Indicators Of Socioeconomic Position Research Articles

#529 Educational level and mortality in patients receiving chronic hemodialysis in Lazio Region—Italy

Abstract Background and Aims In 2010, 2.6 million people received Kidney Replacement Treatment (KRT) worldwide. Hemodialysis (HD) is the most commonly used KRT. HD patients have a consistent risk of death. The impact of Educational Level (Edl) on the mortality in HD patients is unclear. This study aims to analyse the association between the Edls and mortality in incident chronic HD patients using the Lazio Regional Dialysis and Transplant Registry. Method A cohort of incident HD patients between 2008 and 2022 was selected. Patients under 18 years old and with a follow-up period shorter than 91 days were excluded. All patients were characterized by sociodemographic and clinical characteristics at the incident date and were followed from the incident date until the earliest of the following dates: death, transplantation, renal function recovery or end of the study (one or three years after initiation). One-year and three-year Crude Mortality Rates*100 Person Years (CMR*100PY) overall and by Edal (low: up to primary school, medium: secondary school, high: university degree and more) were calculated. Cumulative survival estimates at one year and three years since starting HD, were presented as Kaplan-Meier curves by EdL and compared using the log-rank test. Crude and adjusted Hazard Ratios (HR) and respective 95% Confidence Intervals (95% CI) of the association between EdL and one and three-year mortality were calculated using univariate and multivariate Cox regression models (reference category: low EdL). Sociodemographic and clinical characteristics were considered potential confounders or effect modifiers in the adjusted Cox regression models. Results The cohort counted 9,776; 33.5% had a low EdL, 30.7% had a medium, and 35.8% had a high EdL. The mean age decreased with increasing EdL (73 and 65 in low and high EdL, respectively) as the proportion of females (43.0% and 26.0% in low and high EdL, respectively). During the first year of HD, 1,683 deaths occurred, and 3,827 occurred within three years. One-year CMR*100PY were 24.1 (95% CI 22.4-26.0) in low EdL, 17.4 (95% CI: 15.9-19.0) in medium EdL and 15.0 (95% CI: 13.8-16.4) in high ED. The corresponding three-year CMR were 22.7 (95% CI 21.6-23.8), 17.4 (95% CI 16.4-18.4) and 15.1 (95% CI 14.2-16.0). One-year survivals estimates were 78.0% in low EdL, 83.8% in medium and 85.8% in high EdL (log-rank test: p-value < 0.001). The three-years survival estimates were 51.0% in low EdL, 59.3% in medium EdL and 63.7% in high EdL (log-rank test: p-value < 0.001). In one-year mortality the crude HRs were 0.72 (95% CI: 0.64–0.81) and 0.62 (95% CI: 0.55–0.70) of medium and high EdL vs. low EdL respectively; the corresponding adjusted HRs were 0.93 (95% CI: 0.83–1.06) and 0.92 (95% CI: 0.81–1.04) (Fig. 1). Similar results were obtained for three-year mortality: crude HRs were 0.77 (95% CI: 0.71–0.83) and 0.66 (95% CI: 0.62–0.72); adjusted HRs were 0.99 (95% CI: 0.92–1.08) and 0.97 (95% CI: 0.89–1.06), respectively (Fig. 2).). Conclusion Based on the present study, high educational level does not appear to be associated with lower mortality risk at either one-year or three-years. Hemodialysis patients are constantly monitored by National Health Service; this probably cancels the effect of low educational level on mortality. Although EdL is a strong indicator of socioeconomic position, it does not capture all dimensions of disadvantage. The mechanisms that underline the poor prognosis in Haemodialysis patients are complex and further investigations are needed.

Social inequalities in pregnancy metabolic profile: findings from the multi-ethnic Born in Bradford cohort study.

Lower socioeconomic position (SEP) associates with adverse pregnancy and perinatal outcomes and with less favourable metabolic profile in nonpregnant adults. Socioeconomic differences in pregnancy metabolic profile are unknown. We investigated association between a composite measure of SEP and pregnancy metabolic profile in White European (WE) and South Asian (SA) women. We included 3,905 WE and 4,404 SA pregnant women from a population-based UK cohort. Latent class analysis was applied to nineteen individual, household, and area-based SEP indicators (collected by questionnaires or linkage to residential address) to derive a composite SEP latent variable. Targeted nuclear magnetic resonance spectroscopy was used to determine 148 metabolic traits from mid-pregnancy serum samples. Associations between SEP and metabolic traits were examined using linear regressions adjusted for gestational age and weighted by latent class probabilities. Five SEP sub-groups were identified and labelled 'Highest SEP' (48% WE and 52% SA), 'High-Medium SEP' (77% and 23%), 'Medium SEP' (56% and 44%) 'Low-Medium SEP' (21% and 79%), and 'Lowest SEP' (52% and 48%). Lower SEP was associated with more adverse levels of 113 metabolic traits, including lower high-density lipoprotein (HDL) and higher triglycerides and very low-density lipoprotein (VLDL) traits. For example, mean standardized difference (95%CI) in concentration of small VLDL particles (vs. Highest SEP) was 0.12 standard deviation (SD) units (0.05 to 0.20) for 'Medium SEP' and 0.25SD (0.18 to 0.32) for 'Lowest SEP'. There was statistical evidence of ethnic differences in associations of SEP with 31 traits, primarily characterised by stronger associations in WE women e.g., mean difference in HDL cholesterol in WE and SA women respectively (vs. Highest-SEP) was -0.30SD (-0.41 to -0.20) and -0.16SD (-0.27 to -0.05) for 'Medium SEP', and -0.62SD (-0.72 to -0.52) and -0.29SD (-0.40 to -0.20) for 'Lowest SEP'. We found widespread socioeconomic differences in metabolic traits in pregnant WE and SA women residing in the UK. Further research is needed to understand whether the socioeconomic differences we observe here reflect pre-conception differences or differences in the metabolic pregnancy response. If replicated, it would be important to explore if these differences contribute to socioeconomic differences in pregnancy outcomes.

Socioeconomic position indicators and risk of alcohol-related medical conditions: A national cohort study from Sweden.

Alcohol consumption contributes to excess morbidity and mortality in part through the development of alcohol-related medical conditions (AMCs, including alcoholic cardiomyopathy, hepatitis, cirrhosis, etc.). The current study aimed to clarify the extent to which risk for these outcomes differs as a function of socioeconomic position (SEP), as discrepancies could lead to exacerbated health disparities. We used longitudinal Swedish national registries to estimate the individual and joint associations between 2 SEP indicators, educational attainment and income level, and risk of AMC based on International Classification of Diseases codes, while controlling for other sociodemographic covariates and psychiatric illness. We conducted Cox proportional hazards models in sex-stratified analyses (N = 1,162,679 females and N = 1,196,659 males), beginning observation at age 40 with follow-up through December 2018, death, or emigration. By the end of follow-up, 4,253 (0.37%) females and 11,183 (0.93%) males had received an AMC registration, corresponding to overall AMC incidence rates among females and males of 2.01 and 5.20, respectively. In sex-stratified models adjusted for birth year, marital status, region of origin, internalizing and externalizing disorder registrations, and alcohol use disorder (AUD) registration, lower educational attainment was associated with higher risk of AMC in both females (hazard ratios [HRs] = 1.40 to 2.46 for low- and mid-level educational attainment across 0 to 15 years of observation) and males (HRs = 1.13 to 1.48). Likewise, risk of AMC was increased for those with lower income levels (females: HRs = 1.10 to 5.86; males: HRs = 1.07 to 6.41). In secondary analyses, we further adjusted for aggregate familial risk of AUD by including family genetic risk scores for AUD (FGRSAUD), estimated using medical, pharmacy, and criminal registries in extended families, as covariates. While FGRSAUD were associated with risk of AMC in adjusted models (HR = 1.17 for females and HR = 1.21 for males), estimates for education and income level remained largely unchanged. Furthermore, FGRSAUD interacted with income level, but not education level, such that those at higher familial liability to AUD were more susceptible to the adverse effect of low income. Limitations of these analyses include the possibility of false negatives for psychiatric illness registrations, changes in income after age 40 that were not accounted for due to modeling restrictions, restriction to residents of a high-income country, and the inability to account for individual-level alcohol consumption using registry data. Using comprehensive national registry data, these analyses demonstrate that individuals with lower levels of education and/or income are at higher risk of developing AMC. These associations persist even when accounting for a range of sociodemographic, psychiatric, and familial risk factors. Differences in risk could contribute to further health disparities, potentially warranting increased screening and prevention efforts in clinical and public health settings.

Socioeconomic position, family context, and child cognitive development.

Socioeconomic position (SEP) may have different effects on cognitive development and family context could play a role in this association. This work aimed to analyse the role of socioeconomic positions, measured via various indicators collected longitudinally, in cognitive development at 7-11years of age, evaluating the role of family context as a potential mediator. The study sample included 394 and 382 children from the INMA Gipuzkoa and Valencia cohorts, respectively. SEP indicators were assessed during pregnancy (family social class, parental education, employment, and disposable income) and at 7 (Gipuzkoa) and 11 (Valencia) years of age (At Risk of Poverty or Social Exclusion (AROPE)). Family context and cognitive development were measured with the Haezi-Etxadi Family Assessment Scale 7-11 (HEFAS 7-11) and Raven's Coloured Progressive Matrices (Raven's CPM), respectively. Linear regression models were developed to assess the relationships between (a) SEP-family context, (b) SEP-cognitive development, and (c) family context-cognitive development, adjusting for a priori-selected confounders. Simple and multiple mediation analyses were performed to explore the role of family context in the SEP-cognitive development relationship. Lower SEP was related with a lower cognitive score, this association being particularly robust for family social class. SEP indicators were related to subscales of family context, in particular those regarding cognitive stimulation, parental stress, and parenting. A relationship was also found between these three subscales and child cognitive development, mediating the effect of family social class on child cognition by 5.2, 5.5, and 10.8%, respectively, and 12.0% jointly. Conclusion: Both family SEP and context contribute to a child's cognitive development. Equalising policies and positive parenting programmes could contribute to improving cognitive development in children. What is Known: • Parental social class, education, and employment status have been widely employed to measure socioeconomic position. What is New: • This work focuses on standard measurements of socioeconomic position but also other economic indicators such as the EHII and AROPE, and their effect on child cognitive development and family context. • Promotion of cognitive and linguistic development, parental stress and conflict, and parental profile fostering child development mediated the effect of family social class on cognitive development.

Trends in social inequality in breastfeeding duration in Denmark 2002-2019.

The aim of the present study was to analyse trends in full breastfeeding for at least 4 months across socioeconomic position in Denmark over a 17-year-long period from 2002 to 2019 using parental education as the indicator of socioeconomic position. The study used data on full breastfeeding collected between 2002 and 2019 by community health nurses in the collaboration Child Health Database, n=143,075. Data were linked with five categories of parental education from population registers. Social inequality was calculated as both the relative (odds ratio) and absolute social inequality (slope index of inequality). A trend test was conducted to assess changes in social inequality over time. A social gradient in full breastfeeding was found for the entire study period. The odds ratio for not being fully breastfed for at least 4 months ranged from 3.30 (95% confidence interval 2.83-3.84) to 5.09 (95% confidence interval 4.28-6.06) during the study period for infants of parents with the lowest level of education (primary school) compared with infants of parents with the highest level of education (5+ years of university education). The slope index of inequality was between -38.86 and -48.81 during the entire study period, P=0.80. This indicated that both the relative and absolute social inequality in full breastfeeding to at least 4 months of age was unchanged in the study period from 2002 to 2019. This study showed a persistent relative and absolute social inequality in full breastfeeding for at least 4 months from 2002 to 2019 in Denmark.

Housing tenure and disability in the UK: trends and projections 2004-2030.

Housing is a major influence on health. Housing tenure is associated with housing conditions, affordability, and security and is an important dimension of housing. In the UK there have been profound changes in both housing conditions and the distribution of households by tenure over the past century, that is during the lifetimes of the current population. We firstly reviewed and summarise changes in housing conditions, housing policy and tenure distribution as they provide a context to possible explanations for health variations by housing tenure, including health related selection into different tenure types. We then use 2015-2021 data from a large nationally representative UK survey to analyse associations between housing tenure and self-reported disability among those aged 40-69 controlling for other socio-demographic factors also associated with health. We additionally examine changes in the association between housing tenure and self-reported disability in the population aged 25 and over in the first two decades of the 21st century and project trends forward to 2030. Results show that associations between housing tenure and disability by tenure were stronger than for any other indicator of socio-economic position considered with owner-occupiers having the best, and social renters the worst, health. Differences were particularly marked in reported mental health conditions and in economic activity, with 28% of social renters being economically inactive due to health problems, compared with 4% of owner-occupiers. Rates of disability have increased over time, and become increasingly polarised by tenure. By 2020 the age standardised disability rate among tenants of social housing was over twice as high as that for owner occupiers, with projections indicating further increases in both levels, and differentials in, disability by 2030. These results have substantial implications for housing providers, local authorities and for public health.

Exposure to Adverse Life Events among Children Transitioning into Adolescence: Intersections of Socioeconomic Position and Race.

Racism is shown to diminish the protective effects of family socioeconomic position (SEP) resources for racial minorities compared to the majority groups, a pattern called minorities' diminished returns. Our existing knowledge is minimal about diminished returns of family SEP indicators on reducing exposure to adverse life events among children transitioning into adolescence. To compare diverse racial groups for the effects of family income and family structure on exposure to adverse life events of pre-adolescents transitioning to adolescence. In this longitudinal study, we analyzed data from 22,538 observations belonging to racially diverse groups of American 9-10-year-old children (n = 11,878) who were followed while transitioning to adolescence. The independent variables were family income and family structure. The primary outcome was the number of stressful life events with impact on adolescents, measured by the Life History semi-structured interview. Mixed-effects regression models were used for data analysis to adjust for data nested to individuals, families, and centers. Family income and married family structure had an overall inverse association with children's exposure to adverse life events during transition to adolescence. However, race showed significant interactions with family income and family structure on exposure to adverse life events. The protective effects of family income and married family structure were weaker for African American than White adolescents. The protective effect of family income was also weaker for mixed/other race than White adolescents. While family SEP is protective against children's exposure to adverse life events, this effect is weaker for African American and mixed/other race compared to White youth.

Types of fish consumption differ across socioeconomic strata and impact differently on plasma fish-based omega-3 fatty acids: a cross-sectional study

PurposeWe investigated the associations of socioeconomic position (SEP) with total and type of fish intake in a large general population and validated whether types of fish intake were differently associated with plasma EPA and DHA in a subset of the population.MethodsFrom the Lifelines Cohort Study, 94,246 participants aged 44 ± 13 years old were included to test the association of two SEP indicators, i.e., education level and household income level, with dietary intakes of total, oily, lean, fried, and other types of fish. In a subset of 575 participants (mean age: 50 ± 13 years), EPA and DHA levels were measured in plasma phospholipids and triglycerides. Dietary fish intake was assessed using Food Frequency Questionnaire. Linear regressions were applied and adjusted for relevant covariates.ResultsCompared to the high education level, lower education levels were negatively associated with total, oily, lean, and other fish intake (p < 0.001 for all), and positively associated with fried fish intake (β (SE): 0.04 (0.04), p < 0.001 for middle education; 0.07 (0.04), p < 0.001 for low education), independently of relevant covariates. Similar results were observed for income levels. In the subset population, total and oily fish intakes were positively associated with plasma EPA and DHA (p < 0.02 for all). Lean and other fish intakes were positively associated with only DHA (p < 0.008 for all), but not EPA, while fried fish was not associated with either EPA or DHA in plasma (p > 0.1 for all).ConclusionLower SEP was associated with a lower total intake of fish, and of oily and lean fish, but with higher intake of fried fish. Fried fish was not associated with the fish-based EPA and DHA in plasma. Hence, SEP-related differences in fish consumption are both quantitative and qualitative.

Childhood socioeconomic position and sex-specific trajectories of metabolic traits across early life: prospective cohort study

Socioeconomic inequalities in cardiovascular disease risk begin early in life and are more pronounced in females than males later in life. Causal atherogenic traits explaining this are not well understood. We explored sex-specific associations between childhood socioeconomic position (SEP) and molecular measures of systemic metabolism across early life. Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based birth cohort in southwest England. Pregnant women with an expected delivery date between 1991 and 1992 were invited to participate. Maternal education was the primary indicator of SEP. Concentrations of 148 metabolic traits from targeted metabolomics (nuclear magnetic resonance spectroscopy) from research clinics at ages 7, 15, 18 and 25years were analysed. The sex-specific slope index of inequality (SII) in trajectories of metabolic traits was estimated using multilevel models. Total number of participants included was 6537 (12,543 repeated measures). Lower maternal education was associated with more adverse levels of several atherogenic lipids and key metabolic traits among females at age 7years, but not males. For instance, SII for very small very-low-density lipoprotein (VLDL) concentrations was 0.16SD (95% CI: 0.01, 0.30) among females and-0.02SD (95% CI:-0.16, 0.13) among males. Between 7and 25years, inequalities widened among females and emerged among males particularly for VLDL particle concentrations, apolipoprotein-B concentrations, and inflammatory glycoprotein acetyls. For instance, at 25years, SII for very small VLDL concentrations was 0.36SD (95% CI: 0.20, 0.52) and 0.22SD (95% CI: 0.04, 0.40) among females and males respectively. Prevention of socioeconomic inequalities in cardiovascular disease risk requires a life course approach beginning at the earliest opportunity, especially among females. The UK Medical Research Council and Wellcome (grant ref: 217065/Z/19/Z) and the University of Bristol provide core support for ALSPAC. A comprehensive list of grants funding is available on the ALSPAC website (http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf). KON is supported by a Health Research Board (HRB) of Ireland Investigator Led Award (ILP-PHR-2022-008). JB, GDS and KT work in a unit funded by the UK MRC (MC_UU_00011/1 and MC UU 00011/3) and the University of Bristol. OR is supported by a UKRI Future Leaders Fellowship (MR/S03532X/1). These funding sources had no role in the design and conduct of this study. This publication is the work of the authors and KON will serve as guarantor for the contents of this paper.

Trends in the ability of socioeconomic position to predict individual body mass index: an analysis of repeated cross-sectional data, 1991-2019.

The widening of group-level socioeconomic differences in body mass index (BMI) has received considerable research attention. However, the predictive power of socioeconomic position (SEP) indicators at the individual level remains uncertain, as does the potential temporal variation in their predictive value. Examining this is important given the increasing incorporation of SEP indicators into predictive algorithms and calls to reduce social inequality to tackle the obesity epidemic. We thus investigated SEP differences in BMI over three decades of the obesity epidemic in England, comparing population-wide (SEP group differences in mean BMI) and individual-level (out-of-sample prediction of individuals' BMI) approaches to understanding social inequalities. We used repeated cross-sectional data from the Health Survey for England, 1991-2019. BMI (kg/m2) was measured objectively, and SEP was measured via educational attainment, occupational class, and neighbourhood index of deprivation. We ran random forest models for each survey year and measure of SEP adjusting for age and sex. The mean and variance of BMI increased within each SEP group over the study period. Mean differences in BMI by SEP group also increased: differences between lowest and highest education groups were 1.0kg/m2 (0.4, 1.6) in 1991 and 1.3kg/m2 (0.7, 1.8) in 2019. At the individual level, the predictive capacity of SEP was low, though increased in later years: including education in models improved predictive accuracy (mean absolute error) by 0.14% (- 0.9, 1.08) in 1991 and 1.05% (0.18, 1.82) in 2019. Similar patterns were obtained for occupational class and neighbourhood deprivation and when analysing obesity as an outcome. SEP has become increasingly important at the population (group difference) and individual (prediction) levels. However, predictive ability remains low, suggesting limited utility of including SEP in prediction algorithms. Assuming links are causal, abolishing SEP differences in BMI could have a large effect on population health but would neither reverse the obesity epidemic nor reduce much of the variation in BMI.

Association of Personal Wealth Indicators and Health Care Costs in Persons With Alzheimer's Disease

ObjectivesThere is paucity of studies on the relationship between personal wealth and health care costs among persons with dementia, and earlier studies on other indicators of socioeconomic position have assessed costs after dementia diagnosis only. We investigated how different indicators of personal wealth (disposable income, supplementary income, assets subject to taxation, taxes and tax-like payments, and liabilities) are associated with health care costs in persons with Alzheimer's disease (AD) before and after AD diagnosis. DesignRegister-based nationwide cohort study of persons with AD. Setting and ParticipantsCohort of 70,531 people who received a clinically verified AD diagnosis in Finland between 2005 and 2011 and were community-dwelling at time of diagnosis. MethodsData on income indicators were obtained from Statistics Finland. Data on medication costs and hospital care costs for the 12-month period from 5 years before to 2 years after AD diagnosis were obtained from national registers. Associations of wealth indicators with costs were investigated with multivariate mixed-effect negative binomial regression. ResultsAfter adjustment for age, region, sex, marital status, comorbidities, expensive medications, use of psychotropic and antidementia medication, and highest occupational class before AD, people with higher levels of personal wealth indicators were more likely to have higher total health care costs along the whole follow-up period. The incidence rate ratios (IRRs), 95% CI for highest quintile vs lowest quintile were 1.17, 1.15−1.19 for disposable income, 1.10, 1.08−1.12 for taxable income, 1.18, 1.16−1.19 for supplementary income, 1.07, 1.06−1.09 for taxes, and 1.05, 1.04−1.07 for taxable wealth. Conclusions and ImplicationsOur observation on the association between income/wealth indicators and health care costs in a country with a strong public health care system call for more effective measures in targeting health inequalities in the aging population. Although the different indicators were not completely interchangeable, associations of different indicators were toward the same direction.

Health inequalities in type 2 diabetes: contributions of exposures in the residential environment

Abstract Background People with lower socioeconomic position (SEP) have higher risk of type 2 diabetes (T2D). Besides genetic predisposition, the exposome shapes this risk. This includes exposures in the residential environment. We explored the relationships between SEP, the residential food environment, walkability, greenspace, and T2D. Methods Cross-sectional and longitudinal data from 9188 participants were analyzed. Prevalent T2D was measured by an oral glucose tolerance test. Incident T2D was self-reported in annual follow-up questionnaires. Education, income, and occupation were measured as indicators of SEP. The residential environment was operationalized by address level Food Environment Healthiness Index (FEHI), number of fast-food outlets (FF), walkability index (WI), and proportion of greenspace (GS). Logistic regression and survival analyses were used to model the associations between SEP, the environment and T2D. The proportion of mediation of the association between SEP and T2D was estimated in a causal mediation analysis using a simulation approach. Results Over a median follow-up of 6.2 years, 207 incident cases were identified. Lower SEP was associated with higher risk of T2D. Hazard ratios (HR) were 2.0 (95%CI 1.6-2.6), 1.8 (1.4-2.3) and 1.8 (1.2-2.6) for an interquartile range decrease (IQR) of education, income, and occupation, respectively. HRs for IQR changes of the environmental factors were: FEHI 1.2 (1.0-1.4), FF 0.9 (0.8-1.0), WI 1.2 (1.0-1.6) and GS 1.2 (1.0-1.4). Regression on prevalent T2D yielded similar results. Lower SEP was associated with a less healthy environment (e.g., FEHI -0.08 (-0.10--0.06) for education). Environmental exposures mediated between 0.3% (-8.6-8.6) and 8.5% (2.3-27.4) of the longitudinal associations. Conclusions Lower SEP was associated with prevalent and incident T2D. People with lower SEP lived in a slightly less healthy residential environment. Some of the SEP-T2D association could be mediated by the environment. Key messages • A less healthy residential food environment, lower walkability and less green space might mediate some of the association between SEP and T2D. • More research is needed to clarify the extent to which environmental pathways contribute to health inequalities.

Appropriate Categorization of Inequality to Inform Policy Decisions: Estimating Distribution of Lifetime Health Using Alternative Approaches to Socioeconomic Stratification

ObjectivesEstimation of gradients in lifetime health, notably quality-adjusted life expectancy (QALE), has largely focused on index of multiple deprivation to categorize the population by socioeconomic position. In this article, we estimate QALE using alternate, individual- rather than area-level, indicators of socioeconomic position. MethodsBuilding on previous research methods, the distribution of QALE is estimated across education and income groups based on data from the Health Survey for England and the Office for National Statistics. QALE is estimated for each group by combining multivariate mortality rates and health-related quality of life (HRQL) weights using life tables. HRQL weights were estimated using ordinary least squares and missing data were handled using multiple imputation. ResultsThe estimated lifetime HRQL weights decreased with increased age, lower educational attainment, and lower income. For example, the QALE at birth for males in the lowest educational attainment group was 61.69 quality-adjusted life-years (QALYs), 1.54 QALYs lower than females in the same group. This is in contrast to 76.58 and 75.89 QALYs for males and females in the highest educational attainment group, respectively. A similar trend was observed across income quintiles albeit the gap was less pronounced. ConclusionsThe use of index of multiple deprivation to assess health inequalities may be masking important information about individual-level variation. Decisions makers should consider this alongside the merits of using area-level approaches to categorizing the population if individual-level approaches are preferable.

Trends in the effects of socioeconomic position on physical activity levels and sedentary behavior among Korean adolescents.

We examined trends in physical activity and sedentary behavior in Korean adolescents, and their association with socioeconomic position (SEP). We used data from the Korea Youth Risk Behavior Survey, a nationwide study involving students aged 12-19 conducted between 2009 and 2021. SEP was assessed based on economic status, parental education attainment, and urbanization. Physical activity was categorized into vigorous physical activity, moderate physical activity, and muscle training, and sedentary time was also measured. We conducted the log-binomial regression to calculate prevalence ratios (PRs) and prevalence differences. Our analysis included a total of 593,896 students. We observed an increasing trend in physical activity, but a worsening trend in sedentary behavior. A positive association was found between an adolescent's physical activity and SEP indicators, except for urbanization. Adolescents with higher economic status engaged in more vigorous physical activity (high: PR, 1.26; 95% confidence interval [CI], 1.25 to 1.28; middle: PR, 1.03; 95% CI, 1.02 to 1.04). Similar associations were observed for father's education (tertiary or above: PR, 1.11; 95% CI, 1.09 to 1.13; upper secondary: PR, 1.05; 95% CI, 1.03 to 1.07) and mother's education (tertiary or above: PR, 1.17; 95% CI, 1.15 to 1.20; upper secondary: PR, 1.06; 95% CI, 1.04 to 1.08). Adolescents with higher economic status also showed a higher compliance rate with the guideline restricting sedentary time to 2 hours per day (high: PR, 1.28; 95% CI, 1.25 to 1.30; middle: PR, 1.03; 95% CI, 1.01 to 1.05). Adolescents with higher SEP exhibited more physical activity and less sedentary time than those with lower SEP.

Socioeconomic Position and Type 2 Diabetes: The Mediating Role of Psychosocial Work Environment- the Maastricht Study.

Objective: We examined the association between low socioeconomic position (SEP) and Type 2 Diabetes Mellitus (T2DM), and the mediating role of psychosocial work environment by using counterfactual mediation analysis. Methods: Data from 8,090 participants of The Maastricht Study were analysed. SEP indicators (education, income, occupation), self-reported psychosocial work stressors, (pre)diabetes by oral glucose tolerance test were measured at baseline. Incident T2DM was self-reported per annum up to 9years. Cox regression and causal mediation analyses were performed. Results: 2.8% (N = 172) of the participants without T2DM at baseline reported incident T2DM. People with lower SEP more often had prevalent T2DM (e.g., education OR = 2.49, 95% CI: 2.16-2.87) and incident T2DM (e.g., education HR = 2.21, 95% CI: 1.53-3.20) than higher SEP. Low job control was associated with prevalent T2DM (OR = 1.44 95% CI: 1.25-1.67). Job control partially explained the association between income and prevalent T2DM (7.23%). Job demand suppressed the associations of education and occupation with prevalent T2DM. The mediation models with incident T2DM and social support were not significant. Conclusion: Socioeconomic inequalities in T2DM were present, but only a small part of it was explained by the psychosocial work environment.

The influence of immigrant background and parental education on overweight and obesity in 8-year-old children in Norway

BackgroundLittle is known about the prevalence of overweight/obesity and socio-economic position (SEP) in children with immigrant background in Scandinavia. The purpose of this study is to examine the prevalence of overweight/obesity by immigrant background among children in Norway and to explore the role of SEP in explaining differences in weight status.MethodsAnthropometric data from 8,858 children (age 8.3 years) from the population-based Norwegian Childhood Growth Study were used. Information about immigrant background, country of origin, and parental education (used as an indicator of SEP) were provided by Statistics Norway. For children with immigrant background, regional background was determined based on country of origin. Prevalence ratios (PR) were estimated for overweight/obesity and weight-to-height-ratio (WHtR) ≥ 0.5 by immigration and regional background, using generalized estimating equation log-binominal models adjusting for sex, age, survey year (model 1), residential area, population density (model 2) and parental education (model 3).ResultsChildren with immigrant background had a higher prevalence of overweight/obesity and WHtR ≥ 0.5 than non-immigrant background children. Adjusted for parental education, children with an immigrant background from Southern and Eastern Europe, Asia except South-Asia, and Africa had a higher prevalence of overweight/obesity [PR: 1.37 (95% confidence interval (CI): 1.10–1.72), 1.28 (1.05–1.57), 1.47 (1.13–1.91), respectively] than children with a non-immigrant background. Children originating from Asia except South-Asia had a higher prevalence of WHtR ≥ 0.5 (PR: 1.64, CI: 1.25–2.15) compared to non-immigrant background children. The adjustment for parental education did not substantially change the results.ConclusionChildren with immigrant background had higher prevalence of overweight/obesity than non-immigrant background children. The difference varied according to region of origin but not substantially according to parental education. There is a need for culturally acceptable preventative measures targeting the parents of immigrant background children.

Developing SEP65: A Census-Derived Index of Socio-Economic Position Specifically for the Older Population in Aotearoa New Zealand

BackgroundGlobally, societies are ageing as life expectancy increases and fertility rates decline. Many studies exploring associations between socioeconomic position (SEP) and health outcomes among the older population use conventional working-age measures of SEP (education, occupation, and income) or an area-based deprivation index.MethodsMicrodata from the 2013 New Zealand Census was used to create a new measure of socioeconomic position specifically for the population aged ≥65 years (SEP65), using information about housing tenure, wealth, and receiving government benefits. We dichotomised variables representing income, assets, and housing tenure to apportion 489,264 older people in our analytic sample into low, medium and high levels of SEP. A multivariable logistic regression was used to investigate the relationship between smoking and SEP65, controlling for age, sex, ethnicity and area-level deprivation.ResultsWe report inequities between European, Māori and Pacific populations, which increase with age. We found an inverse relationship between the odds of smoking and levels of SEP65. Moreover, we further validated the SEP65 measure against the New Zealand Index of Deprivation (NZDep2013).At the third SPINE20 summit 2022 which took place in Bali, Indonesia, in August 2022, 17 associations endorsed its recommendations.ConclusionUsing an age-specific measure of SEP for the older population will aid policymakers in the appropriate allocation of resources according to need more effectively than working-age indicators.

Socioeconomic differences in children's victimization to maternal and paternal violence: a register-based study.

To explore the potential of administrative data in assessment of the association between parental socioeconomic position (SEP) and children's violent victimization by biological parents. A longitudinal register-linkage study based on child-mother and child-father data, including all children born in Finland between 1991 and 2017. The data included 1,535,428 children, 796,335 biological mothers, and 775,966 fathers. We used logistic regression with person-years as observations and cluster-robust standard errors to predict children's violent victimization in 2009-2018 and assessed effect modification by child's age and gender. For the SEP indicators, lower maternal education (adjusted odds ratio (OR) 2.90, secondary education OR 1.99) and lower paternal education (OR 2.24, secondary education OR 1.59) were risk factors for violent victimization. Parental social assistance receipt (OR 2.4) and non-employment (OR 1.8-1.9) increased the risk of victimization to maternal and paternal violence. Income was associated with victimization in a gradient-like manner, with ORs ranging from 1.14 to 1.98 among mothers and from 1.29 to 2.56 among fathers. Children with low parental SEP were at the highest risk of parental violence, particularly paternal violence, at ages 3-8 years. All indicators of low SEP increased the risk of children experiencing both maternal and paternal physical violence, especially at ages 3-8 years. Longitudinal register data-because of large samples, no nonresponse or self-report bias, and the possibility to analyze violence committed by mother and father and age-groups separately-have great potential for comprehensive research on the risk factors of parental violence that are difficult to reliably assess with other types of data.

The potential of intervening on childhood adversity to reduce socioeconomic inequities in body mass index and inflammation among Australian and UK children: A causal mediation analysis

BackgroundLower maternal education is associated with higher body mass index (BMI) and higher chronic inflammation in offspring. Childhood adversity potentially mediates these associations. We examined the extent to which addressing...

Oral health and type 2 diabetes in a socioeconomic perspective

AimsThis study aimed to examine the association between type 2 diabetes and poor self-rated oral health, and to investigate whether such association is modified by socioeconomic position. MethodsWe conducted a cross-sectional study, including a population aged 18–75 years with self-reported type 2 diabetes (N = 41,884) and a sex-, age- and municipality-matched reference population from the Health in Central Denmark survey (2020). Multivariable logistic regression was used, and effect modification of indicators of socioeconomic position was examined. ResultsOral health was rated as poor in 37.0% of the population with type 2 diabetes and in 23.8% of the reference population without diabetes. Individuals with diabetes had higher risk of poor oral health (adjusted odds ratio (OR) 1.46 (95% CI: 1.39; 1.53)) than references. Interaction was seen between type 2 diabetes and highest attained education (p < 0.001). Stratified analyses showed higher risk of poor oral health in people with type 2 diabetes across all educational levels. ConclusionsPeople with type 2 diabetes were more likely to rate their oral health as poor than the reference population. Low education strengthened the association between diabetes and poor oral health.