High-income Groups Research Articles

Inequalities in accessibility to daily opportunities in the metropolitan region of Belo Horizonte (Brazil)

Despite the historical core-periphery urbanization pattern marked by profound inequalities in Latin American cities, the emergence of new suburban structures may introduce more complex dynamics of accessibility. In this study, we conduct a novel investigation into inequalities in accessibility to non-work urban opportunities in the Metropolitan Region of Belo Horizonte (MRBH), utilizing a combined analysis of a cumulative opportunity accessibility indicator and population distribution to assess both social and spatial discrepancies. The findings reveal that low-income households experience significantly lower accessibility to urban opportunities, while the development of new suburban structures results in high accessibility levels in high-income neighborhoods. These results highlight two contrasting processes of segregation: low-income groups being displaced to distant peripheral areas with limited accessibility, while high-income groups settling in low-density residential developments with abundant motorized accessibility to nearby opportunities.

Association of frailty with functional difficulty in older Ghanaians: stability between women and men in two samples with different income levels.

Research to date suggests that frailty is higher in women and is associated with functional difficulty. This study builds on the evidence by examining the association between frailty and functional difficulty between low- and higher-income groups and between older men and women in these income groups. This study adopted a cross-sectional design that complied with the STROBE checklist and included steps against confounding and common methods bias. The population was community-dwelling older adults aged 50years or older in two urban neighbourhoods in Accra, Ghana. Participants were either in the low-income group in a low socioeconomic neighbourhood (n = 704) or the higher-income group in a high socioeconomic neighbourhood (n = 510). The minimum sample necessary was calculated, and the hierarchical linear regression analysis was utilised to analyse the data. Frailty was positively associated with functional difficulty in the low- and higher-income samples, but this association was stronger in the higher-income sample. Frailty was positively associated with frailty in men and women within the low- and higher-income samples. The association of frailty with functional difficulty was consistent between low- and higher-income samples, although the strength of the relationship differed between these samples. In both income samples, the foregoing relationship was consistent between men and women, although the strength of the relationship differed between men and women.

Drinking practices: The variation of drinking events across intersections of sex, age and household income.

Investigations of drinking practices often rely on cross-country comparisons of population averages in beverage preferences, drinking volumes and frequencies. Here, we investigate within-culture patterns and variations in where, why and how people drink, answering the research question: how does engagement in drinking practices vary by sex, age and household income? We conducted a cross-sectional analysis examining the societal distribution (by age, sex, household income) of 12 drinking practices: four off-trade practices (in-home consumption; e.g., evening at home with partner) and eight on-trade practices (licensed-venue consumption, e.g., family meal, big night out). Practices were identified in previous analyses of 2019 British event-level diary data (14,742 drinkers aged 18+ reporting 26,220 off-trade and 8768 on-trade occasions). The level of engagement in practices varied by sex, age and income. In the on-trade sector, men, particularly those in low-income groups, engaged in traditional pub-drinking, while women, especially older women, engaged in sociable drinking occasions with family and friends which commonly involved food. Young men and women were similarly likely to engage in heavier on-trade practices, which remained commonplace into midlife. Drinking while socialising with friends, both inside and outside the home, was common among younger age groups across all income bands. From midlife, home drinking often involved a partner, especially for higher income groups. Most drinking practices were shared across the whole population, but level of engagement in them is strongly patterned by age, household income and, particularly in the on-trade sector, sex.

The association between voluntary health insurance and health outcomes in older adults in Europe: A survival analysis

ObjectivesVoluntary health insurance (VHI) often serves a supplementary role in Europe. The ageing population and adoption of cost-sharing models in response to economic pressures raise concerns that VHI could contribute to health inequalities among older people. This study investigates the association of VHI with health outcomes among older people across 16 European countries and Israel. Study designProspective cohort study. MethodsData on participants aged ≥50 years across 16 European countries and Israel were obtained from four waves (2013–2020) of the Survey of Health, Ageing, and Retirement in Europe (SHARE). Gompertz proportional hazards models assessed the association of VHI with mortality and multimorbidity. Hazard ratios (HR) and 95 % confidence intervals (CI) are reported. ResultsVHI prevalence was 38.2 % in 2013 and 34.9 % in 2015, with a higher prevalence among higher-income groups. VHI was associated with a 13 % lower risk of mortality (HR: 0.87, 95% CI: 0.81–0.94) after accounting for demographic, socioeconomic, lifestyle, and health-related factors. VHI was also associated with a lower risk of multimorbidity (HR: 0.92, 95 % CI: 0.87–0.97). ConclusionsVHI was associated with a reduced risk of mortality and multimorbidity, after adjusting for demographic, socioeconomic, lifestyle, and health-related factors. VHI might facilitate the access to timely and high-quality healthcare services, which may exacerbate health inequalities among older individuals.

The impact of information intervention on urban residents' willingness to sort domestic waste

Although many studies have assessed the effectiveness of waste sorting policies, few studies have explored residents' waste sorting behavior from the perspective of information intervention as a nudge. This study conducts an online survey to empirically examine the effects of information intervention on residents' willingness to sort domestic waste in urban China. We design and implement three types of randomized information interventions (positive, negative, and neutral) to 720 residents in the city of Beijing. Results from ordered probit models show that, despite the large amount of intervention-related policy context that the sampled subjects already possess before the intervention, information intervention can still effectively improve urban residents' willingness to sort domestic waste, and that the information framing effect exists. Specifically, while neutral information intervention does not affect urban residents' willingness to sort domestic waste, both positive and negative information interventions improve residents' willingness to sort domestic waste, and positive information intervention has a stronger effect. These effects are heterogeneous depending on gender, age, and income of residents, with the effect in male, young-age, and low-income groups stronger than that of female, old-age, and high-income groups respectively.

Aging population in urban India: Challenges and insights from Kolkata

In Kolkata, the elderly people represent 11.76% of the total population. Here we present new data on the aging population of Kolkata, and address its causes, and consequences. We interviewed 110 elderly male and female who are living with their family members and in old age homes in Kolkata. The data was collected from low, medium, and high-income groups from three urban housing societies as well as five old age homes. It has been observed that the elderly male and female of the low-income group have no medical and life insurance, and many of them are suffering from health issues. Although females up to 60 years are part of Self-Help Group, males are suffering from Loneliness. The elderly male and female of the medium, and high-income group do not have financial issues, but most of them do not visit doctors and health care centers for regular health check-ups. Digital literacy has to be improved. Elderly people staying in old age homes are mentally and physically much better than their counterparts who live with family members. Analysis of existing government policies reveal scope for improvement of the elderly people. We propose social innovation for the elderly population in Kolkata.

Determinants of Public Support for Fee-Contracts in Uzbekistan's Higher Education

This study examines the impact of fee-contract funding (FCF) systems on state higher education (SHES) in Uzbekistan, addressing a gap in existing literature that has primarily focused on standard tuition fees and state subsidies without exploring fee contracts, especially in emerging markets. Using a logistic regression analysis on survey data from 120 participants, the study aims to identify predictors influencing policy support for fee contracts. Findings indicate that income level and education are the strongest predictors of policy favorability, while cultural factors elevate support for "fee contract will make college access easier" as a predictor, though with weaker direct effects. Age and private sector contributions, though correlated with the outcome, were not statistically significant. These results suggest that policy elites in high-income and educated groups favor FCF systems, yet promoting fee contracts as accessibility-enhancing may garner broader support. The study underscores the need for policy interventions and expanded financial aid to promote equitable access, recommending further research into the long-term social and economic effects of fee contracts in similar contexts.

Perceptions of building-integrated nature-based solutions by suppliers versus consumers in Egypt

Can Building-Integrated Nature-based Solutions (BI-NbS) reach their full potential in the Global South? In the Egyptian context, BI-NbS are relatively new with an identified gap between the high potential in theory and low implementation rates in practice. To bridge this gap, the study conducts an in-depth investigation of BI-NbS market conditions to reveal the current trends in the residential buildings market in Egypt. It also identifies the gaps and overlaps in the perceptions of the suppliers and consumers of BI-NbS. Results reveal that the residential sector sales mainly target high-income groups yet very limited and dominated by rooftop systems. Suppliers advocate for high-tech systems over low-tech systems, whereas consumers prefer the latter. The perceptions of suppliers and consumers mostly align regarding the basic aspects such as the production and operation preferences as well as the anxieties and concerns about the relatively new BI-NbS in this regional context. However, they diverge in key aspects affecting market penetration such as implementation conditions, aims, and barriers. Accordingly, the study identified the gap between suppliers and consumers, and outlined recommendations, directed to suppliers and policymakers, for improved market development and local implementation of BI-NbS in emerging markets of the Global South, such as Egypt.

Food insecurity is associated with poor mental health and health risk behaviors in Czechia

Abstract Background Food insecurity (FI) is one of social determinants of health and a profound public health concern because it leads to malnutrition and hence poor health. COVID-19 impacted people disproportionately and exacerbated preexisting social and health inequalities. The aim of this study was to understand how socioeconomic and health conditions affected one’s FI in Czechia during the pandemic using a representative panel of Czech adults from a longitudinal survey, Life During the Pandemic collected in October 2022 as part of a Czech longitudinal survey. Methods A study sample of 1,499 respondents was included in our multiple logistic regression models. Depressive symptoms and anxiety symptoms were assessed using validated questionnaires PHQ-2 and DAG-2. Results Approximately one third of the study sample (32.4%) reported being food insecure. In the fully-adjusted model, adults with depressive symptoms (OR 2.37, CI 1.49, 5.02), problems with sleeping (OR 2.20, CI 1.64, 2.96), smoking habit (OR 2.27, CI 1.68, 3.07), lower fruit and vegetable consumption (OR 1.50, CI 1.04, 2.17) had greater odds of experiencing FI. The lowest income group was associated with 6.2 times greater odds of reporting FI as compared to the high-income group (CI 3.96, 9.67). Lower education attainment also had higher odds of experiencing FI (OR 2.15, CI 1.40, 3.31). Anxiety was not a significant predictor for FI. Conclusions Our study highlights that food insecurity is associated with depressive symptoms, poor quality of sleep and lower consumption of fruit and vegetables among adults. Food insecurity was also evident among lower income and lower education attainment. Funding source This study was supported by The Charles University Grant Agency (GA UK). Key messages • Our study suggests that adults with poor mental health and diet quality experience food insecurity. • Given the established link between a balanced diet and mental well-being, interventions should encompass not only food security but also the quality of dietary intake.

Effects of COVID-19 on flex route transit utilization: An interrupted time series analysis

The COVID-19 outbreak has exerted serious effects on the transportation system, especially public transport. Flex route transit (FRT), one of public transport, has shown significant advantages in transporting passengers during COVID-19 due to its high flexibility and relatively large cabin spaces. This study aims to estimate the effects of the lockdown and first lockdown ease on FRT utilization through interrupted time series analysis. A survey was conducted in Beijing to collect data regarding the daily FRT utilization of individuals, spanning from December 2019 to May 2020. Results indicated that FRT utilization was immediately reduced during the lockdown, and a decreased trend was observed. After the first lockdown ease was rolled out, FRT utilization showed a rising level and trend. Private car owners showed a lower dependence on FRT than non-car owners. The level of income exerted varying effects in a wide range of periods. FRT utilization among the higher income group was more likely to take effect than the lower income group. The study yields various policy implications for FRT operations during COVID-19 or other pandemics.

National trends in adolescents’ mental health by income level in South Korea, pre– and post–COVID–19, 2006–2022

Despite the significant impact of the COVID–19 pandemic on various factors related to adolescent mental health problems such as stress, sadness, suicidal ideation, and suicide attempts, research on this topic has been insufficient to date. This study is based on the Korean Youth Risk Behavior Web–based Survey from 2006 to 2022. We analyzed the mental health problems of adolescents based on questionnaires with medical interviews, within five income groups and compared them with several risk factors. A total of 1,138,804 participants were included in this study, with a mean age (SD) of 15.01 (0.75) years. Of these, 587,256 were male (51.57%). In 2022, the recent period from the study, the weighted prevalence of stress in highest income group was 40.07% (95% CI, 38.67–41.48), sadness was 28.15% (26.82–29.48), suicidal ideation was 13.92% (12.87–14.97), and suicide attempts was 3.42% (2.90–3.93) while the weighted prevalence of stress in lowest income group was 62.77% (59.42–66.13), sadness was 46.83% (43.32–50.34), suicidal ideation was 31.70% (28.44–34.96), and suicide attempts was 10.45% (8.46–12.45). Lower income groups showed a higher proportion with several risk factors. Overall proportion had decreased until the onset of the pandemic. However, a significant increase has been found during the COVID–19 pandemic. Our study showed an association between household income level and the prevalence of mental illness in adolescents. Furthermore, the COVID–19 pandemic has exacerbated mental illness among adolescents from low household income level, underscoring the necessity for heightened public attention and measures targeted at this demographic.

Parents' income has influence on levels of physical activity and sedentary behaviour of junior high school student

This study aims to determine physical activity (PA level) and sedentary behavior (SB level) in students with various parents' income levels. This study used a cross-sectional design. The subjects used in this study were 900 students from 10 schools and ten cities in East Java, Indonesia. Data on students' parents' income were grouped into five categories based on their income level (very low: n = 360; low: n = 231; medium: n = 123; high: n = 79; very high: n = 107). The research instruments used were the Children’s Physical Activity Questionnaire (CPAQ) to measure the level of physical activity (PA level) and the Adolescent Sedentary Activity Questionnaire (ASAQ) to measure the level of sedentary behavior (SB level). The results of the Mann-Whitney statistical test showed significant differences in PA level and SB level between the very low-income group of parents and the low, medium, high, and very high-income groups (p<0.05). In conclusion, the higher the level of parental income, the better the students' physical activity, and the lower their sedentary behaviour. Keywords: Family monthly income, physical activity, sedentary behavior, junior high school student

Relationship between socioeconomic status and stroke: An observational and network Mendelian randomization study

BackgroundThe relationship between socioeconomic status (SES) and stroke remains controversial, and the underlying mediator is unclear. This study aimed to assess the causal relationship of SES with stroke and its subtypes and to identify potential modifiable risk factors responsible for this relationship. MethodsThe study included 372,437 participants from the UK Biobank. Over an average period of 12.13 years, 6,457 individuals (2.7 %) were recorded as having experienced a stroke. Cox proportional hazards model was used to determine the relationship between SES (average annual household income before tax and age at the end of full-time education) and stroke, ischemic stroke, and hemorrhagic stroke. Two-sample Mendelian randomization (MR) was employed to assess the causal relationship between SES and stroke and its subtypes. Furthermore, network MR was utilized to evaluate the potential mediating role of modifiable risk factors for stroke in this causal relationship. ResultsAfter adjusting for factors such as sociodemographic characteristics, health behaviors, health status, and past medical history, participants in the second highest income group showed the lowest risk of stroke, with a hazard ratio (HR) of 0.780 (95 % confidence interval [CI]: 0.702–0.866), and for ischemic stroke, the HR was 0.701 (95 % CI: 0.618–0.795). Those who completed full-time education at the latest age group(>18 years) had the lowest risk of stroke (HR: 0.906, 95 % CI: 0.830–0.988) and ischemic stroke (HR: 0.897, 95% CI: 0.811–0.992). MR analysis showed that higher income and education were both associated with a lower risk of stroke (income: inverse-variance-weighted odds ratio [ORIVW] =0.796, 95 % CI: 0.675–0.940, education: ORIVW = 0.631, 95 % CI: 0.557–0.716) and ischemic stroke (income: ORIVW = 0.813, 95 % CI: 0.684–0.966, education: ORIVW = 0.641, 95 % CI: 0.559–0.735). Additionally, hypertension had the highest mediating effect on this relationship. It accounted for 57.12 % of the effect of income on stroke, 51.24 % on ischemic stroke, and 27 % and 24 % for education. ConclusionHigher SES was associated with a lower risk of stroke and ischemic stroke, and hypertension had the highest mediating effect on this causal relationship. The results have significant public health implications, emphasizing the importance of early intervention to reduce the risk of stroke in low SES populations.

Overnutrition among the School Students in Dhaka City: A Cross-sectional Study

Background: The study focuses on childhood obesity and its rise due to fast food and reduced physical activity.Objective: The aim of this study is to investigate the nutritional assessment, knowledge, attitude and practice of English medium School students aged 11-15 years in Dhaka city. Methodology: This cross-sectional study was conducted among randomly selected 280 school students with anthropometric measurement and using a semi-structured questionnaire with the permission of the student’s guardian/s. Results: The overall prevalence of overweight/obesity in this study found 51.43% where 11.43% were obese and 40.0% were overweight. The students have eaten pizza, burger and pastry according to 20%, 28% and 15% respectively at their tiffin time. About 68% respondents have not played any outdoor games (only computer games regularly). 61% normal BMI students did physical activity regularly and 91% risk BMI respondents didn’t physical activity regularly. The energy intake in last 24 hours of respondents according to their BMI also is statistically significant (p<0.01); the average energy intake of 49% male of normal BMI respondent was about 1576 kJ and the average energy intake of 48% female of normal BMI respondent was about 1455 kJ. On the other hand, the average energy intake of 51% male of risk BMI respondent was about 1819 kJ and the average energy intake of 52% female of risk BMI respondent was about 1707 kJ. Conclusion: Overweight/obesity is a public-health concern among English medium school students, especially in high-income group in Dhaka. From the key finding of the current study, awareness program regarding overweight or obesity along with prevention measures were particularly focus on the English medium school students from their school as well as their family. Keywords: Obesity, Overweight, BMI, Energy Intake, Food consumption, Nutritional value.

Influencer Marketing in Kerala’s Food Industry: The Power of Storytelling

This study delves into the impact of storytelling in influencer marketing within Kerala's food industry, specifically focusing on its influence on consumer perceptions and purchasing decisions. With the increasing prevalence of social media, food influencers play a crucial role in shaping consumer behaviour by sharing authentic and relatable stories that resonate with their followers. The main objectives are to investigate the factors that drive consumer engagement with food influencers and to analyze the storytelling techniques utilized by influencers themselves. To achieve these goals, a mixed-methods approach is used, which involves gathering quantitative data through surveys targeting both consumers and influencers in Kerala. Statistical tools and econometric models are then applied to analyze the data, revealing significant trends and correlations between storytelling and consumer behaviour. Descriptive statistics offer insights into the demographics of consumers and influencers, while cross-tabulation and chi-square tests are used to examine the relationships between categorical variables. Additionally, logistic regression analysis is conducted to assess the impact of trust in storytelling on purchasing behavior. The findings underscore the crucial role of storytelling in building trust and engagement among consumers, particularly among higher-income groups and younger demographics who are influenced by authentic narratives. Furthermore, influencers with extensive experience employ storytelling techniques to enhance their effectiveness and engagement metrics. The study concludes with actionable recommendations for businesses and marketers in the food industry, emphasizing the significance of storytelling in influencer marketing strategies. This research provides valuable insights into the dynamics of influencer marketing in the food sector, offering a framework for future studies on the interaction between storytelling, consumer engagement, and brand loyalty in the digital age. Keywords:Influencer Marketing, Storytelling, Consumer Behavior, Food Industry, Engagement

Income and education disparities in childhood malnutrition: a multi-country decomposition analysis

IntroductionChildhood malnutrition is a complex issue with a range of contributing factors. The consequences of malnutrition are severe, particularly for children. This study aims to identify the factors contributing to inequality gaps in childhood malnutrition. Our study provides insights into modifiable elements to inform interventions targeted at distinct contexts and populations to improve child nutrition.MethodsThis study utilized data from the Demographic and Health Surveys (DHS) of 27 countries. First, the risk differences (RDs) between the prevalence of childhood malnutrition among the determinant variables, household income, and maternal education categories were calculated. The Blinder‒Oaxaca decomposition was subsequently used to determine the extent to which the difference in childhood malnutrition prevalence between low-income and high-income groups and maternal education levels results from the contributory effects of the explanatory variables: child and maternal individual-level compositional factors.ResultsWe examined data from 138,782 children in 27 countries from 2015 to 2020. The prevalence of childhood malnutrition (10.5%) varied across countries, ranging from 6.5% in Burundi to 29.5% in Timor Leste. On average, the prevalence of childhood malnutrition was 11.0% in low-income households and 10.7% among mothers without education. Some nations had pro-low-income (i.e., malnutrition concentrated among children from poor households) or pro-no-maternal education (i.e., malnutrition concentrated among children from mothers with no formal education) inequality in childhood malnutrition, but most did not. We found a complex interplay of compositional effects, such as the child’s age, maternal education, maternal health behavior, and place of residence, that influence the inequality in childhood malnutrition rates across 10 pro-low-income countries. In addition, we also found that a complex mix of compositional effects, such as the household wealth index, maternal health behavior, and maternal age, contribute to childhood malnutrition inequality between educated and uneducated mothers across the 7 pro-no maternal education countries.ConclusionThe prevalence of childhood malnutrition varies among low-income, high-income, and no maternal education-maternal education groups. This study highlights the need for a country-specific approach to addressing childhood malnutrition, with policies and interventions tailored to each country’s specific context.

Prevalence, Risk Factors, and Impact of Long COVID Among Adults in South Korea.

This study aimed to identify the prevalence, risk factors, and impact of long COVID in a community-based representative sample of patients with COVID-19 aged 19-64 years. A total of 975 participants completed online or telephone surveys at 1 and 3 months post-diagnosis, covering persistent symptoms, daily activity limitations, vaccination status, and underlying diseases. Long COVID, as defined by the WHO criteria, had a prevalence of 19.7-24.9% in females and 12.7% in males. Logistic regression revealed that the odds of having long COVID symptoms were higher among females compared to males (OR, 2.43; 95% CI, 1.53-3.87), and higher in those aged ≥ 30 years compared to those aged 19-29 years: 30-39 years (OR, 2.91; 95% CI, 1.59-5.33), 40-49 years (OR, 2.72; 95% CI, 1.51-4.89), and 50-64 years (OR, 1.96; 95% CI, 1.10-3.49). Additionally, patients with underlying diseases had higher odds of long COVID symptoms compared to those without underlying diseases (OR, 1.81; 95% CI, 1.24-2.64). Among those with long COVID, 54.2% experienced daily activity limitations, and 40.6% received treatment. Furthermore, lower income groups faced greater daily activity limitations but had similar treatment rates to higher income groups. These findings emphasize the need for interest in and the development of programs to support these low-income populations.

Energy sufficiency and recognition justice: a study of household consumption

The energy ‘crisis’ in Switzerland during the winter of 2022–23 highlighted the need to integrate the idea of sufficiency into previously efficiency-focused discourses and policies. A mixed-methods approach was used to explore emerging sufficiency practices and energy justice. Qualitative interviews (n = 28) with a diverse range of households and building management companies (‘régies’) in Geneva, as well as a quantitative online survey, were undertaken in 2023. It was found that different measures and recommendations did lead to efforts to reduce energy consumption, but also revealed flaws as practices typically lacked an energy justice perspective. Important discrepancies occurred between low- and high-income groups, tenants and owners, inhabitants of houses and apartments. These included a misrecognition of some residents’ vulnerabilities, their limited agency and a lack of acknowledgment of differentiated responsibilities. This led to a negative impact on the implementation of sufficiency. Some residents were marginalised: feeling anxious, disregarded, powerless, belittled and hence excluded from collective sufficiency efforts. Policy relevance Policies and strategies for the implementation of energy sufficiency measures will not be effective unless they include energy justice issues. If sufficiency policies and strategies are to be effective, they must account for differing housing, tenure, socio-economic conditions, capabilities and tackle recognition-based injustices. Decision-making spaces and processes need to become more inclusive, particularly to represent more vulnerable people, include a broader range of the socio-economic population and account for differing responsibilities.

Health disparities in the risk of severe acidosis: real-world evidence from the All of Us cohort.

To assess the health disparities across social determinants of health (SDoH) domains for the risk of severe acidosis independent of demographical and clinical factors. A retrospective case-control study (n = 13310, 1:4 matching) is performed using electronic health records (EHRs), SDoH surveys, and genomics data from the All of Us participants. The propensity score matching controls confounding effects due to EHR data availability. Conditional logistic regressions are used to estimate odds ratios describing associations between SDoHs and the risk of acidosis events, adjusted for demographic features, and clinical conditions. Those with employer-provided insurance and those with Medicaid plans show dramatically different risks [adjusted odds ratio (AOR): 0.761 vs 1.41]. Low-income groups demonstrate higher risk (household income less than $25k, AOR: 1.3-1.57) than high-income groups ($100-$200k, AOR: 0.597-0.867). Other high-risk factors include impaired mobility (AOR: 1.32), unemployment (AOR: 1.32), renters (AOR: 1.41), other non-house-owners (AOR: 1.7), and house instability (AOR: 1.25). Education was negatively associated with acidosis risk. Our work provides real-world evidence of the comprehensive health disparities due to socioeconomic and behavioral contributors in a cohort enriched in minority groups or underrepresented populations. SDoHs are strongly associated with systematic health disparities in the risk of severe metabolic acidosis. Types of health insurance, household income levels, housing status and stability, employment status, educational level, and mobility disability play significant roles after being adjusted for demographic features and clinical conditions. Comprehensive solutions are needed to improve equity in healthcare and reduce the risk of severe acidosis.

Socioeconomic disparities and cardio-cerebrovascular diseases: A nationwide cross-sectional study.

Although socioeconomic status (SES) is considered a risk factor for cardio-cerebrovascular diseases (CCVDs), few studies have examined this association. In this cross-sectional study, we aimed to assess the prevalence and trends of CCVDs across different SES groups over a 12-year period in a representative Korean population. We analysed 47 745 economically active adults aged ≥30 and <65 years from 97 622 patients in the Korean National Health and Nutrition Examination Survey (2007-18), where a new independent sample of the population was examined each year. We categorised the participants into four groups based on education level and income. The prevalence of hypertension, diabetes mellitus, dyslipidaemia, and CCVD, including angina, myocardial infarction, and stroke, was analysed at four-year intervals. Average age, urban residence, white-collar occupation, and body mass index >30 increased, whereas CCVD prevalence did not change significantly (P = 0.410) over the study period. Low education (odds ratio (OR) = 1.24; 95% confidence interval (CI) = 1.04-1.47, P < 0.001) and low income (OR = 1.14; 95% CI = 1.02-1.28, P = 0.017) were significant determinants of CCVD in addition to existing traditional risk factors. CCVD prevalence was significantly higher in both the low-education and low-income groups compared to the high-education and high-income groups every four years, with no significant change in this gap over the study period (P = 0.239). Despite the increase in the elderly population and the prevalence of obesity, the incidence of CCVDs in Korea has remained unchanged. Individuals with low education or low income had a significantly higher prevalence of CCVD, with the lowest SES group, defined by both low education and low income, consistently having the highest prevalence of CCVDs.