Individual-level Deprivation Research Articles

Material and social deprivation associated with public health actual causes of death among older people in Europe: longitudinal and multilevel results from the Survey of Health, Ageing and Retirement in Europe (SHARE).

Adverse socioeconomic conditions at the individual and regional levels are associated with an increased risk of mortality. However, few studies have examined this relationship using multilevel analysis and, if so, only within a single country. This study aimed to examine this relationship using data from several European countries. Individual-level data were obtained from Waves 5 to 9 of the Survey of Health, Ageing and Retirement in Europe, while regional-level data were obtained from the Luxembourg Income Study Database. Cox regression analysis with gamma-shared frailty and a random intercept for country of residence was used to examine the association between individual mortality from all causes, cancer, heart attack, and stroke and measures of socioeconomic deprivation at the individual level, including material and social deprivation indices, and at the area level, including the Gini index. The risk of mortality from all causes was increased for respondents with material deprivation (hazard ratio (HR) = 1.77, 95% CI = [1.60, 1.96]) and social deprivation (HR = 7.63, 95% CI = [6.42, 9.07]) compared with those without. A similar association was observed between individual deprivation and the risk of mortality from cancer, heart attack, or stroke. Regional deprivation had a modest contextual effect on the individual risk of death from all causes and cancer. However, when individual-level deprivation was included in the models, no contextual effects were found. The results indicate that individual socioeconomic conditions significantly predict causes of death in older European adults, with those with material deprivation and social deprivation having a higher risk of death from all causes, including cancer, heart attack, and stroke, while the Gini index has a minimal effect, although the Gini index reflects regional disparities across Europe.

Persisting social disadvantage and intercensal social mobility in Northern Ireland: an examination of morbidity and all-cause mortality using three waves of the Northern Ireland Longitudinal Study (NILS).

Objective and ApproachUsing census returns from three waves of NILS (1991, 2001, 2011) linked with mortality data, we examined morbidity/mortality outcomes by socio-economic disadvantage over time (using an individual-level deprivation index derived from educational attainment, social class, housing tenure and household car availability at each census). These were combined to generate two indicators of Intercensal social mobility: measuring no change, and upward/downward mobility between censuses. The relationship between mobility (2001-2011) and (separately) self-reported mental ill-health (MIH) at the 2011 Census and all-cause mortality (2011-2015) were examined using logistic regression and Cox PH modelling respectively. Results Population comprised 288,262 individuals aged 25-74 in 2011, recording 19,318 deaths (2011-2015) and 23,959 (8.3%) reporting MIH. MIH: those with no intercensal mobility followed the standard pathway associated with persisting disadvantage (comparing with the most advantaged the least advantaged recorded OR=16.13:95%CI=13.50,19.28); and while both the upwardly and downwardly mobile generally recorded higher ORs than those consistently most advantaged, the magnitude of ORs increased with social distance traversed; and ORs for downward mobility were consistently higher than with upward mobility. Patterns associated with all-cause mortality were similar. ConclusionsThis suggests: upward mobility retains something of the social patterning pertaining in social disadvantage levels left behind; downward mobility may be connected to ongoing health issues. Poor health outcomes remain strongly associated with socio-economic circumstance. Implications Research focusing on relationship between social mobility, disadvantage and health outcomes in NI is limited: access to more precise administrative data will enhance possibilities associated with evidence-based policy formation.

Associations of Area-Level and Parental Individual-Level Social Deprivation with Glycemic Control over Time among Children with Type 1 Diabetes in France: A Longitudinal Cohort Study

Background. Poor glycemic control in patients with type 1 diabetes (T1D) is associated with greater social deprivation. However, the evidence is inconsistent in terms of the type of social deprivation (individual-level or area-level) and whether glycemic control changes over time. Here, we investigated the impacts of individual-level and area-level social deprivation on the glycated hemoglobin (HbA1c) trajectory from the time of T1D diagnosis. Materials and Methods. We retrospectively analyzed a cohort of children who were diagnosed with T1D between 2017 and 2020 at Bordeaux University Hospital. Social deprivation was assessed using both parental individual indicator (EPICES score) and ecological indicator (European Deprivation Index (EDI) score). Piecewise linear mixed-effects models were used to estimate the effects of social deprivation on HbA1c trajectory. Results. We included 168 patients. The most-deprived group included 29% and 22% of all patients, as revealed by the respective EPICES and EDI scores. The two indicators were poorly correlated. The short-term decrease in HbA1c level tended to be smaller in the most-deprived patients over the first 4 months after diagnosis than in other patients (slope difference of 2.68% per year compared with the slope among the least-deprived patients, P=0.056). The long-term trajectory was influenced by area-level deprivation (EDI score); the least-deprived patients (quintile 1) exhibited more stable mean HbA1c levels. Conclusions. Social deprivation may partially explain poor glycemic control in some patients; both short-term individual deprivation and long-term area-level deprivation may be involved. Further research is needed to determine how to integrate this information into a therapeutic strategy.

Preschool-level socio-economic deprivation in relation to emotional and behavioural problems among preschool children in Sweden.

The aim of this study was to explore the association between preschool-level socio-economic deprivation and emotional and behavioural problems among preschool children in Sweden using a multilevel approach. In this cross-sectional study, we used data on 2267 children whose parents and preschool teachers had responded to items measuring individual-level socio-economic deprivation and the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioural problems. Further, the Socioeconomic Structure Compensation Index (SSCI), collected from Uppsala municipality, was used to assess preschool-level socio-economic deprivation. Unadjusted and adjusted multilevel logistic regression models were used to explore the relations between preschool-level socio-economic deprivation and emotional and behavioural problems. In unadjusted models, children who attended preschools classified as highly deprived had elevated odds for emotional symptoms (odds ratio (OR) 1.71) as rated by parents. However, this association did not remain significant after adjusting for individual-level socio-economic deprivation factors. In both unadjusted and adjusted models, children who attended preschools classified as moderately deprived had elevated odds for peer-relationship problems as rated by parents (OR 1.63; adjusted OR 1.48). There were no significant associations between preschool deprivation and emotional and behavioural problems as rated by preschool teachers. Swedish preschools may have a compensatory capacity in addressing children's emotional and behavioural problems, whereas preschool-level deprivation remained significantly associated with peer-relationship problems after controlling for individual-level socio-economic deprivation factors. This implies that peer-relationship problems in deprived preschools need to be addressed in a broader community context.

Profiles of tobacco smokers and ex-smokers in a large-scale random sample survey across Wales: an unsupervised machine-learning cluster analysis

BackgroundThe Welsh government recently set a target to be smoke-free by 2030, which means reducing the prevalence of tobacco smoking in adults to 5% by then. The goal is to improve health and population life expectancy. To support this strategy, we identified profile groups with different sets of socioeconomic and demographic characteristics within the population of smokers. We compared these profiles to those identified in the ex-smoker population to provide a broader understanding of smokers and inform targeting of interventions and policy. MethodsWe did a cross-sectional study using data from the National Survey for Wales. This survey is a random sample telephone survey of individuals aged 16 years and older across Wales carried out from Sept 1, 2021 to Jan 31, 2022, weighted to be representative of the Welsh population. For the smoking subgroup, we did a weighted hierarchical cluster analysis with multiple imputation to impute missing data and repeated it for ex-smokers. In total, 63 survey variables were used in the analysis. These variables included smoking history, e-cigarette use, sociodemographics, lifestyle factors, individual-level deprivation, general health and long-term conditions, mental health, and wellbeing. FindingsAmong the 6407 respondents (weighted proportions: 49% male, 51% female; 28% aged 16–34 years, 46% aged 35–44 years, 26% aged ≥65 years; 95% white, 5% other ethnicity), 841 (13%) smoked and 2136 (33%) were ex-smokers. Four distinctive profiles of smokers were identified, the groups were of relatively comparable size and characterised by similarities described as (1) high-risk alcohol drinkers and without children; (2) single, mostly in social housing, and poor health and mental health; (3) mostly single, younger, tried e-cigarettes, and poor mental health; (4) older couples and poor health; when comparing the groups with each other. Cluster quality and validation statistics were considered fair: silhouette coefficient=0·09, Dunn index (Dunn2)=1·06. Generally, ex-smoker clusters differed from smoking clusters because of themes related to increased sickness, better affluence, employment, and older age (≥75 years). InterpretationThis study suggests that not all smokers are the same, and they do not fall into one coherent group. Smoking cessation interventions to improve the health of ageing populations might need a different approach to consider a wider context or motivations to inform targeted quitting. It is acknowledged that smoking might be underreported because of perceived social unacceptability. FundingPublic Health Wales.

Ancestry-attenuated effects of socioeconomic deprivation on type 2 diabetes disparities in the All of Us cohort

BackgroundDiabetes is a common disease with a major burden on morbidity, mortality, and productivity. Type 2 diabetes (T2D) accounts for roughly 90% of all diabetes cases in the USA and has a greater observed prevalence among those who identify as Black or Hispanic.MethodsThis study aimed to assess T2D racial and ethnic disparities using the All of Us Research Program data and to measure associations between genetic ancestry (GA), socioeconomic deprivation, and T2D. We used the All of Us Researcher Workbench to analyze T2D prevalence and model its associations with GA, individual-level (iSDI), and zip code-based (zSDI) socioeconomic deprivation indices among participant self-identified race and ethnicity (SIRE) groups.ResultsThe study cohort of 86,488 participants from the four largest SIRE groups in All of Us: Asian (n = 2311), Black (n = 16,282), Hispanic (n = 16,966), and White (n = 50,292). SIRE groups show characteristic genetic ancestry patterns, consistent with their diverse origins, together with a continuum of ancestry fractions within and between groups. The Black and Hispanic groups show the highest levels of socioeconomic deprivation, followed by the Asian and White groups. Black participants show the highest age- and sex-adjusted T2D prevalence (21.9%), followed by the Hispanic (19.9%), Asian (15.1%), and White (14.8%) groups. Minority SIRE groups and socioeconomic deprivation, both iSDI and zSDI, are positively associated with T2D, when the entire cohort is analyzed together. However, SIRE and GA both show negative interaction effects with iSDI and zSDI on T2D. Higher levels of iSDI and zSDI are negatively associated with T2D in the Black and Hispanic groups, and higher levels of iSDI and zSDI are negatively associated with T2D at high levels of African and Native American ancestry.ConclusionsSocioeconomic deprivation is associated with a higher prevalence of T2D in Black and Hispanic minority groups, compared to the majority White group. Nonetheless, socioeconomic deprivation is associated with reduced T2D risk within the Black and Hispanic groups. These results are paradoxical and have not been reported elsewhere, with possible explanations related to the nature of the All of Us data along with SIRE group differences in access to healthcare, diet, and lifestyle.

Material deprivation and the Brexit referendum: a spatial multilevel analysis of the interplay between individual and regional deprivation

Abstract In this study, we investigate the relationship between individual and neighbourhood deprivation and the decision to vote for Brexit in the 2016 referendum. Our analysis uses data from the UK Household Longitudinal Study and the English Index of Multiple Deprivation, and employs multilevel models to account for individual-level deprivation, neighbourhood deprivation, and larger-scale regional deprivation. We also examine the interaction between these scales. On average, we find that individual, neighbourhood, and wider area deprivation are associated with a higher likelihood of voting Leave. However, the effect of neighbourhood deprivation is heterogeneous and depends on the broader spatial context: living in deprived neighbourhoods (and to a lesser extent experiencing personal deprivation) has a stronger effect on voting behaviour in more affluent regions. Conversely, the effect of individual and neighbourhood deprivation is close to zero and statistically insignificant in more deprived areas of the country. These results suggest that social comparison processes of in-groups and out-groups operate within larger regional contexts. Our study thus highlights the role of individual and regional deprivation, but also their intersection, in shaping political attitudes and outcomes.

Socioeconomic Deprivation, Genetic Risk, and Incident Dementia

Socioeconomic factors and genetic predisposition are established risk factors for dementia. It remains unclear whether associations of socioeconomic deprivation with dementia incidence are modified by genetic risk. Participants in the UK Biobank aged ≥60 years and of European ancestry without dementia at baseline (2006-2010) were eligible for the analysis, with the main exposures area-level deprivation based on the Townsend Deprivation Index and individual-level socioeconomic deprivation based on car and home ownership, housing type and income, and polygenic risk of dementia. Dementia was ascertained in hospital and death records. Analysis was conducted in 2021. In this cohort study, 196,368 participants (mean [SD] age=64.1 [2.9] years, 52.7% female) were followed up for 1,545,316 person-years (median [IQR] follow-up=8.0 [7.4-8.6] years). In high genetic risk and high area-level deprivation, 1.71% (95% CI=1.44, 2.01) developed dementia compared with 0.56% (95% CI=0.48, 0.65) in low genetic risk and low-to-moderate area-level deprivation (hazard ratio=2.31; 95% CI=1.84, 2.91). In high genetic risk and high individual-level deprivation, 1.78% (95% CI=1.50, 2.09) developed dementia compared with 0.31% (95% CI=0.20, 0.45) in low genetic risk and low individual-level deprivation (hazard ratio=4.06; 95% CI=2.63, 6.26). There was no significant interaction between genetic risk and area-level (p=0.77) or individual-level (p=0.07) deprivation. An imaging substudy including 11,083 participants found a greater burden of white matter hyperintensities associated with higher socioeconomic deprivation. Individual-level and area-level socioeconomic deprivation were associated with increased dementia risk. Dementia prevention interventions may be particularly effective if targeted to households and areas with fewer socioeconomic resources, regardless of genetic vulnerability.

Developing and Validating an Individual-Level Deprivation Index for Children's Health in France.

Deprivation generates many health inequalities. This has to be taken in account to enhance appropriate access to care. This study aimed to develop and validate a pediatric individual-level index measuring deprivation, usable in clinical practice and in public health. The French Individual Child Deprivation Index (FrenChILD-Index) was designed in four phases: item generation then reduction using the literature review and expert opinions, and index derivation then validation using a cross-sectional study in two emergency departments. During these last two phases, concordance with a blinded evaluation by an expert enabled us to determine thresholds for two levels of moderate and severe deprivation. The generation and reduction phases retained 13 items. These were administered to 986 children for the derivation and validation phases. In the validation phase, the final 12 items of the FrenChILD-Index showed for moderate deprivation (requiring single specific care for deprived children) a sensitivity of 96.0% [92.6; 98.7] and specificity of 68.3% [65.2; 71.4]. For severe deprivation (requiring a multidisciplinary level of care), the sensitivity was 96.3% [92.7; 100] and specificity was 91.1% [89.2; 92.9]. The FrenChILD-Index is the first pediatric individual-level index of deprivation validated in Europe. It enables clinical practice to address the social determinants of health and meet public health goals.

Estimating an individual-level deprivation index for HIV/HCV coinfected persons in Canada.

BackgroundHIV-HCV coinfected individuals are often more deprived than the general population. However, deprivation is difficult to measure, often relying on aggregate data which does not capture individual heterogeneity. We developed an individual-level deprivation index for HIV-HCV co-infected persons that encapsulated social, material, and lifestyle factors.MethodsWe estimated an individual-level deprivation index with data from the Canadian Coinfection Cohort, a national prospective cohort study. We used a predetermined process to select 9 out of 19 dichotomous variables at baseline visit to include in the deprivation model: income >$1500/month; education >high school; employment; identifying as gay or bisexual; Indigenous status; injection drug use in last 6 months; injection drug use ever; past incarceration, and past psychiatric hospitalization. We fitted an item response theory model with: severity parameters (how likely an item was reported), discriminatory parameters, (how well a variable distinguished index levels), and an individual parameter (the index). We considered two models: a simple one with no provincial variation and a hierarchical model by province. The Widely Applicable Information Criterion (WAIC) was used to compare the fitted models. To showcase a potential utility of the proposed index, we evaluated with logistic regression the association of the index with non-attendance to a second clinic visit (as a proxy for disengagement) and using WAIC compared it to a model containing all the individual parameters that compose the index as covariates.ResultsWe analyzed 1547 complete cases of 1842 enrolled participants. According to the WAIC the hierarchical model provided a better fit when compared to the model that does not consider the individual’s province. Values of the index were similarly distributed across the provinces. Overall, past incarceration, education, and unemployment had the highest discriminatory parameters. However, in each province different components of the index were associated with being deprived reflecting local epidemiology. For example, Saskatchewan had the highest severity parameter for Indigenous status while Quebec the lowest. For the secondary analysis, 457 (30%) failed to attend a second visit. A one-unit increase in the index was associated with 17% increased odds (95% credible interval, 2% to 34%) of not attending a second visit. The model with just the index performed better than the model with all the components as covariates in terms of WAIC.ConclusionWe estimated an individual-level deprivation index in the Canadian Coinfection cohort. The index identified deprivation profiles across different provinces. This index and the methodology used may be useful in studying health and treatment outcomes that are influenced by social disparities in co-infected Canadians. The methodological approach described can be used in other studies with similar characteristics.

Road traffic noise and cardiovascular disease risk factors in UK Biobank.

AimsThe aim of this study was to investigate the cross-sectional associations of modelled residential road traffic noise with cardiovascular disease risk factors [systolic (SBP) and diastolic blood pressure (DBP), C-reactive protein, triglycerides, glycated haemoglobin, and self-reported hypertension] in UK Biobank.Methods and resultsThe UK Biobank recruited 502 651 individuals aged 40–69 years across the UK during 2006–10. Road traffic noise (Lden and Lnight) exposure for 2009 was estimated at baseline address using a simplified version of the Common Noise Assessment Methods model. We used multivariable linear and logistic regression models, adjusting for age, sex, body mass index (BMI), smoking, alcohol intake, area- and individual-level deprivation, season of blood draw, length of time at residence, and nitrogen dioxide (main model), in an analytical sample size of over 370 000 participants. Exposure to road-traffic Lden >65 dB[A], as compared to ≤55 dB[A], was associated with 0.77% [95% confidence interval (CI) 0.60%, 0.95%], 0.49% (95% CI 0.32%, 0.65%), 0.79% (95% CI 0.11%, 1.47%), and 0.12% (95% CI −0.04%, 0.28%) higher SBP, DBP, triglycerides, and glycated haemoglobin, respectively. Removing BMI from the main model yielded significant positive associations with all five markers with elevated percent changes. The associations with SBP or DBP did not appear to be impacted by hypertension medication while a positive association with prevalent self-reported hypertension was seen in the non-medicated group who exposed to a Lden level of 60–65 dB[A] (odds ratio 1.07, 95% CI 1.00, 1.15).ConclusionExposure to road traffic noise >65 dB[A], independent of nitrogen dioxide, was associated with small but adverse changes in blood pressure and cardiovascular biochemistry.

How does area-level deprivation depress an individual\u2019s self-rated health and life satisfaction? Evidence from a nationwide population-based survey in Japan

BackgroundArea-level deprivation is well known to have an adverse impact on mortality, morbidity, or other specific health outcomes. This study examined how area-level deprivation may affect self-rated health (SRH) and life satisfaction (LS), an issue that is largely understudied.MethodsWe used individual-level data obtained from a nationwide population-based internet survey conducted between 2019 and 2020, as well as municipality-level data obtained from a Japanese government database (N = 12,461 living in 366 municipalities). We developed multilevel regression models to explain an individual’s SRH and LS scores using four alternative measures of municipality-level deprivation, controlling for individual-level deprivation and covariates. We also examined how health behavior and interactions with others mediated the impact of area-level deprivation on SRH and LS.ResultsParticipants in highly deprived municipalities tended to report poorer SRH and lower LS. For example, when living in municipalities falling in the highest tertile of municipality-level deprivation as measured by the z-scoring method, SRH and LS scores worsened by a standard deviation of 0.05 (p < 0.05) when compared with those living in municipalities falling in the lowest tertile of deprivation. In addition, health behavior mediated between 17.6 and 33.1% of the impact of municipality-level deprivation on SRH and LS, depending on model specifications.ConclusionResults showed that area-level deprivation modestly decreased an individual’s general health conditions and subjective well-being, underscoring the need for public health policies to improve area-level socioeconomic conditions.

Neighborhood Deprivation and Preterm Birth in a North Carolina Birth Cohort

Background: Residing in deprived areas can have health impacts beyond individual level deprivation and may increase vulnerabilities to other exposures. Adverse pregnancy outcomes, including preterm birth, have previously been associated with various indicators of area-level deprivation. Methods: We examined associations between neighborhood deprivation and preterm birth in the North Carolina birth registry cohort from 2006 - 2011 (n=653,887). The neighborhood deprivation index (NDI) was developed at the census tract level using principle components analysis with American Community Survey 5-year estimates representing 5 socio-demographic domains: income/poverty, education, employment, housing, and occupation. Risk ratios (RR) (95% confidence intervals) were estimated using multilevel (random-intercept) binomial regression models adjusted for individual-level gestational parent race/ethnicity, marital status, Medicaid status, and age; race-stratified models were also examined. Results: The adjusted RR for preterm birth for each standard deviation increase in NDI in the unstratified analysis was 1.07 (1.06, 1.08). RRs in race-stratified analyses were highest for white parents (1.11 (1.09, 1.13)), followed by black (1.05 (1.04, 1.07) and Hispanic parents (1.03 (1.00, 1.05)). Conclusions: Increases in neighborhood deprivation were associated with increased risk of preterm birth, while the magnitude of association differed by race/ethnicity. In the future, we will explore interactions between neighborhood deprivation and environmental exposures, such as air pollution. The views expressed in this abstract are those of the authors and do not necessarily represent views or policies of the U.S. Environmental Protection Agency.

Sleep timing and sleep problems of preschoolers in Aotearoa/New Zealand: relationships with ethnicity and socioeconomic position

ObjectivesTo provide descriptive sleep data and explore sleep inequities, we investigated maternal reports of when and how well Māori (Indigenous) and non-Māori preschoolers sleep, and examined relationships between ethnicity (child and maternal), socioeconomic position (SEP) and sleep timing and problems of 3–4 year old children in Aotearoa/New Zealand (NZ). MethodsThis study involved cross-sectional analysis of data from the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand longitudinal study. Log-binomial regression models were used to investigate associations between child and maternal demographic variables and preschooler bedtimes, social jetlag and maternally-reported sleep problems. Child models included child ethnicity, child gender, area- and individual-level deprivation. Maternal models included maternal ethnicity, maternal age, area- and individual-level deprivation. Results340 Māori and 570 non-Māori preschoolers and their mothers participated. Māori preschoolers had later average bedtimes and wake times than non-Māori preschoolers. Ethnicity and area-level deprivation were independently associated with later bedtimes. Ethnicity was associated with social jetlag and sleep problems, independent of SEP. Individual-level deprivation was associated with problems falling asleep. Preschoolers of Māori mothers in least deprived areas were more likely to have problems falling asleep than preschoolers of non-Māori mothers in least deprived areas. ConclusionsResearch is needed to understand what sleep timing differences mean for preschoolers’ wellbeing in NZ. Fundamental causes of social and economic disadvantage experienced by Indigenous children and mothers and by families who hold low SEP must be addressed, in order to eliminate sleep health inequities in early childhood.

0356 Associations Between Ethnicity, Socioeconomic Deprivation and Preschoolers’ Sleep Health in Aotearoa/New Zealand

Abstract Introduction In Aotearoa/New Zealand (NZ) ethnic and socioeconomic inequities exist in adult sleep health but less is known about relationships between ethnicity, socioeconomic position and sleep in early childhood. Methods Maternally-completed questionnaire data from a pregnancy-birth cohort were analysed cross-sectionally. Log-binomial regression models investigated independent associations between ethnicity, socioeconomic position and sleep of 340 Māori (Indigenous) and 570 non-Māori 3-4 year olds. Independent variables included child ethnicity, gender, area-level deprivation (NZDep quintiles; 5=most deprived) and individual-level deprivation (NZiDep scores 1-5; 5=most deprived). Dependent variables included typical weekday and weekend sleep duration (&amp;lt;10hrs/10-13hrs), difference in week/weekend sleep duration (&amp;gt;1hr/≤1hr) and midsleep time (≥1hr/&amp;lt;1hr), problems falling asleep and problematic sleep patterns (no vs. moderate/large problem). Results Māori preschoolers were more likely to have short sleep (weekdays: PR=2.23, 95% CI 1.31-3.82; weekends: PR=2.04, 95% CI 1.24-3.36), week/weekend sleep duration difference &amp;gt;1hr (PR=2.47, 95% CI 1.59-3.84), week/weekend midsleep difference ≥1hr (PR=2.38, 95% CI 1.30-4.36) and a moderate/large problem falling asleep (PR=1.43, 95% CI 1.00-2.06) than non-Māori preschoolers. Preschoolers living in most deprived areas were more likely to have short sleep on weekdays (NZDep quintile 4: PR=3.91, 95% CI 1.43-10.72; NZDep quintile 5: PR=4.14, 95% CI 1.54-11.12) and week/weekend sleep duration difference &amp;gt;1hr (NZDep quintile 4: PR=2.34, 95% CI 1.23-4.43) than preschoolers in least deprived areas. Children with higher individual-level deprivation scores were more likely to have short sleep on weekends (NZiDep 5: PR=2.38, 95% CI 1.21-4.67) and a moderate/large problem falling asleep (NZiDep 3: PR=1.72, 95% CI 1.10-2.67) compared to children with lowest scores. Conclusion Ethnic and socioeconomic sleep health inequities exist as early as 3 years of age in NZ. Socio-political drivers of social and economic disadvantage experienced by Māori children and children from families who hold low socioeconomic position must be addressed to achieve equitable sleep health early in the lifecourse. Support Funding support was provided by Massey University New Zealand (Massey University Strategic Innovation Fund; Massey University Research Fund; and Massey University Doctoral Scholarship) and the Health Research Council of New Zealand (HRC 09/233, 08/547).

Predictors of intention translation in flexible sigmoidoscopy screening for colorectal cancer.

This prospective study aimed to identify predictors of intention and subsequent attendance of flexible sigmoidoscopy screening using constructs derived from the Health Belief Model (HBM). A total of 4,330 people aged 54 years and registered at 1 of 83 participating English general practices were sent a preinvitation questionnaire to assess sociodemographics, HBM variables including perceived benefits, barriers, seriousness, health motivation, and external cues to action as well a range of other constructs and personal characteristics known to relate to cancer screening. Of the 1,578 respondents (36.4%), 1,555 (98.5%) answered the intention question: 52.9% stated definitely yes, 38.1% probably yes, 6.8% probably not, and 2.2% definitely not. Intentions were positively associated with a higher score on a scale of benefits (odds ratio [OR] = 4.62; 95% confidence intervals [CI; 3.24, 6.59]) and health motivation, that is, interest in other ways of preventing colorectal cancer (OR = 2.61; 95% CI [1.62, 4.22]), while a higher score on perceived barriers (OR = 0.19; 95% CI [0.12, 0.31]) and currently following recommended healthy lifestyle behaviors (OR = 0.31; 95% CI [0.16, 0.59]) were negatively associated. Attendance was verified for 922 intenders (65.2%) of whom 737 (79.9%) attended. Attendance was predicted by health motivation (OR = 1.75; 95% CI [1.07, 2.86]), perceived benefits (OR = 1.82; 95% CI [1.37, 2.43]), perceived barriers (OR = 0.47; 95% CI [0.32, 0.69]), individual-level deprivation (OR = 0.26; 95% CI [0.14, 0.50]), and having diabetes (OR = 0.48; 95% CI [0.25, 0.94]). This study supported the usefulness of the HBM in predicting cancer screening and was further enhanced by adding non-HBM variables such as individual socioeconomic deprivation and comorbidities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The relationship between individual-level deprivation and health-related quality of life

ObjectiveTo examine the association between individual-level deprivation and health-related quality of life (HRQL) in the general population.MethodsData from a population-based survey in the Canadian province of Alberta were used. Individual-level deprivation was assessed using the Canadian Deprivation Index (CDI) and the Ontario Deprivation Index (ODI). HRQL was assessed using the EQ-5D-5 L. Differences in problems in the EQ-5D-5 L dimensions, index and visual analogue scale (VAS) scores across levels of deprivation were examined. Multivariate logistic and linear regression models adjusted for socio-demographic and other characteristics were used to examine the independent association between deprivation and HRQL.ResultsOf the 6314 respondents, 39% were aged between 18 and 44 years and 38% between 45 and 64 years; 60% were female. Mean EQ-5D-5 L index and VAS scores were 0.85 (standard deviation [SD] 0.14) and 79.6 (SD 17.7), respectively. Almost one-third (30.6%) of respondents reported no problems on all EQ-5D-5 L dimensions. Few participants reported some problems with mobility (23.8%), self-care (6.2%) and usual activities (25.2%), while 59.3 and 35.5% reported some levels of pain/discomfort and anxiety/depression, respectively. Differences between the most and least deprived in reporting problems in EQ-5D-5 L dimensions, index and VAS scores were statistically significant and clinically important. In adjusted regression models for both deprivation indices, the least well-off, compared to the most well-off, had higher likelihood of reporting problems in all EQ-5D-5 L dimensions. Compared to the most well-off, the least well-off had an EQ-5D-5 L index score decrement of 0.18 (p < 0.01) and 0.17 (p < 0.01) for the CDI and ODI, respectively. Similarly, an inverse association was found between the VAS score and the CDI (β = − 17.3, p < 0.01) as well as the ODI (β = − 13.3, p < 0.01).ConclusionIndividual-level deprivation is associated with worse HRQL. Poverty reduction strategies should consider the effects of not only neighbourhood-level deprivation, but also that of individual-level deprivation to improve overall health.

Prejudice and relative deprivation: the effects of self-referenced individual relative deprivation on generalized prejudice in European democracies

ABSTRACTCurrent literature on the economic determinants of prejudice focuses on how relative deprivation might lead to bias by focusing on group perceptions, with little or no attention given to individual-level deprivation. We address this gap in literature by examining how relative and objective individual-level hardship affects generalised prejudice and suggest that both forms of deprivation lead to increase in a wide variety of out-group biases. We test our hypotheses with data from an original cross-national survey conducted in 2015 in nine European countries (N∼18,000) by applying multilevel models. We include macro-level measures of economic context, including measures of unemployment levels and GDP growth. We make a novel contribution to the growing literature on prejudice in European societies: our results are surprising and suggest that individuals experiencing deteriorating living standards are less likely to express generalised prejudice. We suggest that these findings can be explained using political psychology literature: recent studies suggest that low self-esteem increases altruistic behaviour and reduces the level of out-group bias. These findings open new avenues of research and suggest a new way of theorising the relationship between economic deprivation and prejudice.

The Portuguese version of the European Deprivation Index: Development and association with all-cause mortality.

Socioeconomic inequalities are major health determinants. To monitor and understand them at local level, ecological indexes of socioeconomic deprivation constitute essential tools. In this study, we describe the development of the updated version of the European Deprivation Index for Portuguese small-areas (EDI-PT), describe its spatial distribution and evaluate its association with a general health indicator–all-cause mortality in the period 2009–2012. Using data from the 2011 European Union–Statistics on Income and Living Conditions Survey (EU-SILC), we obtained an indicator of individual deprivation. After identifying variables that were common to both the EU-SILC and the census, we used the indicator of individual deprivation to test if these variables were associated with individual-level deprivation, and to compute weights. Accordingly, eight variables were included. The EDI-PT was produced for the smallest area unit possible (n = 18084 census block groups, mean/area = 584 inhabitants) and resulted from the weighted sum of the eight selected variables. It was then categorized into quintiles (Q1-least deprived to Q5-most deprived). To estimate the association with mortality we fitted Bayesian spatial models. The EDI-PT was unevenly distributed across Portugal–most deprived areas concentrated in the South and in the inner North and Centre of the country, and the least deprived in the coastal North and Centre. The EDI-PT was positively and significantly associated with overall mortality, and this relation followed a rather clear dose-response relation of increasing mortality as deprivation increases (Relative Risk Q2 = 1.012, 95% Credible Interval 0.991–1.033; Q3 = 1.026, 1.004–1.048; Q4 = 1.053, 1.029–1.077; Q5 = 1.068, 1.042–1.095). Summing up, we updated the index of socioeconomic deprivation for Portuguese small-areas, and we showed that the EDI-PT constitutes a sensitive measure to capture health inequalities, since it was consistently associated with a key measure of population health/development, all-cause mortality. We strongly believe this updated version will be widely employed by social and medical researchers and regional planners.

Gout Severity, Socioeconomic Status, and Work Absence: A Cross-Sectional Study in Primary Care.

To examine the association between gout severity and socioeconomic status (SES) and gout severity and work absence. Postal questionnaires were sent to adult patients who were registered with 20 general practices and who had consultations regarding gout or had been prescribed allopurinol or colchicine in the preceding 2 years. Gout severity was defined using the following proxy measures: number of attacks, history of oligoarticular/polyarticular attacks, disease duration, and allopurinol use. SES was defined using the English index of multiple deprivation (area level) and using self-reported educational attainment (individual level). Work absence was defined as taking time off from work in the past 6 months because of gout. Adjusted odds ratios (ORadj ; 95% confidence intervals [95% CIs]) were calculated using logistic regression models (adjusted for age, sex, body mass index, gout severity, and comorbidities). A total of 1,184 completed questionnaires were returned. The mean age of patients was 65.6 years, and 84% were male. Not having attended further education ("further education" is defined as attendance after the statutory minimum school-leaving age of 16 years) was associated with having had ≥2 gout attacks in the last year (ORadj 0.54 [95% CI 0.36-0.81]) and oligoarticular/polyarticular attacks (ORadj 0.72 [95% CI 0.50-1.05]). Lower area-level deprivation was associated with fewer attacks (≥2) (ORadj 0.71 [95% CI 0.51-0.98]). Work absence was associated with having had ≥2 gout attacks in the last year (ORadj 2.91 [95% CI 1.22- 6.92]), oligoarticular/polyarticular attacks (ORadj 3.10 [95% CI 1.46-6.61]), and shorter disease duration (>18 years) (ORadj 0.13 [95% CI 0.03-0.50]). Gout severity was associated with individual-level deprivation, countering the historic and negative perception of gout as a "rich man's disease." The association of gout severity with work absence reinforces the argument for earlier urate-lowering therapy to prevent attacks from becoming frequent and debilitating.