Index Of Socioeconomic Disadvantage Research Articles

Estimating income-related and area-based inequalities in mental health among nationally representative adolescents in Australia: The concentration index approach.

Despite the awareness of the importance of mental health problems among adolescents in developed countries like Australia, inequality has not been widely researched. This study, is therefore, aimed to measure and compare household income-related and area-based socioeconomic inequalities in mental health problems (bullying victimization, mental disorders–single and multiple, self-harm and suicidality–ideation, plan and attempt) among Australian adolescents aged 12–17 years. Young Minds Matter (YMM)—the 2nd national cross-sectional mental health and well-being survey involving Australian children and adolescents conducted in 2013–14, was used in this study to select data for adolescents aged 12–17 years (n = 2521). Outcome variables included: bullying, mental disorders, self-harm, and suicidal ideation, plan and attempt. The Erreygers’s corrected concentration index (CI) approach was used to measure the socioeconomic inequalities in mental health problems using two separate rank variables–equivalised household income quintiles and area-based Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) quintiles. The prevalence of mental health problems in the previous 12-months among these study participants were: bullying victimization (31.1%, 95% CI: 29%-33%), mental disorder (22.9%, 95% CI: 21%-24%), self-harm (9.1%, 95% CI: 8%-10%), suicidal ideation (8.5%, 95% CI: 7%-10%), suicidal plan (5.9%, 95% CI: 5%-7%) and suicidal attempt (2.8%, 95% CI: 2%-3%). The concentration indices (CIs) were statistically significant for bullying victimization (CI = -0.049, p = 0.020), multiple mental disorders (CI = -0.088, p = <0.001), suicidal ideation (CI = -0.023, p = 0.047) and suicidal attempt (CI = -0.021, p = 0.002), implying pro-poor socioeconomic inequalities based on equivalized household income quintiles. Similar findings revealed when adolescents mental health inequalities calculated on the basis of area based IRSAD (Index of Relative Socio-economic Advantage and Disadvantage) quintiles. Overall, adolescents from economically worse-off families experienced more mental health-related problems compared to those from economically better-off families. This has implications for prevention strategies and government policy in order to promote mental health and provide equitable healthcare facility.

Suicide rates for young Aboriginal and Torres Strait Islander people: the influence of community level cultural connectedness.

To examine associations between community cultural connectedness indicators and suicide mortality rates for young Aboriginal and Torres Strait Islander people. Retrospective mortality study. Suicide deaths of people aged 10-19 years recorded by the Queensland Suicide Register, 2001-2015. Age-standardised suicide death rates, by Indigenous status, sex, and age group; age-standardised suicide death rates for young First Nations people by area level remoteness and Index of Relative Socioeconomic Advantage and Disadvantage, and by cultural connectedness indicators (at statistical area level 2): cultural social capital index score, community Indigenous language use, and reported discrimination. The age-specific suicide rate was 21.1 deaths per 100 000 persons/year for First Nations young people and 5.0 deaths per 100000 persons/year for non-Indigenous young people (rate ratio [RR], 4.3; 95% CI, 3.5-5.1). The rate for Aboriginal and Torres Strait Islander young people was higher in areas with low levels of cultural social capital (greater participation of community members in cultural events, ceremonies, organisations, and community activities) than in areas classified as having high levels (RR, 1.8; 95% CI, 1.2-2.7), and also in communities with high levels of reported discrimination (RR, 2.7; 95% CI, 1.7-4.3). Associations with proportions of Indigenous language speakers and area level socio-economic resource levels were not statistically significant. We found that suicide mortality rates for Aboriginal and Torres Strait Islander young people in Queensland were influenced by community level culturally specific risk and protective factors. Our findings suggest that strategies for increasing community cultural connectedness at the community level and reducing institutional and personal discrimination could reduce suicide rates.

Associations Between Socioeconomic Status, Patient Risk, and Short-Term Intensive Care Outcomes.

To investigate the association of socioeconomic status as measured by the average socioeconomic status of the area where a person resides on short-term mortality in adults admitted to an ICU in Queensland, Australia. Secondary data analysis using de-identified data from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation linked to the publicly available area-level Index of Relative Socioeconomic Advantage and Disadvantage from the Australian Bureau of Statistics. Adult ICUs from 35 hospitals in Queensland, Australia, from 2006 to 2015. A total of 218,462 patient admissions. None. The outcome measure was inhospital mortality. The main study variable was decile of Index of Relative Socioeconomic Advantage and Disadvantage. The overall crude inhospital mortality was 7.8%; 9% in the most disadvantaged decile and 6.9% in the most advantaged decile (p < 0.001). Increasing socioeconomic disadvantage was associated with increasing severity of illness as measured by Acute Physiology and Chronic Health Evaluation III score, admission with a diagnosis of sepsis or trauma, cardiac, respiratory, renal, and hepatic comorbidities, and remote location. Increasing socioeconomic advantage was associated with elective surgical admission, hematological and oncology comorbidities, and admission to a private hospital (all p < 0.001). After excluding patients admitted after elective surgery, in the remaining 106,843 patients, the inhospital mortality was 13.6%, 13.3% in the most disadvantaged, and 14.1% in the most advantaged. There was no trend in mortality across deciles of socioeconomic status after excluding elective surgery patients. In the logistic regression model adjusting for severity of illness and diagnosis, there was no statistically significant difference in the odds ratio of inhospital mortality for the most disadvantaged decile compared with other deciles. This suggests variables used for risk adjustment may lie on the causal pathway between socioeconomic status and outcome in ICU patients. Socioeconomic status as defined as Index of Relative Socioeconomic Advantage and Disadvantage of the area in which a patient lives was associated with ICU admission diagnosis, comorbidities, severity of illness, and crude inhospital mortality in this study. Socioeconomic status was not associated with inhospital mortality after excluding elective surgical patients or when adjusted for severity of illness and admission diagnosis. Commonly used measures for risk adjustment in intensive care improve understanding of the pathway between socioeconomic status and outcomes.

Do fires discriminate? Socio-economic disadvantage, wildfire hazard exposure and the Australian 2019\u201320 \u2018Black Summer\u2019 fires

We examine the relationship between socio-economic disadvantage and exposure to environmental hazard with data from the catastrophic 2019–2020 Australian wildfires (Black Summer) that burnt at least 19 million hectares, thousands of buildings and was responsible for the deaths of 34 people and more than one billion animals. Combining data from the National Indicative Aggregated Fire Extent (NIAFE) and 2016 Socio-Economic Indexes for Areas (SEIFA), we estimate the correlation between wildfire hazard exposure and an index of community-level socio-economic disadvantage. Wildfire hazard exposure is measured as the interaction between the percentage of area burnt and proximity of the fire to settlements. The results reveal a significant positive relationship between fire hazard exposure and socio-economic disadvantage, such that the most socio-economically disadvantaged communities bore a disproportionately higher hazard exposure in the Black Summer than relatively advantaged communities. Our spatial analysis shows that the socio-economic disadvantage and wildfire hazard exposure relationship exists in inner regional, outer regional and remote areas of New South Wales and Victoria, the two worst-hit states of the Black Summer catastrophe. Our spatial analysis also finds that wildfire hazard exposure, even within a small geographical area, vary substantially depending on the socio-economic profiles of communities. A possible explanation for our findings is resource gaps for fire suppression and hazard reduction that favour communities with a greater level of socio-economic advantage.

Associations between supermarket availability and body size in Australia: a cross-sectional observational study comparing state and territory capital cities

BackgroundResidential environment features such as availability of supermarkets may shape dietary behaviour and thus overweight and obesity. This relationship may not be consistent between cities. This Australian national-level study examined: 1) the relationship between supermarket availability and body size; and 2) whether this relationship varied by capital city.MethodsThis study used 2017–18 Australian National Health Survey data including individual-level socio-demographic information (age, sex, country of birth, education, occupation, household income), and measured body size (height and weight to derive body mass index [BMI], and waist circumference [WC]). Objectively-expressed measures of residential environments included: counts of supermarkets (major chain outlets), counts of amenities (representing walkable destinations including essential services, recreation, and entertainment), and area of public open space - each expressed within road-network buffers at 1000 m and 1500 m; population density (1km2 grid cells); and neighbourhood disadvantage (Index of Relative Socioeconomic Disadvantage) expressed within Statistical Area Level 1 units. Data for adult respondents ≥18 years residing in each of Australia’s state and territory capital cities (n = 9649) were used in multilevel models to estimate associations between supermarket availability and body size sequentially accounting for individual and other environment measures. An interaction term estimated city-specific differences in associations between supermarket availability and body size. Models were consequently repeated stratified by city.ResultsBody size (BMI and WC) and supermarket availability varied between cities. Initial inverse associations between supermarket availability and body size (BMI and WC) were attenuated to null with inclusion of all covariates, except for BMI in the 1000 m buffer model (beta = − 0.148, 95%CI -0.27, − 0.01, p = 0.025). In stratified analyses, the strengths of associations varied between cities, remaining statistically significant only for some cities (BMI: Melbourne, Brisbane Hobart; WC: Brisbane, Hobart) in fully adjusted models. Different patterns of attenuation of associations with inclusion of covariates were evident for different cities.ConclusionsFor Australian capital cities, greater availability of supermarkets is associated with healthful body size. Marked between-city variations in body size, supermarket availability, and relationships between supermarket availability and body size do not, however, support universal, “one-size-fits-all” solutions to change built environments to support healthful body size.

Association between Western Australian children’s unplanned dental presentations and the socioeconomic status of their residential area

Objective This study investigated the link between socioeconomic status and unplanned dental presentations at the Perth Children's Hospital (PCH), as well as the link between the socioeconomic status of unplanned dental patients and any previous admissions to the PCH. Methods Records of 351 unplanned visits to the PCH were collected, including reason for attendance (infection, trauma, other), the patient's residential location (suburb) and the history of any previous presentations at the PCH. The socioeconomic status of each patient was based on the Index of Relative Socio-Economic Disadvantage, divided into quintiles. Geographic information systems (GIS) were used to spatially map the residential locations of the patients with unplanned dental presentations. QGIS was used to map and geocode the data. Analysis of variance and Chi-squared tests were used to determine associations between subgroups and other variables. Results 'Unplanned dental presentation' in this study refers to patients who present without an appointment, including by referral from the emergency department of the PCH or outside the PCH. Approximately two-thirds of unplanned dental presentation among patients from low socioeconomic groups were for dental infection, whereas the major reason for presentation among patients from higher socioeconomic groups was trauma. More than half the patients in low socioeconomic groups had at least one previous presentation at the PCH due to other medical issues. Conclusion Children from low socioeconomic groups, or from outside of Perth, were more likely to present with dental infections, which are mostly preventable at the primary care level; these patients often presented a more significant burden to the health system. Public health interventions should aim to promote preventive oral health care, especially for children from low socioeconomic groups. What is known about the topic? In Western Australia, the most common dental problems requiring hospitalisation among children is dental caries, and children from the lowest socioeconomic backgrounds have the highest prevalence of dental hospitalisations. What does this paper add? Children from lower socioeconomic backgrounds were more likely to have an unplanned presentation at the only tertiary children's hospital in Western Australia due to dental infection. What are the implications for practitioners? Improved access to public dental services, especially in low socioeconomic areas, and the development of more strategies to reduce unplanned dental presentations at a tertiary hospital are needed.

Treatment and outcomes of metastatic colorectal cancer patients in public and private hospitals: results from the South Australian Metastatic Colorectal Cancer Registry.

Studies have reported significant differences in baseline characteristics and outcomes of metastatic colorectal cancer (mCRC) patients when managed in private versus public hospitals. To compare disease, treatment and survival outcomes of patients with mCRC in public versus private hospitals in South Australia (SA). Analysis of prospectively collected data from the SA mCRC Registry. Patterns of care and outcome data according to location of care and socioeconomic status based on Index of Relative Socio-Economic Advantage and Disadvantage were analysed. A total of 3470 patients' data was analysed during February 2006-January 2015. The majority (70%) of patients received treatment in public hospitals. Patients in the upper 50% for Index of Relative Socio-Economic Advantage and Disadvantage score were more likely to receive treatment at a private hospital (41.2% vs 21.56%) compared to <50%. Public patients had higher burden of disease (10.49% vs 7.41%, P = 0.005). Public patients received less treatment compared to the private patients (odds ratio = 0.48 (0.38-0.61), P = 0.01) and rates of surgical resections were lower in public patients. After adjusting for the covariates, public patients survive 1.33 months (P = 0.025) shorter than private patients with follow-up time of 5 years. Patients receiving metastasectomy and more than three lines of treatment were shown to have the greatest survival benefit. Public patients have a higher burden of disease and in comparison are less likely to receive systemic therapy and have lower survival than patients treated in private hospitals.

Adherence rates and risk factors for suboptimal adherence to secondary prophylaxis for rheumatic fever.

AimSecondary prophylaxis with 3–4 weekly benzathine penicillin G injections is necessary to prevent disease morbidity and cardiac mortality in patients with acute rheumatic fever (ARF) and rheumatic heart disease (RHD). This study aimed to determine secondary prophylaxis adherence rates in the Far North Queensland paediatric population and to identify factors contributing to suboptimal adherence.MethodsA retrospective analysis of data recorded in the online RHD register for Queensland, Australia, was performed for a 10‐year study period. The proportion of benzathine penicillin G injections delivered within intervals of ≤28 days and ≤35 days was measured. A multi‐level mixed model logistic regression assessed the influence of age, gender, ethnicity, suburb, Accessibility and Remoteness Index of Australia class, number of people per dwelling, Index of Relative Socio‐economic Advantage and Disadvantage, Index of Education and Occupation, year of inclusion on an ARF/RHD register and individual effect.ResultsThe study included 277 children and analysis of 7374 injections. No children received ≥80% of recommended injections within a 28‐day interval. Four percent received ≥50% of injections within ≤28 days and 46% received ≥50% of injections at an extended interval of ≤35 days. Increasing age was associated with reduced delivery of injections within 35 days. Increasing year of inclusion was associated with improved delivery within 28 days. The random effect of individual patients was significantly associated with adherence.ConclusionsImproved timely delivery of secondary prophylaxis for ARF and RHD is needed as current adherence is very low. Interventions should focus on factors specific to each individual child or family unit.

Breast reconstruction in South Western Sydney.

The rates of breast reconstruction in Australian patients of culturally and linguistically diverse (CALD) backgrounds are currently unknown. This retrospective study determined the rate of breast reconstruction in women who had mastectomy as treatment for breast cancer at public hospitals in South Western Sydney Local Health District (SWSLHD) - a culturally diverse health district in New South Wales, Australia - and compared the rate of reconstruction in the CALD and non-CALD populations. The demographic and clinical data of all female patients who had mastectomy with or without reconstruction for treatment of breast cancer at the five public hospitals in SWSLHD between January 2006 and December 2015 were obtained from the clinical information department of each hospital and from electronic medical records. The average rate of reconstruction in SWSLHD was 9.4% for 2006-2015. Although the reconstruction rate was higher among English-speaking women (9.9%) compared to women from a CALD background (8.6%), the difference was not statistically significant (P = 0.57). The type (autologous versus implant) and timing (immediate versus delayed) of reconstruction did not differ between groups (P = 0.19 and P = 0.22, respectively). The Index of Relative Socio-Economic Disadvantage was not significantly associated with reconstruction (P = 0.74). However, younger patients were more likely to have reconstruction (P < 0.0001) and patients with adjuvant therapy were more likely to have a delayed reconstruction (P = 0.01). This study found a low breast reconstruction rate in public hospitals in SWSLHD. The reconstruction rate did not differ between CALD or English-speaking patients, or between patients from diverse socio-economic backgrounds.

Acute Myocardial Infarction and Community-acquired Staphylococcus aureus Bloodstream Infection: An Observational Cohort Study.

The relationship between acute myocardial infarction and infection was recognized in the early 20th century during influenza epidemics. Most recently, a case control study and a self-control design study have identified an association between Staphylococcus aureus infection and acute myocardial infarction. We assessed the association of community-acquired Staphylococcus aureus bloodstream infection (CA-SABSI) and myocardial infarction in the 365 days following blood culture. This was a cohort study assessing the incidence of myocardial infarction 365 days after blood culture for Staphylococcus aureus. Culture-negative patients had blood cultures collected at hospital attendance and were matched to the CA-SABSI participants by sex, 5-year age strata, and year of culture collection. Pathology information was linked to hospital administrative data and index of relative socioeconomic advantage and disadvantage (ISRAD). The study included 5157 CA-SABSI cases matched to 10 146 blood culture-negative cases. The mortality rate was significantly higher in the CA-SABSI group (10.9%; 562/5157) than in culture-negative cases (5.1%; 521/10 146) at 365 days (P < .0001). In the 7 days following the index blood culture, excluding recurrent events, there were 89 (1.7%) and 37 (.4%) myocardial infarction diagnoses in the CA-SABSI and culture-negative cases, respectively. Multivariable logistic regression for myocardial infarction demonstrated a significant association with CA-SABSI after adjusting for known risk factors (odds ratio [OR], 5; 95% confidence interval [CI], 3.3-7.5; P < .0001). Myocardial infarctions occurring in this short-term risk period were associated with all-cause mortality in a Cox proportional hazard model (OR, 1.7; 95% CI, 1.2-2.4; P < .005). CA-SABSI is associated with an increased short-term risk of myocardial infarction, which is associated with subsequent mortality.

Examining the neighborhood-level socioeconomic characteristics associated with fatal overdose by type of drug involved and overdose setting

BackgroundFatal drug overdose in the United States is a public health crisis fueled by increased opioid and polysubstance use. Few studies have compared the neighborhood-level socioeconomic characteristics associated with overdoses of various substance classes and, to our knowledge, no investigation has yet assessed these factors in relation to polysubstance overdoses. Further, no study has determined whether socioeconomic conditions predict other contextually relevant aspects of overdoses such as whether they occur at-home or out-of-home. MethodsOverdose data (2015–2018) were obtained from the Coroner/Medical Examiner’s Office of Jefferson County, Alabama. The toxicology results of decedents with a known overdose locations (N = 768) were assessed for the presence of synthetic opioids, natural and semi-synthetic opioids, heroin, stimulants, benzodiazepines, and alcohol. Socioeconomic characteristics were obtained from the Unites States Census Bureau at the census tract level. ResultsStimulant overdoses occurred in neighborhoods with the highest rates of disadvantage relative to other substance and polysubstance overdose types. The majority of included overdoses occurred at-home (63.7%) and an index of socioeconomic disadvantage predicted overdose rates for both at-home and out-of-home overdoses. Heroin overdose deaths were more likely to occur at-home while polysubstance stimulant-heroin overdoses were more common out-of-home. ConclusionsAn index of socioeconomic disadvantage was generally predictive of overdose, regardless of the setting in which the overdose occurred (in-home vs. out-of-home). The associations between neighborhood-level socioeconomic characteristics and fatal overdose can be tailored by substance type to create targeted interventions. Overdose setting may be an important consideration for future policy efforts, as overdoses were nearly twice as likely to occur at-home.

Moderators of Parents' Perceptions of the Neighborhood Environment and Children's Physical Activity, Time Outside, and Screen Time.

Increased physical inactivity and sedentary behavior among children are a global health concern. Examine associations between parents' perceived neighborhood environment and children's physical activity, outside time, and screen time, and whether these associations were moderated by age and socioeconomic position (SEP). Parents (N = 1212) completed a survey during the Recording and EValuating Activity in a Modified Park study. The neighborhood perceptions (social and physical environment), children's age, physical activity, outside time, and screen time were parent-reported. The SEP was derived from the Index of Relative Socio-economic Advantage and Disadvantage. Multiple linear and logistic regressions were performed with age and SEP interactions. Favorable perceptions of opportunities to be active and exercise were associated with a higher likelihood of meeting physical activity guidelines. Favorable perceptions of neighborhood ease for walking and a larger social network were also associated with more outdoor time. Moderation analyses revealed that favorable perceptions of several physical and social neighborhood environment features were associated with a higher likelihood of meeting physical activity guidelines in the high-SEP group and were negatively associated with preschoolers' weekday screen time. Future neighborhood environment initiatives and interventions aiming to promote active living communities should consider differences in age and SEP.

An index of geospatial disadvantage predicts both obesity and unmeasured body weight.

Neighborhood context impacts health. Using an index of geospatial disadvantage measures to predict neighborhood socioeconomic disparities would support area-based allocation of preventative resources, as well as the use of location as a clinical risk factor in care of individual patients. This study tested the association of the Area Deprivation Index (ADI), a neighborhood-based index of socioeconomic contextual disadvantage, with elderly obesity risk. We sampled 5066 Medicare beneficiaries at the University of Missouri between September 1, 2013 and September 1, 2014. We excluded patients with unknown street addresses, excluded body mass index (BMI) lower than 18 or higher than 62 as probable errors, and excluded patients with missing BMI data. We used a plot of simple proportions to examine the association between ADI and prevalence of obesity, defined as BMI of 30 and over. We found that obesity was significantly less prevalent in the least-disadvantaged ADI decile (decile 1) than in all other deciles (p < 0.05) except decile 7. Obesity prevalence within the other deciles (2–6 and 8–10) was not significantly distinguishable except that decile 2 was significantly lower than decile 4. Patients with missing BMI data were more likely to reside in the most disadvantaged areas. There was a positive association between neighborhood disadvantage and obesity in this Midwestern United States Medicare population. The association of missing BMI information with neighborhood disadvantage may reflect unmeasured gaps in care delivery to the most disadvantaged patients. These preliminary results support the continued study of neighborhood socioeconomic measures to identify health disparities in populations.

Socioeconomic patterning of vaping by smoking status among UK adults and youth

BackgroundSmoking contributes significantly to socioeconomic health inequalities. Vaping has captured much interest as a less harmful alternative to smoking, but may be harmful relative to non-smoking. Examining inequalities in vaping by smoking status, may offer insights into potential impacts of vaping on socioeconomic inequalities in health.MethodsData were from 3291 youth (aged 10–15) and 35,367 adults (aged 16+) from wave 7 (2015–17) of the UK Household Longitudinal Study. In order to adjust for biases that could be introduced by stratifying on smoking status, marginal structural models were used to estimate controlled direct effects of an index of socioeconomic disadvantage (incorporating household education, occupation and income) on vaping by smoking status (among adults and youth), adjusting for relevant confounders and for selection into smoking states. We also estimated controlled direct effects of socioeconomic disadvantage on being an ex-smoker by vaping status (among adult ever-smokers; n = 18,128).ResultsSocioeconomic disadvantage was associated with vaping among never smoking youth (OR for a unit increase in the socioeconomic index: 1.17; 95%: 1.03–1.34), and among ex-smoking adults (OR: 1.17; 95% CI: 1.09–1.26), with little to no association among never smoking (OR: 0.98; 95% CI: 0.91–1.07) and current smoking (OR: 1.00; 95% CI: 0.93–1.07) adults. Socioeconomic disadvantage was also associated with reduced odds of being an ex-smoker among adult ever-smokers, but this association was moderately weaker among those who vaped (OR: 0.88; 95% CI: 0.82–0.95) than those who did not (OR: 0.82; 95% CI: 0.80–0.84; p-value for difference = 0.081).ConclusionsInequalities in vaping among never smoking youth and adult ex-smokers, suggest potential to widen health inequalities, while weaker inequalities in smoking cessation among adult vapers indicate e-cigarettes could help narrow inequalities. Further research is needed to understand the balance of these opposing potential impacts, and how any benefits can be maximised whilst protecting the vulnerable.

The dietetic workforce distribution geographic atlas provides insight into the inequitable access for dietetic services for people with type 2 diabetes in Australia.

AimDietetic intervention delivered by Accredited Practising Dietitians is demonstrated to improve clinical outcomes of type 2 diabetes. The aim of the present study was to assess the accessibility to dietetic intervention for people with type 2 diabetes in Australia.MethodsPrevalence data and dietitian workforce distribution data were sourced from Diabetes Australia and Dietitians Association of Australia, respectively. Geographical information system mapping and statistical analysis were used to compare the ratios of dietitians to people with type 2 diabetes across the states of Australia and by index of socio‐economic advantage and disadvantage in each state.ResultsAn inequitable distribution of the dietetic workforce and that of the people with type 2 diabetes across Australia was demonstrated. An uneven distribution of the workforce is evidenced across states when compared to the distribution of type 2 diabetes prevalence; with New South Wales having a better ratio than Victoria and South Australia. Maps and prevalence data revealed the dietetic workforce was mostly concentrated in affluent urban centres whereas the type 2 diabetes prevalence rates were higher in rural and remote areas and in areas of lower socio‐economic status.ConclusionsThis research highlights the need to address the limited access to dietetic intervention for those in rural, remote and disadvantaged areas which also have the greatest need. The financial burden of treating diabetic complications on the national health budget necessitates government initiatives. These should include better use of telehealth dietetic consultations and incentives for dietitians to work in rural, remote and disadvantaged areas.

Explicit vs. statistical targeting in affirmative action: Theory and evidence from Chicago's exam schools

Prohibitions on using race in affirmative action have spurred a number of admissions systems to adopt race-neutral alternatives that encourage diversity without appearing to explicitly advantage any particular group. The new affirmative action system for Chicago's exam schools reserves seats for students based on their neighborhood and leaves the rest to be assigned via merit. Neighborhoods are divided into four tiers based on an index of socioeconomic disadvantage. At each school, an equal fraction of seats are reserved for each tier. We show that the order in which seats are processed at schools provides an additional lever to explicitly target disadvantaged applicants. We then characterize tier-blind processing rules that do not explicitly discriminate between tiers. Even under these rules, it is possible to favor certain applicants by exploiting the score distribution across tiers, a phenomenon we call statistical targeting. When disadvantaged applicants systematically have lower scores than other applicants, the optimal tier-blind processing order first assigns merit seats and then the tier seats. Our analysis shows that Chicago has been providing an additional boost to applicants from disadvantaged tiers beyond their reserved slots, a benefit comparable to what they received from the 2012 increase in reserve size.

Socioeconomic, geographic and climatic risk factors for canine parvovirus infection and euthanasia in Australia

Infection of canids with canine parvovirus (CPV) can result in severe, often fatal disease. This study aimed to examine climatic, socioeconomic and geographic risk factors for CPV infection and CPV-associated euthanasia in Australia. Australian veterinary hospital responses (534; 23.5 %) to a national veterinary survey of CPV case occurrences and euthanasias in 2016 were used. Severe caseloads (>40 cases per annum) were reported by 26 (11 %) hospitals (median 60 cases; IQR 50–110). Case reporting, case numbers, and without-treatment euthanasia were significantly associated with disadvantage across all Socio-Economic Index for Areas quintiles (p < 0.0001) – the greater the disadvantage, the more reports. Strong negative correlations were found between case numbers and the Index of Relative Socioeconomic Disadvantage (rSP = –0.3357, p < 0.0001) and also between euthanasia and the Index of Education and Occupation (rSP = –0.3762, p < 0.0001). Hospitals in more remote areas were also more likely to report cases and to euthanize without treatment (p < 0.0001). Of the climate variables, temperature of the hottest month was most strongly positively correlated with case numbers (rSP = 0.421, p < 0.0001), and lower annual rainfall was associated with more case-reporting hospitals (p < 0.0001). These results confirm that socioeconomic disadvantage is a significant risk-factor for CPV infection and outcome, and high temperature may also contribute to risk.

Narrative language skills of maltreated children living in out-of-home care

Purpose: Children’s narrative accounts of their experiences are central to the prosecution of perpetrators of alleged maltreatment. We describe the narrative language skills of children who were placed in out-of-home care (OOHC) following substantiated maltreatment. It was hypothesised that (i) children with such histories would display narrative language skills that fall significantly below published age-expected norms, (ii) narrative language skills and core language skills would be positively correlated and (iii) narrative language skills would be associated with measures of socio-economic disadvantage.Method: Eighty-three children (40 males and 43 females) aged 5;3 to 12;10 (M = 7.9, SD = 2.3) from English-speaking home backgrounds were assessed using the Test of Narrative Language and the Clinical Evaluation of Language Fundamentals (CELF-4) Core Language Score. The Raven’s Coloured Progressive Matrices, a measure of nonverbal intelligence, was employed as a covariate.Result: Forty-two percent of children scored in the below-average range on the Narrative Language Index Ability Index. The same proportion scored at/above age-expected levels on the Narrative Comprehension subtest, and 19% scored at/above age-expected levels on Oral Narration. There was a significant correlation between CELF-4 Core Language Scores and the Narrative Language Index Ability Index. Female carers’ education was significantly positively associated with overall narrative language scores; however, household income and index of socio-economic disadvantage were not significantly associated with narrative language scores.Conclusion: Children who are victims of substantiated maltreatment should be considered at-risk for compromised ability to provide a narrative account of their experiences. The heterogeneity and often scant oral narrative language skills of these children highlights the importance of police/human services training on best-practice forensic interviewing. Policy and practice implications for speech-language pathology early intervention to support the needs of at-risk children are also discussed.

Local Housing Characteristics Associated with Early Childhood Development Outcomes in Australian Disadvantaged Communities.

Disadvantaged communities tend to have poorer early childhood development outcomes. Access to safe, secure, and stable housing is a well-known social determinant of health but there is a need to examine key features of neighbourhood housing that reduce early childhood development inequities. The 2012 Australian Early Development Census (AEDC), a population-wide measure of early childhood development, and the Australian Bureau of Statistics Socio-economic Index for Areas Index of Relative Socio-economic Disadvantage were used to select fourteen disadvantaged local communities in five Australian states and territories based on those performing better (off-diagonal), or as expected (on-diagonal) on the AEDC relative to their socio-economic profile. Between 2015–2017, qualitative and quantitative housing data were collected in the local communities. In total, 87 interviews with stakeholders, 30 focus groups with local service providers and parents, and Australian Census dwelling information were analysed. A comparative case study approach was used to examine differences in housing characteristics (e.g., public housing, density, affordability, and tenure) between disadvantaged local communities performing ‘better than expected’ and ‘as expected’ on early childhood development. Perceived better housing affordability, objectively measured housing tenure (ownership) and perceived and objectively measured lower-density public housing were housing characteristics that emerged as points of difference for disadvantaged local communities where children had relatively better early childhood development outcomes. These characteristics are potential modifiable and policy sensitive housing levers for reducing early childhood development inequities.

Association between area-level socioeconomic status, accessibility and diabetes-related hospitalisations: a cross-sectional analysis of data from Western Victoria, Australia

ObjectiveHospitalisation rates for many chronic conditions are higher in socioeconomically disadvantaged and less accessible areas. We aimed to map diabetes hospitalisation rates by local government area (LGA) across Western Victoria,...