Persons Of Low Socioeconomic Status Research Articles

HIV and risk behaviors of persons of low socio-economic status, Popayan-Colombia (2008-2009)

To determine HIV presence and risk behaviors of persons of low socio-economic status in the city of Popayan-Colombia. Cross-sectional study; between 2008 and 2009, 363 participants of Popayan signed informed consent and received pre and post HIV test counseling. Socio-demographic characteristics and history of STDs, risk behaviors and previous HIV testing were assessed. Descriptive statistics, correlations and multivariate logistic regression were calculated. Mean age 33.5±10,2; 66 %women. Frequency of HIV-positive patients was 3.86 % (95% CI:1.87-5.85), greater in men (7.38%; p= 0.013). Greater frequency of HIV-positive patients was observed in people age 29-37, those without a stable partner, and those with history of risky alcohol consumption (more than five drinks in 2 h). HIV-positive patients frequency in this population was greater than national estimate for general population, aged 15-49 in Colombia, with even greater frequency in men. This study suggests that characteristics associated with low socioeconomic status, in economically active population, without a stable partner and with risky alcohol use, can potentially increase risk of HIV infection.

Is socioeconomic status associated with biological aging as measured by telomere length?

It has been hypothesized that one way in which lower socioeconomic status (SES) affects health is by increasing the rate of biological aging. A widely used marker of biological aging is telomere length. Telomeres are structures at the ends of chromosomes that erode with increasing cell proliferation and genetic damage. We aimed to identify, through systematic review and meta-analysis, whether lower SES (greater deprivation) is associated with shorter telomeres. Thirty-one articles, including 29 study populations, were identified. We conducted 3 meta-analyses to compare the telomere lengths of persons of high and low SES with regard to contemporaneous SES (12 study populations from 10 individual articles), education (15 study populations from 14 articles), and childhood SES (2 study populations from 2 articles). For education, there was a significant difference in telomere length between persons of high and low SES in a random-effects model (standardized mean difference (SMD) = 0.060, 95% confidence interval (CI): 0.002, 0.118; P = 0.042), although a range of sensitivity analyses weakened this association. There was no evidence for an association between telomere length and contemporaneous SES (SMD = 0.104, 95% CI: −0.027, 0.236; P = 0.119) or childhood SES (SMD = −0.037, 95% CI: −0.143, 0.069; P = 0.491). These results suggest weak evidence for an association between SES (as measured by education) and biological aging (as measured by telomere length), although there was a lack of consistent findings across the SES measures investigated here.

The prospective association of socioeconomic status with C-reactive protein levels in the CARDIA study.

Better health is a well-documented benefit of having a higher socioeconomic status (SES). Inflammation may be one pathway through which SES influences health. Using 2658 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, we examine whether two measures of SES assessed at baseline (mean age, 32 ± 4 years)-years of education and household income-predict change in C-reactive protein (CRP) concentrations over the course of 13 years. We also examine whether four health-related behaviors-smoking, fruit and vegetable consumption, physical activity, and alcohol consumption-mediate the prospective association of SES with CRP. Both higher education and household income predicted smaller increases in CRP over the 13 years of follow-up independent of age, sex, race, CARDIA center, body mass, medical diagnoses, medications, and hormone use (among women). Associations did not differ by race or sex. When examined in separate analyses, smoking and fruit and vegetable intake each accounted for a significant proportion of the respective effects of education and household income on CRP change, and physical activity a significant proportion of the effect of household income. These findings suggest that poor health behaviors among persons of lower socioeconomic status can have long-term effects on inflammation.

Abstract 54: An Assessment of Hypertension Care and Consistency of Blood Pressure Control in a General Medical Clinic

Introduction: Nationally, in 2007-8, 69% of people with treated hypertension have blood pressure at target for control. African Americans and persons of lower socioeconomic status are disproportionately affected by hypertension and have lower rates of controlled BP. Although economic, social and behavioral risk factors partially explain these differences in health status, the quality of healthcare may also contribute to poor outcomes among ethnic minorities. We conducted a study to assess the quality and consistency of hypertension care in a general medical clinic (GMC) of a safety net hospital that serves a vulnerable population. Methods: A retrospective chart review of established patients with hypertension was conducted in GMC at John Stroger Hospital of Cook County. Patients were selected using a random sampling method over two weeks. BP control was defined as <140/90 mmHg. Consistent control was defined as BP<140/90 on 4 or more visits. Stage 2 HTN was defined as BP>160/100. The primary outcome measure was proportion with controlled and consistent BP. Results: Of the 200 charts, 108 met inclusion criteria. The mean age was 63 (23-90 years); 56% (60 of 108) were women, 68% (73 of 108) were African American. Dyslipidemia was the most common co-morbidity (82 of 108), followed by diabetes mellitus (59 of 108). The sample had BMI of 32 and 52% ( 56 of 108) had controlled BP and 12% (13 of 108) had stage 2 HTN at the index visit. Only 8% (9 of 108) never had controlled blood pressure across the five visits and 27% (29 of 108) ever had stage 2 HTN. In the overall sample, 42% ( 46 of 108) had consistent control of BP. Among those with controlled BP at the index visit, 73% ( 41 of 56) had consistent control. Among those with elevated BP at the index visit, only 7% (6 of 52) had consistent control.The consistency was not predicted by age, gender, ethnicity, diabetes or number of medications. Conclusion: Among a largely minority population of hypertensive patients and multiple co-morbidities we found deficits in control of BP. Just over half had controlled BP at the index visit, less than half have consistent control of their BP. To approach national rates of control of blood pressure and improve the consistency of control, we recommend a clinic based quality improvement effort

Magnetic resonance imaging appearance of scurvy with gelatinous bone marrow transformation

Scurvy is a lethal but treatable disease that is rare in industrialized countries. Caused by vitamin C deficiency, it is most prevalent in persons of low socioeconomic status and smokers. Low levels of circulating vitamin C result in poor collagen fiber formation that, in turn, leads to demineralized bones, microfractures, and poor healing. Here we report a case of scurvy in a 5-year-old boy with normal radiographs in whom initial concern for leukemia based upon magnetic resonance imaging and clinical presentation led to a bone marrow biopsy revealing gelatinous transformation.

Exploring walking differences by socioeconomic status using a spatial agent-based model

We use an exploratory agent-based model of adults' walking behavior within a city to examine the possible impact of interventions on socioeconomic differences in walking. Simulated results show that for persons of low socioeconomic status, increases in walking resulting from increases in their positive attitude towards walking may diminish over time if other features of the environment are not conducive to walking. Similarly, improving the safety level for the lower SES neighborhoods may be effective in increasing walking, however, the magnitude of its effectiveness varies by levels of land use mix, such that effects of safety are greatest when persons live in areas with a large mix of uses.

Comparison of Socioeconomic Status and Body Composition of Dietary Energy Under-Reporting and Non-Under-Reporting Youth

1. Characteristics of energy intake under-reporting in French adults Vanrullen Berta, Jean-Luc Volatier, Aurélie Bertaut, Ariane Dufour, Jean Dallongeville British Journal of Nutrition CrossRef

Effects of tobacco taxation and pricing on smoking behavior in high risk populations: a knowledge synthesis.

Tobacco taxation is an essential component of a comprehensive tobacco control strategy. However, to fully realize the benefits it is vital to understand the impact of increased taxes among high-risk subpopulations. Are they influenced to the same extent as the general population? Do they need additional measures to influence smoking behavior? The objectives of this study were to synthesize the evidence regarding differential effects of taxation and price on smoking in: youth, young adults, persons of low socio-economic status, with dual diagnoses, heavy/long-term smokers, and Aboriginal people. Using a better practices approach, a knowledge synthesis was conducted using a systematic review of the literature and an expert advisory panel. Experts were involved in developing the study plan, discussing findings, developing policy recommendations, and identifying priorities for future research. Most studies found that raising cigarette prices through increased taxes is a highly effective measure for reducing smoking among youth, young adults, and persons of low socioeconomic status. However, there is a striking lack of evidence about the impact of increasing cigarette prices on smoking behavior in heavy/long-term smokers, persons with a dual diagnosis and Aboriginals. Given their high prevalence of smoking, urgent attention is needed to develop effective policies for the six subpopulations reviewed. These findings will be of value to policy-makers and researchers in their efforts to improve the effectiveness of tobacco control measures, especially with subpopulations at most risk. Although specific studies are needed, tobacco taxation is a key policy measure for driving success.

Reducing mortality in individuals at high risk for advanced melanoma through education and screening

Incidence and mortality rates of melanoma throughout most of the developed world have increased in the past 25 years. We propose that reduction of deaths from melanoma can be best enhanced by strong collaborations between experts in dermatology, primary care, oncology, cancer education and health systems research, epidemiologists, and behavioral scientists, among others. Public and professional educational campaigns should be guided by an understanding of 3 underlying but overlapping roots: epidemiology and preventable mortality (an understanding of who is most likely to be given the diagnosis of thick or late-stage melanoma), biology (an investigation of tumor types that are relatively common but potentially most lethal), and sociology (an analysis of the changes needed in social structures to improve access to those most in need of early detection programs). We review these major concepts, concentrating on the key risk factors for advanced melanoma.

Microfinance-based interventions for health outcomes in persons of low socio-economic status

Microfinance-based interventions for health outcomes in persons of low socio-economic status

Assessing socioeconomic health care utilization inequity in Israel: impact of alternative approaches to morbidity adjustment

BackgroundThe ability to accurately detect differential resource use between persons of different socioeconomic status relies on the accuracy of health-needs adjustment measures. This study tests different approaches to morbidity adjustment in explanation of health care utilization inequity.MethodsA representative sample was selected of 10 percent (~270,000) adult enrolees of Clalit Health Services, Israel's largest health care organization. The Johns-Hopkins University Adjusted Clinical Groups® were used to assess each person's overall morbidity burden based on one year's (2009) diagnostic information. The odds of above average health care resource use (primary care visits, specialty visits, diagnostic tests, or hospitalizations) were tested using multivariate logistic regression models, separately adjusting for levels of health-need using data on age and gender, comorbidity (using the Charlson Comorbidity Index), or morbidity burden (using the Adjusted Clinical Groups). Model fit was assessed using tests of the Area Under the Receiver Operating Characteristics Curve and the Akaike Information Criteria.ResultsLow socioeconomic status was associated with higher morbidity burden (1.5-fold difference). Adjusting for health needs using age and gender or the Charlson index, persons of low socioeconomic status had greater odds of above average resource use for all types of services examined (primary care and specialist visits, diagnostic tests, or hospitalizations). In contrast, after adjustment for overall morbidity burden (using Adjusted Clinical Groups), low socioeconomic status was no longer associated with greater odds of specialty care or diagnostic tests (OR: 0.95, CI: 0.94-0.99; and OR: 0.91, CI: 0.86-0.96, for specialty visits and diagnostic respectively). Tests of model fit showed that adjustment using the comprehensive morbidity burden measure provided a better fit than age and gender or the Charlson Index.ConclusionsIdentification of socioeconomic differences in health care utilization is an important step in disparity reduction efforts. Adjustment for health-needs using a comprehensive morbidity burden diagnoses-based measure, this study showed relative underutilization in use of specialist and diagnostic services, and thus allowed for identification of inequity in health resources use, which could not be detected with less comprehensive forms of health-needs adjustments.

Cigarette Smoking Interventions among Diverse Populations

One of the greatest public health success stories of the past 50 years has been the reduction in cigarette smoking in the United States. Smoking prevalence has decreased by 50% or more in the United States since the 1960s, and although recent reports indicate a plateau in this decline, the long-term downward trend has resulted in an overall smoking prevalence rate of 20.6% in 2009.1 Despite this success, the Healthy People 2010 objective of reducing the prevalence of cigarette smoking among adults to 12% or less has not been realized. This is, in large part, due to the fact that tobacco control efforts have not impacted population subgroups equally. In general, racial/ethnic minority groups and persons of lower socioeconomic status (SES) have not benefited as much as whites and those of higher SES from smoking prevention and cessation programs. If we are to meet the goal of 12% or less smoking prevalence among the overall adult population, more effort is needed to influence tobacco use behaviors among racial/ethnic and low SES populations

Assessing Coronary Risk Assessment: What's Next?

Assessing Coronary Risk Assessment: What's Next?

A Prospective Examination of Service Use by Abused and Neglected Children Followed Up Into Adulthood

A Prospective Examination of Service Use by Abused and Neglected Children Followed Up Into Adulthood

Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection

Cytomegalovirus establishes a lifelong latent infection following primary infection that can periodically reactivate with shedding of infectious virus. Primary infection, reactivation and reinfection during pregnancy can all lead to in utero transmission to the developing fetus. Congenital CMV infections are a major cause of permanent hearing loss and neurological impairment. In this literature review, we found that CMV infection was relatively common among women of reproductive age, with seroprevalence ranging from 45 to 100%. CMV seroprevalence tended to be highest in South America, Africa and Asia and lowest in Western Europe and United States. Within the United States, CMV seroprevalence showed substantial geographic variation as well, differing by as much as 30 percentage points between states, though differences might be explained by variation in the types of populations sampled. Worldwide, seroprevalence among non-whites tended to be 20-30 percentage points higher than that of whites (summary prevalence ratio (PR) = 1.59, 95% confidence interval (CI) = 1.57-1.61). Females generally had higher seroprevalences than males, although in most studies the differences were small (summary PR = 1.13, 95% CI = 1.11-1.14). Persons of lower socioeconomic status were more likely to be CMV seropositive (summary PR = 1.33, 95% CI = 1.32-1.35). Despite high seroprevalences in some populations, a substantial percentage of women of reproductive age are CMV seronegative and thus at risk of primary CMV infection during pregnancy. Future vaccine or educational campaigns to prevent primary infection in pregnant women may need to be tailored to suit the needs of different populations.

Toward Explaining Mental Health Disparities

Mental health disparities refer to the disproportionate amount of psychopathology found among persons of disadvantageous social standing, such as persons of low socioeconomic status (SES). Although social and self selection cannot entirely be ruled out as explanations for these differences, the accumulation of evidence supports a social causation interpretation for a large portion of this association for many disorders. The stress process model is applied to understand how social inequities become mental health disparities. Data from the Los Angeles Depression Study, originated by Leo Reeder are used to illustrate the key idea that explicit causal models are essential to the development of programmatic interventions to alleviate mental health disparities, as distinct from interventions to improve mental health in general. In light of recent work on neighborhood stratification and mental health, I advocate the modification of the social contexts of the stress process.

The value of screening in melanoma

The incidence of cutaneous melanoma has increased substantially in most white populations during the past several decades. Despite improvements in the early recognition of melanoma and the use of novel diagnostic techniques that enhance our diagnostic capabilities, disease-related mortality remains a significant public health issue. In the absence of effective treatment approaches for advanced disease, the best means for reducing deaths by melanoma are screening as well as professional and public education. The role of population-or community-based screening remains controversial, but evidence from self-selected screening campaigns, health care professional surveillance, and specialized pigmented lesions clinics underscores the value of screening and early detection programs, particularly in high-risk groups. Annual screening campaigns coupled with intense media promotion have become commonplace in many countries, and despite their low yield of melanoma detection, the dissemination of educational material and information to the public during these events is important in increasing public awareness. Future directions should include using screening campaigns to target middle-aged and older men and persons of lower socioeconomic status, who suffer most from the burden of the disease and its associated mortality. On a worldwide scale, comprehensive educational and screening campaigns should be implemented or intensified in underserved areas and geographic regions with lower survival rates, such as Eastern European countries. A better understanding of the biology of the disease, already occurring with notable strides, will help us to define better those individuals who will benefit most from screening and early detection efforts. Technologic advances and new diagnostic modalities will afford a more reliable and vigilant surveillance of high-risk individuals, whereas the wide use of the Internet will enhance the distribution of relevant information to the public with the ultimate goal of achieving a better control of melanoma.

Socioeconomic status and coronary heart disease risk prediction.

Achieving the Healthy People 2010 goal of reducing health disparities has been challenging. Disparity in life expectancy by socioeconomic status (SES) has been increasing.1 Much of this disparity is attributable to higher cardiovascular, particularly coronary heart disease (CHD), mortality among persons of lower SES. Disparities in CHD mortality result from multiple factors, including early life environment and material disadvantage,2 social and behavioral risk factors,3 access to care,4 and systematic underestimation of risk among persons with lower SES in clinical care. This Commentary addresses the importance of SES in CHD risk assessment. Current risk-based intervention strategies ignore the independent contribution of SES to CHD and thus may contribute to increasing SES disparities. If CHD risk is better estimated among the poor, it could lead to increased statin use for cholesterol reduction and aspirin use for CHD prevention among this population, which may reduce CHD disparities.

Recommendation for and Receipt of Cancer Screenings Among Medicaid Recipients 50 Years and Older

Persons of low socioeconomic status, including those with Medicaid coverage, are more likely to be diagnosed with cancer at an advanced stage, but little is known about cancer screening practices among Medicaid recipients. Our objective was to identify cancer screening rates among older Medicaid recipients seen in a primary care setting, and to identify patient and physician characteristics associated with screening. We used a stratified cluster sampling design to select a representative sample of 1951 North Carolina Medicaid recipients 50 years and older. Medical records were reviewed in the office of the primary care provider. Principal outcomes were the documentation of physician recommendations for and patient receipt of screening examinations for colorectal, breast, and cervical cancer. Documentation that colorectal, breast, and cervical cancer screening was recommended by the primary care provider was found for only 52.7%, 60.4%, and 51.5% of eligible patients, respectively. Documented rates of adequate screening were 28.2% for colorectal cancer, 31.7% for mammography within 2 years, and 31.6% for Papanicolaou test within 3 years. When medical record and claims data were combined, approximately half of eligible patients had evidence of screening. Length of the patient-physician relationship and African American race were positively associated with screening. Cancer screening rates among older Medicaid recipients fall far short of national objectives. Lack of a screening recommendation by the physician, rather than patient refusal of recommended tests, accounted for most instances of screening delinquency. Efforts to increase cancer screening rates among Medicaid recipients must address patient, physician, and organizational barriers to the routine identification and delivery of preventive services.

Red Blood Cell Docosahexaenoic Acid and Eicosapentaenoic Acid Concentrations Are Positively Associated with Socioeconomic Status in Patients with Established Coronary Artery Disease: Data from the Heart and Soul Study

Traditional cardiac risk factors only partially explain the biological mechanisms by which persons of lower socioeconomic status (SES) have higher cardiovascular risk. Dietary factors, resulting in lower circulating levels of (n-3) fatty acids, may also contribute to the increased risk of cardiovascular disease (CVD) in patients with low SES. We tested whether low SES is associated with RBC levels of (n-3) fatty acids in patients with coronary heart disease. We performed a cross-sectional analysis of 987 adults with stable coronary artery disease (CAD) recruited from San Francisco area outpatient clinics. Four SES measures (household income, education, occupation, and housing status) were assessed by self-report. RBC fatty acid levels of 2 (n-3) fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), were measured in venous blood samples from fasting subjects. Participants with lower household income, education, occupation, and housing status had lower RBC levels of (n-3) fatty acids (P < 0.001 for all 4 measures). In multivariable models, household income, education, and occupation remained strongly associated with DHA and EPA levels after adjustment for demographic factors, BMI, physical activity, statin use, and kidney function (P < 0.001 for all 3 measures). Housing status was not associated with DHA or EPA after multivariable adjustment. Among patients with CAD, 3 indicators of low SES, household income, education, and occupation, were strongly associated with lower RBC levels of (n-3) fatty acids. Our results raise the possibility that (n-3) fatty acids may be an important mediating factor in the association between low SES and CVD.