Individual-level Measures Of Socioeconomic Status Research Articles

Associations between Parental Engagement in the Neonatal Intensive Care Unit and Neighborhood-Level Socioeconomic Status.

This study aimed to (1) determine the effect of neighborhood-level socioeconomic status (SES), which considers the social and physical environment where a person lives, on parental engagement in the Neonatal Intensive Care Unit (NICU) and (2) compare the relationships between parental engagement and individual versus neighborhood-level measures of SES. In this cohort study, parents (n = 45) of premature neonates ≤34 weeks' gestation were assessed at 2 and 6 weeks after birth from December 2017 to October 2019. Neighborhood-level SES was determined using census data per the Association of Maternal and Child Health Programs' methodology, and parents self-reported their education level as an individual-level measure of SES. Data on frequency of engagement in NICU activities, including telephone updates, visitation, providing expressed breastmilk, and participating in kangaroo care, were collected from the electronic medical record. Parent psychosocial factors were assessed using validated surveys. Statistical analysis was performed using Fisher's exact test, t-test, and logistic regression. In multivariate regression analysis, disadvantaged neighborhood-level SES was associated with decreased odds of kangaroo care (OR = 0.16, 95% CI: [0.03-0.89]) and visitation (OR = 0.14, 95% CI: [0.02-0.87]), while lower individual-level SES was not significantly associated with kangaroo care, visiting, calling, or pumping (p > 0.05). Parental engagement was more consistently and significantly associated with neighborhood-level SES than with individual-level SES. Therefore, neighborhood-level SES measures may be more explanatory than individual-level SES measures. Further studies and targeted interventions are needed to address disparities in the frequency of kangaroo care and visitation according to SES. · Parents from disadvantaged neighborhoods are less likely to do kangaroo care and visit the NICU.. · Parent engagement was more significantly associated with neighborhood than with parent education.. · Neighborhood-level SES measures may be more explanatory than individual-level SES measures.. · Interventions are needed to address SES-related disparities in NICU kangaroo care and visitation..

Neighborhood-Level Disadvantage and Delayed Adjuvant Therapy in Head and Neck Cancer

For patients with head and neck squamous cell carcinoma (HNSCC), initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery is recommended by the National Comprehensive Cancer Network Guidelines and the Commission on Cancer. Although individual-level measures of socioeconomic status are associated with receipt of timely, guideline-adherent PORT, the role of neighborhood-level disadvantage has not been examined. To characterize the association of neighborhood-level disadvantage with delays in receiving PORT. This retrospective cohort study included 681 adult patients with HNSCC undergoing curative-intent surgery and PORT from 2018 to 2020 at 4 US academic medical centers. The data were analyzed between June 21, 2023, and March 5, 2024. The primary outcome was delay in initiating guideline-adherent PORT (ie, >6 weeks after surgery). Time-to-PORT (TTP) was a secondary outcome. Census block-level Area Deprivation Index (ADI) scores were calculated and reported as national percentiles (0-100); higher scores indicate greater deprivation. The association of ADI scores with PORT delay was assessed using multivariable logistic regression adjusted for demographic, clinical, and institutional characteristics. PORT initiation across ADI score population quartiles was evaluated with cumulative incidence plots and Cox models. Among 681 patients with HNSCC undergoing surgery and PORT (mean [SD] age, 61.5 [11.2] years; 487 [71.5%] men, 194 [29.5%] women) the PORT delay rate was 60.8% (414/681) and median (IQR) TTP was 46 (40-56) days. The median (IQR) ADI score was 62.0 (44.0-83.0). Each 25-point increase in ADI score was associated with a corresponding 32% increase in the adjusted odds ratio (aOR) of PORT delay (aOR, 1.32; 95% CI, 1.07-1.63) on multivariable regression adjusted for institution, age, race and ethnicity, insurance, comorbidity, cancer subsite, stage, postoperative complications, care fragmentation, travel distance, and rurality. Increasing ADI score population quartiles were associated with increasing TTP (hazard ratio of PORT initiation, 0.71; 95% CI, 0.53-0.96; 0.59; 95% CI, 0.44-0.77; and 0.54; 95% CI, 0.41-0.72; for ADI quartiles 2, 3, and 4 vs ADI quartile 1, respectively). Increasing neighborhood-level disadvantage was independently associated with a greater likelihood of PORT delay and longer TTP in a dose-dependent manner. These findings indicate a critical need for the development of multilevel strategies to improve the equitable delivery of timely, guideline-adherent PORT.

Increasing Area Deprivation Index negatively impacts ovarian cancer survival

IntroductionWhile individual-level measures of socioeconomic status have been well-studied in relation to ovarian cancer survival, no studies to date have examined both state and national-level Area Deprivation Indices (ADIs), which incorporate neighborhood affluence and resources. MethodsWe abstracted clinical data from medical records for ovarian cancer cases from the Vanderbilt University Medical Center and obtained ADIs from the Neighborhood Atlas®. Associations with clinical characteristics were assessed with Spearman correlations and Kruskal-Wallis tests; associations with progression-free survival (PFS) and overall survival (OS) were assessed with Cox proportional-hazards regression. ResultsAmong 184 cases, state and national ADIs were highly correlated, but not related to any cancer characteristics. In multivariable adjusted regression models, both were significantly associated with OS; each decile increase in state or national ADI corresponded to a 9 % or 10 % greater risk of death, respectively. ConclusionsIncreasing area-level deprivation may negatively impact ovarian cancer survival.

Association of neighborhood deprivation with pulmonary function measures among participants in the Gulf Long-Term Follow-up Study

IntroductionIndividual-level socioeconomic status (SES) has been shown to be an important determinant of lung function. Neighborhood level SES factors may increase psychological and physiologic stress and may also reflect other exposures that can adversely affect lung function, but few studies have considered neighborhood factors. ObjectiveOur aim was to assess the association between neighborhood-level SES and lung function. MethodsWe cross-sectionally analyzed 6168 spirometry test results from participants in the Gulf long-term Follow-up Study, a large cohort of adults enrolled following the largest maritime oil spill in US history. Outcomes of interest included the forced expiratory volume in 1 s (FEV1; mL), the forced vital capacity (FVC; mL), and the FEV1/FVC ratio (%). Neighborhood deprivation was measured by linking participant home addresses to an existing Area Deprivation Index (ADI) and categorized into quartiles. Individual-level SES measures were collected at enrollment using a structured questionnaire and included income, educational attainment, and financial strain. We used multilevel regression to estimate associations between ADI quartiles and each lung function measure. ResultsGreater neighborhood deprivation was associated with lower FEV1: βQ2vsQ1: −30 mL (95% CI: −97, 36), βQ3vsQ1: −70 mL (95% CI: −135, −4) and βQ4vsQ1: −104 mL (95% CI: −171, −36). FVC showed similar patterns of associations with neighborhood deprivation. No associations with the FEV1/FVC ratio were observed. ConclusionNeighborhood deprivation, a measure incorporating economic and other stressors, was associated with lower FEV1 and FVC, with magnitudes of associations reaching clinically meaningful levels. The impact of this neighborhood SES measure persisted even after adjustment for individual-level SES factors.

Is place or person more important in determining higher rural cancer mortality? A data-linkage study to compare individual versus area-based measures of deprivation.

Data from Northeast Scotland for 11,803 cancer patients (diagnosed 2007-13) were linked to UK Censuses to explore relationships between hospital travel-time, timely-treatment and one-year-mortality, adjusting for both area and individual-level socioeconomic status (SES). Adjusting for area-based SES, those living >60 minutes from hospital received timely-treatment more often than those living <15 minutes. Substituting individual-level SES changed little. Adjusting for area-based SES those living >60 minutes from hospital died within one year more often than those living <15 minutes. Again, substituting individual-level SES changed little. In Northeast Scotland distance to services, rather than individual SES, likely explains poorer rural cancer survival.Background and objectiveThe Northeast and Aberdeen Scottish Cancer and Residence (NASCAR) study found rural-dwellers are treated quicker but more likely to die within a year of a cancer diagnosis. A potential confounder of the relationship between geography and cancer mortality is socioeconomic status (SES). We linked the original NASCAR cohort to the UK Censuses of 2001 and 2011, at an individual level, to explore the relationship between travel time to key healthcare facilities, timely cancer treatment and one-year mortality adjusting for both area and individual-level markers of socioeconomic status.MethodsA data linkage study of 11803 patients examined the association between travel times, timely treatment and one-year mortality with adjustment for area, and for individual-level, markers of socioeconomic status.ResultsFollowing adjustment for area-based SES measures those living more than 60 minutes from the cancer treatment centre were significantly more likely to be treated within 62 days of GP referral than those living within 15 minutes (Odds Ratio [OR]) 1.41; 95% (Confidence Interval [CI]) 1.23, 1.60]. Replacing area-based with individual-level SES measures from UK Censuses made little impact on the results [OR 1.39; 95% CI 1.22, 1.57].Following adjustment for area-based SES measures of socioeconomic status those living more than 60 minutes from the cancer treatment centre were significantly more likely to die within one year than those living closer by [OR 1.22; 95% CI 1.08, 1.38]. Again, replacing area-based with individual-level SES measures from UK Censuses made little impact on the result [OR 1.20; CI 1.06, 1.35].ConclusionsDistribution of individual measures of socioeconomic status did not differ significantly between rural and urban cancer patients. The relationship between distance to service, timely treatment and one-year survival were the same adjusting for both area-based and individual SES. Overall, it seems that distance to services, rather than personal characteristics, influences poorer rural cancer survival.

Abstract 5788: Area deprivation index and ovarian cancer survival: Preliminary findings for two validated measures

Abstract Objective: Individual-level measures of socioeconomic status (SES), such as income and education, have been well-studied in relation to ovarian cancer survival. Emerging evidence suggests that area-level measures, which incorporate the affluence and resources of a neighborhood, may be significant drivers of these associations. Existing studies on the role of area-level deprivation and cancer outcomes are limited; no studies to date have examined validated state and national-level area-deprivation indices in the context of ovarian cancer. We therefore undertook this study to elucidate relationships between Area Deprivation Index (ADI), clinical characteristics, and ovarian cancer progression and survival. Methods: We abstracted clinical data from electronic medical records for epithelial ovarian cancer cases from the Vanderbilt University Medical Center (VUMC). Patient addresses at the time of treatment were used to ascertain state and national ADIs based on 17 measures from the Census and American Community Survey, including regional education, employment, and housing-quality indices. We used Pearson's coefficient to quantify correlations between continuous variables and the Wilcoxon rank-sum test to assess associations between ADI and clinical characteristics. Associations with progression-free survival (PFS) and overall survival (OS) were quantified by hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional-hazards regression. P-values ≤ 0.05 were considered statistically significant. Results: Among 183 epithelial ovarian cancer cases from the VUMC, state and national ADIs were highly correlated (r = 0.94, p &amp;lt; 0.001). Neither were significantly associated with race, grade, stage, histologic subtype, platinum sensitivity, or residual disease after surgical debulking. The median state ADI was 5.0 (scale: 1-10) and the median national ADI was 61.5 (scale: 1-100). Cases with higher than median state or national ADIs, indicating living in an area with more deprivation, did not have significantly different PFS in crude or multivariable models or OS in crude models. However, after adjustment for age, race, stage of disease, and grade, having a higher ADI was associated with approximately 40% shorter OS (state: HR: 1.40, CI: 1.01-1.94; national: HR: 1.44, CI: 1.03-2.00). Conclusions: Our preliminary findings support the hypothesis that increasing area-level deprivation negatively impacts ovarian cancer survival. Additional research to include additional clinical characteristics and replicate this association in a larger study population are currently underway. Citation Format: Demetra H. Hufnagel, Andrew J. Wilson, Fiona E. Yull, Pamela C. Hull, Joellen Schildkraut, Marta A. Crispens, Alicia Beeghly-Fadiel. Area deprivation index and ovarian cancer survival: Preliminary findings for two validated measures [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5788.

Socio-economic inequalities in fragility fracture outcomes: a systematic review and meta-analysis of prognostic observational studies.

Fragility fractures, especially of the hip, cause substantial excess mortality and impairment in health-related quality of life (HRQoL). This systematic review and meta-analysis aimed to investigate the association between socio-economic status (SES) and post-fracture mortality and HRQoL. PubMed, EMBASE and CINAHL databases were searched from inception to the last week of November 2018 for studies reporting an association between SES and post-fracture mortality and/or HRQoL among people aged ≥ 50years. Risk ratios (RRs) were meta-analyzed using a standard inverse-variance-weighted random effects model. Studies using individual-level and area-based SES measures were analyzed separately. A total of 24 studies from 15 different countries and involving more than one million patients with hip fractures were included. The overall risk of mortality within 1-year post-hip fracture in individuals with low SES was 24% higher than in individuals with high SES (RR 1.24, 95% CI 1.19 to 1.29) for individual-level SES measures, and 14% (RR 1.14, 95% CI 1.09 to 1.19) for area-based SES measures. The quality of the evidence for the outcome mortality was moderate. Using individual SES measures, we estimated the excess HRQoL loss to be 5% (95% CI - 1 to 10%) among hip fracture patients with low SES compared with high SES. We found a consistently increased risk of post-hip fracture mortality with low SES across SES measures and across countries with different political structures and different health and social care infrastructures. The impact of SES on post-fracture HRQoL remains uncertain due to sparse and low-quality evidence.

Socioeconomic Status and the Prediction of Health Promoting Dietary Behaviours: A Systematic Review and Meta-Analysis Based on the Theory of Planned Behaviour.

Dietary behaviours are strongly patterned by socioeconomic status (SES). However, the role of SES in the self-regulation of health promoting dietary behaviours is not fully understood. This systematic review with meta-analysis investigated whether four individual-level measures of SES (income, occupation, education, and ethnicity) moderate the relationships between Theory of Planned Behaviour (TPB) variables and different health promoting dietary behaviours in adults. A systematic literature search identified 106 studies from 77 articles providing information on TPB variables, SES, and health promoting dietary behaviours-choosing health promoting foods and restricting health compromising foods. Random-effects meta-analyses were conducted to generate pooled correlations corrected for sampling and measurement error, and meta-regression was used to test moderating effects of study-level SES. All TPB variables were significantly and positively associated with both health promoting dietary behaviours, with intention having the strongest correlation with behaviour. However, none of the relationships between TPB variables and health promoting dietary behaviours were significantly moderated by study-level SES. Results suggest robust associations between TPB predictors and healthy dietary behaviour that are not patterned by individual-level SES measures.

Validating the use of census data on education as a measure of socioeconomic status in an occupational cohort

Purpose Adjusting for smoking status or a reliable surrogate [such as socioeconomic status (SES)] is critically important in occupational epidemiology studies when any smoking-related cancer or cardiovascular disease is an outcome of interest. Sometimes, however, data on smoking patterns or individual-level smoking surrogates such as job title, education, pay scale or other measures of SES are not readily available in occupational cohorts. Methods and materials To obtain a surrogate measure for missing smoking or individual-level SES data, we demonstrate a method used to obtain and geocode residential address histories which were then linked to area-level SES measures from the United States Census in three test samples and then in a full cohort of workers from the Mound nuclear weapons facility in Dayton, Ohio, USA. The mean educational attainment of the Census Block Group was used to derive a categorical estimate of educational attainment which was compared to self-reported (SR) education available from Mound worker histories using Kappa statistics. Lung cancer mortality patterns between area-derived (AD) and SR education were investigated using Standardized Mortality Ratios (SMR) and Cox Proportional Hazards models with stratification or adjustment by either SR or AD education. Results Home address histories were obtained from linkages of individual worker data to online resources. In the test cohorts, mean educational attainment was the Census Block Group measure found to have the largest magnitude association with individual-level SES measures. Among 7251 Mound workers, 5685 (78.4%) had at least one residential address match (mean 4.9 addresses) identified. The SR and AD educational attainment measures were highly correlated (weighted Kappa coefficient 0.10, p < .0001). SMR patterns by SR and AD educational attainment were similar, with steadily decreasing mortality with increased educational attainment by either measure. Cox models for lung cancer using AD education produced similar results as those using SR education as an adjustment factor. Conclusion When individual-level SES indicators are not available for statistical adjustment, area-level SES measures can serve as a reliable surrogate when investigating outcomes that are affected by lifestyle factors such as smoking.

Comparison of individual-level and contextual-level socioeconomic status indicators in schoolchildren in Ireland: a repeated cross-sectional survey

BackgroundEpidemiological studies mostly focus on individual-level measures of socioeconomic status (SES). Contextual measures can provide a wider picture of a person's environment. We aimed to investigate whether family SES measures are associated with school SES in schoolchildren. MethodsWe included a nationally representative cross-sectional sample of 2929 children aged 6–7 years (51·3% girls) who participated in one of the three measurement rounds (2010, 2012, or 2015) of the Irish Childhood Obesity Surveillance Initiative. Family SES indicators on parental education (high or low), parental occupation (employed or unemployed), housing type (detached or semi-detached house, terraced house, or apartment), and housing ownership (rented or owned) were reported by parents. Schools were split into disadvantaged and non-disadvantaged according to the Department of Education and Skills definition. χ2 tests were conducted to test associations. Ethical approval was obtained by the UCD Human Research Ethics Committee. Parents or children's guardians signed an informed consent form. FindingsThe proportion of mothers with low education level was significantly higher in disadvantaged schools than in non-disadvantaged schools (2010, 62·5% [n=35] vs 36·7% [n=348], p<0·001; 2012, 61·3% [n=49] vs 37·5% [n=346], p<0·001; 2015, 64·9% [n=50] vs 33·9% [n=270], p<0·001), irrespective of the measurement round. Similar results were observed with fathers' education and school SES. Disadvantaged schools had significantly higher percentages of unemployed parents than did non-disadvantaged schools in 2012 (mothers 54·3% [n=44] vs 41·7% [n=384], p=0·028; fathers 27·4% [n=20] vs 13·0% [n=115], p=0·001) and 2015 (46·7% [n=35] vs 30·2% [n=239], p=0·003; 18·7% [n=12] vs 7·4% [n=55], p=0·002), but not in 2010. The percentage of families owning a house was significantly lower in disadvantaged schools than in non-disadvantaged schools (2010 64·8% [n=35] vs 83·8% [n=816], p<0·001; 2012 53·1% [n=43] vs 80·9% [n=758], p<0·001; 2015 55·3% [n=42] vs 83·4% [n=665], p<0·001). InterpretationSchool SES was significantly related to individual-level SES measures over the three study rounds. These findings show that contextual and compositional SES indicators are equally important and should be considered. Ideally, studies should simultaneously examine the effects of both individual-level and contextual-level SES variables. FundingNone.

Neighbourhood deprivation and lung cancer risk: a nested case–control study in the USA

ObjectivesTo examine the association between neighbourhood deprivation and lung cancer risk.DesignNested case–control study.SettingSouthern Community Cohort Study of persons residing in 12 states in the southeastern USA.Participants1334 cases of lung cancer...

Abstract A42: Association between neighborhood deprivation and lung cancer risk in the Southern Community Cohort Study

Abstract Purpose: Counties with the highest rates of lung cancer mortality in the United States from the 1980s have been located in the South. This finding is related to high regional smoking prevalence, but we hypothesized that area-level socioeconomic deprivation may also contribute. We used data from the Southern Community Cohort Study to examine this exposure in a multilevel nested case-control study of incident lung cancer. Methods: Men and women with incident lung cancer were identified through linkage with state cancer registries and the National Death Index (1,334 cases). Approximately four controls were matched to each case on sex, race, age at diagnosis, and year of recruitment (5,315 controls). Individual-level smoking and socioeconomic status were obtained through baseline surveys, while block group-level neighborhood deprivation was obtained from U.S. Census data. Results: After adjustment for smoking and other confounders, but prior to adjustment for individual-level measures of socioeconomic status, there was an increased risk of lung cancer for persons living in neighborhoods with the greatest quartile of deprivation relative to those in neighborhoods with the least (odds ratio (OR) 1.28, 95% confidence interval (CI) 1.00-1.63). Additional adjustment for individual-level measures of socioeconomic status weakened this effect (OR 1.21, 95% CI 0.94-1.55). There was no evidence of effect modification by race or sex. Conclusions: Area-level measures of socioeconomic status were associated with lung cancer risk in this population after control for smoking. Citation Format: Maureen Sanderson, Melinda C. Aldrich, Robert S. Levine, Barbara Kilbourne, Qiuyin Cai, William J. Blot. Association between neighborhood deprivation and lung cancer risk in the Southern Community Cohort Study [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A42.

Socioeconomic status and survival from ventricular fibrillation out-of-hospital cardiac arrest

PurposeOut-of-hospital cardiac arrest (OHCA) is a major cause of death in the United States. How individual-level socioeconomic status (SES) influences survival is uncertain. MethodsThe investigation is a retrospective cohort study of adults who suffered OHCA and presented with a shockable rhythm in a metropolitan county from January 1, 1999–December 31, 2005. Individual-level measures of SES were obtained from vital records and surveys. SES measures included education and occupation. We used multivariable logistic regression to assess the independent association between SES measures and survival to hospital discharge. ResultsOf the 1390 eligible OHCA patients, 374 (27%) survived to hospital discharge. Compared to those with less than high school diploma, the multivariable-adjusted odds ratio of survival was 1.36 (95% confidence interval [CI], 0.87–2.14) for high school graduates, 1.54 (95% CI, 0.95–2.48) for those with some college, and 1.96 (95% CI, 1.17–3.27) for those with college degrees (test for trend across the categories P < .001). We did not observe an independent association between occupation and survival. ConclusionsHigher education was associated with greater survival after OHCA. This relationship was not explained by key demographic or clinical characteristics. A better understanding of the mechanism by which individual-level SES characteristics influence prognosis may provide opportunities to improve survival.

Socio-Economic Status and Childhood Leukemia in California

Objective: To investigate the association between individual- and community-level socio-economic status (SES) and childhood leukemia, particularly its subtypes: acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Study design: We conducted a large case-control registry-based study in California. Methods: Information on 5788 cases and 5788 controls was obtained by linking California cancer and birth registries. We evaluated relative risk of childhood leukemia by community- (census-based) and individual-level SES measures (parental education and source of payment for delivery) using conditional logistic regression. Results: Children in higher census-based SES categories had a tendency toward slightly decreased risk of total childhood leukemia and ALL compared to children of the lowest SES. Compared to < 12 years of school, 13 and more years of parental education were associated with slightly decreased risk of total childhood leukemia, ALL and AML; however, confidence intervals were imprecise. Source of payment for delivery was not associated with either childhood leukemia nor with its subtypes. Conclusion: We found little evidence to support the suggestion that SES is associated with risk of childhood leukemia or either major subtype. It is likely that results of many previous studies that found an association between childhood leukemia and SES were influenced by selection or ecological bias.

Concordance between Individual vs. Area-Level Socioeconomic Measures in an Urban Setting.

Area-level socioeconomic status (SES) measures have been used as a proxy in child health research when individual SES measures are lacking, yet little is known about their validity in an urban setting. We assessed agreement between census block-group and individual-level SES measures obtained from a caregiver telephone survey in Jackson County, Missouri. Associations with prevalence of childhood overweight (OW), low birth weight (LBW), and household smoking exposure were examined using logistic regression models. Seven hundred eighty-one households were surveyed: 49% male, 76% White, mean child age 9.4 years. We found misclassification rates of 20-35% between individual vs. area-level measures of education and income; Kappa indices ranged from 0.26-0.36 indicating poor agreement. Both SES measures showed an inverse association with LBW and smoking exposure. Area-level SES measures may reflect a construct inclusive of neighborhood resources; routine substitution of these measures should be interpreted with caution, despite similar correlations with health outcomes.

Democracy and self-rated health across 67 countries: A multilevel analysis

Existing research has found a positive association between countries' level of democratic governance and the health of their populations, although that research is limited by the use of data from small numbers of high-income countries or aggregate data that do not assess individual-level health outcomes. We extend prior research by using multilevel World Health Survey (2002–2004) data on 313,554 individuals in 67 countries, and find that the positive association between democratic governance and self-rated health persists after adjusting for both individual- and country-level confounders. However, the mechanisms linking democracy and self-rated health remain unclear. Individual-level measures of socioeconomic status, and country-level measures of economic inequality and investments in public health and education, do not significantly mediate the association between democratic governance and self-rated health. The persistent association between democratic governance and health suggests that the political organization of societies may be an important upstream determinant of population health.

Contextual socioeconomic factors associated with childhood mortality in Nigeria: a multilevel analysis

BackgroundChildhood mortality is a well-known public health issue, particularly in the low and middle income countries. The overarching aim of this study was to examine whether neighbourhood socioeconomic disadvantage is...

The influence of neighbourhood informality and socio-economic position on self-rated health among men and women: A multilevel cross-sectional study from Aleppo

Background There is substantial evidence that neighbourhoods have influence on health independent of individual characteristics. However, neighbourhood characteristics are rarely taken into account in the analysis of urban health studies from developing countries. Aims This study aimed to examine the influence of neighbourhood socioeconomic status (SES) and formality status on self-rated health (SRH) of adult men and women residing in formal and informal urban neighbourhoods in Aleppo, Syria. Methods: The study used data from 2038 survey respondents to the Aleppo Household Survey, 2004 (age 18–65 years, 54.8% women, response rate 86%). Respondents were nested in 45 neighbourhoods. Five individual-level SES measures, namely education, employment, car ownership, item ownership and household density, were aggregated to the level of neighbourhood. Multilevel models were used to investigate associations. Results: We did not find evidence from these data of important SRH variation between neighbourhoods. Neighbourhood average of household item ownership was associated with a greater likelihood of reporting excellent SRH in women; odds ratio for an increase of one item on average was 2.3 (95% CI 1.3-4.4 (versus poor SRH)) and 1.7 (95% CI 1.1-2.5 (versus normal SRH)), adjusted for individual characteristics and neighbourhood formality. After controlling for individual and neighbourhood SES measures, women living in informal neighbourhoods were less likely to report poor SRH than women living in formal neighbourhoods (OR= 0.4; 95% CI (0.2- 0.8) (versus poor SRH) and OR=0.5; 95% ; CI (0.3-0.9) (versus normal SRH). Conclusions: The results from this study support the evidence from high income countries that certain characteristic of neighbourhoods affect men and women in different ways. Further research from similar urban settings in developing countries is needed to understand the mechanisms by which informal neighbourhoods influence women’s health.

The influence of neighbourhood formality status and socio-economic position on self-rated health among adult men and women: a multilevel, cross sectional, population study from Aleppo, Syria

BackgroundThere is substantial evidence from high income countries that neighbourhoods have an influence on health independent of individual characteristics. However, neighbourhood characteristics are rarely taken into account in the analysis of urban health studies from developing countries. Informal urban neighbourhoods are home to about half of the population in Aleppo, the second largest city in Syria (population>2.5 million). This study aimed to examine the influence of neighbourhood socioeconomic status (SES) and formality status on self-rated health (SRH) of adult men and women residing in formal and informal urban neighbourhoods in Aleppo.MethodsThe study used data from 2038 survey respondents to the Aleppo Household Survey, 2004 (age 18–65 years, 54.8% women, response rate 86%). Respondents were nested in 45 neighbourhoods. Five individual-level SES measures, namely education, employment, car ownership, item ownership and household density, were aggregated to the level of neighbourhood. Multilevel regression models were used to investigate associations.ResultsWe did not find evidence of important SRH variation between neighbourhoods. Neighbourhood average of household item ownership was associated with a greater likelihood of reporting excellent SRH in women; odds ratio (OR) for an increase of one item on average was 2.3 (95% CI 1.3-4.4 (versus poor SRH)) and 1.7 (95% CI 1.1-2.5 (versus normal SRH)), adjusted for individual characteristics and neighbourhood formality. After controlling for individual and neighbourhood SES measures, women living in informal neighbourhoods were less likely to report poor SRH than women living in formal neighbourhoods (OR= 0.4; 95% CI (0.2- 0.8) (versus poor SRH) and OR=0.5; 95%; CI (0.3-0.9) (versus normal SRH).ConclusionsFindings support evidence from high income countries that certain characteristic of neighbourhoods affect men and women in different ways. Further research from similar urban settings in developing countries is needed to understand the mechanisms by which informal neighbourhoods influence women’s health.

Investigating Individual- and Area-Level Socioeconomic Gradients of Pulse Pressure among Normotensive and Hypertensive Participants

Socioeconomic status is a strong predictor of cardiovascular disease. Pulse pressure, the difference between systolic and diastolic blood pressure, has been identified as an important predictor of cardiovascular risk even after accounting for absolute measures of blood pressure. However, little is known about the social determinants of pulse pressure. The aim of this study was to examine individual- and area-level socioeconomic gradients of pulse pressure in a sample of 2,789 Australian adults. Using data from the North West Adelaide Health Study we estimated the association between pulse pressure and three indices of socioeconomic status (education, income and employment status) at the area and individual level for hypertensive and normotensive participants, using Generalized Estimating Equations. In normotensive individuals, area-level education (estimate: −0.106; 95% CI: −0.172, −0.041) and individual-level income (estimate: −1.204; 95% CI: −2.357, −0.050) and employment status (estimate: −1.971; 95% CI: −2.894, −1.048) were significant predictors of pulse pressure, even after accounting for the use of medication and lifestyle behaviors. In hypertensive individuals, only individual-level measures of socioeconomic status were significant predictors of pulse pressure (education estimate: −2.618; 95% CI: −4.878, −0.357; income estimate: −1.683, 95% CI: −3.743, 0.377; employment estimate: −2.023; 95% CI: −3.721, −0.326). Further research is needed to better understand how individual- and area-level socioeconomic status influences pulse pressure in normotensive and hypertensive individuals.