prevalence of obesity as well as overweight in low SES group was the lowest as compared to other group. Conclusion: The findings of this study suggest that the prevalence of overweight and obesity varies remarkably with different socioeconomic development levels.

Is the success of the SLIMMER diabetes prevention intervention modified by socioeconomic status? A randomised controlled trial.

To explore the role of socioeconomic status (SES) in participation, programme attendance, programme acceptability, adherence to lifestyle guidelines, drop-out, and effectiveness in the SLIMMER diabetes prevention intervention. SLIMMER was a randomised controlled intervention, carried out in a real-world setting, targeting 40- to 70-year-old adults at increased risk of developing type 2 diabetes (n=316). The intervention group participated in a 10-month combined dietary and physical activity programme. Measurements were carried out at baseline, 12months, and 18months. Effectiveness was determined for fasting insulin, HbA1c, weight, BMI, waist circumference, and waist-to-height-ratio. Differences between the low SES (no, primary, or lower secondary school) and higher SES group were tested using logistic regression and ANCOVA. Fifty-two percent of the SLIMMER participants had a low SES. No differences in participation were observed between the low and higher SES group. The most important reason for non-participation in the low SES group was 'lack of interest' (32%), whereas in the higher SES group this was 'I already exercise enough' (31%). Attendance, acceptability, adherence, drop-out, and effectiveness after 12months were similar in the low and higher SES group. After 18months, the low SES group seemed to maintain slightly better effects for fasting insulin, HbA1c, and waist circumference. The current study showed that participation, attendance, acceptability, adherence, drop-out, and effectiveness of the SLIMMER intervention were in general not modified by socioeconomic status. The SLIMMER intervention can contribute to health promotion for individuals in both low and higher socioeconomic groups.

'Fundamental causes' of inequalities in mortality: an empirical test of the theory in 20 European populations.

The 'fundamental causes' theory stipulates that when new opportunities for lowering mortality arise, higher socioeconomic groups will benefit more because of their greater material and non-material resources. We tested this theory using harmonised mortality data by educational level for 22 causes of death and 20 European populations from the period 1980-2010. Across all causes and populations, mortality on average declined by 2.49 per cent (95%CI: 2.04-2.92), 1.83% (1.37-2.30) and 1.34% (0.89-1.78) per annum among the high, mid and low educated, respectively. In 69 per cent of cases of declining mortality, mortality declined faster among the high than among the low educated. However, when mortality increased, less increase among the high educated was found in only 46 per cent of cases. Faster mortality decline among the high educated was more manifest for causes of death amenable to intervention than for non-amenable causes. The difference in mortality decline between education groups was not larger when income inequalities were greater. While our results provide support for the fundamental causes theory, our results suggest that other mechanisms than the theory implies also play a role.

Obesity and its socioeconomic determinants in Iran

ObjectiveTo investigate the socioeconomic inequality of obesity and its determinants in Iran. MethodsData was from Iran's surveillance system for risk factors of non-communicable diseases which was conducted on 89,400 individuals aged 15–64 years in 2005. Principal component analysis was used to create a new variable for defining socioeconomic status of participants. We assessed inequality by calculating a slop index of inequality and concentration index for obesity. Oaxaca-Blinder decomposition analysis was used to determine the determinants of inequality. ResultsThe slop index of inequality and concentration index for obesity was −13.1 (95% Confidence Intervals [CI]: −16.3 to −9.8) percentage points and −0.123, respectively. The level of inequality varied widely between different provinces in Iran and was more severe in women and urban population. Obesity persisted in 20.2% (95% CI: 19.4–20.9) of the low-socioeconomic group and 11.0% (95% CI: 10.5–11.6) of the high-socioeconomic group. More than 90% of this gap was due to differences of independent variables (mainly age, gender and marital status) in two socioeconomic status groups. ConclusionsA pro-rich inequality existed in the obesity in Iran. Older age, female gender and rural residency contributed most to the economic inequality of obesity.

Does social distinction contribute to socioeconomic inequalities in diet: the case of \u2018superfoods\u2019 consumption

BackgroundThe key mechanisms underlying socioeconomic inequalities in dietary intake are still poorly understood, hampering the development of interventions. An important, but sparsely mentioned mechanism is that of ‘social distinction’, whereby those in a higher socioeconomic position adopt dietary patterns by which they can distinguish themselves from lower socioeconomic groups. We investigated the importance of distinction as a mechanism, by testing the socioeconomic gradient in the consumption of so-called ‘superfoods’ and the contribution of a well-established indicator of distinction, cultural participation.MethodsData from participants (25–75 years) of the 2014 survey of the Dutch population-based GLOBE study were used (N = 2812). Multivariable regression models were used to analyse the association between education, income and cultural participation (e.g. visits to museums, opera, theatre, concerts) and the consumption of superfoods (spelt, quinoa and goji berries, chia seeds or wheatgrass).ResultsThe consumption of superfoods is far more prevalent among higher socioeconomic groups. Adjusting for cultural participation strongly attenuated the educational and income gradient in superfoods consumption, whereas cultural participation remained strongly associated with superfoods consumption. Those in the highest quintile of cultural participation reported the highest consumption of spelt products (OR = 2.97, 95% CI = 2.10;4.18), quinoa (OR = 3.50, 95% CI = 2.12;5.79) and goji berries, chia seeds or wheatgrass (OR = 2.69, 95% CI = 1.73;4.17).ConclusionsThe associations between socioeconomic position and the consumption of ‘superfoods’ seem to be partially driven by a process of social distinction. These findings suggest that distinction may be an important, but currently neglected mechanism in generating socioeconomic inequalities in dietary intake. It deserves a more prominent role in interventions to reduce these inequalities.

Identifying adverse effects of area-based health policy: An ethnographic study of a deprived neighbourhood in England

Health interventions commonly have adverse effects. Addressing these could significantly improve health outcomes. This paper addresses an adverse effect common in the promotion of health behaviours: exacerbation of health inequalities between low- and high-socioeconomic groups. Health behaviours – particularly, physical activity - are positioned within the context of social inequality and the inequitable spatial distribution of resources. Area-based health policy that targets deprived areas is assessed for its capacity to promote health behaviours without exacerbating inequality. Data are derived from a 16-month ethnography in a deprived English neighbourhood that was the target of area-based intervention that prioritised the promotion of physical activity. Findings provide evidence of adverse intervention effects that further disadvantaged the low-socioeconomic population. Analysis demonstrates how this was ultimately the outcome of localised policy drifting away from initial commitments to equitable service access. These findings increase understanding of the processes through which adverse intervention effects arise and how they can be mitigated.

Contrasting temporal trends in lung cancer incidence by socioeconomic status among women in New South Wales, Australia, 1985–2009

ObjectiveWe examined long-term trends in lung cancer incidence for women by socioeconomic groups in New South Wales (NSW), Australia. MethodsData on lung cancer incidence for women were extracted from the NSW Cancer Registry database. We divided the study cohort into five quintiles according to an area-based index of education and occupation (IEO) and calculated annual age-standardised incidence rates by IEO quintile for the period 1985–2009. The age-standardised incidence ratio (SIR) was estimated for IEO quintiles and 5-year period of diagnosis using the highest IEO quintile as the reference. ResultsOverall, lung cancer incidence for women aged 25–69 years increased gradually from 19.8 per 100,000 in 1985 to 25.7 per 100,000 in 2009. The trends by IEO quintile were somewhat comparable from 1985 through to 1995, but from then on rates remained relatively stable for women residing in the highest quintile while increasing for women residing in the remaining four quintiles. Consequently, the SIR for all four of the lower IEO quintiles increased significantly over the 25-year period. For example, the SIR in the lowest IEO quintile increased from 1.16 (95% CI, 0.99–1.37) during 1985–1989 to 1.70 (95% CI, 1.50–1.93) during 2005–2009. The corresponding estimates for women aged 70 years or older showed no clear pattern of socioeconomic gradient. ConclusionThe increasing gap in lung cancer incidence between women in the highest socioeconomic group and all others suggests that there is a continued need for the broad implementation of tobacco control interventions, so that smoking prevalence is reduced across all segments of the population and the subsequent benefits are shared more equitably across all demographic groups.

Parents' education and literacy skills: Evidence on inequality of socioeconomic status in Arab countries

The international comparative assessments of students’ achievement have revealed that students in MENA countries have meager literacy skills compared to their peers in other countries. The success of these countries in expanding access to schooling has not been followed by a similar access in equipping students with cognitive skills which are deemed to be important in this knowledge economy. In addition to the low achievement, the persistent inequalities in this region may contribute in the longer run to widen the gap between students from higher socioeconomic groups and those from low socioeconomic groups. A recent study conducted by Isfahani, Belhaj Hassine, and Assaad (2014) shows that a large share of inequality in achievement in MENA countries is due to family background and community characteristics. This study aims to contribute to the growing and rare research papers on inequalities in MENA region. It addresses the disparities in test scores of students in four MENA countries that took part in PISA 2012 assessment, by examining the impact of socioeconomic factors on these scores. Following Martins and Veiga (2010), the study uses two different methodologies. The first one assesses the impact of each component of SES students’ achievement including the school SES composition using hierarchical linear models (HLM). The second one is inherited from medical studies and makes use of the decomposition of the concentration index. The results suggest that parents’ education and school socioeconomic status are positively linked to academic achievement and both of them contribute to the socioeconomic-related inequality in achievement in all countries under study. They are the main, if not the sole drivers of inequality.

Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review.

SummaryBackgroundNon-communicable diseases are the leading global cause of death and disproportionately afflict those living in low-income and lower-middle-income countries (LLMICs). The association between socioeconomic status and non-communicable disease behavioural risk factors is well established in high-income countries, but it is not clear how behavioural risk factors are distributed within LLMICs. We aimed to systematically review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within LLMICs.MethodsWe searched 13 electronic databases, including Embase and MEDLINE, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. No age or language restrictions were applied. We excluded studies that did not allow comparison between more or less advantaged groups. We used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Due to high heterogeneity, we used a narrative approach for data synthesis. We used descriptive statistics to assess whether the prevalence of each risk factor varied significantly between members of different socioeconomic groups. The study protocol is registered with PROSPERO, number CRD42015026604.FindingsAfter reviewing 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals older than 10 years from 39 LLMICs. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than did high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of high socioeconomic status. High socioeconomic groups were found to be less physically active and consume more fats, salt, and processed food than individuals of low socioeconomic status. While the included studies presented clear patterns for tobacco use and physical activity, heterogeneity between dietary outcome measures and a paucity of evidence around harmful alcohol use limit the certainty of these findings.InterpretationDespite significant heterogeneity in exposure and outcome measures, clear evidence shows that the burden of behavioural risk factors is affected by socioeconomic position within LLMICs. Governments seeking to meet Sustainable Development Goal (SDG) 3.4—reducing premature non-communicable disease mortality by a third by 2030—should leverage their development budgets to address the poverty-health nexus in these settings. Our findings also have significance for health workers serving these populations and policy makers tasked with preventing and controlling the rise of non-communicable diseases.FundingWHO.

Disparities in death: Inequality in cause-specific infant and child mortality in Stockholm, 1878‒1926

Background: The decline of child mortality during the late 19th century is one of the most significant demographic changes in human history. However, there is evidence suggesting that the substantial reductions in mortality during the era did little to reduce mortality inequality between socioeconomic groups.Objective: The aim of this study is to examine the development of socioeconomic inequalities in cause-specific infant and child mortality during Stockholm’s demographic transition.Methods: Using an individual-level longitudinal population register for Stockholm, Sweden, between 1878 and 1926, I estimate Cox proportional hazards models to study how inequality in cause-specific hazards of dying from six categories of causes varied over time. The categories included are 1) airborne and 2) food and waterborne infectious diseases, 3) other infectious diseases, 4) noninfectious diseases and accidents, 5) perinatal causes, and 6) unspecified causes.Results: The results show that class differentials in nearly all causes of death converged during the demographic transition. The only exception was the airborne infectious disease category, for which the gap between white-collar and unskilled blue-collar workers widened over time.Conclusions: The results demonstrate that, even in a context of falling mortality and a changing epidemiological environment, higher socioeconomic groups were able to maintain a health advantage for their children by reducing their risks of dying from airborne disease to a greater extent than other groups. Potential explanations for these patterns are suggested, as well as suggestions for future research.Contribution: This is the first paper to use individual-level cause-of-death data to study the long-term trends in inequality of cause-specific child mortality during the demographic transition.

Changing socioeconomic inequalities in cancer incidence and mortality: Cohort study with 54 million person-years follow-up 1981-2011.

Cancer is increasingly responsible for the mortality gap between high and low socioeconomic position groups in high-income countries. This study investigates which cancers are contributing more to socioeconomic gaps in mortality and how this changes over time.New Zealand census data from 1981, 1986, 1991, 1996, 2001 and 2006, were linked to three to five years of subsequent mortality and cancer registrations, resulting in 54 and 42 million years of follow-up cancer incidence and mortality, respectively. Age- and ethnicity-standardised cancer mortality rates and the slope index of inequality (SII) by income were calculated.The contribution of cancer to absolute inequalities (SII) in mortality increased from 16 to 27% for men and from 12 to 31% for women from 1981-84 to 2006-11, peaking in 1991-94 for men and in 1996-99 for women and then levelling off, parallel to peaks in lung cancer inequalities. Lung cancer was the largest driver of cancer inequality trends (49% of the cancer mortality gap in 1981-84 to 33% in 2006-11 for men and 32 to 33% for women) followed by colorectal cancer in men (2 to 11%) and breast cancer in women (declining from 44 to 13%). Women in the lowest income quintile experienced no decline in cancer mortality.The contribution of cancer to income inequalities in all-cause mortality has expanded in this high-income country. Action to address socioeconomic inequalities should prioritise equitable tobacco control, obesity control and improved access to cancer screening, early diagnosis and high quality treatment for those with the lowest incomes.

A study of the dietary habits of school children in Pune city, Maharashtra, India

Background: Diet and nutrition of children influence their current health status and scholastic performance and also have long term consequences reaching well into their adulthood. Further, diet preferences and practices acquired during childhood usually persist for life. Data on nutritional intake of school children is required by public health policy makers to be able to formulate nutritional intervention and also for nutritionists and general practioners to be able to advice parents and care givers regarding the inadequacies in the diet. This study was carried out in Pune city, to study the dietary patterns and preferences of school children in the age group five to eleven years.Methods: Qualitative diet survey was carried out by oral questionnaire method. The data collected was on the food habits, frequency of various types of food eaten and the preferences/dislike to various food items. A database was created in MS Excel and Epi Info was used to analyze data. Appropriate inferential and descriptive statistics were calculated.Results: Around 50% of the children were non-vegetarians and only around 6% were vegetarians. Around 70% of children consumed milk daily though a majority insisted that milk is their least preferred food item. Only 5% children consumed green leafy vegetables daily. A majority of children consumed fruits two to six times. Snacks, fast food and processed food were the most preferred food by the children.Conclusions: Food habits acquired during childhood persist into adulthood and form the basis of either good health or ill health, as the case may be, in the coming years. Hence there is a need to educate parents, especially in the middle and higher socioeconomic groups regarding correct dietary habits for the children to ensure that they can live healthy and productive lives as adults.

Comparison of nutritional status between patients from urban area with rural area undergoing hemodialysis in Kushtia district, Bangladesh: a cross-sectional study

Malnutrition is a common problem in patients with end stage kidney disease (ESKD) undergoing hemodialysis that increases morbidity and mortality rate in Bangladesh. The main objective of this cross sectional study was carried out to compare the nutritional status between urban patients with rural patients undergoing hemodialysis. End-stage renal-failure outpatients who underwent hemodialysis were recruited from Sono Hospital Limited, Kushtia, Bangladesh. Direct method of nutritional assessment including anthropometric measurement, biochemical measurement, clinical assessment and dietary method was carried out. Socio economic data were also collected. The result reveals that 69.0% of the total participants were male and 31.0% were female. The mean age of male was 46.10±13.23 years and that of female was 43.11±16.47 years. Among 142 cases 50.0% were from urban area and 50.0% were from rural area. 53.5% of the total participants were economically satisfied and 46.5% were non-satisfied. 76.3% of high socioeconomic group consisted of urban area and 23.7% consisted of rural area. Again 19.7% of low socioeconomic group consisted of urban area and 80.3% consisted of rural area. According to WHO classification for BMI 15.5% had BMI below 18.5kg/m2 in urban and 18.3% had BMI below 18.5kg/m2 in rural area. Of the total participants 97.2% were anemic, 66.9% had anorexia, 69.7% had depression, 63.4% had nausea, 58.5% had vomiting, 30.3% had heartburn, 47.2% had constipation, 38.0% had dizziness, 19.7% had chest pain, 5.6% had dysphagia, 34.5% had fatigue, 48.6% had headache, 26.1% had diarrhea, 50.7% had pruritus and 13.4% had shortness of breath. Mean±SD hemoglobin level of urban participants was 8.37±1.46 and that of rural participants was 8.12±1.85. The result shows that malnutrition was more prevalent among rural hemodialysis patients than that of urban. The cause of malnutrition was related to low socioeconomic condition and inadequate nutrient intake.Asian J. Med. Biol. Res. December 2016, 2(4): 603-610