Measure Of Socioeconomic Deprivation Research Articles

COVID-19 inequalities in England: a mathematical modelling study of transmission risk and clinical vulnerability by socioeconomic status.

The COVID-19 pandemic resulted in major inequalities in infection and disease burden between areas of varying socioeconomic deprivation in many countries, including England. Areas of higher deprivation tend to have a different population structure-generally younger-which can increase viral transmission due to higher contact rates in school-going children and working-age adults. Higher deprivation is also associated with a higher presence of chronic comorbidities, which were convincingly demonstrated to be risk factors for severe COVID-19 disease. These two major factors need to be combined to better understand and quantify their relative importance in the observed COVID-19 inequalities. We used UK Census data on health status and demography stratified by decile of the Index of Multiple Deprivation (IMD), which is a measure of socioeconomic deprivation. We calculated epidemiological impact using an age-stratified COVID-19 transmission model, which incorporated different contact patterns and clinical health profiles by decile. To separate the contribution of each factor, we considered a scenario where the clinical health profile of all deciles was at the level of the least deprived. We also considered the effectiveness of school closures and vaccination of over 65-year-olds in each decile. In the modelled epidemics in urban areas, the most deprived decile experienced 9% more infections, 13% more clinical cases, and a 97% larger peak clinical size than the least deprived; we found similar inequalities in rural areas. Twenty-one per cent of clinical cases and 16% of deaths in England observed under the model assumptions would not occur if all deciles experienced the clinical health profile of the least deprived decile. We found that more deaths were prevented in more affluent areas during school closures and vaccination rollouts. This study demonstrates that both clinical and demographic factors synergise to generate health inequalities in COVID-19, that improving the clinical health profile of populations would increase health equity, and that some interventions can increase health inequalities.

Clinical, socio-demographic, and parental correlates of early autism traits in a community cohort of toddlers

Identifying factors linked to autism traits in the general population may improve our understanding of the mechanisms underlying divergent neurodevelopment. In this study we assess whether factors increasing the likelihood of childhood autism are related to early autistic trait emergence, or if other exposures are more important. We used data from 536 toddlers from London (UK), collected at birth (gestational age at birth, sex, maternal body mass index, age, parental education, parental language, parental history of neurodevelopmental conditions) and at 18 months (parents cohabiting, measures of socio-economic deprivation, measures of maternal parenting style, and a measure of maternal depression). Autism traits were assessed using the Quantitative Checklist for Autism in Toddlers (Q-CHAT) at 18 months. A multivariable model explained 20% of Q-CHAT variance, with four individually significant variables (two measures of parenting style and two measures of socio-economic deprivation). In order to address variable collinearity we used principal component analysis, finding that a component which was positively correlated with Q-CHAT was also correlated to measures of parenting style and socio-economic deprivation. Our results show that parenting style and socio-economic deprivation correlate with the emergence of autism traits at age 18 months as measured with the Q-CHAT in a community sample.

Uptake of intra-muscular vitamin K administration after birth: A national cohort study.

A long-acting monoclonal antibody against RSV (nirsevimab), given as an injection shortly after birth, is currently being rolled out globally. Carer acceptance of intra-muscular (IM) vitamin K, another injection given shortly after birth, could serve to indicate the acceptability of nirsevimab. We analysed a national dataset of postnatal health visitor visits in Scotland; individual-level data on gestation were not available. The primary outcome measure was the modality of administration of vitamin K; potential explanatory variables were maternal age, infant ethnicity, English as a first language, and measures of socio-economic deprivation. We examined associations between IM vitamin K administration or oral/no vitamin K and each explanatory variable. From 2019 to 2021, questionnaires were available for 142 857 infants; data was missing for 2.7%. IM Vitamin K uptake was high: 95.5% of carers consented, with 1.1% requesting oral vitamin K and 0.9% refusing vitamin K altogether. Infant ethnicity, use of English as a first language, socio-economic status and maternal age were not associated with reduced uptake of IM vitamin K. If IM Vitamin K administration is a valid proxy measure for nirsevimab acceptance, we did not identify groups that might require increased engagement prior to nirsevimab roll-out.

Telemedicine and health disparities: Association between the area deprivation index and primary care telemedicine utilization during the COVID-19 pandemic.

The rapid implementation of telemedicine during the COVID-19 pandemic may have exacerbated the existing health disparities. This study investigated the association between the area deprivation index (ADI), which serves as a measure of socioeconomic deprivation within a geographic area, and the utilization of telemedicine in primary care. The study data source was electronic health records. The study population consisted of patients with at least one primary care visit between March 2020 and December 2021. The primary outcome of interest was the visit modality (office, phone, and video). The exposure of interest was the ADI score grouped into quartiles (one to four, with one being the least deprived). The confounders included patient sociodemographic characteristics (e.g., age, gender, race, ethnicity, insurance coverage, marital status). We utilized generalized estimating equations to compare the utilization of telemedicine visits with office visits, as well as phone visits with video visits. The study population included 41,583 patients with 127,165 office visits, 39,484 phone visits, and 20,268 video visits. Compared to patients in less disadvantaged neighborhoods (ADI quartile = one), patients in more disadvantaged neighborhoods (ADI = two, three, or four) had higher odds of using phone visits vs office visits, lower odds of using video visits vs office visits, and higher odds of using phone visits vs video visits. Patients who resided in socioeconomically disadvantaged neighborhoods mainly relied on phone consultations for telemedicine visits with their primary care provider. Patient-level interventions are essential for achieving equitable access to digital healthcare, particularly for low-income individuals.

How Are Retailers Describing Delta-8 THC?A Mixed-Methods Study in Fort Worth, Texas.

Delta-8 tetrahydrocannabinol (THC) is a largely unregulated psychoactive substance rising in popularity in the United States. This study aimed to understand how retailers explained Delta-8 THC to potential customers and if these descriptions were associated with socioeconomic deprivation surrounding the retail location. In Fort Worth, Texas, stores with retail alcohol, cannabidiol (CBD), or tobacco licenses were called. Among the 133 stores that sold Delta-8 THC, 125 retailers (94%) answered the question "What is Delta-8?" Qualitative methods were used to identify related themes; logistic regression models tested associations between themes and area deprivation index (ADI) scores, a measure of socioeconomic deprivation (1-10; 10 = most deprived areas). Retailers often compared Delta-8 THC to other substances (49%). Although most often described as a type of cannabis (34%), several retailers likened Delta-8 to CBD (19%) or hemp (7%), which are nonpsychoactive. Retailers also described potential effects from use (35%). Some retailers reported that they were unsure of what Delta-8 was (21%), told surveyors to look it up themselves (6%), or withheld information (9%). Higher ADI scores were associated with higher odds of retailers communicating limited information (odds ratio = 1.21, 95% CI [1.04, 1.40], p = .011). Study findings may inform the development of marketing regulations, as well as informational campaigns for both retailers and consumers.

Interaction of race and socioeconomic status as risk modulators of treatment delay and cancer-specific mortality in uterine cancer.

5595 Background: The majority of studies of uterine cancer combine high and low-grade histologies and do not sample a diverse cohort of patients. In many studies race is treated as biologic construct, when it may be better thought of as a proxy for socioeconomic inequity and deprivation. Socioeconomic (SE) deprivation may play a significant role in the disease trajectory of women with uterine cancer. Methods: Data were drawn from the Metropolitan Detroit Cancer Surveillance System which covers a tri-county area of approximately 4 million people. We included non-Hispanic Black (NHB) and White (NHW) women diagnosed with uterine cancer between 2010 and 2018. Poorly differentiated and undifferentiated endometrioid, serous, clear cell, mixed, carcinosarcoma and mucinous histologies were considered high grade. Patients diagnosed by death certificate, or with unknown stage or histology were excluded. Socioeconomic status was assessed using the Yost Score, an area-level composite measure of socioeconomic deprivation derived from census-tract data at cancer diagnosis. Lower Yost quintile indicates higher deprivation. Competing risk analysis was used to determine risk of uterine cancer specific mortality (reported as subdistribution hazard ratio [SHR]) and to assess statistical interaction between race and Yost score. Results: A total of 4,840 patients were identified. Race conferred significant increased risk of cancer-specific mortality (SHR 2.11, p < 0.0001). Race and Yost score interacted to increase risk of cancer-specific mortality in NHB women in the lowest Yost quintile (SHR 2.23, p < 0.0001) compared to NHW and NHB women in the highest quintiles. The interaction between race and Yost score persisted only among women with low grade cancers (SHR 1.7, p = 0.04). Time from diagnosis to surgery increased as Yost score decreased. Women in the lowest Yost quintile had lower likelihood of receiving surgery within 6 weeks of diagnosis (OR 0.74, p = 0.001). This effect persisted among women with low grade cancer (NHB OR 0.75, p = 0.014; lowest Yost quintile OR 0.68, p < 0.0001). An association between race, Yost score and delays in time to surgery was not seen among women with high grade cancers. Conclusions: Race and Yost score, an area-based measure of socioeconomic deprivation, are associated with increased cancer-specific mortality risk among women with low grade cancer. NHB race and high socioeconomic deprivation are associated with delayed primary surgery. The interaction between race and socioeconomic deprivation may underlie known disparities in uterine cancer survival, particularly in low grade disease where there is the greatest opportunity for timely curative surgery.

Neighborhood area-level social determinants and receipt of mammography screening in an area with high deprivation: A retrospective cohort study.

e18550 Background: Early detection through screening mammography has been shown to decrease breast cancer mortality. Screening mammography rates remains low among racial/ethnic minorities and patients with socioeconomic deprivation (SED). Most studies evaluating the role of area-level social determinants of health and breast cancer screening have included only a small number of variables; in this study, a comprehensive and granular measure of socioeconomic deprivation (SED) which included 17 variables was used to determine an association with screening mammogram completion. Methods: A retrospective cohort study was conducted at an academic hospital system between 2014-2020 to identify asymptomatic female patients who received screening mammogram referrals in their primary care clinic after they were deemed eligible per screening guidelines. Patients were assessed for mammogram completion at their annual visits. SED was evaluated using the area deprivation index (ADI), a measure of 17 variables including education, housing, and income at the census block group level. Other covariates analyzed were insurance status, age, and race. Chi-square test, Kruskal-Wallis test and a multivariate logistic regression model were used for statistical analysis. Results: 856 women were referred for screening mammography. 324 (38%) underwent mammogram. Patients with high, moderate, and low SED comprised 69 (8%), 287 (34%) and 500 (58%) of the cohort, respectively. In multivariable analysis, SED and race were not associated with higher screening rates. Uninsured and self-pay patients had the lowest odds of screening mammography completion (AOR 0.22; 95% 0.08, 0.60) and Medicare patients had decreased odds of mammogram completion relative to privately insured patients (AOR 0.64; 95% CI 0.43, 0.97). Older age was associated with a slightly higher odds of mammography completion (AOR 1.02; 95% CI 1.00, 1.04). Conclusions: The receipt of screening mammography was low among all patients relative to previously published rates. Uninsured/self-pay status was the strongest indicator for completion of mammography. Additional research is needed to understand the barriers that may influence mammography completion in this population with high socioeconomic deprivation. Multivariate Logistic Regression Estimates for Associations Between Mammogram Completion and SED category.[Table: see text]

The impact of social determinants on receipt of colonoscopy in an under-resourced hospital service area: A retrospective cohort study.

216 Background: Although colorectal cancer (CRC) screening with colonoscopy reduces the risk of CRC mortality, screening rates remain low among African Americans and low social economic status (SES) patients. However, few studies have assessed CRC screening rates in under-resourced hospital service areas. Using a granular measure of socioeconomic deprivation (SED), we examined the association between social determinants and CRC screening. Methods: We conducted a retrospective cohort study from 2014-2019 to identify primary care patients referred for CRC screening with colonoscopy at an academic hospital system. Patients were assessed at annual visits for completion of colonoscopy. SED was assessed using the area deprivation index (ADI), a composite measure of 17 SED indicators including income, housing, education, and employment at the census block group level. Other social determinants analyzed were race and insurance status. Frequency and multivariable logistic regression were used for statistical analysis. Results: 1040 patients met CRC screening guidelines and were referred for colonoscopy. 136 (13.1%) underwent colonoscopy in the follow-up period. High and low SED made up 655 (63%) and 77 (7.4%) of patients, respectively. SED, race, age, and sex were not associated with higher screening rates. Uninsured patients had a lower rate of screening. After controlling for other social determinants, uninsured patients had the lowest odds of colonoscopy (OR 0.28; 95% CI, 0.08-0.92). Conclusions: In this under-resourced hospital service area, receipt of colonoscopy for CRC screening is significantly lower than previously reported. Furthermore, screening rates were persistently low across strata of SED, race and insurance status, with uninsured patients having the lowest odds of screening. These data suggest that in an under-resourced hospital service area with extensive SED, further research is needed to understand the role of social determinants and behavioral factors to address disparities in CRC screening with colonoscopy. [Table: see text]

Abstract A117: Area deprivation index and rurality in relation to lung cancer prevalence and mortality in a rural state

Abstract Objectives: Lung cancer is the leading cause of cancer-related mortality. In rural areas, socioeconomic deprivation and geographic barriers to care may both influence lung cancer prevalence and outcomes. We sought to describe how socioeconomic deprivation and rurality are related to lung cancer prevalence and mortality. Methods: We conducted a population-based cross-sectional analysis of: 1) prevalent lung cancers identified in a statewide all-payer claims dataset between 2012 and 2016; 2) lung cancer deaths in Maine from 2012-2016, ascertained by the state death registry; 3) rurality; and 4) area deprivation index (ADI), a geographic area-based measure of socioeconomic deprivation. Analyses examined rate ratios for lung cancer prevalence and mortality according to rurality (small/isolated rural, large rural, or urban) and ADI (in quintiles, with highest reflecting the most deprivation) and after adjusting for age, sex, and area-level smoking rates as determined by Behavioral Risk Factor Surveillance System data. Results: Among 1,223,006 adults aged 20+ in the all-payer claims dataset during the 5-year observation period, 8300 received care for prevalent lung cancer and there were 4618 deaths from lung cancer between 2012 and 2016. Of the prevalent lung cancer cases, 36.1% resided in isolated or small rural areas, and 42.6% resided in the highest two quintiles for ADI. Increasing rurality was positively associated with lung cancer prevalence and mortality, but these associations did not persist after adjusting for age, sex and smoking rates. However, increasing ADI was positively associated with both lung cancer prevalence (rate ratio 1.41 (95% CI 1.30-1.54) for ADI quintile 5 vs. quintile 1) and mortality (rate ratio for ADI quintile 5 vs. quintile 1, 1.59 (95% CI 1.41-1.79) in multivariable models adjusted for age, sex, and smoking rates. Conclusion: Socioeconomic deprivation was associated with higher lung cancer prevalence and mortality, but rurality was not. These findings suggest that interventions aimed at improving access to lung cancer prevention, screening, and treatment services should target populations with socioeconomic deprivation, rather than rurality per se. Future research should examine the relationship between socioeconomic deprivation and other indicators of population health in rural areas. Citation Format: Kathleen M Fairfield, Adam Black, Erika Ziller, Kimberly Murray, Lee Lucas, Leo B Waterston, Neil Korsen, Darlene Ineza, Paul KJ Han. Area deprivation index and rurality in relation to lung cancer prevalence and mortality in a rural state [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A117.

The Dynamic Deprivation Index: measuring relative socio-economic deprivation in NZ on a monthly basis

ABSTRACTThe standard measures of relative socio-economic deprivation within New Zealand are the NZDEP studies and the NZ IMD. Although both sets of studies are extremely rigorous, high quality research outputs they are only able to provide a snapshot of the national distribution of relative socio-economic deprivation at fixed points in time. The inability to express deprivation levels as an extended and current time series means that not only are policy analysts and researchers working with outdated information, but also that it is often unfeasible to associate changes in deprivation levels to specific events or policy implementations. The Dynamic Deprivation Index (DDI) assigns a deprivation score and deprivation index to each area unit in New Zealand on a monthly basis. In this paper we look to describe the methodology behind the construction of the DDI and to validate the results therein. We argue that if public bodies were to make the data they hold more easily accessible, then there is no reason why New Zealand should not be able to benefit from a measure of socio-economic deprivation that combines the sophistication of the NZDEP studies or IMD with the contemporaneousness of the DDI.

The association between socioeconomic deprivation and old-age survival in five European countries–A cross-national ecological analysis

Introduction Geographical differences in the spatial distribution of old-age survival exist in Europe and might be attributed to socioeconomic deprivation. In this study, we aimed to estimate the association between socioeconomic deprivation and old-age survival in Europe and investigate whether it varies by country and gender. Methods Our study incorporated five countries (Portugal, Spain, France, Italy, and England) and a total of 1911 small areas. A ten-year survival rate expressing the proportion of population aged 75–84 years who reached 85–94 years old was calculated at area-level for 2001–11. To estimate associations, we used Bayesian spatial models and a transnational measure of socioeconomic deprivation. Additionally, attributable/prevention fractions were calculated. Results Overall, there was a significant association between deprivation and survival in both genders. In England that association was stronger, following a clear dose-response relation. Although lesser in magnitude, significant associations were observed in Spain and Italy, whereas in France and Portugal these were weaker/absent. We projected that the elimination of socioeconomic differences between areas would increase survival by 7.1% and even a slight reduction in socioeconomic differences would mean a 1.6% higher survival in these countries. Conclusions Socioeconomic deprivation was associated with survival among older adults at ecological-level, although with varying magnitude across countries. Reasons for such cross-country differences should be sought. Our results emphasize the importance of reducing socioeconomic differences between areas.

Practice funding and socioeconomic deprivation in English general practices: a longitudinal study 2013–2017

BackgroundThe NHS general practice payment formula has no specific measures of socio-economic deprivation, an important health determinant. Variables related to population health needs are poor predictors of cross-sectional variations in practice payments. Additional years of payments data allow longitudinal analyses.AimDo deprivation scores predict variations in the slope over time of NHS practice payments, after adjusting for organisational and population factors?MethodThe sample was 6898 English practices with more than 500 patients, studied over 4 financial years, 2013–2014 to 2016–2017. The dependent variable was total NHS payments per registered patient (after deductions). The independent variable was the Index of Multiple Deprivation (IMD) 2015 score for each practice (range: 3.2 to 66.5). 17 Confounders were selected for conceptual plausibility and data availability at practice level, and included organisational variables and population variables A random intercepts and random slopes model was fitted to adjust for clustering of measurements within practices. The linear effects of independent variables on payments over time were modelled by fitting interaction terms (product of variable with year). Descriptive statistics and univariable analyses were undertaken.ResultsPractice IMD scores were very weak predictors of longitudinal variations in total payments’ slopes (4.9p/patient/1 unit increase in IMD). We also found that our confounders had very small predictive effects, and payments and IMD were not correlated in any year (Spearman correlation coefficients ranging from 0.01 to 0.06). The median of payments increased from £102.77 (2013–2014) to £115.43 (2016–2017).ConclusionTotal payments increased very slightly more in practices with higher deprivation scores. This suggests that the NHS general practice payment formula may not adequately compensate practices whose populations have greater health needs.

Adolescent mental health and behavioural problems, and intergenerational social mobility: A decomposition of health selection effects

According to the health selection hypothesis, poor mental health and behavioural problems in adolescence limit socioeconomic attainment. But to what extent is health selection driven by prior social causation? This paper quantifies the extent to which health selection – here, restricted or downward intergenerational social class mobility due to poor mental health or behavioural problems – can be attributed to the influence of modifiable childhood risk factors. The UK National Child Development Study provides measures of socioeconomic deprivation and childhood adversities, as well as multiple-informant ratings of adolescents' mental health and behavioural problems, for which confirmatory factor analysis supports a three-factor model. Decomposition analysis is used to robustly assess the extent of attenuation of selection effects when conditioning on the childhood environment. Conduct problems, hyperactivity, and to a lesser extent emotional symptoms at age 16 are associated with individuals' chances of achieving (un)desirable mobility outcomes. When prior childhood risk factors are taken into account, the association of conduct problems with mobility is attenuated by around 50%, indicating a substantial role for confounding and earlier processes of social causation in the generation of this health selection effect. Further analyses indicate that this attenuation is greater for those from the most disadvantaged backgrounds and is mostly driven by the inclusion of indicators of generalised disadvantage such as crowded housing and low income. On the other hand, the effects of emotional symptoms and hyperactivity on mobility outcomes are not significantly accounted for by childhood risk factors. This study adds to the health inequalities literature by interrogating the empirical validity of the usual interpretation of health selection effects as indicating the causal priority of the onset of poor mental health.

Trends in Socioeconomic Inequalities in Body Mass Index, Underweight and Obesity among English Children, 2007-2008 to 2011-2012.

BackgroundSocioeconomic inequalities in childhood obesity have been reported in most developed countries, with obesity more common in deprived groups. Whether inequalities are found in the prevalence of underweight, the rest of the body mass index (BMI) distribution, or have changed across time is not clear.Methods and FindingsThe sample comprised 5,027,128 children on entry (4 to 5 years old) and leaving (10 to 11 years) state primary (elementary) school who participated in the National Child Measurement Programme (England, United Kingdom). We used area-level deprivation (Indices of Multiple Deprivation at the lower super output area) as a measure of socioeconomic deprivation. From 2007–2008 to 2011–2012 inequalities in obesity between the most compared to least deprived group increased (from 7.21% to 8.30%; p<0.001), whereas inequalities in the prevalence of underweight (1.50% to 1.21%; p = 0.15) were stable during this period. There were no differences by age group or by sex, but a three-way interaction suggested inequalities in obesity had increased at a faster rate for 10 to 11 year old girls, than 4 to 5 year old boys, (2.03% vs 0.07%; p<0.001 for interaction). Investigating inequalities across the distribution of zBMI showed increases in mean zBMI (0.18 to 0.23, p<0.001) could be attributed to increases in inequalities between the 50th and 75th centiles of BMI. Using the 2011 to 2012 population attributable risk estimates, if inequalities were halved, 14.04% (95% CI 14.00% to 14.07%) of childhood obesity could be avoided.ConclusionsSocioeconomic inequalities in childhood obesity and zBMI increased in England between 2007–2008 and 2011–2012. Inequalities in the prevalence of underweight did not change. Traditional methods of examining inequalities only at the clinical thresholds of overweight and obesity may have led the magnitude of inequalities in childhood BMI to be underestimated.

Survival for patients with chronic leukemias in the US and Britain: Age-related disparities and changes in the early 21st century.

Chronic lymphocytic leukemia (CLL) and chronic myeloid leukemia (CML) are highly treatable conditions occurring primarily in older patients. Lower survival among older people has been reported in both conditions, but newer treatments may change both the overall survival rate and the relative risk associated with aging. Here, we examine survival for patients with CLL and CML in the United States (US) and England. Patients with CLL and CML were identified from the Surveillance, Epidemiology, and End Results (US) and National Cancer Registry (England). Five-year relative survival was calculated by major age group. Excess hazard ratios (EHR) by age were calculated for each condition, and multivariable analysis was performed to adjust for the following potential confounders: gender, race or ethnic group (US only), period of diagnosis, and a measure of socioeconomic deprivation (England only). Five-year relative survival increased for both CLL and CML in both England and the US between 1996-2000 and 2006-2010. However, relative age-related disparities persisted. For CLL, the EHR for death was 9.44 (7.84-11.36) in the US and 6.14 (5.65-6.68) in England for ages 85+ compared to ages 55-64. For CML, the EHR was 3.52 (3.17-3.90) in the US and 4.54 (4.13-4.98) in England for ages 75+ compared to ages 45-64. Survival improved for patients with chronic leukemias in the early 21st century. However, age-related disparities persist, despite clinical trial evidence that treatment in older adults with chronic leukemia can be safe and effective. Further research to determine the reasons for the lower survival in older patients and greater awareness of this problem may improve survival for older patients with chronic leukemia.

S135 Asthma, Occupation and Quality of Life in a historically Industrialised Area of the United Kingdom

IntroductionWhilst harmful inhaled workplace exposures are known to be associated with either the development or aggravation of asthma, little is known about the specific relationship between asthma, occupational exposures and...

S133 COPD, Occupation and Quality of Life Among Residents of a Historically Industrialised Area

IntroductionCOPD is known to significantly affect health and quality of life, and is increasingly recognised to have a significant contribution from occupational exposures, particularly vapours, gases, dusts and fumes (VGDF)....

Modeling violent crime rates: A test of social disorganization in the city of Tshwane, South Africa

Tests of social disorganization theory are commonplace in international criminological literature. Indeed a plethora of studies had emerged over the past seventy years examining and extending the theory throughout much of the developed world. The testing, however, of the landmark theory's key propositions in Africa in general, and South Africa in particular, is in its infancy. This study aimed to address this shortcoming by analyzing associations between various census measures of social disorganization and violent crime rates in the city of Tshwane, South Africa. Overall, marginal support was found for the social disorganization theory: violent crime in Tshwane was associated with certain measures of socioeconomic deprivation, and residential mobility. The study not only demonstrated the applicability of certain elements of Western criminological theory to contemporary urban South Africa, but also revealed important differences in the ecological dynamics of violent crime across differing cultural contexts.

Socioeconomic deprivation, urban-rural location and alcohol-related mortality in England and Wales

BackgroundMany causes of death are directly attributable to the toxic effects of alcohol and deaths from these causes are increasing in the United Kingdom. The aim of this study was to investigate variation in alcohol-related mortality in relation to socioeconomic deprivation, urban-rural location and age within a national context.MethodsAn ecological study design was used with data from 8797 standard table wards in England and Wales. The methodology included using the Carstairs Index as a measure of socioeconomic deprivation at the small-area level and the national harmonised classification system for urban and rural areas in England and Wales. Alcohol-related mortality was defined using the National Statistics definition, devised for tracking national trends in alcohol-related deaths. Deaths from liver cirrhosis accounted for 85% of all deaths included in this definition. Deaths from 1999-2003 were examined and 2001 census ward population estimates were used as the denominators.ResultsThe analysis was based on 28,839 deaths. Alcohol-related mortality rates were higher in men and increased with increasing age, generally reaching peak levels in middle-aged adults. The 45-64 year age group contained a quarter of the total population but accounted for half of all alcohol-related deaths. There was a clear association between alcohol-related mortality and socioeconomic deprivation, with progressively higher rates in more deprived areas. The strength of the association varied with age. Greatest relative inequalities were seen amongst people aged 25-44 years, with relative risks of 4.73 (95% CI 4.00 to 5.59) and 4.24 (95% CI 3.50 to 5.13) for men and women respectively in the most relative to the least deprived quintiles. People living in urban areas experienced higher alcohol-related mortality relative to those living in rural areas, with differences remaining after adjustment for socioeconomic deprivation. Adjusted relative risks for urban relative to rural areas were 1.35 (95% CI 1.20 to 1.52) and 1.13 (95% CI 1.01 to 1.25) for men and women respectively.ConclusionsLarge inequalities in alcohol-related mortality exist between sub-groups of the population in England and Wales. These should be considered when designing public health policies to reduce alcohol-related harm.

Free-roaming and surrendered dogs and cats submitted to a humane shelter in Wellington, New Zealand, 1999–2006

AIMS: To describe submissions of dogs and cats to an animal welfare shelter over a 6-year period, and to evaluate the association between the numbers of dogs and cats submitted per square kilometre, human population density, and standardised measures of socioeconomic deprivation. METHODS: Details of free-roaming and surrendered dogs and cats presented to the Wellington shelter of the Society for the Prevention of Cruelty to Animals (SPCA) for the period 01 July 1999 to 28 February 2006 were recorded in a relational database. Data were plotted as counts of animals presented to the shelter each month as a function of calendar time. Kernel-smoothing techniques were used to describe the spatial distribution of capture location. The association between the number of dogs and cats submitted per square kilometre, human population density (both estimated at the mesh-block level), and mesh-block socioeconomic deprivation index were quantified using the Pearson product-moment correlation coefficient (r). RESULTS: The data comprised submission details for 3,709 dogs and 13,563 cats. There was a progressive decline in the number of dogs and cats submitted to the shelter over the study period, and a marked seasonal variation in submissions of cats. Submission density of dogs and cats was positively associated with human population density (Pearson's r=0.12; 95% CI=0.06–0.20 and 0.39; 95% CI=0.33–0.45, respectively) and socioeconomic deprivation (Pearson's r=0.12; 95% CI=0.05–0.19 for both dogs and cats). CONCLUSIONS: Active approaches to free-roaming cat control by the Wellington SPCA should focus on the period June to September, prior to the feline breeding season, in population-dense and socioeconomically deprived areas. Composite analyses of submission details from all animal shelters in the Wellington region should allow factors associated with the distribution of free-roaming dogs and cats to be more precisely estimated.