Individual Socioeconomic Status Research Articles

The Influence of Socioeconomic Status on the Prognosis and Profile of Patients Admitted for Acute Heart Failure during COVID-19 Pandemic: Overestimated Aspects or a Multifaceted Hydra of Cardiovascular Risk Factors?

Background: Heart failure (HF) is a complex clinical syndrome that represents a great burden on public health systems due to its increased prevalence, disability and mortality rates. There are multiple triggers that can induce or aggravate a preexisting HF, socioeconomic status (SES) emerging as one of the most common modifiable risk factors. Our study aimed to analyze the influence of certain SES indicators on the outcome, clinical aspects and laboratory parameters of patients with HF in North-Eastern Romania, as well as their relationship with other traditional cardiovascular risk factors. Methods: We conducted a prospective, single-center study comprising 120 consecutively enrolled patients admitted for acute HF. The evaluation of individual SES was based upon a standard questionnaire and evidence from official documents. Results: the patients’ age ranged between 18 and 94 years; Out of 120 patients, 49 (40.8%) were women and 71 (59.2%) were men, residing in rural 59 (49.2%) or urban 61 (50.8%) areas. 14.2% were university graduates, while 15.8% had only attended primary school. The majority of the patients are or were employed in the service sector (54.5%), followed by industry (29.2%) and agriculture (20%). The mean monthly income was 306.1 ± 177.4 euro, while the mean hospitalization cost was 2471.8 ± 2073.8 euro per patient. The individual income level was positively correlated with urban area of residence, adequate household sanitation facilities and healthcare access, and negatively associated with advanced age and previous hospitalizations due to HF. However, the individual financial situation was also positively correlated with the increased prevalence of certain cardiovascular risk factors, such as arterial hypertension, anemia or obesity, but not with total cholesterol or male gender. Concerning the direct impact of a poor economic status upon prognosis in the setting of acute HF, our results showed no statistically significant differences concerning the in-hospital or at 1-month follow-up mortality rates. Rather than inducing a direct impact on the short-term outcome, these findings concerning SES indicators are meant to enhance the implementation of policies aimed to provide adequate healthcare for people from all social layers, with a primary focus on modifiable cardiovascular risk factors.

A machine learning approach to predict reversion from mild cognitive impairment to normal cognition: A population‐based cohort study

AbstractBackgroundPredicting the probability of the reversion from mild cognitive impairment (MCI) to cognitively normal (CN) status can inform preventive treatments at individual, institutional and social level. This study aims to build a prediction model using a machine learning approach for reversion from MCI to CN status.MethodThe study included 7,422 participants above 65 years old with MCI from Chinese Longitudinal Health Longevity Survey (Figure 1). LightGBM was used to build a prediction model of 154 variables, including individual and household socioeconomic status, dietary/lifestyle, cardiometabolic, psychological factors and history of diseases. SHAP values were used to interpret the impact of the top 40 variables that contributed to the LightGBM model. Multivariable Cox regression with elastic net penalty was also conducted for comparison. Model performance was assessed according to a range of learning metrics including area under the receiver operating characteristic curve (AUC).Results1,604 (21.6%) participants reversed from MCI to CN with a median follow‐up of 2.8 years. The top 40 features were presented in the figure 2. The concordance index of the LightGBM model was 0.71, which is much higher than the traditional multivariable Cox regression with elastic net penalty (0.66).ConclusionThe machine learning approach could develop a more accurate early identification of recovery of MCI patients. The predicting can guide the recovery process of MCI patients.

Frailty associations with socioeconomic status, healthcare utilisation and quality of life among older women residing in regional Australia.

Objectives:The health and well-being of older women may be influenced by frailty and low socioeconomic status (SES). This study examined the association between frailty and SES, healthcare utilisation and quality of life (QOL) among older women in regional Australia.Methods:Cross-sectional analysis of the Geelong Osteoporosis Study was conducted on 360 women (ages ≥60yr) in the 15-year follow up. Frailty was identified using modified Fried’s phenotype. Individual SES measures and healthcare utilisation were documented by questionnaire. Area-based SES was determined by cross-referencing residential addresses with the Australian Bureau of Statistics Index of Relative Socio-economic Advantage and Disadvantage (IRSAD). QOL was measured using the Australian World Health Organisation Quality of Life Instrument (WHOQoL-Bref). Multinomial logistic regression was conducted with frailty groupings as outcome.Results:Sixty-two (17.2%) participants were frail, 199 (55.3%) pre-frail and 99 (27.5%) robust. Frail participants were older with higher body mass index. Frailty was associated with lower education but not marital status, occupation or IRSAD. Strong associations with frailty were demonstrated for all WHOQoL-Bref domains. Frailty was associated with more primary care doctor visits (p<0.001).Conclusions:This population-based study highlights the significant impact of frailty on older women, indicating reduced QOL and increased primary care doctor visits.

Socioeconomic status and risk of incident venous thromboembolism

BackgroundAlthough venous thromboembolism (VTE) is a leading cause of morbidity and mortality, and socioeconomic status (SES) affects human health and health behavior, few studies have examined the association between SES and VTE. ObjectivesWe aimed to investigate the association between SES, assessed individually and in a composite score by levels of education, income, and employment status, and incident VTE. MethodsWe used Danish national registries to identify 51 350 persons aged 25–65 years with incident VTE during 1995–2016. For each case, we used incidence density sampling to select five age‐, sex‐, and index‐year‐matched controls from the general Danish population (n = 256 750). SES indicators, including education, income, and employment status, were assessed 1 and 5 years before the VTE. We used conditional logistic regression to compute odds ratios (ORs) with 95% confidence intervals (CIs) for VTE according to individual SES indicators and a composite SES score in analyses adjusted for age, sex, and comorbidities. ResultsCompared with low levels, high educational level (OR 0.74; 95% CI 0.71–0.77), high income (OR 0.70; 95% CI 0.68–0.72), and high employment status (OR 0.66; 95% CI 0.64–0.68) were associated with decreased risk of VTE, even after adjusting for comorbidities. A composite SES score was superior to the individual indicators in assessing VTE risk (OR for high vs. low score: 0.61; 95% CI 0.59–0.63). In sensitivity analysis with SES indicators measured 5 years before the VTE, the risk estimates remained essentially the same. ConclusionHigh levels of both individual SES indicators and a composite SES score were associated with decreased VTE risk.

Association of a housing based individual socioeconomic status measure with diabetic control in primary care practices

AimsSocioeconomic status (SES) is an important variable that impacts healthcare outcomes. However, grouped SES data is not always representative of all members and it is difficult to obtain individual level data. A validated individual housing-based measure termed HOUSES is available, but has not been studied in diabetes. We hypothesize that patients in the lowest HOUSES quartile are associated with worse diabetic control as measured by the D5. MethodsA retrospective cohort study of 5463 patients with diabetes in 5 patient centered medical home practices in southeast Minnesota was conducted. HOUSES is a validated, standardized housing-based SES measure constructed from publicly available county assessor’s office data. Diabetic control was assessed by the D5 (HgbA1c < 8, BP < 140/90, statin use, nonsmoking status, and antiplatelet therapy). ResultsIn the lowest HOUSES quartile, more patients had an uncontrolled D5 (56.4%) than any of the other quartiles (49.2%, 49.8%, 49.6% respectively, p < 0.001). A multivariate analysis shows the adjusted odds of D5 control for patients in the 2nd, 3rd or 4th HOUSES quartiles as opposed to the 1st quartile are 1.28, 1.21, and 1.20, respectively. ConclusionLower SES as represented by the first quartile of HOUSES index, is associated with lower odds of D5 control and thus worse diabetic outcomes. Using the HOUSES index to identify these individuals in a patient centered medical home might prove useful in deciding where to focus diabetic control efforts.

Loneliness in older parents: marital transitions, family and social connections, and separate bedrooms for sleep

ObjectivesThis research innovatively analyzed the marital transitions (i.e., divorce and widowhood) of older Taiwanese parents, their sleep problems and spousal specific characteristics (i.e., separate bedrooms for sleep and marital relationships) as well as their social and family connections, all of which were simultaneously reflected in emotional and social domains of loneliness.MethodsData are from 1645 older parents from Northern Taiwan. Loneliness was assessed by a De Jong-Gierveld short scale with emotional and social domains. We conducted multivariate logistic regression to examine the associations of marital transitions and family/social connections regarding sleep problems and psychological well-being with loneliness in social and emotional domains. Besides sleep problems and individual socioeconomic status, we included data on couples’ sleeping arrangements and marital relationships.ResultsSocial loneliness was significantly associated with being divorced (AOR = 1.80, 95% CI 1.13–2.86) and living alone (AOR = 1.50, 95% CI 1.02–2.23). In contrast, strong family cohesion and frequent weekly contact with friends were associated with lower social loneliness. Married parents who slept in separate bedrooms were more likely than bed-sharing couples to feel emotional and social loneliness, despite adjusting for their sleep problems. Furthermore, satisfactory spousal relationships significantly decreased the magnitude of associations in the social domain.DiscussionOur findings support significant associations between loneliness in later life and major marital transitions, family and social connections and sleep problems which differ in social and emotional domains. Independent of relationship satisfaction, separate bedrooms relate to higher risks of emotional loneliness in older adults.

Living in a block group with a higher eviction rate is associated with increased odds of preterm delivery

BackgroundHousing instability is associated with adverse pregnancy outcomes. Recent studies indicate that eviction, which may affect a larger segment of the population than other forms of housing instability, is also...

Need-supportive teaching is positively associated with students' well-being: A cross-cultural study

Research rooted in self-determination theory (SDT) has shown that need-supportive teaching, which involves support for students' needs for autonomy, competence, and relatedness, is associated with better motivation, engagement, and achievement. However, there is a lack of research on how need-supportive teaching is associated with student well-being. In addition, past studies on SDT have mostly confined themselves to a limited range of cultural contexts, usually Western cultures. To address these gaps, we examined the association between need-supportive teaching and students' well-being across eight distinct cultural groups (Western Europe, East-Central Europe, East Europe, Latin America, English-speaking, Confucian, Southeast Asia, African, and the Middle East). We analyzed secondary data from the Program for International Student Assessment which included responses from 513,295 students nested in 70 societies. Data were analyzed using hierarchical linear modeling. Results indicated that need-supportive teaching was associated with better subjective, eudaimonic, and social well-being. Results held across the eight cultural groups and were robust to the inclusion of covariates at the individual (gender, socioeconomic status, immigration status, and parent support) and school (school socioeconomic status and percentage of local students within a school) levels. Our study provides strong support to the SDT assumption that need-supportive teaching is associated with optimal functioning across different cultural contexts. Theoretical and practical implications are discussed.

Neighborhood Socioeconomic Deprivation in Young Adulthood and Future Respiratory Health: The CARDIA Lung Study

PurposeThere are limited data on the relationship between neighborhood level factors and their association with lung health independent of individual socioeconomic status. We sought to determine whether baseline neighborhood level socioeconomic deprivation in young adults is associated with greater 20-year decline in lung function and higher risk of future lung disease, independent of baseline individual income, education, and smoking status. MethodsThis multicenter population-based cohort study included 2689 participants in Coronary Artery Risk Development in Young Adults (CARDIA) for whom neighborhood deprivation was determined at year 10 (baseline for study) and who had complete lung function measurements at years 10 and 30. Baseline neighborhood deprivation was defined using 1990 Census blocks as a combination of 4 factors involving median household income, poverty level, and educational achievement. The outcomes were decline in lung function over 20 years (year 10 to 30) and odds of emphysema (year 25). ResultsIn multivariable regression models, greater baseline neighborhood deprivation was associated with greater decline in lung function (−2.34 mL/year excess annual decline in forced expiratory volume in 1 second (FEV1) in the highest versus lowest deprivation quartile (P = .014)). Furthermore, baseline neighborhood deprivation was independently associated with greater odds of emphysema (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.42-6.30). ConclusionsResidence in neighborhoods with greater socioeconomic deprivation in young adulthood, independent of individual income and smoking, is associated with greater 20-year decline in forced expiratory volume in 1 second and higher risk of future emphysema.

Long-Term Air Pollution Exposures and Major Depression in Older U.S. Adults: The Health and Retirement Study

BACKGROUND AND AIM: Major depression is a leading cause of morbidity worldwide, especially during later life. Since heritability is modest (40-50%), there is interest in understanding risk from environmental factors like air pollution. However, research examining this issue is scarce, and often does not use clinical diagnostic criteria. Here, we aimed to quantify associations of air pollution with prevalent major depression in a cohort that deploys diagnostic assessments. METHODS: We conducted a repeated measure analysis of 2008-2016 interviews from the Health and Retirement Study, a nationally representative cohort of older adults in the United States. Major depression status was determined biennially using the Composite International Diagnostic Interview Short Form, with a cutoff of 5. We estimated 1-year average PM2.5, PM10-2.5, NO2, and O3 concentrations at participant residences using fine-scale spatiotemporal models. To estimate prevalence ratios, we fit generalized linear models that accounted for sample weights and clustering by participant. All models included demographic characteristics, individual and neighborhood socioeconomic status, calendar time, and geographic area. RESULTS:Among 25,305 participants with complete data, there was a mean age of 63 years, 53% were female, and most were Non-Hispanic White (73%), with some Black (11%) and Hispanic participants. Eight percent reported major depression. In fully adjusted models, we observed that higher PM2.5 and NO2 concentrations were associated with a greater prevalence of major depression (PR: 1.13 per 3 µg/m³ PM2.5, 95% CI: 1.03, 1.23; PR: 1.23 per 5 ppb NO2, 95% CI: 1.06, 1.20). Only the association with NO2 was robust to adjustment for other pollutants, however, and no associations were observed with PM10-2.5 or O3. CONCLUSIONS:Overall, we observed a robust association of major depression prevalence with long-term exposure to NO2 but not with other air pollutants. This suggests that traffic may be a modifiable risk factor that could be targeted to reduce socioeconomic disparities in mental health. KEYWORDS: Traffic-Related Air Pollution, Major Depression, Psychiatric Epidemiology, Health Disparities

Ambient air pollution and risk of SARS-CoV-2 infection and of COVID-19 disease in a cohort study in Catalonia (COVICAT Cohort)

BACKGROUND AND AIM: Air pollution has been associated with a higher risk of COVID-19 in ecological studies. We examined the association of pre-pandemic air pollution with SARS-CoV-2 infection, immunological response, and COVID-19 disease in a general population cohort. METHODS: 9,605 adult participants from a general population cohort in Catalonia were contacted post-lockdown in June-November 2020 and administered web- or telephone-based questionnaires. We drew blood samples from 4090 participants, and determined IgG, IgM, and IgA antibodies for five viral target antigens (Luminex assay). We defined disease as previous diagnoses or hospital admission with COVID-19, or reporting 4 or more COVID-19 symptoms. We used the ELAPSE model to assess annual pre-pandemic (2010) exposure to particulate matter (PM2.5), NO2, Black Carbon (BC), and O3. We calculated log-binomial Relative Risks (RR) adjusting for age, sex, type of questionnaire, individual and area-based socioeconomic status, and lifestyle factors. RESULTS:Of the 9,605 participants 481 (5.0%) had COVID-19 disease. Among those tested for SARS-Cov-2 antibodies, 743 (18.1%) had been infected. There were no associations between air pollutants and SARS-CoV-2 infection: increases in average annual levels of 5μg/m3 of NO2 and PM2.5 and 1μg/m3 of BC were associated with RRs (95%CI) of 1.02 (0.98-1.06), 1.07 (0.85-1.35) and 1.08 (0.92-1.29) respectively. Among infected participants, increasing air pollutant levels were associated with higher IgG responses. Air-pollutants were associated in the overall population with increased risk of COVID-19 disease with RRs of 1.07 (95%CI 1.02-1.11) for NO2, 1.45 (1.07-1.97) for PM2.5, and 1.28 (1.02-1.59 for BC. O3 was associated with a slightly decreased risk (RR=0.98, 0.97-1.00). We observed similar results among those infected. We observed slightly higher risks of COVID-19 disease associated with air-pollutants in obese participants and those with lower socioeconomic position. CONCLUSIONS:Exposure to pre-pandemic air-pollutants was associated with a higher risk of COVID-19 disease although not associated with a higher risk of SARS-CoV-2 infection. KEYWORDS: COVID-19, SARS-CoV-2, immunology, air-pollution, cohort

Long-term air pollution exposure and diabetes incidence in two prospective cohorts of U.S. women

BACKGROUND AND AIM: Global prevalence of type 2 diabetes (T2DM) is increasing. Research has identified links between air pollution exposure and T2DM through metabolic and inflammatory pathways, but more large cohort studies are needed to help disentangle which pollutants are responsible and which individuals are most susceptible. Our aim was to prospectively evaluate the association between long-term exposure to fine particulate matter (PM₂.₅) and T2DM incidence in the US-based Nurses’ Health Study (NHS) and Nurses’ Health Study II (NHSII) cohorts. METHODS: Monthly PM₂.₅ exposures were predicted from spatiotemporal models and linked to participants’ residential addresses from 1989-2007. Biennial participant questionnaires provided rich individual level covariate data. Self-reported clinician diagnosis of T2DM was confirmed via a validated supplementary questionnaire. We used Cox proportional hazards models to assess the relationship between time-varying two-year average PM₂.₅ exposure and incident T2DM in each cohort. We adjusted for time-varying covariates including lifestyle factors, menopausal status and hormone use, and markers of individual and neighborhood socioeconomic status (nSES). Results were meta-analyzed and heterogeneity was assessed. We also examined interactions by self-reported physical activity level and nSES. RESULTS:Over follow-up, there were 10,108 incident T2DM cases during 1,182,400 and 1,574,821 person-years of follow-up among the 96,291 and 112,941 women in NHS and NHSII, respectively. In fully adjusted models, the meta-analysis HR for an interquartile range (4.8 µg/m³) increase in two-year PM₂.₅ exposure was 1.04 (95% CI: 1.01, 1.08) for incident T2DM. Results were similar in models for cumulative exposure. We found suggestive evidence of effect modification by physical activity level, but not by nSES. The association between PM₂.₅ and T2DM was stronger in more physically active women. CONCLUSIONS:Our results support the growing evidence of a positive association between air pollution and T2DM. KEYWORDS: air pollution, particulate matter, long-term exposure, incidence, obesity and metabolic disorders

Ambient air pollution and socioeconomic status in China

BACKGROUND AND AIM: Air pollution disparities by socioeconomic status (SES) are well documented for the US, with most literature indicating an inverse relationship (i.e., higher concentrations for lower-SES populations). Limited knowledge exists for China, a country accounting for 26% of global premature deaths from ambient air pollution. We propose and test the opposite relationship as in the US: in China, air pollution exposures are higher for high-SES than for the low-SES populations. Underlying this framework is that in China’s current industrialization and urbanization stage, economic development is correlated with both SES and air pollution. METHODS: We test our air pollution inequality theory by combining estimated 2015 annual-average ambient concentrations for nitrogen dioxide (NO2) and fine particulate matter (PM2.5), derived from a national empirical model for China with 1 km spatial resolution, with demographic information derived from national gridded GDP per capita at 1 km resolution and (separately) a national representative sample of 21,095 individuals from the China Health and Retirement Longitudinal Study (CHARLS) 2015 cohort. We quantify the air pollution disparities among individual’s rural-to-urban migration status and SES factors (education, occupation, and income). We compare results using three approaches to SES measurement (individual SES score; community-averaged SES score; gridded GDP per capita). RESULTS:Consistent with our theory, ambient NO2 and PM2.5 concentrations are higher for higher-SES populations than for lower-SES population, and higher for long-standing urban residents than for rural-to-urban migrant populations. For example, for the three SES measurements, a 1-IQR increase in SES corresponds to concentration (units: μg/m3) increases of 5.6 - 9.4 NO2 and 3.5 - 6.0 PM2.5. This pattern holds in rural and urban locations, across geographic regions, across levels of spatial resolution, and for modeled versus measured pollution concentrations. CONCLUSIONS:Multiple analyses reveal that in China, ambient NO2 and PM2.5 air pollution levels are higher for high-SES than for low-SES individuals. KEYWORDS: Ambient air pollution, Socioeconomic status, NO2, PM2.5

Long-term PM2.5 exposure and diagnosis of amyotrophic lateral sclerosis: a population-based case-control study in Denmark

BACKGROUND AND AIM: Evidence for an association between fine particle (PM2.5) exposure and neurodegenerative diseases is increasing. Whether PM2.5 exposure is relevant in amyotrophic lateral sclerosis (ALS) pathogenesis is still unknown. Only two epidemiological studies have evaluated long-term PM2.5 exposure effects in ALS. We aim to assess long-term PM2.5 exposure and ALS incidence and identify potential critical windows of exposure. METHODS: We leveraged data from the Danish National Patient Registry (NPR) on prospectively collected ALS cases (1989-2013). One-to-five controls per case were selected through the Danish Civil Registry, matched on sex, and year of birth. We estimated 1-, 5-, and 10-year PM2.5 average exposures at residential address, lagged one-year pre-diagnosis. We also estimated 1-year exposure averages from the date of diagnosis to 10 years pre-diagnosis. All exposures were estimated using predictions from a validated spatio-temporal model. We used conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for the 1-, 5-, and 10- years exposures, adjusting for individual socioeconomic status, place of birth, civil status, and residence area. This analysis will be followed by a distributed lag analysis using the estimated 1-year exposure averages dating back to 10-years pre-diagnosis. RESULTS:Our analysis included data from 2,195 cases and 6,690 controls. In the preliminary analysis of the 1-, 5-, and 10-years exposure windows, we found no association between ALS diagnosis and PM2.5. The estimated ORs per 1 µg/m3 increase in PM2.5 were 1.00 (95%CI: 0.96–1.04), 0.99 (95%CI: 0.96–1.03), and 0.99 (95%CI: 0.95–1.02) for 1-, 5-, and 10-year averaged PM2.5 exposure respectively. CONCLUSIONS:Our preliminary results suggest no association between PM2.5 and ALS diagnosis. However, averaging long-term exposure decreases temporal exposure contrasts. Our lagged analysis will be important to more precisely analyze windows of exposure dating back to 10 years pre-diagnosis and crucial to verify our preliminary findings. KEYWORDS: ALS, air pollution, particle matter, windows of exposure

Individual and contextual socioeconomic status as effect modifier in the air pollution-birth outcome association

BackgroundSeveral studies have examined whether air pollution is associated with adverse births outcomes, but it is not clear if socioeconomic status (SES) modifies this relationship. ObjectivesWe investigated if maternal education and area-level socioeconomic status modified the relationship between ozone, nitrogen dioxide and particulate matter with aerodynamic diameter <10 μm (PM10) on preterm births (PTB; gestational age <37 weeks) and term low birth weight (TLBW; weight < 2500 g on term deliveries). MethodsAnalyses were based on almost 1 million singleton live births in São Paulo municipality between 2011 and 2016. The final sample included 979,306 births for PTB analysis and 888,133 for TLBW analysis. Exposure to PM10, NO2 and O3 were based on date of birth and estimated for the entire gestation and for each trimester. Multilevel logistic regression models were conducted to examine the effect of air pollutants on both adverse birth outcomes and whether it was modified by individual and area-level SES. ResultsIn fully adjusted models, over the entire pregnancy, a 10 μg/m3 increase in O3 and PM10 was associated with increased chance of PTB (odds ratio; OR = 1.14 CI 1.13, 1.16 and 1.08 CI = 1.02, 1.15 respectively) and PM10 with TLBW (OR = 1.08 CI 1.03, 1.14). Associations were modified by maternal educational and area-level SES for both outcomes. Mothers of lower education had an additional chance of PTB and TLBW due to PM10 exposure (OR = 1.04 CI 1.04, 1.05 and 1.10 CI 1.08, 1.14 respectively), while mothers living in low SES areas have an additional chance for TLBW (OR = 1.05 CI 1.03, 1.06). Similar modification effects were found for O3 exposure. Trimester specific associations were weaker but followed a similar pattern. ConclusionSocioeconomic status modifies the effect of air pollution on adverse birth outcomes. Results indicate that mothers with lower SES may be more susceptible to air pollution effects.

Socioeconomic status and social relationships in persons with spinal cord injury from 22 countries: Does the countries' socioeconomic development moderate associations?

BackgroundSocial relationships are powerful determinants of health and inequalities in social relationships across socioeconomic status (SES) groups may contribute to social inequalities in health. This study investigates inequalities in social relationships in an international sample of persons with spinal cord injury and explores whether social gradients in relationships are moderated by the countries’ socioeconomic development (SED).MethodsData from 12,330 participants of the International SCI Community Survey (InSCI) performed in 22 countries were used. We regressed social relationships (belongingness, relationship satisfaction, social interactions) on individual SES (education, income, employment, financial hardship, subjective status) and countries’ SED (Human Development Index) using multi-level models (main effects). To test potential moderation of the SED, interaction terms between individual SES and countries’ SED were entered into multi-level models.ResultsPaid work, absence of financial hardship and higher subjective status were related to higher belongingness (OR, 95% CI: 1.50, 1.34–1.67; 1.76, 1.53–2.03; 1.16, 1.12–1.19, respectively), higher relationship satisfaction (OR, 95% CI: 1.28, 1.15–1.42; 1.97, 1.72–2.27; 1.20, 1.17–1.24, respectively) and fewer problems with social interactions (Coeff, 95% CI: 0.96, 0.82–1.10; 1.93, 1.74–2.12; 0.26, 0.22–0.29, respectively), whereas associations with education and income were less consistent. Main effects for countries’ SED showed that persons from lower SED countries reported somewhat higher relationship satisfaction (OR, 95% CI: 0.97, 0.94–0.99) and less problems with social interactions (Coeff, 95% CI: -0.04, -0.09- -0.003). Results from moderation analysis revealed that having paid work was more important for relationships in lower SED countries, while education and subjective status were more important for relationships in higher SED countries (interaction terms p<0.05).ConclusionSocial relationships in persons with spinal cord injury are patterned according to individual SES and the countries’ SED and larger socioeconomic structures partly moderate associations between individual SES and social relationships.

Socioeconomic inequalities in dementia risk among a French population-based cohort: quantifying the role of cardiovascular health and vascular events

This study aimed to investigate the role of cardiovascular health (CVH) and vascular events as potential contributors to socioeconomic inequalities in dementia using causal mediation analyses. We used data from the Three-City Cohort, a French population-based study with 12 years of follow-up, with active search of dementia cases and validated diagnosis. Individual socioeconomic status was assessed using education, occupation and income. A CVH score as defined by the American Heart Association and incident vascular events were considered separately as mediators. We performed multi-level Cox proportional and Aalen additive hazard regression models to estimate the total effects of socioeconomic status on dementia risk. To estimate natural direct and indirect effects through CVH and vascular events, we applied two distinct weighting methods to quantify the role of CVH and vascular events: Inverse Odds Ratio Weighting (IORW) and Marginal Structural Models (MSM) respectively. Among 5581 participants, the risk of dementia was higher among participants with primary education (HR 1.60, 95%CI 1.44–1.78), blue-collar workers (HR 1.62, 95%CI 1.43–1.84) and with lower income (HR 1.23, 95%CI 1.09–1.29). Using additive models, 571 (95% CI 288–782) and 634 (95% CI 246–1020) additional cases of dementia per 100 000 person and year were estimated for primary education and blue-collar occupation, respectively. Using IORW, the CVH score mediate the relationship between education or income, and dementia (proportion mediated 17% and 26%, respectively). Yet, considering vascular events as mediator, MSM generated indirect effects that were smaller and more imprecise. Socioeconomic inequalities in dementia risk were observed but marginally explained by CVH or vascular events mediators.

Management of Smart Grids: A Review

Electrical power grid has witnessed continuous changes over the past century but phenomenal developments are visible in the last two decades or so. The demand of 24x7x365 power supply, and development in socio-economic status of individuals and nations the demand of electrical power hence grid complexity is rising. Moreover shifting to renewables has opened a whole new can of worms. The conventional approach of grid management is unable to cater the needs of such a complex demand and supply needs. The present work is an approach addressing various modalities, modes of operation and management of smart grids. This includes demand side management in household and non-household scenarios, ICT and cyber security concerns.

A vezetői beosztás mint egészségprotektív tényező szellemi munkát végzők körében

Employment is an important health protective factor but also entails workplace psychosocial risks with multiple impacts on health. The present study aimed at examining the association between employment position and subjective health in a relatively homogenous sample of public servants with mostly tertiary degrees. Online health survey was conducted among employees of two large public institutes in a large city in Hungary. The questionnaire contained items on demographic data, health status, mental health, health behaviour, and work-related questions including employment position (leadership). Data analysis was carried out by employment position in two (manager, subordinate) and three (manager, subordinate with college degree, subordinate with no college degree) strata. Subjective health, satisfaction with life, sense of coherence, pathological stress, sickness absence, social support in the workplace and private life were most favourable among those in leadership position. Work ability did not differ by employment position, but sleep time was significantly less favourable (shorter) among leaders compared to subordinates. Subordinates with no college degree had the worst measures of health. Employment position is related to individual socioeconomic status and workplace psychosocial stress, therefore research on workplace stress should include employment level as a potential confounder. Psychosocial stress at workplaces should be monitored for which various recommendations are available. The simplest method is to monitor mid- and long-term turnover and sickness absence stratified for employment position and proportionate to the workforce. Orv Hetil. 2021; 162(29): 1172-1179.

Association between socioeconomic status and physical inactivity in a general Japanese population: NIPPON DATA2010.

BackgroundLower socioeconomic status (SES) may be related to inactivity lifestyle; however, the association between SES and physical inactivity has not been sufficiently investigated in Japan.MethodsThe study population is the participants of NIPPON DATA2010, which is a prospective cohort study of the National Health and Nutrition Survey 2010 in Japan. They were residents in 300 randomly selected areas across Japan. This study included 2,609 adults. Physical activity was assessed by physical activity index (PAI) calculated from activity intensity and time. The lowest tertile of PAI for each 10-year age class and sex was defined as physical inactivity. Multivariable logistic regression analyses were conducted to examine the association of SES (employment status, educational attainment, living status, and equivalent household expenditure (EHE)) with physical inactivity.ResultsIn the distribution of PAI by age classes and sex, the highest median PAI was aged 30–39 years among men (median 38.6), aged 40–49 years among women (38.0), and median PAI was decreased with increasing age. Multivariable-adjusted model shows that not working was significantly associated with physical inactivity after adjustment for age in all age groups and sexes. Not living with spouse for adult women and elderly men was significantly associated with physical inactivity compared to those who living with spouse. However, neither educational attainment nor EHE had any significant associations with physical inactivity.ConclusionsThe result indicated that physical inactivity was associated with SES in a general Japanese population. SES of individuals need to be considered in order to prevent inactivity lifestyle.