Low Socioeconomic Position Research Articles

The relative roles of early life, physical activity, sedentarism and diet in social and economic inequalities in body mass index and obesity risk between 9 and 18

BackgroundStudies in many middle and high-income countries describe an increasing prevalence of adiposity and obesity among children and adolescents. Prevalence is higher among families of low socioeconomic position (SEP) and systematic reviews have identified relevant factors, but have not quantified their relative importance to SEP differentials. This paper examines the relative importance of different factors to Body Mass Index (BMI) and obesity trajectories from age 9 to age 17/18. MethodsMulti-level models of child BMI/obesity risk trajectory by maternal education were conducted using a nationally representative cohort of children born in Ireland in 1998 and aged 9 at baseline (N = 8568), with follow-up at 13 and 17/18 years (88% and 73% response rate respectively). Models were stratified by sex and both time-varying (e.g. child physical activity, diet, sedentary activity) and time-invariant (e.g. early life) factors were tested. ResultsSignificant inverse gradients in BMI and obesity risk by level of maternal education were present across both sexes and at each age; unadjusted absolute differentials in obesity risk between highest/lowest education groups increased by 56% for males and 42% for females between age 9 and 17/18. Early life factors accounted for 22% of the differential in obesity risk between the lowest and highest education groups among males at age 9, falling to 13% at 17/18. Among females the proportion fell from 33 to 23%. Unadjusted absolute high/low maternal education group differentials in BMI were 7.5 times higher among males and 11 times higher among females at 17/18 than at age 9. ConclusionsGiven the importance of early life exposures to subsequent differentials in BMI and obesity risk our findings suggest that policy makers should focus resources on primary prevention during the prenatal and early life period if they wish to reduce the prevalence of child and adolescent obesity.

Binge drinking and oral health-related quality of life in older adults: Socioeconomic position matters.

The objective of the study was to investigate whether the association between binge drinking and oral health-related quality of life (OHRQoL) differs by socioeconomic position (SEP) in Brazilian older adults. The adverse health effects of alcohol consumption disproportionately affect socioeconomically disadvantaged and older individuals. Moreover, measures of binge drinking may capture different domains of the association between alcohol misuse and health that might be independent of the traditional markers of volume or frequency of consumption. Evidence of the association between alcohol use and oral health outcomes has failed to consider binge drinking and possible effect modification by SEP. We conducted a secondary cross-sectional analysis using the baseline data from The Brazilian Longitudinal Study of Ageing (2015-2016). Effect Measure Modification analyses using multivariable Poisson regression models tested whether the association between past-month binge drinking and higher scores of the Oral Impacts on Daily Performance (OIDP) questionnaire differed in magnitude by level of household wealth and educational attainment, assessed using Relative Excess Risk due to Interaction (RERI) and simple slope test. The analytical sample comprised 8857 individuals. Participants who were from low-wealth households or with lower education and reported past-month binge drinking had 27% (95% CI: 1.16 to 1.39) and 28% (95% CI: 1.18 to 1.40) higher OIDP scores, respectively, than those not binge drinkers from higher SEP, and super-additive associations were detected (RERI for household wealth: 0.12; RERI for educational attainment: 0.14). Binge drinkers from low SEP have poorer OHRQoL. Public oral health initiatives aiming to combat binge drinking are likely to disproportionately benefit vulnerable groups.

Perception Matters: Perceived vs. Objective Air Quality Measures and Asthma Diagnosis among Urban Adults.

Urban air pollution is consistently linked to poorer respiratory health, particularly in communities of lower socioeconomic position (SEP), disproportionately located near highways and industrial areas and often with elevated exposures to chronic psychosocial stressors. Fewer studies, however, have considered air pollution itself as a psychosocial stressor and whether pollution may be impacting health through both direct physiologic and psychosocial pathways. We examined data on perceived air pollution exposures from a spatially representative survey of New York City adults through summer and winter 2012 (n = 1183) using residence-specific ambient nitrogen dioxide (NO2) and fine particulate matter (PM2.5) exposure estimates. We used logistic regression to compare associations for perceived and objective air quality on self-reported asthma and general health, adjusting for sociodemographics and mental health. In models including all exposure metrics, we found small but significant associations for perceived air quality (OR = 1.12, 95% CI: 1.04-1.22) but not for NO2 or PM2.5. Neither perceived nor objective pollution was significantly associated with self-reported general health. Results suggest that perceived air quality may be significantly associated with adult asthma, more so than objective air pollution and after adjusting for mental health-associations not observed for self-reported general health.

Challenges and successes in the sustainment of Dutch community-level smoking cessation interventions for residents with a low socioeconomic position

BackgroundWhen health promotion interventions are implemented, the gains are often short-lived, as interventions are seldom successfully sustained. The current study explores how and under what conditions community-level smoking cessation interventions for people with a lower socioeconomic position can be sustained, drawing upon interventions delivered in Dutch neighbourhoods with a predominantly low socioeconomic position.MethodsWe conducted 15 semi-structured interviews with key stakeholders from three Dutch community-level smoking cessation interventions implemented at least three years prior. The topic guide was developed based on the Determinants of Innovation framework and transcripts were analysed thematically.ResultsWe identified several factors that promote the sustainment of smoking cessation community-level interventions: 1) structural, long-term funding through the commitment of health insurers and policy makers; 2) continued stakeholder enthusiasm and involvement; 3) training and time for professionals to discuss smoking cessation, thereby also increasing the visibility of the intervention for professionals and residents; 4) integrating the intervention with existing initiatives and adapting it to be compatible with current working practices of executive staff; and 5) planning for sustainment as a team from the outset.ConclusionsThe current study highlights challenges and successes in intervention sustainment for people with a lower socioeconomic position. Lack of structural funding was one of the most challenging aspects for intervention sustainment in which health insurers and policy makers can play an important role. Planning for sustainment from the outset would enable intervention coordinators to consider the abovementioned factors early on. This need not be done alone but can best be discussed within a team of stakeholders.

Upstream Determinants of Overweight and Obesity in Europe.

To review the upstream determinants of overweight and obesity in Europe, including food and built environments, and political, commercial, and socioeconomic determinants. Overweight and obesity affect 60% of European adults, and one in three children, and are more common in individuals with low compared to high socioeconomic position (SEP). Individuals in low SEP groups are more exposed to unhealthy built and food environments, including higher exposure to unhealthy food marketing. Industries influencing the food system have much economic power, resulting in ignoring or silencing the role of ultra-processed foods and commercial practices in weight gain. Overall, effective policies to address overweight and obesity have been insufficiently implemented by governments. To accelerate implementation, strengthened political commitment is essential. Policies must also focus on the upstream, structural, and systemic drivers of overweight and obesity; be comprehensive; and target socioeconomic inequalities in diets and physical activity.

Socioeconomic differences in children's victimization to maternal and paternal violence: a register-based study.

To explore the potential of administrative data in assessment of the association between parental socioeconomic position (SEP) and children's violent victimization by biological parents. A longitudinal register-linkage study based on child-mother and child-father data, including all children born in Finland between 1991 and 2017. The data included 1,535,428 children, 796,335 biological mothers, and 775,966 fathers. We used logistic regression with person-years as observations and cluster-robust standard errors to predict children's violent victimization in 2009-2018 and assessed effect modification by child's age and gender. For the SEP indicators, lower maternal education (adjusted odds ratio (OR) 2.90, secondary education OR 1.99) and lower paternal education (OR 2.24, secondary education OR 1.59) were risk factors for violent victimization. Parental social assistance receipt (OR 2.4) and non-employment (OR 1.8-1.9) increased the risk of victimization to maternal and paternal violence. Income was associated with victimization in a gradient-like manner, with ORs ranging from 1.14 to 1.98 among mothers and from 1.29 to 2.56 among fathers. Children with low parental SEP were at the highest risk of parental violence, particularly paternal violence, at ages 3-8 years. All indicators of low SEP increased the risk of children experiencing both maternal and paternal physical violence, especially at ages 3-8 years. Longitudinal register data-because of large samples, no nonresponse or self-report bias, and the possibility to analyze violence committed by mother and father and age-groups separately-have great potential for comprehensive research on the risk factors of parental violence that are difficult to reliably assess with other types of data.

Difficulties in Treating Ethnic Minority Children with ADHD and the Role of Mobile Applications

There is proof that kids and teens from ethnic minorities get less health care than theirnon-minority peers, despite the fact that Attention Deficit Hyperactivity Disorder (ADHD) ismore common in these populations. Minority children might not receive timely, adequateADHD intervention because of the low socioeconomic position of minority parents, their lackof awareness regarding ADHD, and the available remedial techniques. People are looking tothe digital world for answers to challenges in their daily lives as the number of mobile applicationsgrows. People with impairments now have equal access to learning opportunitiesbecause to technological advancements. The majority of their time is now spent on mobiledevices by kids. As a result, using mobile applications to solve their problems would be quitesuccessful. Mobile learning, also known as e-learning programs that utilize mobile devices,can be employed as a form of therapy to enhance both executive functioning and generalwell-being. Also, by practicing cognitive and metacognitive task abilities more frequently, theyincrease motivation in kids and teenagers. Also, the understanding and retention of the presentedinformation might be aided by the audiovisual stimuli offered through smartphoneapplications. They may therefore serve as crucial learning aids for kids with ADHD. The currentstudy examines the function and efficacy of mobile applications in enhancing the qualityof life of children from ethnic minorities who have Attention Deficit Hyperactivity Disorder(ADHD), as well as the barriers that may impede or delay their access to treatment services.

Is a lower socio-economic position associated with poorer outcomes for end-of-life care?

Is a lower socio-economic position associated with poorer outcomes for end-of-life care?

Socioeconomic inequalities in alcohol-related harm in adolescents: a prospective cohort study of 68,299 Danish 15–19-year-olds

Evidence shows that similar levels of alcohol consumption lead to greater harm in adults with low socioeconomic position (SEP) compared to high SEP. We investigated if SEP is associated with alcohol-related hospital contacts in adolescents, and whether differences in risk can be explained by differences in levels of alcohol consumption, drinking pattern, and substance use. This is a prospective cohort study of 68,299 participants aged 15-19 years old from the Danish National Youth Cohort 2014. SEP was operationalised as parent educational level, family income and perceived financial strain in the family. Data were linked to national registers and participants were followed up for five years from 2014 to 2019. Outcomes were hospital contacts due to alcohol. Multilevel Poisson regression was used to estimate incidence rates (IR) and incidence rate ratios (IRR). During 280,010 person years of follow-up, 872 participants had an alcohol-attributable hospital contact; intoxications (n=778, 89%) were the most common diagnosis. Low as compared to high SEP was associated with higher IRR of alcohol-attributable hospital contacts for all three SEP measures. The adjusted IRR of harm was 1.73 (95% CI: 1.29-2.33) for elementary school as the highest parent education compared to longer parent education and 1.57 (95% CI: 1.30-1.89) for family financial strain compared to those without financial strain. Adjustment for weekly alcohol intake, drinking pattern and substance use did not substantially change results. Cubic spline analysis of the association between family income and alcohol-attributable hospital contacts revealed a dose-response relationship with decreasing risk of alcohol-related harm with higher income. Our findings suggested that alcohol-related harm is more common in socioeconomically disadvantaged adolescents despite similar levels of alcohol consumption, regardless of differences in drinking pattern or substance use. Future preventive strategies should prioritise young adolescents, including those who are most disadvantaged. Tryg Foundation (ID: 153539).

Impact of Psychological and Social Determinants on Health

The World Health Organization defines the Social Determinants of Health (SDH) as "the conditions under which people are born, grow, work, live, and age, as well as the broader set of forces and systems influencing the conditions of daily life". Psychosocial variables and social determinants both have an important role in determining a person's health and well-being. The psychological, social, and cultural dimensions of these issues can have an impact on a person's behavior and health. Stress, education, poverty, social exclusion, discrimination, and violence are a few examples of these psychosocial determinants. These elements can be protective or, on the other hand, raise the risk of physical and mental illness and lower people's quality of life. Social determinants of health are a combination of social, economic, and physical factors. They play a role in determining the patterns of illness, disease, and health that are observed in a population. They establish the circumstances in which people are conceived, develop, live, work, and age. Health and medical care, economic security, social and communal context, local geography and built environment, and education are all examples of social determinants of health. The connection between individuals and their social and physical environments frequently worsens poor health outcomes. Low socioeconomic position, unemployment, strained family ties, and hazardous neighborhoods have been shown in studies to have a significant negative impact on mental health. Additionally, those who suffer from severe psychological disorders are more probable to experience social segregation, poverty, food insecurity and housing uncertainty all of which can decrease quality of life and hamper rehabilitation. Pakistan experienced the largest gain among the SAARC nations between 2013 and 2018, increasing its happiness score by 26 points, and is expected to rank among the top 20 gainers globally in 2020 [2]. However, it lowers to 4.934from 2018-2020 and is ranked 105 out of 149 happiest countries. There could be a number of causes for this downward tendency. The need of the hour is to pinpoint the causes of Pakistan's declining happiness level. These findings would help policymakers get rid of or manage the factors contributing to people's lower levels of happiness. It is improbable to understate the importance of social and psychological factors in determining health. Healthcare systems and politicians may create initiatives that successfully promote well-being, lessen health inequities, and enhance overall health outcomes by understanding and addressing these variables. A healthier and more equal society must be built via comprehensive strategies that incorporate socioeconomic inequities and mental health care. In order to promote a more inclusive and sustainable society, the international community is making great progress towards reaching many Sustainable Development Goals (SDGs). We are covering several SDGs described by United Nations which include: SDG 1, “No Poverty”; SDG 2, "Zero Hunger"; SDG 3, "Good Health and Well-being"; SDG 4, "Quality Education"; SDG 5, "Gender Equality"; SDG 8, "Decent Work and Economic Growth" and SDG 10, "Reduced Inequalities". The elimination of poverty, hunger, and inequality, as well as the promotion of sustainable economic growth, are the top priorities behind these objectives. By achieving these objectives, we can collectively work towards a more sustainable and equitable future in which no one is left behind.

Birth size, school performance and family social position: a study of 650,000 children

BackgroundLow birth weight (BW) is associated with lower cognitive functioning, but less is known of these associations across the full range of the BW distribution and its components. We analyzed how BW, birth length (BL) and birth ponderal index (BPI, kg/m3) are associated with school performance and how childhood family social position modifies these associations.MethodsMedical birth records of all Finnish children born in 1987–1997 were linked to school performance records at 16 years of age (N = 642,425). We used population averaged and within-siblings fixed-effects linear regression models.ResultsBL showed a linear and BW a curvilinear association with school performance whereas for BPI the association was weak. The strongest association was found for BL explaining 0.08% of the variation in school performance in boys and 0.14% in girls. Demographic, gestational and social factors partly explained these associations. Similar but weaker associations were found within sibships. The association of BL with school performance was stronger at lower levels of family social position.ConclusionBL shows a linear association with school performance and can explain more school performance variation than BW. At the population level, BL can offer useful information on intrauterine environmental factors relevant for cognitive performance.ImpactBirth length is linearly associated with school performance in late adolescence and explains a larger proportion of school performance variation than birth weight.The association between birth length and school performance is stronger in families with lower socio-economic position.At the population level, birth length can offer information on the intrauterine environment relevant for later cognitive performance.

Trends in socioeconomic inequalities in behavioural non-communicable disease risk factors: analysis of repeated cross-sectional health surveys in England between 2003 and 2019

BackgroundPrevious studies have shown that those in lower socioeconomic positions (SEPs) generally have higher levels of behavioural non-communicable disease (NCD) risk factors. However, there are limited studies examining recent trends in inequalities. This study examined trends in socioeconomic inequalities in NCD behavioural risk factors and their co-occurrence in England from 2003–19.MethodsThis time-trend analysis of repeated cross-sectional data from the Health Survey for England examined the relative index of inequalities (RII) and slope index of inequalities (SII) in four NCD behavioural risk factors: smoking; drinking above recommended limits; insufficient fruit and vegetables consumption; and physical inactivity.FindingsPrevalence of risk factors has reduced over time, however, this has not been consistent across SEPs. Absolute and relative inequalities increased for physical inactivity; relative inequalities also increased for smoking; for insufficient fruit and vegetable consumption, the trends in inequalities depended on SEPs measure. Those in lower SEPs experienced persistent socioeconomic inequalities and clustering of behavioural risk factors. In contrast, those in higher SEPs had higher prevalence of excessive alcohol consumption; this inequality widened over the study period.InterpretationInequalities in smoking and physical inactivity are persisting or widening. The pattern of higher drinking in higher SEPs obscure the fact that the greatest burden of alcohol-related harm falls on lower SEPs. Policy attention is required to tackle increasing inequalities in smoking prevalence, low fruit and vegetable consumption and physical inactivity, and to reduce alcohol harm.

The new normal for children’s physical activity and screen viewing: a multi-perspective qualitative analysis of behaviours a year after the COVID-19 lockdowns in the UK

BackgroundThe COVID-19 pandemic significantly impacted children’s physical activity. Recent evidence indicated children’s accelerometer-measured physical activity levels have, on average, returned to near pre-pandemic levels in 2022, though sedentary behaviour remains higher. However, insufficient physical activity levels among children continues to be a critical public health issue in the UK, with only 41% meeting physical activity guidelines. This study aimed to provide in-depth analysis of how the pandemic has shaped children’s physical activity patterns beyond the short-term periods following lockdowns and identify the new challenges to engaging children in physical activity.MethodsOne-to-one interviews with parents (n = 22), school staff (n = 9), and six focus groups with children aged 10–11 years (n = 45) were conducted between February and July 2022. Topics explored changes to children’s physical activity and sedentary behaviour patterns, including screen-viewing, and factors influencing any changes. The framework method was used for analysis.ResultsFive themes were generated. Theme 1 described residual lockdown habits, including increased screen-viewing within the home, while activities outside the home continued to feel less spontaneous. Theme 2 highlighted an interrupted development of social, emotional, and physical skills among children compared to what would be expected pre-pandemic. This coincided with Theme 3 which reflected increased mental health challenges among families, creating complex barriers to children’s physical activity. A new normal for child physical activity was evoked and explored in Theme 4, with greater dependence on structured and organised activities. However, Theme 5 highlighted that girls and children with lower socio-economic position may be especially at risk of decreased physical activity.ConclusionsThere is a new normal for children’s physical activity that is characterised by increased dependence on structured and organised physical activities, such as active clubs, and less on unstructured and spontaneous physical activities, such as physical play. While this may suit many children, girls and children from lower socio-economic households face barriers to participating in the new normal. It is important that affordable and equitable opportunities are provided to all children to prevent physical activity and health inequalities.

Characteristics of heart failure in the Amsterdam metropolitan area (AMSTERDAM-HF): Data from a dynamic general practice cohort (2011−2021)

BackgroundHeart failure (HF) is a common cardiac syndrome with a high disease burden and poor prognosis in our aging populations. Understanding the characteristics of patients with newly diagnosed HF is essential for improving care and outcomes. The AMSTERDAM-HF study is aimed to examine the population characteristics of patients with incident HF. MethodsWe performed a retrospective dynamic cohort study in the Amsterdam general practice network consisting of 904,557 individuals. Incidence HF rates, geographical demographics, patient characteristics, risk factors, symptoms prior to HF diagnosis, and prognosis were reported. ResultsThe study identified 10,067 new cases of HF over 6,816,099 person-years. The median age of patients was 77 years (25th–75th percentile: 66–85), and 48% were male. The incidence rate of HF was 213.44 per 100,000 patient-years, and was higher in male versus female patients (incidence rate ratio: 1.08, 95%-CI:1.04–1.13). Hypertension (men 46.3% and women 55.8%), coronary artery disease (men 36% and women 25%) and diabetes mellitus (men 30.5% and women 26.8%) were the most common risk factors. Dyspnoea and oedema were key reported symptoms prior to HF diagnosis. Survival rates at 10-year follow-up were poor, particularly in men (36.4%) compared to women (39.7%). Incidence rates, comorbidity burden and prognosis were worse in city districts with high ethnic diversity and low socio-economic position. ConclusionOur study provides insights into incident HF in a contemporary Western European, multi-ethnic, urban population. It highlights notable sex, age, and geographical differences in incidence rates, risk factors, symptoms and prognosis.

An overview of facilitators and barriers in the development of eHealth interventions for people of low socioeconomic position: A Delphi study

ObjectiveeHealth interventions can improve the health outcomes of people with a low socioeconomic position (SEP) by promoting healthy lifestyle behaviours. However, developing and implementing these interventions among the target group can be challenging for professionals. To facilitate the uptake of effective interventions, this study aimed to identify the barriers and facilitators anticipated or experienced by professionals in the development, reach, adherence, implementation and evaluation phases of eHealth interventions for people with a low SEP. MethodWe used a Delphi method, consisting of two online questionnaires, to determine the consensus on barriers and facilitators anticipated or experienced during eHealth intervention phases and their importance. Participants provided open-ended responses in the first round and rated statements in the second round. The interquartile range was used to calculate consensus, and the (totally) agree ratings were used to assess importance. ResultsTwenty-seven professionals participated in the first round, and 19 (70.4%) completed the second round. We found a consensus for 34.8% of the 46 items related to highly important rated barriers, such as the lack of involvement of low-SEP people in the development phase, lack of knowledge among professionals about reaching the target group, and lack of knowledge among lower-SEP groups about using eHealth interventions. Additionally, we identified a consensus for 80% of the 60 items related to highly important rated facilitators, such as rewarding people with a low SEP for their involvement in the development phase and connecting eHealth interventions to the everyday lives of lower-SEP groups to enhance reach. ConclusionOur study provides valuable insights into the barriers and facilitators of developing eHealth interventions for people with a low SEP by examining current practices and offering recommendations for future improvements. Strengthening facilitators can help overcome these barriers. To achieve this, we recommend defining the roles of professionals and lower-SEP groups in each phase of eHealth intervention and disseminating this study’s findings to professionals to optimize the impact of eHealth interventions for this group.

Tobacco-control policy support among people from low socioeconomic positions in Massachusetts

People from low socioeconomic positions (SEP) are at a higher risk of smoking, face greater barriers to smoking cessation, and have lower access to health information. To improve tobacco-related health outcomes, policies requiring altering labeling on cigarette packs could be implemented. However, public support is needed to influence the policymaking process. We assessed factors associated with supporting tobacco-control communication policies. We analyzed data from Project CLEAR, a study conducted in Massachusetts. The analytic sample included participants who answered questions on their support for three policies: 1) graphic health warnings (GHWs), 2) Quitline number, and 3) smoking cessation information on cigarette packs (n = 357). Binomial logistic regression modeling was conducted by policy. Independent variables included demographic characteristics and smoking status. We found that younger vs. older individuals (aOR = 0.41, 95 %CI:0.23–0.72), males vs. females (aOR = 0.58, 95 %CI:0.35–0.96), and people who smoke vs. those who don’t smoke (aOR = 0.41, 95 %CI:0.24–0.70) were less likely to support a law requiring GHWs. Participants with a low vs. higher level of education (aOR = 0.55, 95 %CI:0.32–0.95) were less likely to support a law requiring a Quitline number. Younger (18–39) vs. older individuals (aOR = 0.53, 95 %CI:0.29–0.94), males vs. females (aOR = 0.57, 95 %CI:0.34–0.96), and participants with a low vs. higher level of education (aOR = 0.56, 95 %CI:0.32–0.98) were less likely to support a law requiring cessation information on cigarette packs. Findings suggest that targeted theory-based public health and communication strategies should be developed to increase awareness and support towards policies that would help reduce cigarette smoking among people from low SEP to eliminate tobacco-related health inequities in the US.

Socioeconomic position as a predictor of youth's movement trajectory profiles between ages 10 and 14 years

BackgroundCombinations of movement behaviors (i.e., physical activity, sedentary behavior, sleep) are associated with health and developmental outcomes in youth. Youth vary in how they accumulate these behaviors, both in volume and specific domains (e.g., sedentary time spent on recreational screen activities vs homework). The aim of this study was to examine how youth’s combined general and domain-specific movement trajectories differ by socioeconomic position.MethodsWe conducted a longitudinal, group-based multi-trajectory analysis to identify general and domain-specific movement trajectory profiles for 2457 youth from age 10 to 14 years from the Longitudinal Study of Australian Children from 2014–2018. We used multinomial logistic regression to test if socioeconomic position predicted profile membership.ResultsWe identified three general movement trajectory profiles for both sexes, four domain-specific profiles for males, and five for females. For general movement trajectories, females from lower socioeconomic positions were more likely to be a combination of less active and more sedentary than females from higher socioeconomic positions. Males across socioeconomic positions spend similar amounts of time in physical activity, sedentary time, and sleep. For domain-specific movement trajectories, youth from lower socioeconomic positions were likely to spend a combination of less time in education-based sedentary behavior and more time in recreational screen activities than their higher socioeconomic position peers.ConclusionOur results indicate that socioeconomic position predicted in which domains youth accumulate their movements. Future observational research and interventions targeting different socioeconomic groups should therefore consider domain-specific movement trajectories.

Traditional lifestyle factors partly mediate the association of socioeconomic position with intrahepatic lipid content: The Maastricht study

Recent studies have unveiled an association between socioeconomic position (SEP) and intrahepatic lipid (IHL) content. The aim of this study was to examine to what extent traditional lifestyle factors mediate the relationship between SEP and IHL content, independent of aetiology, and non-alcoholic fatty liver disease (NAFLD). We used cross-sectional data derived from The Maastricht Study (N= 4,001; mean age: 60 years, 49% women, 32% low education level, 21% diabetes, 21% NAFLD). Education, income, and occupation were used as indicators of SEP. Physical activity (accelerometer), intake of total energy, alcohol, saturated fat, protein, vitamin E, dietary fibre, and fructose from sugar-sweetened beverages (SSBs) and fruit juice (food frequency questionnaires) were potential mediators. IHL content was quantified by magnetic resonance imaging. Age, sex, and type 2 diabetes were covariates. Multiple parallel mediation analyses (bootstraps= 10,000) were performed. Individuals with a low education level had a 1.056-fold higher IHL content (95% CI: 1.03-1.08) and a 44% greater NAFLD risk (OR:1.44; 95% CI:1.18-1.77) compared with those with higher education levels. Approximately 8.9% of educational disparity in risk of IHL content was attributable to moderate-to-vigorous physical activity; 6.3% to fructose intake from SSBs; 5.5% to dietary fibre; and -23% to alcohol. Approximately 8.7% of educational disparity in risk of NAFLD was attributable to moderate-to-vigorous physical activity; and 7.7% to fructose intake from SSBs. However, the indirect effect of these mediators was small (0.998 for IHL content and 1.045 for NAFLD) in comparison to the total effect. Similar results were found when income and occupation were used as SEP indicators. Societal measures may alleviate the burden of NAFLD and further studies that identify mediators other than traditional lifestyle factors are warranted to define the relationship underlying SEP and IHL content. Individuals with a low or medium level of education, income, or occupational status had more fat accumulation in their livers than individuals with a higher education, income, or occupational status. This difference may be attributed to the influence of unhealthy lifestyle factors, such as reduced physical activity and a higher intake of sugar-sweetened beverages among individuals with lower socioeconomic position. Nevertheless, other yet unknown factors may also play a role.

A closer look at demand-side explanations for the Matthew effect in formal childcare uptake in Europe and Australia

Although formal childcare is considered a key social investment policy to combat inequality, available research indicates that in most European and other high-income countries parents with lower socio-economic positions are less likely to use formal childcare. As the literature on the underlying causes of this so-called Matthew effect has not yet converged, this article is the first to assess whether educational gradients in formal childcare uptake can be accounted for by micro-level employment potential and work–family attitudes in 14 European countries and Australia. Complementing available research on supply-side factors such as policy design features, this study indicates that a large part of the educational gradients in formal childcare uptake persist after controlling for socio-demographic background variables, employment potential, and work–family attitudes as micro-level predictors. However, this study also shows that a considerable part of the educational differentiation in formal childcare uptake reflects differential employment potential. This finding turns attention to policies other than childcare to enhance labour market outcomes for lower educated groups, which in turn might attenuate the Matthew effect in formal childcare. Furthermore, a positive relation between individual-level work–family attitudes and the uptake of formal childcare is also identified as a partial explanation for educational gradients in formal childcare uptake. Although the explanatory power of work–family attitudes as an underlying determinant of the Matthew effect is more limited compared to employment potential, such variation in the acceptance of maternal employment and formal childcare should also be considered in the design of inclusive work–family policies.

Family socioeconomic position and changes in planned health care for children with chronic diseases during the COVID-19 pandemic in Italy.

In this study, we aimed at evaluating whether, during the COVID-19 pandemic, children affected by chronic diseases were impacted by the deferral of planned healthcare caused by the restriction measures. This study was conducted using data from the Italian NINFEA birth cohort, which include children born between 2005 and 2016. Women who completed the 4-year NINFEA follow-up questionnaire before November 2020 (N = 5,307) were invited to complete a questionnaire targeted at evaluating the impacts of the pandemic on their children's health. The questionnaire asked mothers to report whether their children had a chronic disease or condition that required one or more regular health checks by a doctor in 2019 (used as a reference period) and whether the children had problems getting routine health checks after March 2020. We obtained information on 3,721 children. Out of 353 children with a chronic disease that required at least one medical visit in 2019, 130 (36.8%) experienced problems during the pandemic. Lower family income was associated with a higher risk of experiencing health access problems. We observed that children living in families at lower income tertiles had more chance of experiencing healthcare access problems than children living in families at the highest income tertiles (prevalence rate ratio for a tertile decrease in family income: 1.22; 95% CIs: 1.02-1.49). Our study underlines that the COVID-19 pandemic may have caused healthcare access problems for children with prevalent chronic diseases, especially among those living in households with a low socioeconomic position.