Higher Socioeconomic Status Groups Research Articles

Analysis of Socio-Economic Status and Gender Related Differential Item Functioning Using Item Response Theory Approach

The study investigated detecting differential item functioning using item response theory in West African Senior School Certificate English language test in south-south Nigeria. 2 research questions were formulated to guide the study. Using descriptive research survey design for the study, study population was 117845 Senior Secondary 3 students in Edo, Delta, Rivers and Bayelsa state. A sample of 1309 (604 males, 705 females) drawn through multi stage sampling technique was used for the study. Two valid instruments titled: Socio-economic status questionnaire (SSQ) and WASSCE/SSCE English language objective test (ELOT) were used to collect data for the study. The reliability indices of the instruments were estimated using the Cronbach Alpha method of internal consistency and Richard Kuderson 20 with coefficient values of .84 for the English Language objective test and .71 for the socio-economic status questionnaire respectively. Chi-square and Lord Wald test statistics statistical technique employed by Item Response Theory for Patient Reported Outcome (IRTPRO) was the technique used in data analysis which provided answers to the research questions at.05 level of significance. On analysis, the result revealed that 13 items functioned differently significant between the male and female group and significantly 23 items differentially functioned between High and low socio-economic status group. Thus, this shows 18% DIF based on gender and 32% based on socio-economic status indicating large DIF and items that are potentially biased. Based on the findings, recommendation were made and one among others was that Item Response theory should be used as DIF detection method by large scale public examination and test developers.

Valenced social identities and the digital divide in online health communities

Online health communities (OHCs) often struggle to retain active users because they endow users with both a positive and a stigmatized social identity that respectively encourages and discourages their engagement. We integrate social identity theory with the concepts of social stigma, psychological capital, and digital divide to investigate this phenomenon. We collected survey data from 221 users from one large online lymphoma community in November 2017. We find that users' positive social identity had a positive influence on how they perceived the effectiveness of OHCs and this influence was stronger for the high socio-economic status (SES) group; at the same time, a stigmatized social identity had a negative influence on perceived effectiveness of OHCs and this influence was stronger for the low SES group. Moreover, users’ perceived effectiveness of OHCs had positive influences on their participation and recommendation intentions, and the influences on participation and recommendation intentions were stronger for the high and the low SES group, respectively. Our study highlights the dual influences of valenced social identities on user engagement with OHCs through their effectiveness perceptions and interprets these influences through the lens of digital divide. The findings also offer practical insights for the effective management of OHCs.

Exploring the use of workplaces to recruit \u201chard-to-reach\u201d male drinkers to a survey on alcohol use and awareness of health messages

BackgroundLower socioeconomic status (SES) groups, particularly lower SES males, are at greater risk of alcohol-related harm than higher SES groups, despite drinking at the same level or less. However, they are rarely recruited for research through typical recruitment strategies. Consequently, limited evidence exists on patterns of alcohol use and effectiveness of public health messages for these groups. Using workplaces to recruit male drinkers from lower SES backgrounds may provide a feasible and accessible approach to research participation and enable improved understanding of alcohol use, drinking motives and acceptance of alcohol-related public health messages in this underrepresented and high-risk group. We investigated workplace-based strategies to recruit male drinkers from lower SES backgrounds. We also investigated their experiences and motivations for alcohol use, and acceptance of alcohol-related public health messages.MethodsA feasibility element investigated the effectiveness of workplace-based strategies to recruit male drinkers from lower SES backgrounds in the south west of England. A pilot element investigated this population’s experiences and motivations for alcohol use, and acceptance of alcohol-related public health messages, through a mixed-methods survey.ResultsFeasibility results indicated that workplace-based recruitment strategies, including recruiting participants in person at their workplace and providing a financial incentive, effectively led to the recruitment of 84 male drinkers (70% recruitment rate), predominately from lower SES backgrounds, to a survey. Pilot results indicated that more than half of participants were at increasing risk of alcohol-related harm, and approximately one fifth engaged in weekly heavy episodic drinking. Participation in campaigns aimed at reducing alcohol use, and knowledge of government alcohol consumption guidelines, were low. Participants reported negative beliefs about alcohol including health effects, dependency and excess use, and financial and occupational effects. Positive beliefs about alcohol included relaxation, socialising, and enjoyment.ConclusionsWorkplace-based recruitment, using in-person recruitment and a financial incentive, may be a feasible strategy to recruit male drinkers from lower SES backgrounds. Pilot results may direct larger scale research aiming to understand alcohol use in this population and inform targeted public health messages. Workplace-based recruitment may represent a promising avenue for future research aiming to tackle inequalities in participation in alcohol research.

A STUDY OF MORAL JUDGMENT OF SCHOOL CHILDREN BELONGING TO DIFFERENT SOCIO-ECONOMIC STATUS AND SCHOOL BACKGROUNDS

Socio Economic Status (SES) is one among important indicators to evaluate the health and nutritional status of family. It is a position attained by an individual within a system of hierarchical social structure. The present study examines the moral judgment of school children belonging to different socio economic status and school background.The sample of 100 students from convent school background and 100 from nagar palika background was selected by adopting stratified simple random sampling technique.In case of convent schools, students of low SES group have shown better moral judgment than the students of high SES group. There exists no significant difference in the moral judgment of high and low S.E.S. group students of Nagar Palika background schools.

Subtle Increments in Socioeconomic Status and Bilingualism Jointly Affect Children’s Verbal and Nonverbal Performance

ABSTRACT In contrast to research that examines the effects of socioeconomic status (SES) and bilingualism on development by comparing clearly disparate groups, the present study investigated the role of subtle differences in these experiences for their joint impact on performance on a verbal fluency task and an executive function (EF) task. The study involved 234 6-year-old children who were assessed for nonverbal intelligence and English vocabulary; parents completed a questionnaire providing demographic information and details about children’s language experiences. Children were assigned continuous scores for SES based on parents’ education and for bilingualism based on experience with non-English languages. Both continuous scores were normally distributed, so median split calculations created binary groups indicating relative levels of SES (high vs. middle) and bilingualism (more monolingual vs. more bilingual). For verbal fluency, there were no group differences in semantic fluency but phonological fluency was performed better by children from higher SES backgrounds, both in between-group and continuous analyses. For EF, the between-group analysis revealed an interaction in which bilingual children in the higher SES group outperformed all other children; nonetheless, a positive relation between degree of bilingualism and EF was significant across the whole sample. Thus, both SES and bilingualism affected language and cognitive development with limiting conditions for each experience. The discussion considers the effect of these subtle differences in SES and bilingual experience on development of essential cognitive abilities, the relation between these results and previous research, and the importance of how groups are defined in research addressing individual differences.

Socioeconomic status during youth and risk of car crash during adulthood. Findings from the DRIVE cohort study

BackgroundYoung drivers of low socioeconomic status (SES) have a disproportionally high risk of crashing compared with their more affluent counterparts. Little is known if this risk persists into adulthood and...

Social Support and Academic Burnout Among University Students: A Moderated Mediation Model.

PurposeAn increasing number of studies have been carried out to investigate the relationship between social support and study motivation among university students, but underlying mechanisms behind this pathway have not been fully verified. In the present study, we aimed to test the effect of social support on academic burnout (decrease in study motivation); examine the mediating effect of life satisfaction on the association between social support and academic burnout; and explore whether this mediating effect varied across (moderated mediation) students of different socioeconomic status (SES).Materials and MethodsData for 503 students were collected in a Chinese university through a composited survey regarding social support, life satisfaction, SES, and academic burnout. Data analysis and the investigation of combined effects in the model were carried out via conditional process modeling.ResultsResults indicated that social support was negatively associated with academic burnout. In addition, life satisfaction had a partial mediation effect on the relationship between social support and academic burnout, and SES moderated this mediation effect. Specifically, the mediation effect was found to be more significant among students in the high SES group than those in the lower one.ConclusionThis study is novel in that it establishes empirically how academic burnout is associated with a typical society analytical variable (ie, social support) among students in tertiary education. It also investigates an alternative scenario to explain the underlying mechanism of social support on academic burnout against the most popular explaining model. Implications of the study for effective elimination of the decrease in study motivation across students with different SES are discussed.

Effectiveness of a universal vaccination program with an HPV quadrivalent vaccine in young Brazilian women

We examined human papillomavirus (HPV) vaccine effectiveness in a nationwide sample of women aged 16 to 25 years who utilized the public health system in Brazil. This was a cross-sectional, multicentric survey conducted between September 2016 and November 2017 (POP-Brazil Study). A total of 5,945 young adult women were recruited from 119 public primary care units from all 27 federative units of Brazil by trained health professionals. The participants participated in a face-to-face interview and provided biological samples for genital HPV analysis. HPV genotyping was performed using a Linear Array HPV genotyping test in a central laboratory. Sampling weights were applied to the data. Overall, 11.92% (95% CI 10.65, 13.20) of the participants reported having been vaccinated. The frequency of vaccination was highest in 16- to 17-year-old women, with a decreasing vaccination rate with increasing age, and vaccinated women were more likely to belong to the high socioeconomic status group. The use of a quadrivalent vaccine decreased the HPV types 6, 11, 16, and 18 by 56.78%, from 15.64% in unvaccinated women to 6.76% in vaccinated women (P < 0.01), even after adjustment for age. Those who received the vaccine had lower HPV 16 (2.34% in vaccinated vs 8.91% in unvaccinated, P < 0.01) and 6 rates (2.06% vs 5.77%, P < 0.01). Additionally, a higher rate of high-risk HPV types other than HPV 16 and 18 (40.47% in vaccinated vs 32.63% in unvaccinated, P < 0.01) was observed. In conclusion, the results of this study support the effectiveness of HPV vaccination in Brazil. Continuous surveillance must be assured to monitor the HPV infection rate in the vaccination era.

Decomposition of socioeconomic inequality in growth disorders to its determinants in pediatric population: the CASPIAN IV study.

The current study aims to evaluate socioeconomic inequality in growth disorders and its determinants in Iranian children and adolescents. In this nationwide cross-sectional survey, 14,880 students aged 6-18years were selected through multistage cluster sampling method from urban and rural areas of 30 provinces of Iran in 2011. Socioeconomic status (SES) was calculated using principle component analysis. Socioeconomic inequality in growth disorders (including; underweight, excess weight, overweight, general obesity, abdominal obesity, and short stature) was assessed using concentration index (C) and slope index of inequality (SII). The Oaxaca Blinder decomposition method was used to determine determinants of this inequality. Totally, 13,486 students participated in this study (participation rate: 90.6%), comprising 50.8% boys and 75.6% urban inhabitants. Their mean age was 12.47 ± 3.36years with no significant gender difference. The prevalence of excess weight, overweight, and general and abdominal obesity increased linearly as SES increased, and the prevalence of underweight and short stature decreased linearly as SES increased. The C index for underweight and short stature was negative, which suggests that inequality was in favor of high SES groups, and regarding overweight, excess weight, general and abdominal obesity, the index was positive, indicating that inequality was in favor of in low SES groups. Our findings show a considerable inequality in prevalence of growth disorders in Iranian children and adolescents. These findings provide practical information for health policies and programs.

Time trends of socioeconomic inequalities in adolescent smoking in Okinawa, Japan, 2008\u20132016: a repeated cross-sectional study

BackgroundSmoking among Japanese adolescents has decreased noticeably. However, little is known whether the decreasing trend in adolescent smoking can be seen across all socioeconomic status (SES) groups. This study aimed to examine trends in socioeconomic inequalities in smoking among Japanese adolescents between 2008 and 2016.MethodsWe conducted a repeated cross-sectional study using data from three surveys of high school students in Okinawa, Japan, in 2008, 2012, and 2016. The study participants consisted of 7902 students in grades 10 through 12 (15–18 years). Smoking was assessed as current cigarette use. SES indicators included familial SES (parental education and family structure) and student’s own SES (school type). To evaluate absolute and relative inequalities, prevalence differences (PDs) and ratios (PRs) between low and high SES groups were estimated. The slope index of inequality (SII) and relative index of inequality (RII) were also calculated.ResultsSmoking prevalence among boys and girls significantly declined from 11.5% and 6.2% in 2008 to 4.7% and 1.9% in 2016, respectively. Similar decreasing trends in smoking were found among most of the SES groups. The PDs and SII for parental education in boys and family structure in girls decreased over time while those for school type persisted among boys and girls. The PRs and RII for school type in boys increased while those for other SES indicators among both sexes remained stable over time.ConclusionsSmoking among Japanese adolescents has been declining and time trends of socioeconomic inequalities in smoking varied by absolute and relative measures. Further policies and/or interventions to reduce smoking inequalities should focus on the context of schools, especially in vocational high schools.

Inequality, chronic undernutrition, maternity, and diabetes mellitus as the determinant of anemia among ever-married women in Bangladesh

BackgroundAnemia is a public health concern at a global level. This study aims to delineate the association between household economic inequalities, and anemia among reproductive age group women in Bangladesh, along with other confounders.MethodsA cross-sectional population sample from Bangladesh Demographic and health survey data comprising of 5920 reproductive age group women aged between 15 and 49 years was used in this study. The analyses were performed through the application of proportional odds into four models (viz., Model:1 socio-economic, Model:2 socio-demographic factors, Model 3: diabetics and maternity statis, Model 4: nutritional status.)ResultsThe respondents from low and medium socioeconomic status (SES) households vs. richest households were 1.90 (95% CI, 1.65,2.17; p < .01) and 1.41 (95% CI, 1.12,1.78; p < .01) times more likely to suffer from anemia (Model 1). From the model 2 it appears that he likelihood of being anemic reduces for the low and medium SES groups vs. high SES group when sociodemographic variables are added (OR, 1.69, 95% CI, 1.43,1.99 and OR, 1.35, 95% CI, .07,1.70; p < 0.01, respectively). Model 3 evident that after adding the variables of diabetes and maternity status, the association between having anemia belonging to low and medium SES vs. high SES becomes weaker (OR1.36, 95% CI,0.85,2.15 and OR, 1.15, 95% CI, 0.6,2.19; p > .05, respectively). Moreover, the strength of the association between anemia and the subjects with pregnant vs. the subjects without these (OR: 1.7 (1.12, 4.02; p < 0.05) 1.47(0.11,3.399; p < 0.05) conditions was reduced after factoring body mass index (BMI, model 4). Besides, thin women (MBI < 18.50 Kg/m2) shows significantly become more likely to be anemic in comparison to women of normal BMI (OR:1.34, .92,1.96; p < 0.05) (model 4).ConclusionsBMI, pregnancy, and diabetes mellitus were observed to be significantly associated with anemia, and the strength of the association was low with anemia and socioeconomic inequality.

A Pancreatic Cancer Multidisciplinary Clinic Eliminates Socioeconomic Disparities in Treatment and Improves Survival.

National studies have demonstrated disparities in the treatment and survival of pancreatic cancer patients based on socioeconomic status (SES). This study aimed to identify specific differences in perioperative management and outcomes based on patient SES and to study the role of a multidisciplinary clinic (MDC) in mitigating any variations. The study analyzed patients undergoing pancreaticoduodenectomy for pancreatic ductal adenocarcinoma in a large hospital system. The patients were categorized into groups of high and low SES and whether they were managed by the authors' pancreatic cancer MDC or not. The study compared differences in disease characteristics, receipt of multimodality therapy, perioperative outcomes, and recurrence-free and overall survival. Of the 162 low-SES patients and 119 high-SES patients, 54% were managed in the MDC. Outside the MDC, low-SES patients were less likely to receive neoadjuvant chemotherapy and had less minimally invasive surgery, a longer OR time, less enhanced recovery participation, and more major complications (p<0.05). No SES disparities were observed among the MDC patients. Despite similar tumor characteristics, the low-SES patients had inferior median overall survival (21 vs 32 months; p=0.005), but the MDC appeared to eliminate this disparity. Low SES correlated with inferior survival for the non-MDC patients (17 vs 32 months; p<0.001), but not for the MDC patients (24 vs 25 months; p=0.33). These findings persisted in the multivariable analysis. A pancreatic cancer MDC standardizes treatment decisions, eliminates disparities in surgical outcomes, and improves survival for low-SES patients.

Sex, Age, and Socioeconomic Differences in Nonfatal Stroke Incidence and Subsequent Major Adverse Outcomes.

Data about variations in stroke incidence and subsequent major adverse outcomes are essential to inform secondary prevention and prioritizing resources to those at the greatest risk of major adverse end points. We aimed to describe the age, sex, and socioeconomic differences in the rates of first nonfatal stroke and subsequent major adverse outcomes. The cohort study used linked Clinical Practice Research Datalink and Hospital Episode Statistics data from the United Kingdom. The incidence rate (IR) ratio of first nonfatal stroke and subsequent major adverse outcomes (composite major adverse cardiovascular events, recurrent stroke, cardiovascular disease-related, and all-cause mortality) were calculated and presented by year, sex, age group, and socioeconomic status based on an individual's location of residence, in adults with incident nonfatal stroke diagnosis between 1998 and 2017. A total of 82 774 first nonfatal stroke events were recorded in either primary care or hospital data-an IR of 109.20 per 100 000 person-years (95% CI, 108.46-109.95). Incidence was significantly higher in women compared with men (IR ratio, 1.13 [95% CI, 1.12-1.15]; P<0.001). Rates adjusted for age and sex were higher in the lowest compared with the highest socioeconomic status group (IR ratio, 1.10 [95% CI, 1.08-1.13]; P<0.001). For subsequent major adverse outcomes, the overall incidence for major adverse cardiovascular event was 38.05 per 100 person-years (95% CI, 37.71-38.39) with a slightly higher incidence in women compared with men (38.42 versus 37.62; IR ratio, 1.02 [95% CI, 1.00-1.04]; P=0.0229). Age and socioeconomic status largely accounted for the observed higher incidence of adverse outcomes in women. In the United Kingdom, incidence of initial stroke and subsequent major adverse outcomes are higher in women, older populations, and people living in socially deprived areas.

Polysomnographic Study to Evaluate Obstructive Sleep Apnoea Syndrome in Obese and Non Obese Adolescents

Introduction: Obesity in adolescents is an emerging problem in developing countries like India, especially among higher socioeconomic status group. Obesity is the most important reversible risk factor for Obstructive Sleep Apnoea Syndrome (OSAS) in adolescents. Adolescent obesity with OSAS if not treated, can result in serious morbidity in cognitive, cardiovascular, somatic growth, development and metabolic disorders in future. Aim: To compare the sleep pattern between the obese and non obese adolescents and to evaluate OSAS. Materials and Methods: This was an observational study carried out at Life Style Laboratory, Department of Physiology, Bangalore Medical College and Research Institute, Karnataka, India. The study involved 30 obese and 30 non obese male adolescents, who were subjected to overnight Polysomnography (PSG) in the sleep laboratory. According to Kale’s criteria, epochs were manually scored which were compiled and statistically analysed for parameters like Sleep Latency (SL), Actual Sleep Time (AST), wake after sleep onset, percentage of Non Rapid Eye Movement (NREM), Rapid Eye Movement (REM) sleep stages, Sleep Efficiency (SE). The number of apnoeas and hypopnoeas were also noted to calculate Apnoea Hypopnoea Index (AHI). These parameters were compared for statistical significance using student t-test. Adolescents with AHI ≥1 were diagnosed with OSAS. Results: Mean age of obese adolescents was 17.7±0.97 years and their mean BMI was 28±0.73 kg/m2. OSAS was found in 22 out of 30 obese (73%) and 14 out of 30 (46%) non obese adolescents. It was found that apnoeas (3±4.80 vs 1±0.89), hypopnoeas (27.36±26.5 vs 5.46±2.97) and AHI (4.17±3.90 vs 0.89±0.43) were significantly more among obese adolescents when compared with non obese adolescents respectively. PSG parameters like SL, Wake After Sleep Onset (WASO) were prolonged and AST, SE were reduced significantly in obese adolescents. Conclusion: Adolescents with obesity had greater occurrence of OSAS, along with altered sleep architecture in them.

Testing of a Dual Process Model to Resolve the Socioeconomic Health Disparities: A Tale of Two Asian Countries.

A wealth of past studies documented that individuals of lower socioeconomic status (SES) are more susceptible to both acute and chronic life stress than those of higher SES, but some recent evidence documents that not all individuals from the lower SES group experience immense stress. The present study was grounded in theories of coping and psychological adjustment, and a dual process model was formulated to address some resolved issues regarding socioeconomic disparities in health. For a robust test of the proposed dual process model, data were collected from two Asian countries—Hong Kong and Indonesia—with different socioeconomic heritage and conditions. Consistent with the predictions of our model, the present findings revealed that coping flexibility was a psychological mechanism underlying the positive association between social capital and health for the lower SES group, whereas active coping was a psychological mechanism underlying this positive association for the higher SES group. These patterns of results were largely replicable in both Asian samples, providing robust empirical support for the proposed dual process model.

Beyond the social gradient: the role of lifelong socioeconomic status in older adults' health trajectories.

Inequalities in older adults’ health rarely consider life-course aspects of socioeconomic status (SES). We examined the association between lifelong SES and old-age health trajectories, and explored the role of lifestyle factors and depressive symptoms in this association. We followed 2760 adults aged 60+ from the Swedish National Study on Care and Aging, Kungsholmen. SES groups were derived using latent class analysis incorporating seven socioeconomic measures spanning childhood, midlife, and late life. We measured health using the Health Assessment Tool, which combines gait speed, cognition, multimorbidity, and disability. Linear mixed models were used to estimate health trajectories. Four SES groups were identified: High (34.9%), Middle (40.2%), Low (21.2%), and Mixed (3.8%). The Mixed group reported greater financial difficulties in childhood and older age, but varying SES attainment in midlife. Baseline health scores indicated that Mixed SES experienced substantial cognitive and physical deficits 12 years earlier than the High SES group. Compared to the High SES group, the Mixed SES group had the fastest health deterioration (β×time=−0.07, 95% CI:−0.11,−0.02); other groups followed a gradient (High>Middle>Low). Lifestyle factors and depressive symptoms attenuated the gradient but did not explain Mixed group’s health disadvantage. Life-long SES measures are crucial for understanding older adults’ health inequalities.

SES differences in marital fertility widened during the fertility transition\u2014evidence from global micro-level population data

The decline in human fertility during the demographic transition is one of the most profound changes to human living conditions. To gain a better understanding of this transition we investigate the association between socioeconomic status (SES) and marital fertility in different fertility regimes in a global and historical perspective. We use data for a large number women in 91 different countries for the period 1703–2018 (N = 116,612,473). In the pre-transitional fertility regime the highest SES group had somewhat lower marital fertility than other groups both in terms of children ever born (CEB) and number of surviving children under 5 (CWR). Over the course of the fertility transition, as measured by the different fertility regimes, these rather small initial SES differentials in marital fertility widened, both for CEB and CWR. There was no indication of a convergence in marital fertility by SES in the later stages of the transition. Our results imply a universally negative association between SES and marital fertility and that the fertility differentials widened during the fertility transition.

Abstract 16911: Socioeconomic Status as a Predictor of Post-Operative Mortality and Outcomes in Carotid Artery Stenting vs Carotid Endarterectomy

Introduction: The association between socioeconomic status (SES) and adverse surgical outcomes represents an emerging area of concern. Furthermore, with regard to carotid stenosis, Carotid Artery Stenting (CAS) has been demonstrated to pose a greater risk of postoperative complications, such as stroke, than Carotid Endarterectomy (CEA). This study aims to compare the impact of low SES on patients undergoing Carotid Artery Stenting (CAS) versus Carotid Endarterectomy (CEA). Methods: The National Inpatient Sample (NIS) was queried from 2010 to 2015. Patients who underwent CAS and CEA were identified. Patients of the highest and lowest median income quartiles by zip code were selected and compared based on demographics, hospital characteristics, and comorbidities (Charleston Comorbidity Index: CCI). Primary and secondary outcomes were in-hospital mortality and postoperative stroke, respectively. Multivariable analysis was used to determine the effect of SES on in-hospital mortality. Results: 3,516 and 1,909 underwent CAS; 22,852 and 15,547 patients underwent CEA in the low and high SES groups, respectively. Low SES was a significant independent predictor of mortality (OR = 2.07 [1.25-3.53], p = 0.005) for patients who underwent a CEA, but not for those undergoing CAS. CCI and age were strong predictors of mortality for both procedures (CAS odds ratio (OR)(age) 1.05[1.00-1.10] p = 0.05, OR(CCI) 1.45[1.17-1.80] p &lt; 0.001; CEA: OR(age) 1.03[1.01-1.06] p = 0.01, OR(CCI) 1.60[1.45-1.77] p &lt; 0.001). Of secondary outcomes, stroke was strongly associated with CEA, while bleeding was with CAS. [Figure 1]. Conclusions: Low SES is a significant independent predictor of postoperative mortality in patients who underwent CEA, but not CAS. CEA is also associated with a higher incidence of stroke in these patients. These findings suggest that there may be a benefit to a minimally invasive approach (CAS) rather than the present standard of care (CEA), in selected low SES patients.

The prevalence of awake bruxism and sleep bruxism in the Dutch adolescent population.

ObjectivesThis study aimed to assess the prevalence of awake bruxism and sleep bruxism in the Dutch adolescent population.Materials and MethodsAs part of a large epidemiologic survey on oral health of the general Dutch adolescent population in 2017, a total of 920 subjects were asked about their bruxism behaviour during daytime and during sleep. The collected data were subjected to stratified analysis by two age groups (for 17 and 23 years, respectively), gender and socio‐economic status.ResultsA prevalence of 4.1% and 4.2% was found for awake bruxism and of 7.6% and 13.2% for sleep bruxism. Women reported awake bruxism more often than men in the 17‐year‐old age group (5.0% and 3.2%, respectively), while in the 23‐year‐old age group it was the other way around (4.0% and 4.4%, respectively). Regarding sleep bruxism, women reported higher percentages than men in both age groups (7.8% versus 7.5% and 14.9% versus 11.5%, respectively). Concerning socio‐economic status (SES), awake bruxism was more often found in high SES groups (4.6% versus 3.7% and 4.9% versus 4.0% in both age groups, respectively) as well as for sleep bruxism in the 23‐year‐old group (16.5% versus 8.6%). In the 17‐year‐old group, sleep bruxism was more often reported in the low SES group (9.7% versus 5.3%).ConclusionsSleep bruxism is a common condition in the Dutch adolescent population, while awake bruxism is rarer.Clinical relevanceDental caregivers can use this information when negative healthcare outcomes are present amongst adolescents.

The impact of socioeconomic status on secondary prevention of the acute coronary syndrome

Abstract Background Although socioeconomic status (SES) has been reported to be associated with health inequities, there are limited studies exploring the association between SES and secondary prevention of acute coronary syndrome (ACS) in countries with universal health cover. Purpose The aim is to examine whether SES has an impact on the secondary prevention of ACS in Australia. Methods Australian SNAPSHOT ACS data (2012) and its 18-month follow-up data were linked to admissions data from 6 jurisdictions covering all states and territories, national death index and Medicare Pharmaceutical Benefits Scheme data covering up to 3 years post-discharge. The five SES groups (lowest in Group 1 and highest in Group 5) were derived from the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) using the residential postcode at baseline. Outcomes were cardiac rehabilitation (CR) participation and smoking rate at 18 months post discharge as well as the use of ≥3 of the 4 indicated medications, all-cause death and cardiovascular disease (CVD) rates by 36 months of discharge. Outcomes were compared between the groups using the multilevel logistic regression with covariates of SES (5 groups), sex, GRACE risk score (4 groups), ACS diagnosis (STEMI/NSTEMI/UA) and the jurisdictions where the admissions data were linked. Results Of 1655 patients with ACS (mean age 68±13.5 yrs, 65% were male), who were discharged from hospital alive and had linked data available, 353 (21%) were in SES Group 1 (lowest SES), 369 (22%) in Group 2, 382 (23%) in Group 3, 296 (18%) in Group 4 and 255 (15%) in Group 5 (highest SES). Baseline clinical characteristics were comparable across the five SES groups. At 18-month after discharge, 1014 (61%) patients were followed-up with comparable loss to follow-up in each group. After adjustment, fewer patients in the lower SES groups (Groups 1 and 2) had participated in CR than those in the highest SES group (Group 5) (OR (95% CI): 0.60 (0.36, 0.99) and 0.56 (0.35, 0.91), respectively). Moreover, the odds of smoking was greater in Group 3 than Group 5 (2.60 (1.15, 5.89)) but no trend was found across the groups. By 36 months of discharge after adjustment, there was no difference in the odds of using ≥3 out of 4 medications between the SES groups. Despite this, patients in Groups 1 and 2 were significantly more likely to die than those in the highest SES group (1.96 (1.19, 3.21) and 1.91 (1.19, 3.07), respectively). The odds of CVD readmission did not differ across SES groups. Conclusion This study suggests that patients with low SES were less likely to participate in CR programs and more likely to die than those with high SES. Smoking rates varied between patients with intermediate and high SES but no trend was found across the groups. Despite the universal health cover available, inequity between the SES groups still exist. Future research is needed to further explore strategies to help close the evidence-practice gaps. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Australian National Heart Foundation Postdoctoral Fellowship