Indicators Of Socioeconomic Deprivation Research Articles

Spatial patterning, correlates, and inequality in suicide across 432 neighborhoods in Taipei City, Taiwan

More than half of the world's population now lives in urban areas. Understanding the spatial distribution of suicide in these settings may inform prevention. Previous analyses of the spatial distribution of suicide in cities have largely been conducted in Western nations. We investigated the spatial pattern of suicide and factors associated with its spatial distribution in Taipei City, Taiwan. We estimated smoothed standardized mortality ratios for overall suicide and suicide by sex/age group across 432 neighborhoods (mean population size: 5500) in Taipei City (2004–2010) using Bayesian hierarchical models. A range of area-level characteristics including socioeconomic deprivation, social fragmentation, income inequality, and linking social capital were investigated for their associations with suicide mortality. Overall suicide rates were below average in the city center, whereas above average rates were found in some suburbs. The cartogram highlighted the concentration of suicide burden in one western area of the city. Male suicides demonstrated generally similar spatial patterning across age groups, while the geographic distribution of female suicides differed by age. After adjusting for other variables, two area characteristics were found to be associated with area suicide rates: the proportion of divorced/separated adults (rate ratio [RR] per one standard deviation increase = 1.08, 95% confidence interval 1.01–1.16), an indicator of social fragmentation; and median household income (RR = 0.80, 0.73–0.86), an indicator of socioeconomic deprivation. There was a 1.8-fold difference in suicide rates between neighborhood quintiles with the lowest and the highest median household income, with middle-aged males showing the largest gradient (3.2-fold difference). The geography of suicide in Taipei City showed spatial patterning and socioeconomic correlates distinct from cities in Western nations. There is a need for future research to better understand the correlates of change in the geographic distribution of suicide throughout the process of urban development.

Stillbirth among women in nine states in India: rate and risk factors in study of 886,505 women from the annual health survey

ObjectivesTo assess the rate of stillbirth and associated risk factors across nine states in India.DesignSecondary analysis of cross-sectional data from the Indian Annual Health Survey (2010–2013).SettingNine states in India: Madhya...

Patterns in Horse–Human Relationships: The Case of Wales

Abstract This paper explores some of the different relationships that horses and humans experience in the case study country of Wales. In doing so, it pays attention to differential patterns of equine care/lack of care and explores these from a sociological perspective considering evidence of the potential impact of cultural practices and socio-economic status in particular. The paper concludes that access to common lands and “fly grazing” may be associated with specific values and norms which may result in equine neglect, while indicators of socio-economic deprivation and patterns of equine neglect do not seem to be related. The paper highlights the variation in equine care across this relatively small national population and suggests some areas where further explanatory work could usefully be undertaken in order for us to better understand the care-relationships between horses and their keepers.

Individual and neighbourhood socioeconomic disparities and high blood pressure in France: Results from a cross-sectional analysis of the CONSTANCES cohort

Introduction The influence of socioeconomic status (SES) on cardiovascular outcomes has already been well-established. Lower income, lower education or manual occupation are associated with a higher prevalence of cardiovascular risk factors such as high blood pressure (HBP) as well as with cardiovascular mortality. Neighborhood factors, such as the affluence of the area of residence have also been associated with cardiovascular diseases. However, few studies have been able to analyze jointly the influence of individual and neighborhood SES on the prevalence of HBP. We aimed to do so using a large sample of French adults. Methods Participants are randomly selected adults aged 18 to 69 recruited to the CONSTANCES cohort between 2012 and 2015. Information on lifestyle was collected by a self-administered questionnaire. Blood pressure (BP) was measured in 16 recruitment centers using a standardized protocol. HBP has been defined as BP over 140/90 mmHg and/or taking antihypertensive medication as indicated by matched records from the national database or reimbursements from the French health insurance. SES has been defined at an individual-level using education and at a neighborhood-level through an indicator of socioeconomic deprivation of the area of residence (FDep), divided in quintiles in this study. Analyses were stratified by gender. We first calculated prevalence of HBP according to individual and neighborhood variables separately. We then performed three-level logistic regressions (recruitment center, neighborhood, individual) to analyze jointly the influence of individual and neighborhood SES on the prevalence of HBP, taking into account the specific structure of the data. Results A total of 63,627 individuals (53% women) recruited between 2012 and 2015 were included in the analyses. Mean age in men and women was 48.8 ± 13.3 years and 47.2 ± 13.5 years, respectively. In this sample, 19,383 individuals were classified hypertensive, so the crude prevalence of HBP was 30.5%. Using 2016 French population as reference, standardized prevalence of HBP was 27.5% [95% CI: 27.1–27.8], higher among men (33.8% [95% CI: 33.2–34.5%]) than women (21.3% [95% CI: 20.8–21.8%]). Prevalence increased with age, from 9.5% in 18–34 years to 63.5% in people aged 65 years and more. Prevalence of HBP strongly differed according to the education level in all age groups in both gender. For instance in women with no diploma, prevalence of HBP increased from 10% among 18–34 years to 65% among 65–70 years compared with 4% to 46% in women with highest diploma. The corresponding age-adjusted odds ratios (OR) for prevalence of HBP comparing the lowest versus highest level of education were 2.22 [95% CI: 2.00–2.50] in women and 1.82 [95% CI: 1.67–2.00] in men. Regarding neighborhood, living in more deprived areas was associated with a higher prevalence of HBP in women and men. Age-adjusted ORs for prevalence of HBP comparing the most versus least deprived quintile of areas of residence were 1.61 [95% CI: 1.47–1.75] in women and 1.69 [95% CI: 1.56–1.85] in men. In models including both individual and neighborhood indicators, OR comparing the lowest versus highest level of education were 2.09 [95% CI: 1.87–2.34] in women and 1.70 [95% CI: 1.53–1.88] in men. OR for prevalence of HBP comparing the most versus least deprived quintile of areas of residence were 1.25 [95% CI: 1.11–1.41] in women and 1.15 [95% CI: 1.03–1.30] in men. Conclusions In this cross-sectional analysis of a large sample of adults, we found marked socioeconomic gradients of HBP in all age groups and among both men and women. Individual and contextual indicators of SES were independently associated with the prevalence of HBP.

Automated Image Sampling and Classification Can Be Used to Explore Perceived Naturalness of Urban Spaces.

The psychological restorative effects of exposure to nature are well established and extend to just viewing of images of nature. A previous study has shown that Perceived Naturalness (PN) of images correlates with their restorative value. This study tests whether it is possible to detect degree of PN of images using an image classifier. It takes images that have been scored by humans for PN (including a subset that have been assessed for restorative value) and passes them through the Google Vision API image classification service. The resulting labels are assigned to broad semantic classes to create a Calculated Semantic Naturalness (CSN) metric for each image. It was found that CSN correlates with PN. CSN was then calculated for a geospatial sampling of Google Street View images across the city of Edinburgh. CSN was found to correlate with PN in this sample also indicating the technique may be useful in large scale studies. Because CSN correlates with PN which correlates with restorativeness it is suggested that CSN or a similar measure may be useful in automatically detecting restorative images and locations. In an exploratory aside CSN was not found to correlate with an indicator of socioeconomic deprivation.

“Geography of suicide in Hong Kong: Spatial patterning, and socioeconomic correlates and inequalities”

Past urban research on Western nations tends to show high suicide rates in inner city and socioeconomically deprived areas. However, little is known about geographic variations in suicide in non-Western cities. We used Bayesian hierarchical models to estimate smoothed standardised mortality ratios (2005–2010) for suicide in people aged 10 years or above in each geographic unit in Hong Kong at two levels, i.e. large street block (n = 1639; median population = 1860) and small tertiary planning unit group (n = 204; median population = 14,850). We further analysed their associations with a range of area socioeconomic characteristics and a deprivation index. The “city centre” of Hong Kong, a generally non-deprived area, showed mostly below average suicide rates. However, there were high rates concentrating in some socioeconomically deprived, densely populated areas, including some inner city areas, across the city. Males had greater geographic variations in rates than females, except the elderly group. The use of smaller geographic units revealed finer detailed suicide distribution than the use of larger units, and showed that suicide rates were associated with indicators of socioeconomic deprivation (population with non-professional jobs and low median household income), and social fragmentation (proportions of unmarried adults and divorced/separated adults), but not with Gini coefficient. Sex/age groups had different associations with suicide rates. Areas in the most deprived quintile had a suicide rate more than two times higher than the least deprived. The association between suicide and deprivation was stronger in males than females and more marked in the younger populations compared to the elderly. The spatial distribution of suicide in Hong Kong showed distinct patterning and a stronger association with income compared to findings from Western countries. Suicide prevention strategies should consider tackling the marked socioeconomic gradient in suicide and high risk in young and middle-aged males living in deprived areas.

Ethnic variations in five lower gastrointestinal diseases: Scottish Health and Ethnicity Linkage Study

ObjectivesOur objective was to augment the limited evidence mainly from local, clinical studies of ethnic differences in gastrointestinal disorders. Our question was: are there ethnic variations in hospitalisation/death for lower...

Depressão e apoio social em gestantes de fetos com malformações atendidas em um hospital materno-infantil público de referência no Rio de Janeiro

INTRODUÇÃO: A gestação e o puerpério são os períodos de maior prevalência de depressão na vida da mulher. Complicações obstétricas, incluindo malformações congênitas, são importantes fatores de risco para depressão durante a gestação. Gestantes de fetos malformados vivenciam um Evento de Vida Estressante (EVE) grave. Esse fato pode ser agravado quando há ausência de apoio social. OBJETIVOS: O presente estudo teve como objetivo estimar a depressão em gestantes atendidas em um hospital materno-infantil público de referência para malformações fetais na cidade do Rio de Janeiro. MÉTODO:Foram realizadas entrevistas com 86 gestantes de fetos com malformações, das quais foram avaliadas as características sociodemográficas, condições clínicas/obstétricas, diagnóstico de depressão, apoio social e EVE. O período compreendido da pesquisa foi entre agosto de 2011 e julho de 2012. RESULTADOS: A prevalência de depressão durante a gestação foi 17.4% (IC95% 0,09-0,26), sendo associada à variável estar desempregada. As dimensões de ausências de apoio emocional e de informação apresentaram a maior frequência (57%). CONCLUSÃO: A depressão é um transtorno comum em gestantes de fetos com malformações e está associada a indicadores de privação socioeconômica. Portanto, são necessárias a implementação de políticas sociais e intervenções psicossociais adequadas para reduzir o sofrimento psíquico da depressão gestacional nessa população.

Repeat attenders at National Health Service walk-in centres – a descriptive study using routine data

Whilst numerous studies have examined repeat attendance at general practices or emergency departments, little is known about repeat attenders at walk-in centres. The aim of this study was to examine age, gender, socio-economic status, distance from walk-in centre, day and time of attendance in relation to repeat attendance at walk-in centres. Descriptive study using routine data from four walk-in centres in England, two of which were located in London and were accessible to local and commuter populations. Data for 2 years (2003-2004) were examined. Age, gender, day and time of attendance were obtained from administrative records. Distance was calculated from the census output area of residence to walk-in centre attended. The Index of Multiple Deprivation (Income Domain) was used as an indicator of socio-economic deprivation at the small-area level. Thirty-nine percent of 272,701 attendances by 166,486 patients were repeat attendances. Seventy percent of patients attended once, 27.9% attended two to five times, and 2.2% attended on over five occasions over the 2-year study period. Patients attending the two London walk-in centres lived closer than those attending the two walk-in centres outside London (percentage living 6 km or more from walk-in centre: 9% and 12% compared with 18% and 22%). The London walk-in centres had a higher percentage of single attenders (74.1% and 78%) compared with the other two walk-in centres (63.3% and 64.7%). Repeat attenders lived closer to walk-in centres than single attenders. Adjusted odds ratios for patients living within 3 km of the walk-in centre relative to patients living 6 km or more from the walk-in centre ranged from 1.59 [95% confidence interval (CI) 1.42-1.78] to 3.34 (95% CI 3.12-3.57) for patients attending two to five times, and from 2.37 (95% CI 1.36-4.11) to 14.99 (95% CI 11.30-19.88) for patients with over five attendances. There was substantial variation with significant contrasting patterns in odds ratios across walk-in centres in relation to the other variables. Repeat attenders were older than single attenders at three of the four walk-in centres. Repeat attenders tended to be more likely to be male at two walk-in centres, and less likely to be male at the other two walk-in centres. Socio-economic deprivation tended to be associated with repeat attendance at one of the walk-in centres. There were also significant and contrasting patterns in relation to day and, to a lesser extent, time of attendance. Users living near walk-in centres are more likely to be repeat attenders. Age, gender, socio-economic deprivation, day and time of attendance had significantly higher or lower odds ratios for repeat attendance at different walk-in centres, suggesting that organizational and other factors may determine patterns of repeat attendance.

Poverty, violence and depression during pregnancy: a survey of mothers attending a public hospital in Brazil

Depression in women is associated with social deprivation and violence. We describe the prevalence and risk factors for depression during pregnancy, in particular the association with poverty and violence, in a Brazilian setting. A cross-sectional survey of women in the third trimester of pregnancy attending a public hospital maternity clinic from August 2003 to July 2004 in Rio de Janeiro. Participants were interviewed about their sociodemographic status, obstetric and medical conditions, substance use, stressful life events, and social support. Depression was diagnosed through the Composite International Diagnostic Interview (CIDI). A total of 230 of 240 eligible women consented to participate. The 12-month prevalence of depression was 19.1% (95% CI 14.4-24.9). On multivariate analyses, having been educated beyond primary school was protective (OR 0.5, 95% CI 0.2-0.9). Risk factors were: being divorced or widowed (OR 4.9, 95% CI 1.3-18.3); a history of depression before pregnancy (OR 7.9, 95% CI 3.1-20.5); loss of an intimate relationship (OR 8.4, 95% CI 3.3-21.4), experienced financial difficulties (OR 6.6, 95% CI 2.5-17.2) and having been exposed to violence in the previous year (OR 4.2, 95% CI 1.5-11.8). Depression is common during pregnancy and is associated with indicators of socio-economic deprivation, violence and the loss of an intimate relationship, and with a previous history of depression. Psychosocial interventions and appropriate social policies need to be implemented in this population to reduce the burden of maternal depression.

Define high risk behaviours, not high risk groups

EDITOR,--The two papers on factors influencing the reported incidence of tuberculosis in London and the United Kingdom provide valuable evidence of the association of various indicators of socioeconomic deprivation with the disease.1 2 I wonder, however, if confusion has arisen in combining risk groups with risk factors. AIDS researchers and educators …

An assessment of the effectiveness of cervical cytology screening in Sheffield

In a district where cytology services were severely stressed, small area variations in cervical cancer and cervical screening activity showed the same lack of concordance as in other studies of larger areas. In electoral wards with high indices of socio-economic deprivation, where the incidence of and deaths from cervical cancer were high, screening uptake was low in women aged 35 years and over, and the number of smears taken by general practitioners disproportionately low. Moreover, there was evidence of a high case fatality rate in the most deprived areas. Whilst there was a strong negative correlation between smear rate in older women and indicators of socio-economic deprivation (rs−0.7l,p<0.001), this was not the case for younger women amongst whom smears were taken with particularly high frequency by health authority and family planning clinics. Eighty-three per cent of deaths from cervical cancer in Sheffield occurred in those aged 50 years or over, but only 12 per cent of smears come from this group. Sufficient resources are currently deployed to allow each woman in the district aged between 15 and 64 years to have a smear every four years. A high proportion however are having smears more frequently and approximately 50 per cent of smear resources are being used by 19 per cent of women.