Influence Of Socioeconomic Environment Research Articles

Baseline characteristics, reperfusion treatment secondary prevention and outcome after acute ischemic stroke in three different socioeconomic environments in Europe.

The differences in vascular risk factors' and stroke burden across Europe are notable, however there is limited understanding of the influence of socioeconomic environment on the quality of secondary prevention and outcome after acute ischemic stroke. In this observational multicenter cohort study, we analyzed baseline characteristics, reperfusion treatment, outcome and secondary prevention in patients with acute ischemic stroke from three tertiary-care teaching hospitals with similar service population size in different socioeconomic environments: Bern/CH/n = 293 (high-income), Gdansk/PL/n = 140 (high-income), and Lutsk/UA/n = 188 (lower-middle-income). We analyzed 621 patients (43.2% women, median age = 71.4 years), admitted between 07 and 12/2019. Significant differences were observed in median BMI (CH = 26/PL = 27.7/UA = 27.8), stroke severity [(median NIHSS CH = 4(0-40)/PL = 11(0-33)/UA = 7(1-30)], initial neuroimaging (CT:CH = 21.6%/PL = 50.7%/UA = 71.3%), conservative treatment (CH = 34.1%/PL = 38.6%/UA = 95.2%) (each p < 0.001), in arterial hypertension (CH = 63.8%/PL = 72.6%/UA = 87.2%), atrial fibrillation (CH = 28.3%/PL = 41.4%/UA = 39.4%), hyperlipidemia (CH = 84.9%/PL = 76.4%/UA = 17%) (each p < 0.001) and active smoking (CH = 32.2%/PL = 27.3%/UA = 10.2%) (p < 0.007). Three-months favorable outcome (mRS = 0-2) was seen in CH = 63.1%/PL = 50%/UA = 59% (unadjusted-p = 0.01/adjusted-p CH-PL/CH-UA = 0.601/0.981), excellent outcome (mRS = 0-1) in CH = 48.5%/PL = 32.1%/UA = 27% (unadjusted-p < 0.001/adjusted-p CH-PL/CH-UA = 0.201/0.08 and adjusted-OR CH-UA = 2.09). Three-months mortality was similar between groups (CH = 17.2%/PL = 15.7%/UA = 4.8%) (unadjusted-p = 0.71/adjusted-p CH-PL/CH-UA = 0.087/0.24). Three-months recurrent stroke/TIA occurred in CH = 3.1%/PL = 10.7%/UA = 3.1%, adjusted-p/OR CH-PL = 0.04/0.32). Three-months follow-up medication intake rates were the same for antihypertensives. Statin/OAC intake was lowest in UA = 67.1%/25.5% (CH = 87.3%/39.2%/unadjusted-p < 0.001/adjusted-p CH-UA = 0.02/0.012/adjusted-OR CH-UA = 2.33/2.18). Oral intake of antidiabetics was lowest in CH = 10.8% (PL = 15.7%/UA = 16.1%/unadjusted-p = 0.245/adjusted-p CH-PL/CH-UA = 0.061/0.002/adjusted-OR CH-UA = 0.25). Smoking rates decreased in all groups during follow-up. Substantial differences in presentation, treatment and secondary prevention measures, are linked to a twofold difference in adjusted 3-months excellent outcome between Switzerland and Ukraine. This underscores the importance of socioeconomic factors that influence stroke outcomes, emphasizing the necessity for targeted interventions to address disparities in treatment and secondary prevention strategies.

Cancer Patients' Survival According to Socioeconomic Environment in a High-Income Country with Universal Health Coverage.

Simple SummaryThe main aim of our paper was to quantify the potential impact of socioeconomic environment on cancer patients’ survival in Slovenia in the 21st century. Despite of universal health coverage and after accounting for basic demographic variables (age and gender), differences in stage at diagnosis, as well as the impact of the cancer treatment improvements over time, we show that cancer patients in Slovenia who have a lower socioeconomic status experience worse survival and increased mortality. The results of this analysis could help decision-makers to better understand inequalities in cancer burden and inform the development of policies to improve or resolve them.Despite having an established systematic approach to population survival estimation in Slovenia, the influence of socioeconomic environment on cancer patients’ survival has not yet been evaluated. Thus, the main aim of our study was to quantify the potential impact of socioeconomic environment on cancer patients’ survival in our population in the 21st century. The net survival was calculated and stratified into quintiles of Slovenian version of the European Deprivation Index for all adult cancer patients diagnosed between 2004 and 2018 using the national cancer registry data. After accounting for basic demographic variables (age and gender), differences in stage at diagnosis, as well as the impact of the cancer treatment improvements over time, we found that cancer patients in Slovenia with lower socioeconomic status experience worse survival and have higher mortality. In particular, the odds of dying from oral, stomach, colorectal, liver, pancreatic, lung, breast, ovarian, corpus uteri, prostate, and bladder cancers, as well as for melanoma, leukemia, and non-Hodgkin lymphoma, are significantly higher in the socioeconomically most deprived group of patients compared to the most affluent group. The inequalities in cancer burden we found could help decision-makers to better understand the magnitude of this problem.

Abstract MP65: Occupational Complexity and Childhood Socioeconomic Environment Influence Mid-to-Late-Life 20-year Change in Cognitive Function; The Atherosclerosis Risk in Communities (aric) Study

Background: We tested the hypothesis that lower childhood SES is associated with greater age-and disease-related cognitive decline. We further examined potential protective effects of high adulthood occupational complexity in the association of childhood SES with cognitive decline. Methods: Childhood neighborhood SES (child nSES) was ascertained at midlife among 12440 ARIC participants using retrospective historical county-level census-based measures of median household income, value of owner occupied housing units, percent of households receiving interest, dividend, or net rental income, educational attainment, and proportion of adults in professional, management, or executive occupations. An occupational complexity index (OCI) was derived from self-reported occupational categories at baseline. Cognitive function was assessed at ARIC visits 2 (1990-1993), 4 (1996-1998), and 5 (2011-2013) according to performance on tests of memory, executive function/processing speed and language. A composite global cognition z-score was estimated, with missing data imputed using multiple imputation by chained equations. Linear mixed effects models, adjusted for baseline age, sex, and race-study center, were used to examine the association of distribution-based tertiles of the child nSES summary score with baseline and 20-year change in cognitive function. We further examined interactions by OCI tertiles. Results: Global cognitive z scores in adulthood were persistently higher at baseline among participants with high (Visit 2 β =0.545 (95% CI 0.514, 0.576) as compared to intermediate (Visit 2 β=0.348 (95% CI 0.317, 0.381)) and low (Visit 2 β = 0.007 (95% CI -0.030, 0.044) child nSES. Participants with high,as compared to low, OCI, had higher baseline cognitive function across all tertiles of child nSES (Figure, p&lt;0.01). Conclusion: The positive association of child nSES with adult cognitive function is modified by adulthood occupational complexity. Child nSES is not associated with a 20-year cognitive change.

Social Capital and Quality of Life among Urban and Rural Older Adults. Quantitative Findings from the Irish Longitudinal Study on Ageing

While the association between health and quality of life (QoL) is well established, our understanding of the effect of inter-relationships and the wider social context is less well understood. Our aim was to examine the association between social capital, area-level deprivation, quality of relationships, and the control/autonomy domain of QoL. Data was from The Irish Longitudinal Study on Ageing (TILDA), a prospective nationally representative study of community-dwelling older adults in the Republic of Ireland. QoL was measured using CASP-19. Mixed effects linear regression models were estimated, stratified by urban rural location. QoL increased until around 68 years before decreasing into oldest age. Social cohesion was associated with the QoL of urban participants while social decay was important to the QoL of both urban and rural participants. Functional limitations, depressive symptoms and loneliness were also associated with poorer QoL. Social capital and the socio-economic environment influence QoL, independent of other factors. We show that the relationship between the social environment and QoL differs between rural and urban populations. While social decay was important in both settings, social cohesion was related to QoL among urban dwellers only and higher levels of area level deprivation was associated with lower QoL among rural residents.

Socioeconomic environment and disparities in cancer survival for 19 solid tumor sites: An analysis of the French Network of Cancer Registries (FRANCIM) data.

Social inequalities are concerning along the cancer continuum. In France, social gradient in health is particularly marked but little is known about social gradient in cancer survival. We aimed to investigate the influence of socioeconomic environment on cancer survival, for all cancers reported in the French Network of Cancer Registries. We analyzed 189,657 solid tumors diagnosed between 2006 and 2009, recorded in 18 registries. The European Deprivation Index (EDI), an ecological index measuring relative poverty in small geographic areas, assessed social environment. The EDI was categorized into quintiles of the national distribution. One- and five-year age-standardized net survival (ASNS) were estimated for each solid tumor site and deprivation quintile, among men and among women. We found that 5-year ASNS was lower among patients living in the most deprived areas compared to those living in the least deprived ones for 14/16 cancers among men and 16/18 cancers among women. The extent of cancer survival disparities according to deprivation varied substantially across the cancer sites. The reduction in ASNS between the least and the most deprived quintile reached 34% for liver cancer among men and 59% for bile duct cancer among women. For pancreas, stomach and esophagus cancer (among men), and ovary and stomach cancer (among women), deprivation gaps were larger at 1-year than 5-year survival. In conclusion, survival was worse in the most deprived areas for almost all cancers. Our results from population-based cancer registries data highlight the need for implementing actions to reduce social inequalities in cancer survival in France.

Understanding the Influence of Socioeconomic Environment on Paediatric Antiretroviral Treatment Coverage: Towards Closing Treatment Gaps in Sub-Saharan Africa.

Many sub-Saharan African countries have massively scaled-up their antiretroviral treatment (ART) programmes, but many national programmes still show large gaps in paediatric ART coverage making it challenging to reduce AIDS-related deaths among HIV-infected children. We sought to identify enablers of paediatric ART coverage in Africa by examining the relationship between paediatric ART coverage and socioeconomic parameters measured at the population level so as to accelerate reaching the 90-90-90 targets. Ecological analyses of paediatric ART coverage and socioeconomic indicators were performed. The data were obtained from the United Nations agencies and Forum for a new World Governance reports for the 21 Global Plan priority countries in Africa with highest burden of mother-to-child HIV transmission. Spearman's correlation and median regression were utilized to explore possible enablers of paediatric ART coverage. Factors associated with paediatric ART coverage included adult literacy (r=0.6, p=0.004), effective governance (r=0.6, p=0.003), virology testing by 2 months of age (r=0.9, p=0.001), density of healthcare workers per 10,000 population (r=0.6, p=0.007), and government expenditure on health (r=0.5, p=0.046). The paediatric ART coverage had a significant inverse relationship with the national mother-to-child transmission (MTCT) rate (r=-0.9, p<0.001) and gender inequality index (r=-0.6, p=0.006). Paediatric ART coverage had no relationship with poverty and HIV stigma indices. Low paediatric ART coverage continues to hamper progress towards eliminating AIDS-related deaths in HIV-infected children. Achieving this requires full commitment to a broad range of socioeconomic development goals.

Training a medical workforce to meet the needs of diverse minority communities

BackgroundThe growing demand for a competent health workforce to meet the needs of increasingly diverse societies has been widely acknowledged. One medical school in New Zealand explored the integration of the commonly used patient-centred model approach, with an intersectional framework in the development of a cultural competency training programme. In the Pacific Immersion Programme, medical students in their fourth year of training are given the opportunity to learn about different factors that influence the health and health care of a minority community through immersion in that community. The programme objectives include enabling students to learn through experience living within the local community context, and supporting them to re-evaluate their own personal beliefs, assumptions and/or prior prejudices. This study evaluates the usefulness of this programme in the training of medical students to work in diverse communities.MethodsTwo analytical approaches were used for evaluation. Deductive and inductive analyses were conducted on 235 reflective essays completed by three cohorts of students from 2011 to 2013 to ascertain the value of the programme for student learning. In addition, one cohort was invited to complete a pre and post-programme questionnaire.ResultsOverall, the students found the programme to be a valued learning environment. They found living within a Pacific family environment to be an eye opening experience. It increased students comfort level in cross cultural engagement and emphasised the importance of patient’s perspectives in health care provision. Students’ self-reported knowledge about Pacific cultural values, protocols, traditional beliefs and the main health challenges increased significantly after the programme. They appreciated learning directly from community members, and through observations about how culture, beliefs and the socio-economic environment influence peoples’ health and wellbeing.ConclusionsMedical schools are required to train a competent health workforce to meet the needs of diverse communities. The Pacific Immersion Programme provides a unique learning environment which can improve the training of doctors to work in diverse communities. The key to its success is enabling students to be engaged learners from “the inside” rather than an “outsider looking in”. The Programme enables experiential learning in a sensitive and meaningful way and can be useful for training in other institutions.

Linking HRM Practices and Institutional Setting to Collective Turnover: An Empirical Exploration

The present study addresses the relationship between human resources management (HRM) practices and employee turnover by taking into account the influence of socioeconomic environment. Data was collected at company level with an international sample of 830 companies from 12 countries (Netherlands, Belgium, United Kingdom, Brazil, Switzerland, China, France, Italy, Poland, Germany, South Africa, and Spain). A division into four bundles of human resources (HR) practices is introduced: remunerative, communication, developmental, and well-being practices. The influence of the socioeconomic environment was factored in by including the institutional setting in terms of the level of coordination as a country-level variable. The results showed that collective turnover is related to both a country’s institutional determinants and to company HR practices. Remunerative HR practices may have a negative influence in terms of enhancing turnover, particularly within countries high in coordination. HR well-being practices are the most beneficial practices in terms of reducing employee turnover. Our study adds to our knowledge on the relation between HR practices and turnover from an international perspective. It complements the empirical knowledge on the effectiveness of HRM practices in a cross-national setting and supports the notion that the institutional context should be given more attention when studying HR effectiveness.

Parental separation: a risk for the psychomotor development of children aged 28 to 32months? A cross-sectional study.

BackgroundIn Western countries, about a quarter of children are affected by parental separation and a number of authors have previously investigated how familial structure impacts children’s health. The purpose of the work: to analyze the psychomotor development of children aged 28 to 32 months based on family structure (parents together or separated), independently of the influence of socio-economic environment that is well documented.To analyse the psychomotor development of children younger than 3 years based on family structure (parents together or separated) independently of the influence of socio-economic environment that is well documented.MethodsCross-sectional study by examination of 28 871 children as part of a free preventive medicine consultation. The data came from an assessment conducted 28 to 32 months after birth during which information was collected about the psychomotor development: to perform a standing jump, dress themselves, draw a vertical line and circle, use the “I” pronoun, build a three-word sentence, and say their first nameResultsTen percent of the children had separated parents. Compared to parents who were together, when adjusting for the socioeconomic environment, as well as all potential confounders, the adjusted odds ratios (ORs) (95 % confidence interval [CI]) for children with separated parents, in terms of their ability to perform a standing jump, dress themselves, and draw a vertical line and circle were respectively 0.9 (0.7-1.1), 1.1 (0.9-1.2), 1.3 (1.1-1.4) and 1.2 (1.1-1.4). The adjusted ORs (95 % CI) for children’s inability to say the “I” pronoun, build a three-word sentence, and say their first name were respectively 1.2 (1.1-1.3), 1.3 (1.2-1.5), and 1.2 (0.9-1.5).ConclusionsAfter adjusting for sociocultural factors and other potential confounders, we observed that the children exhibited slower progression in psychomotor development, especially in language and graphic abilities when their parents were separated. While the implications of our study are somewhat limited, they do provide us with the necessary arguments enabling us to set up a prospective cohort study. Such a study should be able to better assess the impact of parental separation on the child's development, confirming our preliminary results.

Evaluation of the Relationship Between Socio-economic Environment and Oro-dental Health of Children in Diourbel Health District in Senegal

The objective of this paper was to evaluate the socio economic environment influence on oral health of children in the sanitary district of Diourbel to formulate recommendations for its improvement by conducting a descriptive cross-section study. Data were registered and analyzed using Epi Info 6.04 d release. A logistic regression analysis was used to identify factors associated with dependant variables. On a theoretical target of 1600 children, 1237 have been examined: 508 in urban area and 729 in rural area. The children of the rural area were significantly younger, more scholarized, and from poorer families. They were statistically sicker than those of the urban area. Oro-dental affections were more frequent among the children of age less than nine years, no scholarized, and living in poor families. The oro-dental affections prevalence is linked to the socioeconomic environment. This confirms the correlation between bad health and poverty in one hand, and between good health and development in other hand. In the WHO international classification of the diseases, the most important death factor is extreme poverty. It exercises its harmful influence at all the stages of human life, since the conception to the death. Unfortunately, most of the world inhabitants are located facing the double threatens of poverty and in equity, and the double blight of suffering and disease. Oral Pathology represents a real public health problem, more frequent in rural areas. Thus, a multisectoral strategy with a longitudinal follow-up is needed to improve the oral health of children.

Correction of misclassification bias induced by the residential mobility in studies examining the link between socioeconomic environment and cancer incidence

BackgroundMany international ecological studies that examine the link between social environment and cancer incidence use a deprivation index based on the subjects’ address at the time of diagnosis to evaluate socioeconomic status. Thus, social past details are ignored, which leads to misclassification bias in the estimations. The objectives of this study were to include the latency delay in such estimations and to observe the effects. MethodsWe adapted a previous methodology to correct estimates of the influence of socioeconomic environment on cancer incidence considering the latency delay in measuring socioeconomic status. We implemented this method using French data. We evaluated the misclassification due to social mobility with census data and corrected the relative risks. ResultsInclusion of misclassification affected the values of relative risks, and the corrected values showed a greater departure from the value 1 than the uncorrected ones. For cancer of lung, colon–rectum, lips–mouth–pharynx, kidney and esophagus in men, the over incidence in the deprived categories was augmented by the correction. ConclusionsBy not taking into account the latency period in measuring socioeconomic status, the burden of cancer associated with social inequality may be underestimated.

Keep the children walking: active school travel in Tirana, Albania

This paper examines how characteristics of the physical and socio-economic environment influence children’s school travel mode in Tirana, the capital of Albania. A survey of students aged 11 to 13, revealed that an overwhelming majority walk to school, while bicycling and bus use are minimal. Students who walk to school often do so as part of a larger group of schoolmates, attend schools that are located relatively near their house, are faced with relatively few major road crossings during their journey, and belong to families that are less likely to own a car. Children who are driven to school (only 13.5% of our sample) usually have higher-income families and live farther from the school. Although Tirana’s high residential density has some environmental drawbacks, we deem it positive in that its result is that most students live very close to their schools and in close proximity to classmates walking to school. The fine grain pattern of the urban public school network contributes to the short distances between schools and homes. We provide a number of recommendations for the promotion of walking in home-school trips, as well as for the future physical development of the city and the school network.

Influence of socioeconomic environment on survival in patients diagnosed with esophageal cancer: a population-based study

The influence of social environment on survival in patients with cancer has been demonstrated in many studies, subjects living in the most deprived areas having a poorer prognosis. Geographic remoteness and limited access to specialized care centers are often associated with socioeconomic deprivation. The aim was to assess the influence of social environment and geographic remoteness on the relative survival of patients diagnosed with esophageal cancer between 1997 and 2004 in the department of Calvados in France. The study population, which was provided by the Calvados digestive cancer registry, included 629 patients. Relative survival was used to estimate the influence of social environment and geographic remoteness on patient survival. Five-year survival rates were 14.1%, 15.1%, 11.8%, 8.8%, and 11.4%, respectively, for patients living in the least to the most deprived areas (P= 0.39). The influence of social environment was significant after adjustment for clinical variables, patients living in the most deprived areas having the worst survival. These discrepancies cannot totally be explained by differences in access to care, cancer extension, or morphology at diagnosis. No association was observed between distance to the nearest cancer center and survival. Social environment appears to induce disparities among patients diagnosed with esophageal cancer, with a worse prognosis for patients living in the most deprived areas.

Pattern and process in MAEUL, a traditional Korean rural landscape

Land-use changes due to the socio-economic environment influence landscape patterns and processes, which affect habitats and biodiversity. This study considers the effects of such land-use changes, particularly on the traditional rural "Maeul" forested landscape, by analyzing landscape structure and vegetation changes. Three study areas were examined that have seen their populations decrease and age over the last few decades. Five types of plant life-forms (Raunkier life-forms) were distinguished to investigate ecosystem function. Principle component analysis was used to understand vegetation dynamics and community characteristics based on a vegetation similarity index. Ordination analysis transformed species-coverage data was introduced to clarify vegetation dynamics. Landscape indices, such as area metrics, edge metrics, and shape metrics, showed that spatial heterogeneity has increased over time in all areas. Pinus densiflora was the main land-use plant type in all study areas but decreased over time, whereas Quercus spp. increased. Over a decade, P. densiflora communities shifted to deciduous oak and plantation. These findings indicate that the impact of human activities on the Maeul landscape is twofold. While forestry activities caused heavy disturbances, the abandonment of traditional human activities has led to natural succession. Furthermore, it can be concluded that the type and intensity of these human impacts on landscape heterogeneity relate differently to vegetation succession. This reflects the cause and consequence of patch dynamics. We discuss an approach for sustainable landscape planning and management of the Maeul landscape based on traditional management.

The influence of socioeconomic environment on the effectiveness of alcohol prevention among European students: a cluster randomized controlled trial

BackgroundAlthough social environments may influence alcohol-related behaviours in youth, the relationship between neighbourhood socioeconomic context and effectiveness of school-based prevention against underage drinking has been insufficiently investigated. We study whether the social environment affects the impact of a new school-based prevention programme on alcohol use among European students.MethodsDuring the school year 2004-2005, 7079 students 12-14 years of age from 143 schools in nine European centres participated in this cluster randomised controlled trial. Schools were randomly assigned to either control or a 12-session standardised curriculum based on the comprehensive social influence model. Randomisation was blocked within socioeconomic levels of the school environment. Alcohol use and alcohol-related problem behaviours were investigated through a self-completed anonymous questionnaire at baseline and 18 months thereafter. Data were analysed using multilevel models, separately by socioeconomic level.ResultsAt baseline, adolescents in schools of low socioeconomic level were more likely to report problem drinking than other students. Participation in the programme was associated in this group with a decreased odds of reporting episodes of drunkenness (OR = 0.60, 95% CI = 0.44-0.83), intention to get drunk (OR = 0.60, 95% CI = 0.45-0.79), and marginally alcohol-related problem behaviours (OR = 0.70, 95% CI = 0.46-1.06). No significant programme's effects emerged for students in schools of medium or high socioeconomic level. Effects on frequency of alcohol consumption were also stronger among students in disadvantaged schools, although the estimates did not attain statistical significance in any subgroup.ConclusionsIt is plausible that comprehensive social influence programmes have a more favourable effect on problematic drinking among students in underprivileged social environments.Trial registrationISRCTN: ISRCTN18092805

Access to care, socioeconomic deprivation and colon cancer survival

The influence of socioeconomic environment on cancer survival has been established in numerous studies in the EU and the US, prognosis being constantly poorer for the most underprivileged patients. To investigate the influence of distance to care centre and deprivation on colon cancer survival, using a multilevel Cox model and taking into account cancer stage at diagnosis and treatment modalities. The study population comprised all cases of colon cancer diagnosed between 1997 and 2000 in two French areas covered by specialized cancer registries (n = 2066). Road distance to the nearest reference care centre was associated with poorer prognosis even after adjustment for stage at diagnosis (P for trend = 0.01). Subgroups analysis showed that this association was maximal for patients with advanced cancer [RR = 1.27 (1.04-1.51); P for trend = 0.015] for whom access to chemotherapy varying according to distance explained the major part of geographic inequalities in survival. The major effect of distance from reference care centre on survival suggests that current regional health planning does not guarantee equity in cancer management. Improvement in access to adjuvant therapy, especially for patients with advanced cancers, seems crucial for reducing geographic disparities in colon cancer survival.