Levels Of Material Deprivation Research Articles

Impact of Brazil's Bolsa Família Programme on cardiovascular and all-cause mortality: a natural experiment study using the 100 Million Brazilian Cohort.

Cardiovascular disease (CVD) has a disproportionate effect on mortality among the poorest people. We assessed the impact on CVD and all-cause mortality of the world's largest conditional cash transfer, Brazil's Bolsa Família Programme (BFP). We linked administrative data from the 100 Million Brazilian Cohort with BFP receipt and national mortality data. We followed individuals who applied for BFP between 1 January 2011 and 31 December 2015, until 31 December 2015. We used marginal structural models to estimate the effect of BFP on all-age and premature (30-69 years) CVD and all-cause mortality. We conducted stratified analyses by levels of material deprivation and access to healthcare. We checked the robustness of our findings by restricting the analysis to municipalities with better mortality data and by using alternative statistical methods. We studied 17 981 582 individuals, of whom 4 855 324 were aged 30-69 years. Three-quarters (76.2%) received BFP, with a mean follow-up post-award of 2.6 years. We detected 106 807 deaths by all causes, of which 60 893 were premature; and 23 389 CVD deaths, of which 15 292 were premature. BFP was associated with reductions in premature all-cause mortality [hazard ratio (HR) = 0.96, 95% CI = 0.94-0.98], premature CVD (HR = 0.96, 95% CI = 0.92-1.00) and all-age CVD (HR = 0.96, 95% CI = 0.93-1.00) but not all-age all-cause mortality (HR = 1.00, 95% CI = 0.98-1.02). In stratified and robustness analyses, BFP was consistently associated with mortality reductions for individuals living in the two most deprived quintiles. BFP appears to have a small to null effect on premature CVD and all-cause mortality in the short term; the long-term impact remains unknown.

Tobacco control policies in India were unable to address inequities in Tobacco-related harm

IntroductionThe Global Adult Tobacco Survey (GATS) India 2016–17 has shown that increased regulations over time impacted tobacco use culture, which opened the doors for further regulation, making it an iterative process. But do the ‘tobacco control policies’ reach till most deprived sections of society? This paper tries to answer this question. MethodsIn this paper, the relative reduction in tobacco use prevalence is seen (from 2009 to 10 to 2016–17) across different levels of material deprivation and educational attainment. The relative reduction in prevalence/ use of various forms of smoking and smokeless tobacco products was also studied.Material Deprivation as a new index was computed, where the weightage was given to various variables related to household ownership of various material things as available in data sets of GATS Survey. The recoded variables were then added and further categorised into six levels of material deprivation where Level 1 corresponds to least deprived and Level 6 corresponds to most deprived.The relative reduction in the prevalence of tobacco use was calculated with the formula [(P1-P2)/P1]*100, where P1 is the prevalence of tobacco use (smoking or smokeless) during GATS1 (2009–10), and P2 is the prevalence of tobacco use (smoking or smokeless) during GATS2 (2016–17). ResultsIt has been shown that the higher the level of material deprivation, the lesser the relative reduction in the prevalence of tobacco use. The relative reduction in tobacco use was more for higher levels of educational attainment. It has been found that relative reduction is more for smoking products as compared to smokeless tobacco (SLT) products. Khaini and Bidis are emerging as popular products, which are least regulated by existing tobacco control policies. ConclusionThe reduction in the prevalence of tobacco use from GATS1 to GATS2 is inequitous across levels of material deprivation and levels of educational attainment by individuals. Also, there is a tendency for product substitution among tobacco users.

Spatio-temporal analysis of mental illness and the impact of marginalization-based factors: a case study of Ontario, Canada

ABSTRACT Mental illness is a predominant medical condition in Canada. Marginalized groups in the Canadian population such as those with low income, the poorly educated and ethnic minorities are susceptible to mental health disorders. Using mental health-related emergency department visits as an indicator of mental illness cases, we employ a Bayesian spatio-temporal regression model to estimate mental illness risk across the 35 public health units of Ontario, Canada from 2006 to 2017. The association between mental illness and the following marginalization-related factors: material deprivation, residential instability and ethnic concentration is also evaluated. Over the assessed period, the relative risk of mental illness ranged from 0.45 (95% CI: 0.44–0.46) to 3.29 (95% CI: 3.20–3.37). Health units with elevated levels of material deprivation and residential instability were positively associated with increased mental illness risk whilst areas with higher ethnic concentration were linked with lower risk. Findings showed that the temporal trend of risk continuously increased over the 11 year period, with health units in northern Ontario experiencing higher risk compared to southern units. The management of psychiatric disorders presents a significant challenge to the Canadian health-care system. An understanding of the geographic distribution of mental health risk across space and time can be useful for improved policy-making and public health monitoring.

Welfare resources and social risks in times of social and economic change: a multilevel study of material deprivation in European countries

ABSTRACTThis paper studies the association between collective welfare resources, levels of and inequalities in, material deprivation among ‘new’ as well as ‘old’ social risk groups four years into the global crisis. The data are based on the cross-sectional survey EU-SILC (European Union Statistics on Income and Living Conditions) 2012. The multilevel analysis includes 27 European countries and 294,803 individuals between 18 and 64 years of age. The results demonstrate that the risk of material deprivation decreased in absolute terms with increasing welfare generosity among all three risk groups studied: individuals facing limiting long-standing illness, the non-employed and the low educated. In some instances the modifying effect of welfare generosity was stronger among the advantaged group than among the disadvantaged groups. The low educated benefitted the most in terms of a substantially lower risk of material deprivation. Results also show that both the absolute inequalities and levels of material deprivation were consistently lower in generous welfare states. The findings support the view that directing undue weight on risks, risk assessment and risk management in the context of social work practices should not reduce the importance of collective welfare resources to alleviate welfare problems among disadvantaged groups.

Comparison of socio-economic indicators explaining inequalities in Healthy Life Years at age 50 in Europe: 2005 and 2010

The first estimates of Healthy Life Years at age 50 (HLY50) across the EU25 countries in 2005 showed substantial variation in healthy ageing. We investigate whether factors contributing to HLY50 inequalities have changed between 2005 and 2010. HLY50 for each country and year were calculated using Sullivan's method, applying the age-specific prevalence of activity limitation from the European Union Statistics on Income and Living Conditions (EU-SILC) survey to life tables. Inequalities in life expectancy at age 50 (LE50) and HLY50 between countries were defined as the difference between the maximum and minimum LE50 or HLY50. Relationships between HLY50 and macro-level socio-economic indicators were investigated using meta-regression. Men and women were analysed separately. Between 2005 and 2010 HLY50 inequalities for both men and women in Europe increased. In 2005 and 2010 HLY50 inequalities exceeded LE50 inequalities, particularly in the established EU15 countries in 2010 where HLY50 inequalities (men: 10.7 years; women: 12.5 years) were four times greater for men and three times for women than LE50 inequalities (men: 2.4 years; women: 4.1 years). Only material deprivation significantly explained variation in EU25 HLY50 in both years with, additionally, long-term unemployment in 2010. Our results suggest that inequalities in HLY50 across Europe are large, increasing and partly explained by levels of material deprivation. Moreover long-term unemployment has become more influential in explaining variation in HLY50 between 2005 and 2010.

The association between social deprivation and the prevalence and severity of dental caries and fluorosis in populations with and without water fluoridation.

BackgroundTo determine the association between social deprivation and the prevalence of caries (including caries lesions restricted to enamel) and enamel fluorosis in areas that are served by either fluoridated or non-fluoridated drinking water using clinical scoring, remote blinded, photographic scoring for caries and fluorosis. The study also aimed to explore the use of remote, blinded methodologies to minimize the effect of examiner bias.MethodsSubjects were male and female lifetime residents aged 11–13 years. Clinical assessments of caries and fluorosis were performed on permanent teeth using ICDAS and blind scoring of standardized photographs of maxillary central incisors using TF Index (with cases for fluorosis defined as TF > 0).ResultsData from 1783 subjects were available (910 Newcastle, 873 Manchester). Levels of material deprivation (Index of Multiple Deprivation) were comparable for both populations (Newcastle mean 35.22, range 2.77-78.85; Manchester mean 37.04, range 1.84-84.02). Subjects in the fluoridated population had significantly less caries experience than the non-fluoridated population when assessed by clinical scores or photographic scores across all quintiles of deprivation for white spot lesions: Newcastle mean DMFT 2.94 (clinical); 2.51 (photo), Manchester mean DMFT 4.48 (clinical); 3.44 (photo) and caries into dentine (Newcastle Mean DMFT 0.65 (clinical); 0.58 (photo), Manchester mean DMFT 1.07 (clinical); 0.98 (photo). The only exception being for the least deprived quintile for caries into dentine where there were no significant differences between the cities: Newcastle mean DMFT 0.38 (clinical); 0.36 (photo), Manchester mean DMFT 0.45 (clinical); 0.39 (photo). The odds ratio for white spot caries experience (or worse) in Manchester was 1.9 relative to Newcastle. The odds ratio for caries into dentine in Manchester was 1.8 relative to Newcastle. The odds ratio for developing fluorosis in Newcastle was 3.3 relative to Manchester.ConclusionsWater fluoridation appears to reduce the social class gradient between deprivation and caries experience when considering caries into dentine. However, this was associated with an increased risk of developing mild fluorosis. The use of intra-oral cameras and remote scoring of photographs for caries demonstrated good potential for blinded scoring.

The contribution of local parks to neighbourhood social ties

The social ties between the residents of urban neighbourhoods are in decline due to changing work patterns, increased mobility and developments in communications. Neighbourhood open spaces, and green spaces in particular, provide opportunities for social interactions that may help the residents to establish recognition and develop relationships. This paper investigates the contribution of local parks to the development of social ties in inner-city neighbourhoods. Combining quantitative methods (questionnaire survey) with a qualitative approach (focus group discussions), the research was carried out in three inner-city neighbourhoods in Greater Manchester, UK, characterised by different levels of material deprivation and ethnic diversity. The social survey explored the associations between the respondents’ visits to local parks and the number of friends and acquaintances they had. The findings suggest that local parks may support the development of social ties in inner-city areas. Associations were found between the quality of the parks, the character of visits, and the extent of social ties in the neighbourhood. The study concludes that for inner-city parks to realise their full potential in supporting social interactions and developing social ties, they need to be well-maintained and provide good recreational facilities. The development of social ties was also found to be considerably affected by the characteristics of the individuals and the neighbourhood.

Do area-level population change, deprivation and variations in deprivation affect individual-level self-reported limiting long-term illness?

A previous study showed that variations in deprivation within small localities in England and Wales influenced the rates of self-reported limiting long-term illness, controlling for overall levels of deprivation. These results suggest that while morbidity is related to overall levels of material deprivation, the distribution of resources within small areas have a significant effect on health outcomes. However, it is possible that these area effects become redundant once individual-level characteristics are accounted for. This analysis examines whether area-level deprivation and variations in deprivation are significant indicators of individual-level limiting long-term illness, once individual characteristics have been accounted for.