Large-scale Population-based Survey Research Articles

0738 Association of socio-demographic determinants, smoking, and obesity with sleep trouble among women of reproductive age

Abstract Introduction While sleep quality in women is well known to be affected by hormonal factors such as menstrual cycle, pregnancy, and postpartum period, the connections between their sleep and socio-demographic characteristics are not widely studied. Our study objective was to examine the self-reported sleep problems among women of reproductive age in the US and their association with socio-demographic determinants of health as well as other health-related factors using the National Health and Nutrition Examination Survey (NHANES). Methods We analyzed a secondary data with 5,610 female participants aged 15 to 49 years who participated in the NHANES conducted during 2013 – 2018 to examine for the prevalence of self-reported sleep trouble as well as socio-demographic determinants (age, ethnicity, marital status, education, and income) and the presence of smoking and obesity. A design-based F-test and survey-based generalized linear model with Poisson family and log link function were performed to estimate the adjusted and unadjusted prevalence ratio (PR) with statistical significance of associated factors. Results The likelihood of trouble sleeping for those in the age group of 41 to 49 were significantly higher than those in the age group of 15 to 20 (PR 1.77 [95% CI 1.14-2.77]). Significantly more minority women including non-Hispanic Asian (PR 0.46 [95% CI 0.32-0.67]), Hispanic (PR 0.63 [95% CI 0.46-0.86]), and non-Hispanic black (PR 0.73 [95% CI 0.54-0.99]) reported less likely to have trouble sleeping than non-Hispanic multiracial group. When looking at marital status, married individuals reported less trouble sleeping (PR 0.83 [95% CI 0.80-0.99]) as compared to those who never married. Smoking was also associated with more trouble sleeping (PR 1.43 [95% CI 1.27-1.61]). Prevalence of reporting trouble sleeping was significantly higher for obese women compared to those with normal weight (PR 1.25 [95% CI 1.07-1.46]). There were no statistically significant differences in reported sleep trouble based on education status and income. Conclusion Using the large-scale population-based cross-sectional survey analysis, we identified that the problem of sleep disturbance was independently and positively associated with the higher age, unmarried, smokers and obese women in the reproductive age group. Support (if any)

Sleep Problems and New Occurrence of Chronic Conditions during the COVID-19 Pandemic in the UK.

The COVID-19 pandemic has negatively impacted upon sleep health. Relatively little is known about how this may influence the population's health subsequently. This prospective longitudinal study aims to examine the consequences of sleep problems for physical and mental health during the COVID-19 pandemic in the UK, using data from the Understanding Society: COVID-19 Study, a large-scale population-based survey with 12,804 adults aged 16 and above. A measure of sleep problems was derived from Pittsburgh Sleep Quality Index (PSQI) questions, reflecting seven dimensions of sleep quality. Binary logistic regressions were applied to investigate the relationship between sleep problem and the incidence of cardiovascular disease (CVD), hypertension, diabetes, obesity, arthritis and an emotional, nervous or psychiatric problem over the 15 months follow-up period. The analysis confirms that sleep problems are prevalent and vary between sub-groups among adults. Notably, sleep problems are then significantly associated with a higher risk of cardiovascular disease, hypertension, diabetes, obesity, arthritis and emotional, nervous or psychiatric problems, independent of demographic, socioeconomic, familial and health confounders. Our findings suggest promoting good sleep hygiene should be prioritised during the pandemic, and more generally as part of wider programmes aimed at promoting good physical and mental health.

Alcohol consumption and related disorders in Iran: Results from the National Surveillance of Non-Communicable Diseases' Survey (STEPs) 2016.

Alcohol consumption is a public health concern which is illegal in Iran. Moreover, due to cultural and religious beliefs, the available population-based research findings on alcohol consumption are inadequate. We aimed to provide an estimate on alcohol consumption using a large-scale population-based survey in Iran. The National Surveillance of Non-Communicable Risk Factors in Iran was a population-based survey conducted in 2016. The epidemiologic distribution of alcohol consumption and its related disorders were assessed using weighted survey methods and multiple logistic regression models. Age standardized rates were calculated using Iran's national population census in 2016. At the national level, the prevalence rates of lifetime and current alcohol consumption were 8.00% (95% CI: 7.67-8.32) and 4.04% (95% CI: 3.81-4.27), respectively. The highest prevalence was reported among 25 to 34 year-olds. Individuals of higher socioeconomic status consumed significantly greater levels of alcohol. At provincial level, the highest and lowest percentages of the current alcohol drinking rates in Iran's provinces were, 23.92% (95% CI: 17.56-30.28) and 0.4% (95% CI: 0-1.18) in males, 1.58% (95% CI: 0.22-2.94) and 0% in females, respectively. In urban regions, the highest alcohol consumption rate was more than 22 times greater than the lowest alcohol consumption rate. Current alcohol drinkers were 2 times more prone to injury as compared to nondrinkers (ORadj: 2.0, 95%CI: 1.7, 2.3). In Iran, the prevalence of alcohol consumption is low, although there is a considerable variation of alcohol consumption at provincial level as well as in different gender groups. Therefore, preventive WHO-recommended measures should be adopted more seriously by vulnerable groups.

Environmental Inequality in Austria: Sociodemographic Disparities in Perceived Environmental Quality

This quantitative study investigates the relationship between perceived environmental conditions (air pollution, noise, extreme heat, access to green space) and socioeconomic status in Austria. Building upon the work of Baud and Wegscheider-Pichler (2019) and integrated into the theoretical framework of environmental justice, it aims to enrich the empirical body of literature on environmental inequality in Austria by adding the subjective perspective of affected individuals in order to highlight individual vulnerabilities and capability to adapt. Data from the Austrian Microcensus 2019, a large-scale population-based survey, is used. In this survey, information on perceived exposure to adverse environmental conditions was collected from a total of 7,021 respondents. To analyse the association between subjective exposure and sociodemographic characteristics, binomial and ordinal logistic regression models are applied. The findings suggest that lower income is associated with a lower perception of overall environmental quality and a higher level of perceived exposure to air pollution. A correlation between income and level of noise disturbance is only present in Vienna, and no relationship between income and perceived heat stress can be identified. However, in almost all categories of adverse environmental impacts, women feel more affected than men, and housing conditions are significantly related to perceived noise annoyance. Mixed results are found regarding the role of migration background. While individuals with migration backgrounds report higher personal exposure to air pollution, they rate the overall environmental quality as better than people without migration backgrounds. In line with other empirical studies, the results confirm that exposure to adverse environmental conditions is distributed unequally across society in Austria. To address these inequalities, concerns of environmental justice should be integrated into public discourse and policymaking.

Knowledge, Attitudes, and Practices Toward COVID-19 Among Chinese Teachers, Shenzhen: An Online Cross-sectional Study During the Global Outbreak of COVID-19.

Background: Adequate understanding and precautionary behaviors are of vital importance to contain the spread of coronavirus disease 2019 (COVID-19). To date, the knowledge, attitudes, and practices (KAP) toward COVID-19 among different populations have been reported, whereas such information is unavailable in teachers. We aimed to investigate the KAP of teachers associated with COVID-19 during the global outbreak.Methods: A large-scale population-based survey was conducted to gather information on COVID-19-related KAP among Chinese teachers using a self-administered questionnaire. We received 10,658 responses in April 2020, out of which 8,248 were enrolled in the final analysis. Participants responded to a self-administered questionnaire concerning demographic characteristics and KAP associated with COVID-19.Results: This work included 4,252 (51.6%) teachers in kindergartens, 2,644 (32.1%) teachers in primary schools, and 1,352 (16.4%) teachers in secondary schools. The knowledge level (mean: 4.46 out of seven points) was relatively lower than the levels of attitudes (mean: 3.27 out of four points) and practices (mean: 4.29 out of five points) toward COVID-19. Knowledge scores significantly varied by the collected demographic variables except education worksite (p < 0.05), whereas practice scores significantly differed in age groups (p < 0.05), education level (p < 0.001), education worksite (p < 0.001), and years of teaching (p < 0.001). The multivariate logistic analysis indicated that poor knowledge related to COVID-19 was common among men, younger, and less-educated teachers. In contrast, female teachers and those with higher education levels tend to have good practices against COVID-19.Conclusion: The present work suggested the knowledge gaps regarding COVID-19 were needed to be corrected immediately in teachers. Given the critical role of teachers in the education system, health authorities should take gender, age, and education level into account when developing suitable health interventions.

Impact of sleep duration, physical activity, and screen time on health-related quality of life in children and adolescents

BackgroundExisting studies on health-related quality of life (HRQoL) mainly covered single growth stages of childhood or adolescence and did not report on the trends in the relationships of HRQoL with sleep duration, physical activity, and screen time. This study aimed to establish the population norm of HRQoL in children and adolescents aged 6–17 years and examine the associations of screen time, sleep duration, and physical activity with HRQoL in this population.MethodsWe conducted a large-scale cross-sectional population-based survey study of Hong Kong children and adolescents aged 6 to 17 years. A representative sample of students were interviewed to assess their HRQoL using PedsQL and EQ-5D-Y-5L. Multivariable homoscedastic Tobit regression with linear form or restricted cubic spline of predictors was used to analyze the associations between screen time, sleep duration, and HRQoL. Multiple imputation by chained equations was performed to deal with missing data.ResultsA total of 7555 respondents (mean age 11.5, SD 3.2; 55.1% female) were sampled. Their EQ VAS scores, PedsQL physical summary scores, and psychosocial summary scores were positively correlated with sleep duration and moderate/vigorous activity but was negatively correlated with screen time.ConclusionsChildren and adolescents who had longer exposure to screen, shorter sleep duration, and lower physical activity levels appeared to have poorer HRQoL as assessed by PedsQL and EQ-5D-Y-5L. Advice and guidance on screen time allocation for children and adolescents should be provided at the levels of school, community, and family.

P137 Epidemiological study of influenza vaccination and RA

Abstract Background/Aims Rheumatoid arthritis (RA) has been known as an autoimmune and inflammatory disease. Previous studies found individuals with RA had a two-fold increased risk of infections compared to general population. For infectious disease as influenza, vaccination may confer protection. However, whether or not influenza vaccination is safe to be given to genetically predisposed individuals with RA still on debate since there is an evidence that influenza vaccine as inflammatory stimulus could induce RA. Methods This study aims to provide an up-to-date epidemiological evidence between influenza vaccination and RA among American adults from 18 years old. Methods With case-control study design using 2014 Full year consolidated data in Medical Expenditure Panel Survey (MEPS), the association between influenza vaccination and RA among adult 18 years old and above were assessed using logistic regression analysis adjusted for potential covariates (age, sex, comorbidity, body mass index (BMI), education, smoking status, and insurance status) to estimate odds ratio (OR). Results In the crude model, individuals who reported receiving influenza vaccine were 2.02 (95% CI: 0.97-4.22) times more likely to develop RA, although the association were not significant. In the full adjusted model, the magnitude of association was decreased to 0.25 (95% CI: 0.06-1.05), but the significance was still not reached. Conclusion Analysing a comprehensive and large-scale population-based survey dataset (MEPS 2014) with adjustment for potential confounders suggested that receiving influenza vaccine did not increase the risk of RA and we have no evidence to suggest that influenza vaccination is not safe to be given to genetically predisposed individuals with RA. Further studies with more complete confounders, such as physical activity level and nutrition intake are strongly recommended. Disclosure N. Juber: None. A. Wannasri: None. T. Do: None.

Dietary Fiber and Human Papillomavirus Infection among US Women: The National Health and Nutrition Examination Survey, 2003–2016

The impact of dietary fiber on human papillomavirus (HPV) infection is still underway. The aim of our study was to investigate the association between intake of dietary fiber and HPV infection. Overall, 14,151 eligible women, aged 18–59 years old, who submitted an adequate sample for HPV test, were collected from an ongoing, large scale population-based survey for seven cycles. The association of dietary fiber intake and HPV infection was assessed in multivariate logistic models. For sensitivity analysis, generalized additive model (GAM) and smooth curve fitting were employed to verify the robustness of the results. Among 14,151 eligible participants, intake of dietary fiber was negatively associated with HPV infection. Each additional increase in log10 dietary fiber consumption was associated with a 57% lower risk of HPV infection (OR, 0.43; 95% CI 0.38–0.48). The result is stable in minimally and fully adjusted model. The possibility of nonlinear association of dietary fiber and HPV infection has been excluded by GAM and smooth curve fitting. There was an inverse linear correlation between intake of dietary fiber and HPV infection. Our findings obtained from NHANES dataset suggested that increasing dietary fiber consumption may be associated with the prevalence of HPV infection.

Spatiotemporal heterogeneity of social contact patterns related to infectious diseases in the Guangdong Province, China

The social contact patterns associated with the infectious disease transmitted by airborne droplets or close contact follow specific rules. Understanding these processes can improve the accuracy of disease transmission models, permitting their integration into model simulations. In this study, we performed a large-scale population-based survey to collect social contact patterns in three cities on the Pearl River Delta of China in winter and summer. A total of 5,818 participants were face-to-face interviewed and 35,542 contacts were recorded. The average number of contacts per person each day was 16.7 considering supplementary professional contacts (SPCs). Contacts that occurred on a daily basis, lasted more than 4 hours, and took place in households were more likely to involve physical contact. The seasonal characteristics of social contact were heterogeneous, such that contact in the winter was more likely to involve physical contact compared to summer months. The spatial characteristics of the contacts were similar. Social mixing patterns differed according to age, but all ages maintained regular contact with their peers. Taken together, these findings describe the spatiotemporal distribution of social contact patterns relevant to infections in the Guangdong Province of China. This information provides important parameters for mathematical models of infectious diseases.

The prevalence of gout and hyperuricemia in middle-aged and elderly people in Tibet Autonomous Region, China: A preliminary study.

Objective:Gout and hyperuricemia are common public health problem. There has been no epidemiological survey of gout and hyperuricemia in Tibet Autonomous Region, the southwest of China. Therefore, we estimated the prevalence of gout and hyperuricemia in Luoma Town, Naqu City, Tibet Autonomous Region of China.Methods:A population-based cross-sectional survey was conducted among 1458 residents of Luoma Town, Tibet Autonomous Region, age ≥40 years. We used questionnaires in face-to-face interviews, anthropometric measurements and serum uric acid test. Hyperuricemia was defined as serum uric acid level ≥7 mg/dl in men and ≥6 mg/dl in women. The definition of gout in this study was on the basis of new 2015ACR/EULAR classification criteria.Results:Nine hundred eighty-nine participants completed all items of gout and 818 participants attended to be taken blood samples for serum UA levels test. The overall crude prevalence of gout and hyperuricemia was 0.30% and 1.83% respectively. It was more prevalent in men than in women (2.86% vs 0.75%, P = .034) in hyperuricemia group. Tibetan had a lower age-standardized prevalence of gout 0.26% (95% confidence interval (CI): 0%–0.60%) and hyperuricemia 2.05% (95% confidence interval (CI): 0.99%–3.44%) compared with the China Health and Retirement Longitudinal Study results.Conclusion:This is the first large-scale population-based survey to demonstrate the prevalence of gout and hyperuricemia of the middle-aged and elderly population in Tibet Autonomous Region, China. The prevalence of gout and hyperuricemia is relatively lower than other places in China, and that might be influenced by ethnicity, genetic and environment factors. These findings will be useful for the future researches and health care strategies.

Animal-related injuries and fatalities: evidence from a large-scale population-based cross-sectional survey in rural Bangladesh

ObjectiveThis study determines the magnitude and pattern of animal-related injury mortalities and morbidities in rural Bangladesh.Design and settingA cross-sectional survey was conducted in 51 Unions of 7 subdistricts of Bangladesh...

Maternal adherence to micronutrient supplementation before and during pregnancy in Northwest China: a large-scale population-based cross-sectional survey

ObjectivesTo report the situation of maternal micronutrient supplementation before and during pregnancy in Northwest China and to examine the rates of and factors related to the adherence to micronutrient supplementation...

Gender disparities in health care expenditures and financing strategies (HCFS) for inpatient care in India.

Despite the vast literature on health care expenditures (HCE) and health care financing strategies (HCFS) in low- and middle-income countries, there is limited evidence of gender disparity in HCFS for inpatient care. We examined gender disparities in HCE and HCFS for inpatient care among adults aged 15 and older in India which is widely known for gender-based discrimination in sex-selective abortion, nutrition, and access to health care. Using data from a nationally representative large-scale population-based survey, we investigated the relationship between the gender of adult patients and HCE as well as sources of health care financing. Simple percentage distribution, cross-tabulation, a two-level random intercept model, and multinomial logit regression were used to examine the role of gender in HCE and sources of health care financing for inpatient care. Average HCE is lower for women in adult age groups, regardless of the type of disease and duration of stay in the hospital. This result remained unchanged after controlling for other background variables of the patients. Women are also discriminated against more when health care has to be paid for by borrowing, sale of assets, or contributions from friends and relatives (distressed financing). Multinomial logit results show that the probability of distressed financing is less for females than for males (borrowing: β = −0.27; confidence interval [CI], −0.37 to −0.17; P = .001; selling assets/contribution from friends and relatives: β = −0.27; CI, −0.39 to −0.14; P = .001). The predicted probability of using health care financing implies that the health of adult men is considered to be more important, in terms of resorting to distressed financing, than that of adult women HCE on adult women inpatients is systematically lower than that of adult men inpatients. Further, women in India have less access to inpatient care through distressed HCFS.

Exposures to road traffic, noise, and air pollution as risk factors for type 2 diabetes: A feasibility study in Bulgaria

Type 2 diabetes mellitus (T2DM) is a growing public health problem in Bulgaria. While individual and lifestyle determinants have been researched; till date there has been no study on environmental risks such as road traffic, noise, and air pollution. As a first step toward designing a large-scale population-based survey, we aimed at exploring the overall associations of prevalent T2DM with exposures to road traffic, noise, and air pollution. A total of 513 residents of Plovdiv city, Bulgaria were recruited. Individual data on self-reported doctor-diagnosed T2DM and confounding factors were linked to objective and self-rated exposure indicators. Logistic and log-link Poisson regressions were conducted. In the fully adjusted logistic models, T2DM was positively associated with exposures to Lden 71-80 dB (odds ratio (OR) = 4.49, 95% confidence interval (CI): 1.38, 14.68), fine particulate matter (PM)2.5 25.0-66.8 μg/m3 (OR = 1.32, 95% CI: 0.28, 6.24), benzo alpha pyrene 6.0-14.02 ng/m3 (OR = 1.76, 95% CI: 0.52, 5.98) and high road traffic (OR = 1.40, 95% CI: 0.48, 4.07). Lden remained a significant risk factor in the: Poisson regression model. Other covariates with consistently high multivariate effects were age, gender, body mass index, family history of T2DM, subjective sleep disturbance, and especially bedroom location. We concluded that residential noise exposure might be associated with elevated risk of prevalent T2DM. The inferences made by this research and the lessons learned from its limitations could guide the designing of a longitudinal epidemiological survey in Bulgaria.

Population Movement and Virus Spreading: HEV Spreading in a Pilgrimage City, Mashhad in Northeast Iran; an Example

BackgroundHepatitis E Virus (HEV) infection is a significant public health concern and responsible for large outbreaks of acute hepatitis in poor sanitary and living conditions.ObjectivesTo investigate the impact of population movements on virus spreading, a large-scale population-based survey was performed in a pilgrimage- tourism area, the great Mashhad, capital city of Khorasan province.Patients and MethodsA cross-sectional study was carried out among 1582 randomly selected individuals from general population of Mashhad, north east of Iran, between May to September 2009. Serum samples were tested for total anti-HEV antibody using a specific enzyme linked immunoassay (ELISA) kit.ResultsThe prevalence of HEV infection was 14.2% (225/1582) with a maximum of 25.5 % (14/55) in densely populated areas. The highest prevalence was observed in visitant areas (≥ 20%) near the holly shrine with crowded hotels and inns. The differences between these areas and other districts were statistically significant (P < 0.001). The findings indicated that 13.2% (95/718) of males and 15.0% (130/864) of females were HEV positive; this difference is not significant. Seroprevalence increases with age rising , from 12.8% in subjects less than five years to 28.6% in individuals with more than 65 years old. Although, there were no meaningful differences between HEV seropositivity and socio-economic status, Illiterate individuals were significantly at higher risk for infection than educated persons (P < 0.001).ConclusionsThese findings demonstrated that, high prevalence of HEV is related to populated district, which can reach to the highest rate in hotels and inns close to visitants. Traditional sanitation and water supplying systems are the second important factor for the virus transmission. Therefore, it can be concluded that such areas need efficient surveillance systems to prevent the spreading of infectious diseases.

OP0151-PC Does Primary Care Management of Low-Back Pain Differ in Older Persons? Results from the Musician Study

BackgroundIt has been suggested that older persons are less likely to receive optimal care for pain and a recent population study suggested that the management of low back pain in...

Prevalence of trachoma in unity state, South Sudan: results from a large-scale population-based survey and potential implications for further surveys.

BackgroundLarge parts of South Sudan are thought to be trachoma-endemic but baseline data are limited. This study aimed to estimate prevalence for planning trachoma interventions in Unity State, to identify risk factors and to investigate the effect of different sampling approaches on study conclusions.Methods and FindingsThe survey area was defined as one domain of eight counties in Unity State. Across the area, 40 clusters (villages) were randomly selected proportional to the county population size in a population-based prevalence survey. The simplified grading scheme was used to classify clinical signs of trachoma. The unadjusted prevalence of trachoma inflammation-follicular (TF) in children aged 1–9 years was 70.5% (95% CI: 68.6–72.3). After adjusting for age, sex, county and clustering of cases at household and village level the prevalence was 71.0% (95% CI: 69.9–72.1). The prevalence of trachomatous trichiasis (TT) in adults was 15.1% (95% CI: 13.4–17.0) and 13.5% (95% CI: 12.0–15.1) before and after adjustment, respectively. We estimate that 700,000 people (the entire population of Unity State) require antibiotic treatment and approximately 54,178 people require TT surgery. Risk factor analyses confirmed child-level associations with TF and highlighted that older adults living in poverty are at higher risk of TT. Conditional simulations, testing the alternatives of sampling 20 or 60 villages over the same area, indicated that sampling of only 20 villages would have provided an acceptable level of precision for state-level prevalence estimation to inform intervention decisions in this hyperendemic setting.ConclusionTrachoma poses an enormous burden on the population of Unity State. Comprehensive control is urgently required to avoid preventable blindness and should be initiated across the state now. In other parts of South Sudan suspected to be highly trachoma endemic, counties should be combined into larger survey areas to generate the baseline data required to initiate interventions.

Reference values for respiratory pressures in a general adult population – results of the Study of Health in Pomerania (SHIP)

Respiratory muscle pressures have been gaining increasing interest because of prognostic value. The study aim was to acquire reference values for respiratory pressures in a large-scale population-based survey--the Study of Health in Pomerania (SHIP). One thousand eight hundred and nine participants (885 men) of a cross-sectional epidemiologic survey, called 'Study of Health in Pomerania--SHIP', underwent lung function and respiratory muscle pressure measurements. After excluding individuals with cardiopulmonary disorders, prediction equations for men and women were established by quantile regression analysis. The final study population comprised 912 individuals (432 men), aged 25-80 years. The study provides a representative set of sex-specific prediction equations of respiratory muscle strength. Respiratory pressures are decreasing with age and are lower in women when compared to men. Prediction equations for relevant respiratory pressures are given. Based on this well-described population-based survey with extensive cardiopulmonary investigations to exclude relevant interfering disorders a sufficient comprehensive set of reference values was obtained.

Impact of Different Definitions of Airflow Limitation on the Prevalence of Chronic Obstructive Pulmonary Disease in the General Population

Background: Recent surveys report a surprisingly high prevalence of chronic obstructive pulmonary disease (COPD) worldwide. However, there is evidence that the application of a fixed ratio of forced expiratory volume in 1 s (FEV₁) to forced vital capacity (FVC) may result in a relevant misclassification of airflow limitation. Objectives: The definition of airflow limitation does have a significant impact on its prevalence. Methods: Individual values of lung volumes were assessed in comparison to a reference population by applying either a fixed ratio below 0.7 or the fifth percentile of FEV₁ in relation to FVC. Based on a large-scale population-based survey, reference equations for lung volumes were derived by quantile regression analysis based on 1,809 subjects aged 25–85 years. Both functional definitions were applied to calculate the prevalence of airflow limitation. Results: The prevalence of airflow limitation was significantly higher when applying the fifth percentile compared to the fixed ratio of 0.7 for all age groups and both sexes (all 6.7 vs. 1.9%; women 6.7 vs. 1.3%; men 6.6 vs. 2.6%). Almost 26% of the subjects with airflow limitation complained of dyspnea, whereas COPD had not been previously diagnosed by a physician in 87%. Conclusion: The definition of airflow limitation has a major impact on the observed prevalence rates.

Social inequality in perceived environmental exposures in relation to housing conditions in Germany

In Germany the impact of socioeconomic factors on environmental exposures and adverse housing conditions has been rarely studied up to now. The aim of our study was to assess whether and, if yes, how perceived exposure to noise and air pollution is influenced by socioeconomic status in Germany. We used data from a large-scale population-based survey. In this survey, data on perceived exposure to noise and air pollution and on socioeconomic status and housing conditions were collected on an individual basis. The study population consisted of 7275 adults aged 17–98 years (40% women), each representing the head of one household. For the association between perceived environmental exposure and social factors confounder-adjusted odds ratios (OR) with 95% confidence intervals were calculated by binary or ordinal logistic regression. In bivariate analyses subjects with non-German nationality, East Germans, respondents with low income, those with lower educational and occupational status, and subjects living in adverse housing conditions were more likely to report being highly exposed. In multivariate analyses high perceived exposure to noise was associated with low household income (OR 1.52 [95% CI 1.13–2.05] lowest versus highest income group). Perceived air pollution exposure was also related to household income (1.67 [1.14–2.44] lower middle versus highest income group). Further associated variables were need for renovation of the house, type of house, and type of neighborhood. This study shows that in Germany, as in other industrial countries, environmental exposures are distributed unequally and that especially economic differences play important roles.