Individual-level Socioeconomic Indicators Research Articles

Association between socioeconomic status and traumatic dental injury in permanent teeth: A systematic review with meta-analysis.

The aim of this study was to systematically review observational studies assessing the association between socioeconomic status (SES) and traumatic dental injuries (TDI) in permanent dentition. Electronic searches were performed in PubMed, EMBASE, Web of Science, LILACS, CINAHL, COCHANE Library and ScoINDEX databases for articles published up to February 2023. Two independent reviewers performed the search and critical appraisal of the studies. The inclusion criteria were observational studies that evaluated the association between individual-level socioeconomic indicators and TDI (clinically examined) in permanent teeth. Quality assessment of included articles was conducted using the Newcastle-Ottawa Scale. Global meta-analysis was performed with all studies and different subgroup analysis based on socioeconomic indicators (household income, educational level or any other indicator), age (children, early adolescents, late adolescents or young adults) and economic classification of the country (high, upper-middle or lower-middle). A random-effects model was used to estimate pooled prevalence ratios (PR) and respective 95% confidence intervals (CI) for each study. The search strategy retrieved 11 315 publications. According to eligibility criteria, 17 articles were included in the meta-analysis. Individuals with low SES were 17% more likely to have TDI (PR 1.17; 95% CI 1.05-1.30). The subgroup analysis also revealed that the indicator (household income, PR 1.16; 95% CI 1.00-1.34) and the economic classification of the country (upper-middle, PR 1.19; 95% CI 1.07-1.33) influenced the association of SES with TDI occurrence. Individuals with lower SES were more likely to present with TDI in permanent dentition than those with higher SES.

Neighborhood disadvantage, health status, and health care utilization after blood or marrow transplant: BMTSS report

AbstractLiving in a disadvantaged neighborhood is associated with poor health outcomes. Blood or Marrow Transplant (BMT) survivors remain at risk of chronic health conditions requiring anticipatory management. We hypothesized that among BMT survivors, neighborhood disadvantage was associated with poor self-reported routine health care utilization and health. We leveraged data from BMTSS – a retrospective cohort study examining long-term outcomes among individuals surviving ≥2 y following BMT at three institutions between 1974 and 2014. Participants in this analysis completed the BMTSS survey (sociodemographics; chronic health conditions; time since routine check-up; self-reported health). The Area Deprivation Index (ADI) represented neighborhood disadvantage; this composite indicator of 17 census measures is a percentile rank (0 = least deprived to 100 = most deprived). Multivariable ordered logit regression adjusted for clinical factors and individual-level sociodemographics, modeling associations between ADI, time since routine check-up, and self-reported health. Among 2,857 survivors, median ADI was 24 (interquartile range: 10-46). Adjusting for self-reported individual-level socioeconomic indicators and chronic health conditions, patients in more disadvantaged neighborhoods had higher odds of reporting longer intervals since routine check-up (ORADI_continuous = 1.007, P < .001) and poorer health status (controlling for time since check-up; ORADI_continuous = 1.005, P = .003). Compared with patients living in the least disadvantaged neighborhood (ADI = 1), patients in the most disadvantaged neighborhood (ADI = 100), had twice the odds (ORADI = 1.007^99 = 2.06) of reporting no routine visits and 1.65-times the odds of reporting poor health (ORADI = 1.005^99 = 1.65). In BMT survivors, access to health care and health status are associated with area disadvantage. These findings may inform strategies to address long-term care coordination and retention for vulnerable survivors.

Examining the Association of Socioeconomic Position with Microcephaly and Delayed Childhood Neurodevelopment among Children with Prenatal Zika Virus Exposure.

Increased rates of Zika virus have been identified in economically deprived areas in Brazil at the population level; yet, the implications of the interaction between socioeconomic position and prenatal Zika virus exposure on adverse neurodevelopmental outcomes remains insufficiently evaluated at the individual level. Using data collected between September 2015 and September 2019 from 163 children with qRT-PCR and/or IgM-confirmed prenatal exposure to Zika virus participating in a prospective cohort study in Rio de Janeiro, Brazil (NCT03255369), this study evaluated the relationships of socioeconomic indicators with microcephaly at birth and Bayley-III neurodevelopmental scores during the early life course. Adjusted logistic regression models indicated increased odds of microcephaly in children born to families with lower household income (OR, 95% CI: 3.85, 1.43 to 10.37) and higher household crowding (OR, 95% CI: 1.83, 1.16 to 2.91), while maternal secondary and higher education appeared to have a protective effect for microcephaly compared to primary education (OR, 95% CI: 0.33, 0.11 to 0.98 and 0.10, 0.03 to 0.36, respectively). Consistent with these findings, adjusted linear regression models indicated lower composite language (−10.78, 95% CI: −19.87 to −1.69), motor (−10.45, 95% CI: −19.22 to −1.69), and cognitive (−17.20, 95% CI: −26.13 to −8.28) scores in children whose families participated in the Bolsa Família social protection programme. As such, the results from this investigation further emphasise the detrimental effects of childhood disadvantage on human health and development by providing novel evidence on the link between individual level socioeconomic indicators and microcephaly and delayed early life neurodevelopment following prenatal Zika virus exposure.

Neighbourhood disadvantage and child behaviour in Montevideo, Uruguay: a mixed methods study

BackgroundThe neighbourhood context is important for child development, but little evidence exists on neighbourhood-based challenges and resources in South American cities. We used a mixed methods approach to quantify the effect of neighbourhood disadvantage on child behaviour and to empower parents to explain life in disadvantaged neighbourhoods in Montevideo, Uruguay. MethodsA study within the Salud Ambiental Montevideo (SAM) longitudinal cohort yielded a cross-sectional sample of 225 (63% of total) children aged 6–8 years with complete data. Teacher ratings of child behaviour were collected using the Connors' Teacher Rating Scale—Revised (CTRS-R) and Behavior Rating Inventory of Executive Function (BRIEF). Five indicators of neighbourhood disadvantage were collected from Montevideo census data, and combined into to a single neighbourhood disadvantage factor. In the analyses of the relation between neighbourhood disadvantage and child behaviour scores we controlled for individual-level socioeconomic indicators, child IQ, and concentrations of lead in blood. In a nested study, we conducted semi-structured interviews with ten caregivers of SAM children in low-income neighbourhoods. Parents discussed what neighbourhood means to them and what they liked and disliked about their neighbourhood, perceptions of community services, and raising children in their neighbourhood. Parents were also asked to photograph their neighbourhoods and to discuss the meaning of at least four of their photographs during the interview. FindingsOne SD increase in neighbourhood disadvantage was related to a 1% increase in prevalence ratio on scores of oppositional behaviour (p=0·048) and a 4% increase in prevalence ratio on emotional control problem ratings (p=0·006). Neighbourhood disadvantage was unrelated to hyperactive behaviours and inhibitory control scores. From the interviews, common themes emerged on the importance of playgrounds, neighbourhood disorder, fears over crime, and lack of infrastructure. Many interviewees perceived that their neighbourhoods had been safer in the past. Suggestions for improving neighbourhoods included: better waste management, increased policing, traffic regulation, and improved local clinics. InterpretationNeighbourhood disadvantage is related to child behaviour beyond the influences of individual-level socioeconomic factors. Low-income neighbourhoods in Montevideo face challenges related to local infrastructure and services. Parents advocated for improved infrastructure, health services, transportation, and safety. Future studies should test specific mechanisms behind the effects of neighbourhood disadvantage and child behaviour in Montevideo. FundingUS National Institute of Environmental Health Sciences (NIEHS) and Fogarty International (FI) Institute under grant number R21ES16523, and by NIEHS grant R21ES019949.

DNA methylation and socioeconomic status in a Mexican-American birth cohort

BackgroundMaternal social environmental stressors during pregnancy are associated with adverse birth and child developmental outcomes, and epigenetics has been proposed as a possible mechanism for such relationships.MethodsIn a Mexican-American birth cohort of 241 maternal-infant pairs, cord blood samples were measured for repeat element DNA methylation (LINE-1 and Alu). Linear mixed effects regression was used to model associations between indicators of the social environment (low household income and education, neighborhood-level characteristics) and repeat element methylation. Results from a dietary questionnaire were also used to assess the interaction between maternal diet quality and the social environment on markers of repeat element DNA methylation.ResultsAfter adjusting for confounders, living in the most impoverished neighborhoods was associated with higher cord blood LINE-1 methylation (β = 0.78, 95%CI 0.06, 1.50, p = 0.03). No other neighborhood-, household-, or individual-level socioeconomic indicators were significantly associated with repeat element methylation. We observed a statistical trend showing that positive association between neighborhood poverty and LINE-1 methylation was strongest in cord blood of infants whose mothers reported better diet quality during pregnancy (pinteraction = 0.12).ConclusionOur findings indicate a small yet unexpected positive association between neighborhood-level poverty during pregnancy and methylation of repetitive element DNA in infant cord blood and that this association is possibly modified by diet quality during pregnancy. However, our null findings for other adverse SES indicators do not provide strong evidence for an adverse association between early-life socioeconomic environment and repeat element DNA methylation in infants.

Associations among Neighborhood, Race, and Sleep Apnea Severity in Children. A Six-City Analysis.

Prior researchers found that individual-level environmental and social indicators did not explain the racial disparity in obstructive sleep apnea syndrome. Neighborhood socioeconomic variables, as well as risk factors for a range of adverse behavioral and health outcomes, may better explain this racial disparity and help identify modifiable intervention targets. To evaluate the associations of neighborhood socioeconomic variables with obstructive sleep apnea severity and to assess whether the neighborhood variables explain the association between race and obstructive sleep apnea severity. We performed a cross-sectional analysis of data of 774 children in six cities who participated in the Childhood Adenotonsillectomy Trial. The outcome variable was the apnea-hypopnea index (AHI). Neighborhood socioeconomic variables were obtained on the basis of the children's residential addresses and information in the American Community Survey. Regression models were used to assess the associations among neighborhood conditions, race, and AHI. Higher poverty rate and percentage of single-female-headed households were associated with higher AHI (P = 0.008 and 0.002, respectively). African American race was associated with a 1.33 (1.08-1.64 95% confidence interval)-fold increase in AHI, adjusting for age and sex. After controlling for poverty rate or percentage of single-female-headed households with children, the association between race and AHI levels was no longer significant (P = 0.15 and 0.26, respectively), and the magnitude of race association decreased 34 or 55%, suggesting that the association between race and AHI levels was largely explained by poverty rate or percentage of single-female-headed households with children. Neighborhood socioeconomic variables in comparison with individual-level socioeconomic indicators provides better explanations for the racial disparity in pediatric obstructive sleep apnea syndrome. Further research aimed at identifying factors that aggregate in disadvantaged neighborhoods and increase sleep apnea risk may suggest modifiable intervention targets. Clinical trial registered with clinicaltrials.gov (NCT00560859).

Linking spatial scale to changes in workplace earnings – An exploratory approach

The paper investigates the importance of spatial scale for changes in earnings at the workplace by using spatial regression applied to workplace-level micro data in an exploratory purpose. A floating grid technique is used to define equal-sized workplaces and their daily-reach surrounding zones as divided into three spatial entities: working-square, local area and hinterland. On the basis of geo-referenced information on workplaces and places of residence along with numerous individual-level socio-economic indicators, the results of the regression models reveal that the indicators of the daily-reach area play a dominant role and that their contribution varies over spatial entities. Among the spatial entities, the working-square (km square) surrounding the workplace is more important than the workplace itself, the local area and the hinterland. Moreover, the results suggest that internal factors related to population size, diversity of trade and industry and educational level contribute to about one-third of changes in work income at the workplace level. It can be concluded that knowledge, learning and human capital are strongly associated with increased earnings.

Do observed or perceived characteristics of the neighborhood environment mediate associations between neighborhood poverty and cumulative biological risk?

ObjectiveTo examine contributions of observed and perceived neighborhood characteristics in explaining associations between neighborhood poverty and cumulative biological risk (CBR) in an urban community. MethodsMultilevel regression analyses were conducted using cross-sectional data from a probability sample survey (n=919), and observational and census data. Dependent variable: CBR. Independent variables: neighborhood disorder, deterioration and characteristics; perceived neighborhood social environment, physical environment, and neighborhood environment. Covariates: neighborhood and individual demographics, health-related behaviors. ResultsObserved and perceived indicators of neighborhood conditions were significantly associated with CBR, after accounting for both neighborhood and individual level socioeconomic indicators. Observed and perceived neighborhood environmental conditions mediated associations between neighborhood poverty and CBR. ConclusionsFindings were consistent with the hypothesis that neighborhood conditions associated with economic divestment mediate associations between neighborhood poverty and CBR.

Socio‐economic disadvantage at the area level poses few direct barriers to smoking cessation for Australian smokers: Findings from the International Tobacco Control Australian cohort survey

Area-level indicators of socio-economic variation are frequently included in models of individual health outcomes. Area disadvantage is linearly related to smoking prevalence, but its relation to cessation outcomes is less well understood. To explore the relationship between area-level disadvantage and prospective data on smoking cessation. The Australian cohort of the International Tobacco Control Four-Country Survey (N = 3503) was used to prospectively examine the contribution of area-level socio-economic disadvantage to predicting three important smoking-cessation outcomes: making a quit attempt, achieving 1 month abstinence and achieving 6 month abstinence from smoking, while controlling for individual-level socio-economic indicators and other individual-level covariates related to smoking cessation. Only two independent associations were observed between socio-economic disadvantage and cessation outcomes. Area-level disadvantage was related to 1 month abstinence in a non-linear fashion, and the individual experience of smoking-induced deprivation was associated with a lower likelihood of making quit attempts. Despite the documented higher prevalence of smoking among the more disadvantaged and in more disadvantaged areas, socio-economic disadvantage was not consistently related to making quit attempts, nor to medium-term success. Nevertheless, indirect effects of disadvantage, like its impact on psychological distress, cannot be ruled out, and considering smokers' individual psychosocial circumstances is likely to aid cessation efforts. Socio-economic disadvantage, particularly at the area level, poses few direct barriers to smoking cessation.

Commentary: Why are we biased against bias?

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Area characteristics, individual-level socioeconomic indicators, and smoking in young adults: the coronary artery disease risk development in young adults study.

The 10-year follow-up examination in 1995-1996 to the population-based Coronary Artery Disease Risk Development in Young Adults Study was used to compare the strength with which socioeconomic indicators at the individual and area levels are related to smoking prevalence and to investigate contextual effects of area characteristics. When categories based on similar percentile cutoffs were compared, differences across area categories in the odds of smoking were smaller than differences across categories based on individual-level indicators. In Whites, there was evidence of a significant contextual effect of area characteristics on smoking: Living in the most disadvantaged area quartiles was associated with 50-110% higher odds of smoking, even after controlling for individual-level socioeconomic indicators. Clear contextual effects of area characteristics were not present in Blacks, but there was evidence that contextual effects may emerge at higher levels of individual-level socioeconomic position. Similar results were obtained for census tracts and block groups. Even in the presence of contextual effects, area measures may underestimate associations of individual-level variables with health outcomes. On the other hand, as illustrated by the presence of contextual effects, area- and individual-level measures are likely to tap into different constructs.

Neighborhood socioeconomic status and all-cause mortality.

This study sought to determine the contribution of neighborhood socioeconomic status to all-cause mortality and to explore its correlates. As part of the longitudinal "Gezondheid en LevensOmstandigheden Bevolking en omstreken" (GLOBE) study in the Netherlands, 8,506 randomly selected men and women aged 15-74 years from 86 neighborhoods in the city of Eindhoven reported on their socioeconomic status in the 1991 baseline survey. During the 6-year follow-up, 487 persons died. Neighborhood socioeconomic status was derived from individual reports on socioeconomic status. Its effect on mortality was stringently controlled for four individual-level socioeconomic indicators. Persons living in a neighborhood with a high percentage of unemployed/disabled or poor persons had a higher mortality risk than did those living in a neighborhood with a low percentage of unemployed/disabled or poor persons. This was independent of individual socioeconomic characteristics, including individual unemployment/disability or reports of severe financial problems. Educational and occupational neighborhood indicators were similarly, but less strongly, related to mortality. The prevalence of poor housing conditions, social disintegration, and unhealthy psychologic profiles and behaviors was higher in neighborhoods with a low socioeconomic status. Contextual effects of socioeconomic status may thus be due to one or more of these specific circumstances. The findings indicate potential public health benefits of modifying socioeconomic characteristics of areas.