Low Socioeconomic Position Research Articles

Perceptions of a caring school climate and mental well-being: a one-way street? Results from a random intercept cross-lagged panel model

We investigated the between- and within-person longitudinal relationship between perceptions of a caring school climate and mental well-being, and the role of socioeconomic position (SEP) for these constructs among high school students in Norway (N = 1508; 60.7% girls). Using a random intercept cross-lagged panel model, we found positive concurrent associations between perceptions of a caring school climate and mental well-being at both between and within levels, and positive cross-lagged effects at the within-person level from mental well-being to later perceptions of a caring school climate across all time points. SEP was positively associated with mental well-being at time one, and at all time points with perceptions of a caring school climate. The findings suggest that mental well-being is a significant contributor to how Norwegian adolescents subsequently perceive their school context, and underscore the importance of school staff being particularly attentive toward students who struggle with mental health, as well as those with lower SEP.

The role of the perceived food environment on the eating behavior of people with lower socioeconomic positions in municipal settings

Abstract Food environments are an important determinant of diet and play a crucial role in the development of obesity and overweight. People with lower socioeconomic position (LSEP) often have an unhealthier diet. Perceived characteristics of the food environment have a critical and distinct role in influencing diet, since they take people's experiences and reality into account. Therefore, the aim of this study was to explore the role of the perceived food environment on the eating behavior of people with LSEP in two municipalities in Belgium, and to identify potential actions which can be taken by these municipalities to promote a healthy diet. 23 people with LSEP were recruited through purposeful convenience sampling until data saturation was achieved. The photovoice and photo-elicitation method were used to capture respondents’ perception of their food environment and to identify potential actions, both individually (n = 16) and in group (n = 7), that play a role in a diet. All data was transcribed and analyzed thematically using NVIVO 20.0. Multiple local actions to improve a healthy diet were identified during the interviews and focus groups. Respondents identified affordable and accessible cooking classes, opening a social restaurant/store and including affordable healthy recipes in the municipal newspaper as potential actions. Actions such as making at-home delivery of healthy groceries financially accessible to everyone and to distribute vouchers instead of food parcels at food banks also came forward. Furthermore, respondents cited a lack of information about where healthy food was available as a barrier and identified a central overview of affordable and healthy food and communal field visits to local food producers such as farmers as potential actions. These results show that people with LSEP identified a wide variety of actions related to the food environment that local governments and related stakeholders can take to promote healthy eating. Speakers/Panelists Ingrid Stegeman EuroHealthNet, Brussels, Belgium

Health inequalities in type 2 diabetes: contributions of exposures in the residential environment

Abstract Background People with lower socioeconomic position (SEP) have higher risk of type 2 diabetes (T2D). Besides genetic predisposition, the exposome shapes this risk. This includes exposures in the residential environment. We explored the relationships between SEP, the residential food environment, walkability, greenspace, and T2D. Methods Cross-sectional and longitudinal data from 9188 participants were analyzed. Prevalent T2D was measured by an oral glucose tolerance test. Incident T2D was self-reported in annual follow-up questionnaires. Education, income, and occupation were measured as indicators of SEP. The residential environment was operationalized by address level Food Environment Healthiness Index (FEHI), number of fast-food outlets (FF), walkability index (WI), and proportion of greenspace (GS). Logistic regression and survival analyses were used to model the associations between SEP, the environment and T2D. The proportion of mediation of the association between SEP and T2D was estimated in a causal mediation analysis using a simulation approach. Results Over a median follow-up of 6.2 years, 207 incident cases were identified. Lower SEP was associated with higher risk of T2D. Hazard ratios (HR) were 2.0 (95%CI 1.6-2.6), 1.8 (1.4-2.3) and 1.8 (1.2-2.6) for an interquartile range decrease (IQR) of education, income, and occupation, respectively. HRs for IQR changes of the environmental factors were: FEHI 1.2 (1.0-1.4), FF 0.9 (0.8-1.0), WI 1.2 (1.0-1.6) and GS 1.2 (1.0-1.4). Regression on prevalent T2D yielded similar results. Lower SEP was associated with a less healthy environment (e.g., FEHI -0.08 (-0.10--0.06) for education). Environmental exposures mediated between 0.3% (-8.6-8.6) and 8.5% (2.3-27.4) of the longitudinal associations. Conclusions Lower SEP was associated with prevalent and incident T2D. People with lower SEP lived in a slightly less healthy residential environment. Some of the SEP-T2D association could be mediated by the environment. Key messages • A less healthy residential food environment, lower walkability and less green space might mediate some of the association between SEP and T2D. • More research is needed to clarify the extent to which environmental pathways contribute to health inequalities.

Socioeconomic differences in SARS-CoV-2-antigen contacts after one year of the vaccination campaign

Abstract Background Evidence on the SARS-CoV-2 serological status of the German population by socioeconomic position (SEP) is still limited for the vaccine era of the pandemic, but could contribute to the understanding of the unequal risks of severe COVID-19. This study aims to evaluate the socioeconomic patterns of antigen contacts through infection, vaccination or both (‘hybrid immunity’) after one year of vaccination campaign in Germany. Methods We used nationwide serological and self-reported data from the population-based German seroepidemiological Corona Monitoring Nationwide study (RKI-SOEP-2, November 2021-February 2022) to estimate prevalence ratios (PR) of SARS-CoV-2 infection, COVID-19 vaccination (at least one dose of vaccine), basic immunization (at least two SARS-CoV-2 antigen contacts), and three antigen contacts by education and income. Estimates were derived from Poisson regression models adjusted for age, sex, migration status, urban-rural residence, federal state and date of participation. Results Across 10,448 adult participants, low-education groups had a 1.35-fold greater risk of SARS-CoV-2 infection compared to high-education groups (95% CI 1.01-1.82, p = 0.045). COVID-19 vaccination and basic immunization decreased with lower education and income. Low-education and low-income groups were less likely to have had at least three SARS-CoV-2 antigen contacts (PR low vs. high education: 0.74, 95% CI 0.65-0.84, p < 0.001; PR low vs. high income: 0.66, 95% CI 0.57-0.77, p < 0.001) Conclusions The results show socioeconomic inequalities in SARS-CoV-2 infections, COVID-19 vaccinations and antigen contacts, suggesting a lower level of protection against severe COVID-19 for individuals with low and medium SEP. The majority of the German population exhibits further prevention potential, which could be addressed via more targeted interventions. Future research, pandemic response and vaccination campaigns should address the specific needs and barriers of these groups. Key messages • Multiple antigen contacts, especially through vaccination, are less prevalent in groups with low or medium socioeconomic position. • Potential to prevent severe COVID-19 exists in the majority of the German population after one year of vaccination campaign.

Socioeconomic inequalities in health-related functioning among people with Type 2 Diabetes

Abstract Background Type 2 Diabetes mellitus (T2DM) is a common chronic disease which disproportionally affects disadvantaged groups. People with a low socioeconomic position (SEP) have increased risk of T2DM and people with a low SEP and T2DM have higher HbA1c levels and a higher risk to develop T2DM complications compared to their high SEP counterparts. The aim of this study is to analyze longitudinal socioeconomic differences in health-related functioning in people living with T2DM. Methods Cross-sectional and longitudinal data from 2,004 participants of The Maastricht Study with T2DM were used. SEP was determined by baseline measures of education, occupation and income. Health-related functioning (physical, mental and social) was measured with the SF-36 and the Impact on Participation and Autonomy survey (scores 0-100). Associations of SEP and health-related functioning were studied over a 10-year period (baseline 2010-2018) using linear mixed methods adjusting for demographics, disease characteristics and lifestyle factors. Results Low SEP participants had significantly worse health-related functioning compared to those with a high SEP. For example, participants with low income had lower scores for physical (-4.00[CI 2.62;-5.38]), mental (-2.81[-1.52;-4.10]) and social functioning (-9.10[-6.35;-11.85]) compared to high-income participants. In addition, participants with a low education significantly declined more in mental (interaction estimate time -0.21[-0.05;-0.37]) and social functioning (-0.39[-0.02;-0.76]) compared to participants with high education. Conclusions In individuals with T2DM, socioeconomic health differences are apparent in health-related functioning. Moreover, differences in mental and social functioning widened even more between different levels of education. Beyond disease characteristics and lifestyle, more attention is needed for socioeconomic differences in health-related functioning for people living with T2DM, both in research and practice. Key messages • Among people with T2DM, those with a lower SEP have worse health-related function then individuals with a higher SEP, even with similar demographics, disease characteristics and lifestyle patterns. • Additionally, people with T2DM and low education decline more over time in mental and social functioning than people with T2DM and high education.

Socioeconomic inequalities in type 2 diabetes and job demands/control/support - The Maastricht Study

Abstract Background Low socioeconomic position (SEP) is an important determinant of Type 2 Diabetes Mellitus (T2DM). Adverse environments in the exposome might be involved; however, the environmental factors are under-studied compared to lifestyle. We explored low job control, high job demands, and low job support as pathways between SEP and T2DM. Methods Cross-sectional and longitudinal data from 8,090 participants of The Maastricht Study were used. Prevalent T2DM was measured by an oral glucose tolerance test and incident T2DM was self-reported in annual follow-up questionnaires. SEP was operationalized by baseline measures of education, occupation, and income. The work stressors were measured by questionnaires at baseline. For Cox regression, the survival time was computed by midpoint imputation. The associations of SEP, job demands, control, and support with T2DM were examined as well as the mediating role of the work stressors by using a counterfactual framework. Results 2.8% (N = 172) of the participants without T2DM at baseline reported incident T2DM. People with lower SEP were more likely to report T2DM during the follow-up course (e.g.; education HR = 2.21, 95%CI: 1.53-3.20) and more often had prevalent T2DM. Low job control was associated with prevalent T2DM (OR = 1.44 95%CI: 1.25-1.67), but not with incident T2DM. Job control explained 7.23% of the relationship between income and prevalent T2DM. Job demand suppressed the relationship of education (3.65%) and occupation (3.72%) with prevalent T2DM. Conclusions Our findings provide modest evidence for environmental injustice in T2DM exposome. The substantial higher risks of diabetes in low SEP is to a small extent explained by lower control at work. Furthermore, by having lower psychosocial job demands, they are protected against T2DM. Key messages • Job demands and control play a role in SEP and prevalent T2DM relationship. • Work stressors might not be a major target for tackling socioeconomic inequalities in type 2 diabetes.

Socioeconomic Disparities in Beliefs about Cancer: Irish National Cancer Awareness Survey

Abstract For most tumour types survival varies according to socioeconomic position (SEP) and stage at diagnosis. The aim of this study was to examine the association between SEP and beliefs about cancer, and the impact of beliefs on symptom awareness and help-seeking. This is important as negative beliefs about cancer may represent a modifiable target in cancer awareness campaigns aimed at adults aged 50+ years. A cross-sectional study of 1,327 adults aged 50+ years was conducted using data from the Irish National Cancer Awareness Survey, 2022. SEP was indexed using educational attainment. Beliefs about cancer were assessed using the Awareness and Beliefs about Cancer measure, symptom awareness using the Cancer Awareness Measure, and help-seeking using the French Cancer Barometer. Latent Clas Analysis (LCA) was used to identify unobserved ‘beliefs about cancer’ subgroups across belief items. Multivariable logistic regression, adjusted for age, sex, smoking status and cancer experience, was then used to identify associations between SEP and belief subgroups, and subsequently between belief subgroups and symptom awareness and anticipated help-seeking. LCA identified two subgroups: n = 1,033 (77.7%) broadly positive and n = 294 (22.3%) broadly negative. Those with primary education or less, and those with secondary education, were more likely to endorse negative beliefs relative to those with tertiary education (aOR 3.20 (95%CI 1.84, 5.53;p<0.001) and aOR 1.88(95%CI 1.32, 2.70;p<0.001) respectively). Compared to the positive beliefs subgroup, the negative subgroup were less aware of persistent cough as a potential cancer symptom (aOR 0.60(95%CI 0.40, 0.88);p=0.01) and less likely to anticipate seeing a doctor first with symptoms (aOR 1.52 (95%CI 1.11, 2.08;p=0.009) ‘other’ vs. ‘doctor’). Negative beliefs about cancer are associated with lower SEP. Negative beliefs about cancer should be targeted in health promotion campaigns seeking to increase awareness and help-seeking behaviour. Key messages • There is a need for interventions to increase symptom awareness and encourage timely help-seeking in those with symptoms suggestive of cancer particularly among socioeconomically disadvantaged groups. • Negative beliefs about cancer should be targeted in health promotion campaigns seeking to increase awareness and help-seeking behaviour.

Early life social and health determinants of higher education across three generations

Abstract Background Associations of social and health disadvantages at birth with educational attainment are well-documented. Less is known about the magnitude of the associations across different historical contexts. We investigated associations between a range of early life disadvantages and higher educational attainment across three successive generations. Methods The data were from the register-based Uppsala Birth Cohort Multigenerational Study in Sweden. The study samples include three generations born in 1915-1929 (G1, n = 10 587), 1933-1972 (G2, n = 6566), and 1973-1978 (G3, n = 6684). The outcome was attainment of higher education (more than senior high school) assessed at age 30+ years. Exposures were parental socioeconomic position (SEP), mother's marital status, parity, gestational age and birth weight for gestational age. Multiple logistic regression models were fitted to evaluate the associations across three generations. Results are presented as Average Marginal Effects (AME). Results Low parental SEP was associated with lower probability of higher educational attainment in all three generations. The difference between low versus high parental SEP among men declined by 32 percentage points in G2 (AME: 0.32; 95% CI: 0.27, 0.38) and 27 percentage points in G3 (AME: 0.27; 95% CI: 0.21, 0.33) compared to G1. Among women, the corresponding declines in G2 and G3 were 35 and 28 percentage points. Mothers’ unmarried marital status and high parity were associated with lower probability of education, with no evidence of decline across generations. The association between small for gestational age and education among men persisted across generations while showing a decline in G3 women. Conclusions Associations between early life factors and education persisted across three generations. The influence of parental socioeconomic background on educational attainment appeared to level off in the youngest generation after becoming attenuated in the preceding generation. Key messages • Association between small for gestational age and educational attainment persisted across generations, with an attenuation among the youngest cohort of women. • High parity was associated with lower chance of educational attainment, with no evidence of effect attenuation across generations.

Using repeated measures to study the contribution of alcohol consumption and smoking to the social gradient in all-cause mortality: Results from the Stockholm Public Health Cohort.

The social gradient in consumption behaviours has been suggested to partly explain health inequalities. The majority of previous studies have only included baseline measurements and not considered potential changes in behaviours over time. The study aimed to investigate the contribution of alcohol consumption and smoking to the social gradient in mortality and to assess whether the use of repeated measurements results in larger attenuations of the main association compared to using single baseline assessments. Longitudinal survey data from the population-based Stockholm Public Health Cohort from 2006 to 2014 was linked to register data on mortality until 2018 for 13,688 individuals and analysed through Cox regression. Low socioeconomic position (SEP) was associated with increased mortality compared with high SEP; hazard ratios 1.56 (95% CI 1.30-1.88) for occupational status and 1.77 (95% CI 1.49-2.11) for education, after adjustment for demographic characteristics. Using repeated measurements, alcohol consumption and smoking explained 44% of the association between occupational status and all-cause mortality. Comparing repeated and baseline measures, the percentage attenuation due to alcohol consumption increased from 11% to 18%, whereas it remained similar for smoking (25-23%). Smoking and alcohol consumption explained a large part of the association between SEP and mortality. Comparing results from time-fixed and time-varying models, there was an increase in overall percentage attenuation that was mainly due to the increased proportion explained by alcohol consumption. Repeated measurements provide a better estimation of the contribution of alcohol consumption, but not smoking, for the association between SEP and mortality.

Letting people flourish: defining and suggesting skills for maintaining and improving positive health.

The concept of "positive health" emerged from the need for a holistic and more dynamic perspective on health, emphasising the ability of individuals to adapt and self-manage. The positive health conversation tool helps understand how people score on six positive health dimensions. However, skills within these dimensions to maintain or improve health have not yet been described. This is important for enabling individuals to put health advice into practise. Therefore, this paper aims to define and suggest skills for maintaining and improving positive health. Suggestions for definitions of skills within the positive health dimensions are described using the functional, interactive, and critical health literacy framework. Additionally, executive functions and life skills were incorporated. Moreover, the environment's role in these individual skills was noted, mentioning organisational health literacy that emphasises organisations' responsibility to provide comprehensible health information to all individuals. We propose that health promotion interventions can incorporate the proposed skills in practical exercises while aligning intervention materials and implementation tools with end-users and implementers. The suggested skills for maintaining and improving positive health are a first step towards a more comprehensive understanding and open to discussion. These skills may also be applied to other practical conversation tools for maintaining or improving health. Increasing positive health through the defined skills may be especially relevant to those with a lower socioeconomic position who also have limited health literacy and thereby may contribute to reducing health inequalities. Taken together, strengthening the defined skills may hopefully contribute to allowing people to flourish in life.

Socioeconomic inequalities in cardiovascular disease: a causal perspective.

Socioeconomic inequalities in cardiovascular disease (CVD) persist in high-income countries despite marked overall declines in CVD-related morbidity and mortality. After decades of research, the field has struggled to unequivocally answer a crucial question: is the association between low socioeconomic position (SEP) and the development of CVD causal? We review relevant evidence from various study designs and disciplinary perspectives. Traditional observational, family-based and Mendelian randomization studies support the widely accepted view that low SEP causally influences CVD. However, results from quasi-experimental and experimental studies are both limited and equivocal. While more experimental and quasi-experimental studies are needed to aid causal understanding and inform policy, high-quality descriptive studies are also required to document inequalities, investigate their contextual dependence and consider SEP throughout the lifespan; no simple hierarchy of evidence exists for an exposure as complex as SEP. The COVID-19 pandemic illustrates the context-dependent nature of CVD inequalities, with the generation of potentially new causal pathways linking SEP and CVD. The linked goals of understanding the causal nature of SEP and CVD associations, their contextual dependence, and their remediation by policy interventions necessitate a detailed understanding of society, its change over time and the phenotypes of CVD. Interdisciplinary research is therefore key to advancing both causal understanding and policy translation.

Adaptation and Implementation of Pictorial Conversation Aids for Early-Stage Breast Cancer Surgery and Reconstruction: A Quality Improvement Study.

After a diagnosis of early-stage breast cancer, women of lower socioeconomic position (SEP) report worse outcomes than women of higher SEP. A pictorial conversation aid was shown to improve decision outcomes in controlled contexts. No such intervention existed in France. In Phase 1, our aim was to adapt, for use in France, two pictorial conversation aids for breast cancer surgery and reconstruction. In Phase 2, our aim was to implement them in a regional cancer center serving a diverse population. In phase 1, we used iterative qualitative methods to adapt the conversation aids with a convenience sample of patients and health professionals. In phase 2, we tested their implementation using PDSA cycles with volunteer surgeons. In phase 1, we interviewed 10 health professionals and 5 patients to reach thematic data saturation. They found the conversation aids usable and very acceptable (especially patients) and suggested small changes to further simplify the layout and content (including a glossary). In phase 2, three surgeons started the first PDSA cycle, for 4 weeks. Only one additional surgeon agreed to take part in the second cycle. The third cycle was cancelled since no new surgeon agreed to take part. Time was a barrier for 2 out of 4 surgeons, potentially explaining the difficulty recruiting for the third cycle. The evaluation was otherwise positive. The surgeons found the conversation aids very useful during their consultations and all intended to continue using them in the future. It was possible to adapt, for use in France, pictorial conversation aids proven to be effective elsewhere. While the adapted conversation aids were deemed usable by health professionals and very acceptable to patients, their implementation using PDSA cycles proved slow.

Preventing Heart Failure Readmission in Patients with Low Socioeconomic Position.

This review aims to summarize the current burden of heart failure (HF) in the United States, specifically in patients with low socioeconomic position (SEP), and synthesize recommendations to prevent HF-related hospital readmissions in this vulnerable population. As treatments have improved, HF-related mortality has declined over time, resulting in more patients living with HF. This has led to an increase in hospitalizations, however, putting excess strain on our healthcare system. HF patients with low SEP are a particularly vulnerable group, as they experience higher rates of hospitalization and readmission compared to their high SEP counterparts. The Hospital Readmission Reduction Program (HRRP) was created to motivate interventions that reduce hospital readmissions across diseases, with HF being a primary target. Numerous readmission prevention efforts have been suggested to target the pre-hospitalization, hospitalization, and post-hospitalization phases, including addressing social determinants of health (SDoH), improving coordination of care, optimizing discharge plans, and improving adherence to follow-up care and medication regimens. Many of these proposed interventions show promise in reducing HF-related readmissions and issues surrounding adequate caregiver support may be particularly important to reduce readmissions among persons in low SEP. Reducing HF-related hospital readmissions is possible, even in vulnerable populations like those with low SEP, but this will require coordinated efforts across the healthcare system and throughout the life course of these patients. Caregiver support is a necessary part of optimized care for low SEP HF patients and future efforts should consider interventions that support these caregivers.

Trajectories of CVD medication after statutory retirement: contributions of pre-retirement sociodemographic, work and health-related factors: a register study in Finland

BackgroundCardiovascular diseases (CVDs) are prevalent in older people, but few studies focus on developmental patterns in CVD medication directly after transition to statutory retirement.We thus aimed to identify trajectories of CVD medication after retirement, and their sociodemographic, work and health-related determinants.MethodsWe used complete register data of former employees of the City of Helsinki, Finland. All who reached their statutory retirement in 2000–2013, with five-year follow-up data (n = 6,505, 73% women), were included. Trajectories of CVD medication were identified with group-based trajectory modelling using data from Finnish Social Insurance Institution’s reimbursement register. Sociodemographic, work and health-related determinants of trajectory group membership were analysed using multinomial logistic regression.ResultsSix trajectories of CVD medication were distinguished: "constant low" (35%), “late increase” (6%), “early increase” (5%), "constant high" (39%), "high and decreasing " (8%), and "low and decreasing” (7%). The majority (74%) of the retirees fell into the "constant low" and "constant high" categories. Lower occupational class and increased pre-retirement sickness absence were associated with the "constant high" trajectory. Further, those with lower educational attainment were more prone to be in the “early increase” trajectory.ConclusionsIndividuals in lower socioeconomic positions or with a higher number of pre-retirement sickness absence may be considered at higher risk and might benefit from early interventions, e.g. lifestyle interventions and interventions targeting working conditions, or more frequent monitoring.

Health professional’s perception of a smoking cessation intervention among disadvantaged patients participating in a pragmatic randomized trial

IntroductionIndividuals who have a low socio-economic position (SEP) are more likely to smoke and face greater barriers to quitting tobacco. However, the effectiveness of tailored interventions has been limited probably due to specific challenges relative to this population. We conducted a mixed-method study to better understand health professionals’ perceptions and barriers when implementing a preference-based smoking cessation (SC) intervention among disadvantaged smokers.MethodsA self-administered online questionnaire was sent to health professionals (doctors’ and other health professionals specialized in SC) participating in “STOP” a pragmatic multicentre randomized controlled trial. Perceptions regarding patient eligibility, the doctor-patient relationship, general study organization, and satisfaction were measured.ResultsTwenty-eight STOP study investigators responded. Health professionals prioritize smoking cessation for disadvantaged patients, but face challenges in approaching and following them. A research intervention providing cessation tools based on preference was deemed useful but generally undermined by time constraints. Health professionals’ preconceptions regarding patients in low SEP having other “pressing problems” which might be exacerbated by quitting smoking were also identified. Further, participation in a research intervention was perceived as not satisfactory due to workload and lack of time.ConclusionOur results highlight general barriers inherent to implementing pragmatic trials. They also present specific challenges in smoking cessation trials among disadvantaged population, essential to advance equity in tobacco control.

Development of geographic inequality in dental caries and its association with socioeconomic factors over an 18-year period in Denmark

BackgroundFew studies have examined the development of geographic and socioeconomic inequalities in caries over time or have simultaneously assessed individual-level socioeconomic position (SEP) and neighborhood-level factors as a multi-layered phenomenon influencing caries inequalities. This study examined (i) the trends in geographic inequalities in caries among adolescents in Denmark and (ii) how the association between SEP and caries has progressed over time, when accounting for individual and neighborhood-level confounding factors.MethodsThis nationwide repeated cross-sectional study included 15-year-olds in Denmark from 1995, 2003, and 2013 (n = 149,808). The outcome was caries experience (measured by the decayed, missing, and filled tooth surfaces [DMFS] index). The exposure of interest was SEP, indicated by the previous year’s parental education, occupational social class, and (equivalized) disposable household income. Covariates included individual-level factors (immigration status, country of origin, number of children and persons in the family, and household type) and neighborhood (residence municipality)-level factors (Gini index; proportion of unemployed, low-educated, and unmarried/non-cohabiting individuals; proportion of single-parent households and households with overcrowding). Data sources included the Danish national dental and administrative social registers and Statistics Denmark’s statistics database (StatBank). Data were analyzed using spatial and spatiotemporal modelling utilizing zero-inflated negative binomial regressions and integrated nested Laplace approximations for Bayesian parametric inference. Observed caries experience geo-maps of the Danish municipalities for 1995, 2003, and 2013 were created.ResultsBetween 1995 and 2013, caries prevalence in the 15-year-olds declined sharply (1995, 71%; 2013, 45%). Caries experience declined in nearly all socioeconomic subgroups and municipalities. However, geographic inequalities persisted with higher caries levels largely concentrated in the relatively deprived areas of Denmark. Increasing relative socioeconomic inequalities in caries over time were observed with significant graded associations between SEP and caries despite adjustment for the various individual and neighborhood-level covariates and the effect of assessment year (e.g., 15-year-olds with parents having basic education had 1.91-fold [95% CI: 1.86–1.95] higher caries experience than those having parents with high education).ConclusionsReducing these enduring inequalities will likely require additional resources and targeted supportive and preventive measures for adolescents from lower SEP backgrounds and those residing in municipalities with higher caries prevalence.

Trends in the effects of socioeconomic position on physical activity levels and sedentary behavior among Korean adolescents.

We examined trends in physical activity and sedentary behavior in Korean adolescents, and their association with socioeconomic position (SEP). We used data from the Korea Youth Risk Behavior Survey, a nationwide study involving students aged 12-19 conducted between 2009 and 2021. SEP was assessed based on economic status, parental education attainment, and urbanization. Physical activity was categorized into vigorous physical activity, moderate physical activity, and muscle training, and sedentary time was also measured. We conducted the log-binomial regression to calculate prevalence ratios (PRs) and prevalence differences. Our analysis included a total of 593,896 students. We observed an increasing trend in physical activity, but a worsening trend in sedentary behavior. A positive association was found between an adolescent's physical activity and SEP indicators, except for urbanization. Adolescents with higher economic status engaged in more vigorous physical activity (high: PR, 1.26; 95% confidence interval [CI], 1.25 to 1.28; middle: PR, 1.03; 95% CI, 1.02 to 1.04). Similar associations were observed for father's education (tertiary or above: PR, 1.11; 95% CI, 1.09 to 1.13; upper secondary: PR, 1.05; 95% CI, 1.03 to 1.07) and mother's education (tertiary or above: PR, 1.17; 95% CI, 1.15 to 1.20; upper secondary: PR, 1.06; 95% CI, 1.04 to 1.08). Adolescents with higher economic status also showed a higher compliance rate with the guideline restricting sedentary time to 2 hours per day (high: PR, 1.28; 95% CI, 1.25 to 1.30; middle: PR, 1.03; 95% CI, 1.01 to 1.05). Adolescents with higher SEP exhibited more physical activity and less sedentary time than those with lower SEP.

Gynaecologic and breast cancers in women living with HIV in South Africa: A record linkage study.

Breast and gynaecologic cancers account for approximately half of all cancers diagnosed amongst women in South Africa, many of whom also live with HIV. We aimed to determine the incidence of and risk factors for developing breast and gynaecologic cancers in women living with HIV (WLHIV) in South Africa. This is a longitudinal analysis of the South African HIV Cancer Match study including women aged ≥15 years with two or more HIV-related laboratory tests. We used Cox proportional hazard models to determine the association of Human Papilloma Virus (HPV)-related and hormone-related gynaecologic cancer with patient- and municipal-level characteristics. From 3 447 908 women and 10.5 million years of follow-up, we identified 11 384 incident and 7612 prevalent gynaecologic and breast cancers. The overall crude incidence rate was 108/1 00 000 person-years (pyears) (95% confidence interval [CI]: 106-110), with the highest incidence observed for cervical cancer (70/1 00 000 pyears; 95% CI: 68.5-71.7). Low CD4 cell counts and high HIV RNA viral loads increased the risk of cervical and other HPV-related cancers. Age was associated with both HPV-related and hormone-related cancers. Women accessing health facilities in high socioeconomic position (SEP) municipalities were more likely to be diagnosed with HPV-related cancers and breast cancer than women accessing care in low SEP municipalities. It is important to improve the immunologic status of WLHIV as part of cancer prevention strategies in WLHIV. Cancer prevention and early detection programmes should be tailored to the needs of women ageing with HIV. In addition, SEP disparities in cancer diagnostic services have to be addressed.

Socioeconomic Position and Type 2 Diabetes: The Mediating Role of Psychosocial Work Environment- the Maastricht Study.

Objective: We examined the association between low socioeconomic position (SEP) and Type 2 Diabetes Mellitus (T2DM), and the mediating role of psychosocial work environment by using counterfactual mediation analysis. Methods: Data from 8,090 participants of The Maastricht Study were analysed. SEP indicators (education, income, occupation), self-reported psychosocial work stressors, (pre)diabetes by oral glucose tolerance test were measured at baseline. Incident T2DM was self-reported per annum up to 9years. Cox regression and causal mediation analyses were performed. Results: 2.8% (N = 172) of the participants without T2DM at baseline reported incident T2DM. People with lower SEP more often had prevalent T2DM (e.g., education OR = 2.49, 95% CI: 2.16-2.87) and incident T2DM (e.g., education HR = 2.21, 95% CI: 1.53-3.20) than higher SEP. Low job control was associated with prevalent T2DM (OR = 1.44 95% CI: 1.25-1.67). Job control partially explained the association between income and prevalent T2DM (7.23%). Job demand suppressed the associations of education and occupation with prevalent T2DM. The mediation models with incident T2DM and social support were not significant. Conclusion: Socioeconomic inequalities in T2DM were present, but only a small part of it was explained by the psychosocial work environment.

Socioeconomic position and the pre-diagnostic interval among patients diagnosed with head and neck squamous cell carcinoma - a population-based study from DAHANCA

Background The socioeconomic differences in survival are pronounced for patients diagnosed with head and neck cancer; disease stage at diagnosis is suggested to be a main driver of this association. This nationwide, population-based study investigates socioeconomic differences in the pre-diagnostic interval and disease stage at diagnosis. Material and Methods Information on patient-reported symptoms, symptom onset and disease-specific factors was obtained from the nationwide population-based Danish Head and Neck Cancer Group (DAHANCA) database for patients diagnosed with head and neck squamous cell carcinoma between 2008 and 2019 in Denmark. Socioeconomic position (SEP) was measured by individual-level education, income and cohabitation status obtained from administrative registers. Socioeconomic differences in the interval from symptom onset to diagnosis were investigated in general linear models with 95% confidence intervals (CIs); overall and by subsite, symptom and comorbidity score. Consultation patterns prior to diagnosis were examined using methods for change-point detection. Associations with advanced-stage disease were estimated in logistic regression models. Results Patients with low, medium and high SEP had a similar interval from patient-reported symptom onset to diagnosis of 10 weeks. Although this interval varied according to primary symptom and anatomical subsite, no apparent socioeconomic differences were observed within these subgroups. Aligned with the patient-reported symptom onset, a distinct increase in consultation rates was observed at 9 weeks (95% CI [7.3; 10.7]) for patients with low SEP and 7 weeks (95% CI [4.8; 9.2]) for patients with high SEP, with overlapping CIs. Patients with low compared to high SEP had increased odds for advanced-stage glottic and oral cavity squamous cell carcinoma. For the remaining subsites the association varied according to SEP-indicator and TNM-edition. Conclusion The interval from symptom onset to diagnosis and consultation patterns were similar across SEP groups. Still, socioeconomic differences in stage at diagnosis were observed for some – but not all – subsites.