Measures Of Socioeconomic Position Research Articles

Geographical variation in prostate cancer testing explained by socio-economic position in Stockholm

Abstract Background Prostate cancer screening using prostate-specific antigen (PSA) testing is controversial but remains prevalent in many countries. Despite its prevalence there is little information in Sweden or globally on the spatial heterogeneity in PSA testing. This study aims to describe the spatio-temporal variation in PSA testing in the Stockholm region specifically at the municipality and small area level. Additionally, it aims to quantify the extent to which socio-economic position (SEP) indicators such as education, income, and country of birth explain the observed variation in PSA testing. Methods A retrospective population-based register study was conducted, encompassing men aged 40 years and older residing in the Stockholm region from 2007 to 2016. Utilizing spatial smoothing techniques, we calculated the age-standardised proportion of men undergoing PSA testing prior to any prostate cancer diagnosis within each area for every calendar year. Furthermore, we used Bayesian logistic regression models with spatial random effects to estimate the individual-level association between PSA testing and socio-economic position. The proportion of variance in PSA testing explained by various measures of SEP was also estimated at both the municipality and small area levels. Results Significant geographical disparities in PSA testing were observed across small areas within Stockholm. The proportion of variance explained in PSA testing at the small area level was highest for income (32.6%), followed by education (9.7%) and country of birth (7.4%). Incorporating all SEP measures led to a higher proportion of explained variance at the small area level (41.6%) compared to the municipality level (24.8%). Conclusions PSA testing was significantly associated with various socio-economic indicators and some of the spatial variation could be explained by SEP. It would be useful to ascertain whether similar patterns are observed in other regions or countries. Key messages • The findings suggested widespread and consistent opportunistic prostate cancer screening practices within the Stockholm region, raising concerns regarding potential overdiagnosis and overtreatment. • The socio-economic differences in prostate cancer screening could partially explain the differences in cancer incidence and mortality.

All cause and cause specific mortality in 15-24-year-olds in Denmark 2010 to 2022: nationwide study of socioeconomic predictors

ObjectiveTo assess inequalities in all cause and cause specific mortality in young people and if there are differences across gender and age groups.DesignNationwide cohort study of socioeconomic predictors.SettingDenmark, 1 January...

O-162 Ethnic disparity in the use of treatment with assisted reproductive technologies in Denmark

Abstract Study question Is ethnic background among 18-45-year-old women associated with initiating ART-treatment in Denmark? Summary answer Results indicate ethnic disparity in the use of ART-treatment, with immigrants and descendants having lower odds of initiating ART-treatment compared to women with Danish origin. What is known already The use of fertility treatment has increased over the past decades. Ethnic disparity exists in the use of health care, but there is limited knowledge about the association between ethnicity and use of fertility treatment. Previous studies have shown that women with lower socioeconomic position (SEP) have lower odds of initiating ART-treatment compared to women with higher SEP. Immigrants and descendants often have lower SEP compared to the general population, but specific mechanisms might be at play when residing and navigating in a new country and healthcare system. Study design, size, duration This is a national, register-based study based on the DANAC II cohort. Women initiating ART-treatment (IVF or ICSI) aged 18–45 were identified in the Danish IVF Register from 1994-2017. According to the time of ART-treatment women were included in the study and randomly age-matched with 10 untreated women in the background population. The study population consisted of 676.355 women. Participants/materials, setting, methods The probability of initiating ART-treatment was compared across ethnic groups and examined in logistic regression analysis. Migration status and country of origin were used as proxies for ethnic group in separate analysis. Age was accounted for by matching, and additional factors of interest such as SEP measures were classified as potential mediators and thus not included in the main analyses. The effect of duration of residence in Denmark was analysed separately among immigrants. Main results and the role of chance The study population consisted of 526.507 (78 %) women of Danish origin, 142.656 (21 %) were immigrants and 7.192 (1 %) descendants of immigrants. Among women of Danish origin 11 % had initiated ART-treatment compared to 5 % of immigrants and 9 % of descendants. Immigrants had 56 % lower odds of receiving first ART-treatment compared to women of Danish origin (OR 0,44, CI 95 % 0,43-0,45), while descendants had 22 % lower odds compared to women of Danish origin (OR 0,78, CI 95 % 0,72-0,84). Regarding the analysis looking at country of origin results showed that 3-4 % of women originating from western countries had received first ART-treatment, compared to 6-8 % of women originating from non-western countries. Women originating from western countries had between 65-78% lower odds for receiving first ART-treatment compared to women of Danish origin. Odds of receiving ART-treatment among women of non-western origin was between 34-47 % lower compared to women of Danish origin. This indicates that disparity in first ART-treatment is particularly distinctive among women of western origin, possibly explained by differences in reasons for migrating. Limitations, reasons for caution Information on the reason for infertility and desire to have children could have provided more insight into the disparity. Data about basis for residence could have provided information on reasons for immigration and duration of residence. Wider implications of the findings Infertility and childlessness can have severe consequences for individuals and society, and equal access to fertility treatment is important, not least in a universal welfare society. The results of this study indicate ethnic disparity in ART-treatment, and we encourage further research regarding the possible causes and barriers to initiate treatment. Trial registration number not applicable

When in the lifecourse? Socioeconomic position across the lifecourse and biological health score

PurposeEducational attainment is associated with multiphysiological wear and tear. However, associations with measures of socioeconomic position (SEP) across different life-stages are not established. MethodsUsing regression models and data from 8105 participants from the UK Household Longitudinal Study (Understanding Society), we examined associations of lifecourse SEP with an overall biological health score (BHS). BHS is broader than usual measures of biological ‘wear and tear’ and is based on six physiological subsystems (endocrine, metabolic, cardiovascular, inflammatory/immune, liver, and kidney), with higher scores indicating worse health. Lifecourse SEP was based on respondents’ parental, first, and most recent occupations. ResultsAssociations with SEP at all life-stages demonstrated higher BHS with increasing disadvantage (e.g. slope index of inequality (SII) (95 % CI) for most recent SEP: 0.04 (0.02, 0.06)). There was little difference in the magnitude of associations for SEP measured at each life-stage. Cumulative disadvantage across the lifecourse showed a stepped association with increasing BHS (SII (95 % CI): 0.05 (0.04, 0.07)). Associations were largely driven by metabolic, cardiovascular, and inflammatory systems. ConclusionOur results suggest that disadvantaged SEP across the lifecourse contributes cumulatively to poorer biological health, highlighting that every life-stage should be a target for public health policies and intervention.

Examining the Psychometric Properties of the Family Affluence Scale in Norwegian Health Behaviour in School-Aged Children Surveys: Implications for Time Trend Analysis

This study assessed the applicability of the Family Affluence Scale II (FASII) for conducting time trend analysis within Norway's “Health Behaviour in School-Aged Children Study” (HBSC), spanning from 2002 to 2018. A dataset comprising 27,470 valid questionnaires was employed to assess the psychometric properties of the FASII with respect to validity and reliability for use at single- and multiple times points. The analytical approach encompassed a range of statistical techniques, including confirmatory factor analysis (CFA), multi-group CFA, polychoric correlation testing between FASII scores and perceived family wealth, a subjective measure of socioeconomic position (SEP), and an assessment of perceived family wealth and FASII scores across time. The results of the study revealed an overall good model fit in CFA and a positive correlation between FASII scores and perceived family wealth. However, the analysis uncovered measurement non-invariance across survey years, sex, and age groups. Measurement non-invariance hampers direct time-to-time comparisons of FASII scores, impeding the assessment of affluence development over time. Despite this limitation, FASII maintains its utility for ranking affluence and measuring health outcomes at single time points. As such, this study offers valuable insight into the suitability of FASII for time trend analysis within the Norwegian HBSC data and broader research on social inequality.

Socioeconomic inequalities in greenhouse gas emissions from household travel in Aotearoa/New Zealand

BackgroundA just transition to a decarbonised transport system requires understanding current inequity in transport-related greenhouse gas emissions (GHGe). MethodsWe used the population-based nationally representative New Zealand Household Travel Survey (2015–2018 data) to examine inequalities in GHGe from household travel by NZDep (an area measure of socioeconomic position [SEP]). ResultsThere was a broadly linear association between SEP and GHGe from household travel. People resident in the least deprived areas emitted around 79 % more GHGe per week from household travel than those in the most [mean 63.6 CO2eq (95 %CI 58.5–68.6) compared to 35.6 kg CO2eq (95 %CI (32.6–38.6)]. Most of the difference was due to the additional 97 km per week travelled by car by people resident in the least deprived areas. Residents in the least deprived areas travelled further and more frequently for paid and unpaid work and leisure purposes than those in the most. Air travel also showed significant inequities with 2.4 % of residents in the least deprived areas reporting air travel in the last week compared to 0.1 % in the most deprived. Air travel was the second largest source of mean weekly transport emissions in residents living in the least deprived areas. ConclusionThere are large inequities by area deprivation in GHGe from household travel in Aotearoa/New Zealand. Transport policy needs to focus on measures to reduce emissions that are effective and reduce inequities. Significant work on policy processes, design and evaluation need to occur to facilitate this dual transformation.

Social inequalities in pregnancy metabolic profile: findings from the multi-ethnic Born in Bradford cohort study.

Lower socioeconomic position (SEP) associates with adverse pregnancy and perinatal outcomes and with less favourable metabolic profile in nonpregnant adults. Socioeconomic differences in pregnancy metabolic profile are unknown. We investigated association between a composite measure of SEP and pregnancy metabolic profile in White European (WE) and South Asian (SA) women. We included 3,905 WE and 4,404 SA pregnant women from a population-based UK cohort. Latent class analysis was applied to nineteen individual, household, and area-based SEP indicators (collected by questionnaires or linkage to residential address) to derive a composite SEP latent variable. Targeted nuclear magnetic resonance spectroscopy was used to determine 148 metabolic traits from mid-pregnancy serum samples. Associations between SEP and metabolic traits were examined using linear regressions adjusted for gestational age and weighted by latent class probabilities. Five SEP sub-groups were identified and labelled 'Highest SEP' (48% WE and 52% SA), 'High-Medium SEP' (77% and 23%), 'Medium SEP' (56% and 44%) 'Low-Medium SEP' (21% and 79%), and 'Lowest SEP' (52% and 48%). Lower SEP was associated with more adverse levels of 113 metabolic traits, including lower high-density lipoprotein (HDL) and higher triglycerides and very low-density lipoprotein (VLDL) traits. For example, mean standardized difference (95%CI) in concentration of small VLDL particles (vs. Highest SEP) was 0.12 standard deviation (SD) units (0.05 to 0.20) for 'Medium SEP' and 0.25SD (0.18 to 0.32) for 'Lowest SEP'. There was statistical evidence of ethnic differences in associations of SEP with 31 traits, primarily characterised by stronger associations in WE women e.g., mean difference in HDL cholesterol in WE and SA women respectively (vs. Highest-SEP) was -0.30SD (-0.41 to -0.20) and -0.16SD (-0.27 to -0.05) for 'Medium SEP', and -0.62SD (-0.72 to -0.52) and -0.29SD (-0.40 to -0.20) for 'Lowest SEP'. We found widespread socioeconomic differences in metabolic traits in pregnant WE and SA women residing in the UK. Further research is needed to understand whether the socioeconomic differences we observe here reflect pre-conception differences or differences in the metabolic pregnancy response. If replicated, it would be important to explore if these differences contribute to socioeconomic differences in pregnancy outcomes.

Factors associated with repeat emergency department visits for mental health care in adolescents: A scoping review

ObjectivesThe aim of this review was to identify factors associated with multiple visits to emergency department (ED) services for mental health care in adolescents. MethodsElectronic databases (MEDLINE, PsycINFO, Embase, CINAHL, Web of Science and ProQuest Dissertations & Thesis Global) were searched for evidence that presented an association between risk factors or correlates of multiple visits to the emergency departmental for mental health care by 10–24 year olds. High impact use was defined as at least one return ED visit for mental health care. Primary studies of any quantitative design were included, with no exclusions based on language or country and all possible risk factors were considered. Data were extracted and synthesised using quantitative methods; frequencies of positive, negative and null associations were summarised for categories of potential risk factors. ResultsSixty-five studies were included in the review. Most studies were from North America and reported a wide range of measures of high impact ED use, the most common being a binary indicator of multiple ED visits. Sex/gender and age were the most frequently reported risk factors. Measure of previous or concurrent access to mental health care was consistently positively associated with high impact use. Having private health insurance, compared with public or no insurance, was generally negatively associated with high impact use. Proxy measures of socioeconomic position (SEP) showed associations between lower SEP and more high impact use in a small number of studies. No other factors were consistently or uniformly associated with high impact use. ConclusionsThe review identified a substantial evidence base but due to the variability in study design and measurement of both risk factors and outcomes, no consistent risk factors emerged. More research is needed, particularly outside North America, using robust methods and high quality routinely collected data.

Assessment of census-tract level socioeconomic position as a modifier of the relationship between short-term PM2.5 exposure and cardiovascular emergency department visits in Missouri

IntroductionAmbient particulate matter ≤ 2.5 µm in aerodynamic diameter (PM2.5) exposure elevates the risk for cardiovascular disease morbidity (CVDM). The aim of this study is to characterise which area-level measures...

Role of cardiovascular health factors in mediating social inequalities in the incidence of dementia in the UK: two prospective, population-based cohort studies

The contribution of modifiable risk factors to social inequalities in dementia, observed in longitudinal studies, remains unclear. We aimed to quantify the role of cardiovascular health factors, assessed using Life's Essential 8 (LE8) score, in mediating social inequalities in incidence of dementia and, for comparison, in incidence of stroke, coronary heart disease, and mortality. In this prospective, population-based cohort study, we collected data from the UK Whitehall II Study and UK Biobank databases. Participants were included if data were available on SEP, outcomes and LE8 (smoking, physical activity, diet, body mass index, blood pressure, fasting blood glucose, lipid levels, sleep duration). The primary outcome was incident dementia and secondary outcomes were stroke, coronary heart disease, and mortality. Outcomes were derived from electronic healthcare records. Socioeconomic position (SEP) was measured by occupation in Whitehall II and education in UK Biobank. Counterfactual mediation analysis was used to quantify the extent to which LE8 score explained the associations of SEP with all outcomes. Analyses involved Cox regression, accelerated failure time models, and linear regression; and were adjusted for age, sex, and ethnicity. Between 10.09.1985 and 29.03.1988, a total of 9688 participants (mean age±SD 44.9±6.0; 67% men) from the Whitehall II study, and between 19.12.2006 and 01.10.2010, 278,215 participants (mean age±SD 56.0±8.1; 47% men) from the UK Biobank were included. There were 606 and 4649 incident dementia cases over a median (interquartile range) follow-up of 31.7 (31.1-32.7) and 13.5 (12.7-14.1) years respectively in Whitehall II and UK Biobank. In Whitehall II, the hazard ratio was 1.85 [95% CI 1.42, 2.32] for the total effect of SEP on dementia and 1.20 [1.12, 1.28] for the indirect effect via the LE8, the proportion mediated being 36%. In UK Biobank, the total effect of SEP on dementia was 1.65 [1.54, 1.78]; the indirect effect was 1.11 [1.09, 1.12], and the proportion mediated was 24%. The proportions mediated for stroke, coronary heart disease, and mortality were higher, ranging between 34% and 63% in Whitehall II and between 36% and 50% in UK Biobank. In two well-characterised cohort studies, up to one third of the social inequalities in incidence of dementia was attributable to cardiovascular health factors. Promotion of cardiovascular health in midlife may contribute to reducing social inequalities in risk of dementia, in addition to cardiovascular diseases and all-cause mortality. This study used adult measures of SEP, further research is warranted using lifecourse measures of SEP. NIH (RF1AG062553).

Socioeconomic position, family context, and child cognitive development.

Socioeconomic position (SEP) may have different effects on cognitive development and family context could play a role in this association. This work aimed to analyse the role of socioeconomic positions, measured via various indicators collected longitudinally, in cognitive development at 7-11years of age, evaluating the role of family context as a potential mediator. The study sample included 394 and 382 children from the INMA Gipuzkoa and Valencia cohorts, respectively. SEP indicators were assessed during pregnancy (family social class, parental education, employment, and disposable income) and at 7 (Gipuzkoa) and 11 (Valencia) years of age (At Risk of Poverty or Social Exclusion (AROPE)). Family context and cognitive development were measured with the Haezi-Etxadi Family Assessment Scale 7-11 (HEFAS 7-11) and Raven's Coloured Progressive Matrices (Raven's CPM), respectively. Linear regression models were developed to assess the relationships between (a) SEP-family context, (b) SEP-cognitive development, and (c) family context-cognitive development, adjusting for a priori-selected confounders. Simple and multiple mediation analyses were performed to explore the role of family context in the SEP-cognitive development relationship. Lower SEP was related with a lower cognitive score, this association being particularly robust for family social class. SEP indicators were related to subscales of family context, in particular those regarding cognitive stimulation, parental stress, and parenting. A relationship was also found between these three subscales and child cognitive development, mediating the effect of family social class on child cognition by 5.2, 5.5, and 10.8%, respectively, and 12.0% jointly. Conclusion: Both family SEP and context contribute to a child's cognitive development. Equalising policies and positive parenting programmes could contribute to improving cognitive development in children. What is Known: • Parental social class, education, and employment status have been widely employed to measure socioeconomic position. What is New: • This work focuses on standard measurements of socioeconomic position but also other economic indicators such as the EHII and AROPE, and their effect on child cognitive development and family context. • Promotion of cognitive and linguistic development, parental stress and conflict, and parental profile fostering child development mediated the effect of family social class on cognitive development.

Intrinsic capacity trajectories and socioeconomic inequalities in health: the contributions of wealth, education, gender, and ethnicity

BackgroundLife-long health inequalities exert enduring impacts and are governed by social determinants crucial for achieving healthy aging. A fundamental aspect of healthy aging, intrinsic capacity, is the primary focus of this study. Our objective is to evaluate the social inequalities connected with the trajectories of intrinsic capacity, shedding light on the impacts of socioeconomic position, gender, and ethnicity.MethodsOur dynamic cohort study was rooted in three waves (2009, 2014, 2017) of the World Health Organization’s Study on Global AGEing and Adult Health in Mexico. We incorporated a nationally representative sample comprising 2722 older Mexican adults aged 50 years and over. Baseline measurements of socioeconomic position, gender, and ethnicity acted as the exposure variables. We evaluated intrinsic capacity across five domains: cognition, psychological, sensory, vitality, and locomotion. The Relative Index of Inequality and Slope Index of Inequality were used to quantify socioeconomic disparities.ResultsWe discerned three distinct intrinsic capacity trajectories: steep decline, moderate decline, and slight increase. Significant disparities based on wealth, educational level, gender, and ethnicity were observed. Older adults with higher wealth and education typically exhibited a trajectory of moderate decrease or slight increase in intrinsic capacity. In stark contrast, women and indigenous individuals were more likely to experience a steeply declining trajectory.ConclusionsThese findings underscore the pressing need to address social determinants, minimize gender and ethnic discrimination to ensure equal access to resources and opportunities across the lifespan. It is imperative for policies and interventions to prioritize these social determinants in order to promote healthy aging and alleviate health disparities. This approach will ensure that specific demographic groups receive customized support to sustain their intrinsic capacity during their elder years.

Characteristics of older unpaid carers in England: a study of social patterning from the English Longitudinal Study of Ageing.

A growing number of older people provide unpaid care, but contemporary research evidence on this group is limited. This study aims to describe the characteristics of older people who provide unpaid care and how these vary by socioeconomic position. Using recent information from the English Longitudinal Study of Ageing (ELSA wave 9, 2019), we analysed cross-sectional data on 1,282 unpaid carers aged ≥50. Data on sociodemographics, health, social wellbeing, care intensity and caregiver-recipient relationships were extracted. Total net non-pension wealth quintiles were used as a relative measure of socioeconomic position. Differences between the poorest and richest wealth quintiles were examined through logistic regression. Most older carers in ELSA were female and looking after another older person. Poor mental and physical health and social isolation were common, and socially patterned. Compared with carers in the middle wealth group, the poorest group were more likely to be living with the person they cared for (odds ratio (OR) 1.56 [95% confidence interval (CI) 1.03-2.36]) and more likely to experience loneliness (OR 2.29 [95% CI 1.42-3.69]), dependency (i.e. the need for help with activities of daily living) (OR 1.62 [95% CI 1.05-2.51]), chronic pain (OR 1.81 [95% CI 1.23-2.67]), a higher number of diseases (OR 1.75 [95% CI 1.15-2.65]) and fair/poor self-rated health (OR 2.59 [95% CI 1.79-3.76]). The poorest carers were also less likely to have a high quality of life (OR 0.51 [95% CI 0.33-0.80]) or be in work (OR 0.33 [95% CI 0.19-0.59]). Our findings suggest that financially disadvantaged unpaid carers (and their households) may have the greatest needs for intervention and support. Focussing resources on this group has potential to address social inequalities.

The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use – results of a scoping review

BackgroundBesides macrolevel characteristics of a health care system, mesolevel access characteristics can exert influence on socioeconomic inequalities in healthcare use. These reflect access to healthcare, which is shaped on a smaller scale than the national level, by the institutions and establishments of a health system that individuals interact with on a regular basis. This scoping review maps the existing evidence about the influence of mesolevel access characteristics and socioeconomic position on healthcare use. Furthermore, it summarizes the evidence on the interaction between mesolevel access characteristics and socioeconomic inequalities in healthcare use.MethodsWe used the databases MEDLINE (PubMed), Web of Science, Scopus, and PsycINFO and followed the ‘Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR)’ recommendations. The included quantitative studies used a measure of socioeconomic position, a mesolevel access characteristic, and a measure of individual healthcare utilisation. Studies published between 2000 and 2020 in high income countries were considered.ResultsOf the 9501 potentially eligible manuscripts, 158 studies were included after a two-stage screening process. The included studies contained a wide spectrum of outcomes and were thus summarised to the overarching categories: use of preventive services, use of curative services, and potentially avoidable service use. Exemplary outcomes were screening uptake, physician visits and avoidable hospitalisations. Access variables included healthcare system characteristics such as physician density or distance to physician. The effects of socioeconomic position on healthcare use as well as of mesolevel access characteristics were investigated by most studies. The results show that socioeconomic and access factors play a crucial role in healthcare use. However, the interaction between socioeconomic position and mesolevel access characteristics is addressed in only few studies.ConclusionsSocioeconomic position and mesolevel access characteristics are important when examining variation in healthcare use. Additionally, studies provide initial evidence that moderation effects exist between the two factors, although research on this topic is sparse. Further research is needed to investigate whether adapting access characteristics at the mesolevel can reduce socioeconomic inequity in health care use.

Life-Course Socioeconomic Position and Mild Cognitive Impairment in Midlife: Evidence from the 1958 British Birth Cohort

BackgroundDementia has been the leading cause of death in the UK since 2015. Increasing evidence supports an association between socioeconomic position (SEP) and dementia onset in later life. However, limited studies have examined how life-course SEP influences the development of mild cognitive impairment (MCI), an intermediate state potentially preceding dementia. Therefore, the present study aims to examine the relationship between life-course SEP and MCI amongst adults aged 50 years in Great Britain.MethodsWe employed data from the National Child Development Study (NCDS), also known as the 1958 British Birth Cohort, to determine the associations between SEP and MCI in 6590 participants. We categorised life-course measures of SEP as stable high/low or moving upward/downward over the life course. We assessed MCI at age 50 using one standard deviation below the averaged combined scores from all cognitive tests available. We then used binary logistic regression to estimate the longitudinal associations between life-course SEP and MCI.ResultsRelative to those of a high SEP across the life course, participants who moved upward, downward, or remained at a low SEP were significantly associated with 25% (95% CI 1.02–1.54, p = 0.035), 70% (95% CI 1.27–2.27, p < 0.001), and 85% (95% CI 1.50–2.29, p < 0.001), respectively, higher odds of MCI, independent of all selected covariates.ConclusionsLower life-course SEP was associated with significantly higher odds of MCI onset in middle life within the NCDS cohort. Public health policies targeting cognitive impairment should encompass a life-course approach to reduce socioeconomic inequalities.

Is education level, as a proxy for socio-economic position, related to device-measured and self-reported sedentary behavior in European older adults? A cross-sectional study from the SITLESS project.

Sedentary behavior (SB) is a determinant of health in older adult people. Educational level is a primary driver of health disparities and is demonstrated to be a reliable measure of socioeconomic position. We aimed to examine the associations between educational level and self-reported along with device-measured SB in older adults living in Europe and the association of mentally active and passive SB domains with the educational level and gender in these associations. The design is cross-sectional. One thousand three hundred and sixty participants aged 65 and over (75.3±6.3 years old, 61.8% women) participated. Inclusion criteria were scored with the Short Physical Performance Battery. Variables that describe the sample were assessed with an interview, and device-measured SB was assessed with an accelerometer. SB was assessed with the Sedentary Behavior Questionnaire and an accelerometer. Multiple linear regression models were used to study the association between the level of education and SB. Participants self-reported an average of 7.82 (SD: 3.02) daily waking hours of SB during weekend days, and the average of device-measured SB was 11.39 (1.23) h. Total mentally active SB (weekdays and weekends) was associated with the education level (p < 0.000). Participants were more sedentary during the week than during weekends, regardless of level of education (p < 0.000). Education level was significantly associated with self-reported mean hours per day in 46SB (p = 0.000; R=0.026; 95%CI). Low education level in older adults is associated with self-reported SB but not with objective SB measures.

Functional limitation in the older Brazilian adults: Association with multimorbidity and socioeconomic conditions.

The aim of this study was to assess the association between multimorbidity and the presence of functional limitation in basic (BADL) and instrumental activities of daily living (IADL) among Brazilian older adults and to verify whether this association is moderated by socioeconomic conditions. Cross-sectional study with data from the Brazilian National Health Survey (PNS) (2019) for the Brazilian population aged 60 years and over. The dependent variables were functional limitation, based on self-reported difficulty in performing one or more activities of daily living, including six BADL (feeding, bathing, using the toilet, dressing, crossing a room on the same floor and getting out of bed) and four IADL (shopping, managing money, taking medication and using transportation). The independent variables were multimorbidity (presence of two or more self-reported chronic diseases) and socioeconomic measures (per capita household income, asset score, and education level). The association between multimorbidity and outcomes was assessed using adjusted logistic regression models. The moderating effect of socioeconomic conditions on the association between multimorbidity and functional limitations was assessed by including an interaction term. The final sample consisted of 22,725 individuals. The prevalence of functional limitation was 8.5% (95%CI: 7.9-9.2) and 18.6% (95%CI: 17.8-19.5) in BADL and IADL, respectively. Multimorbidity was associated with BADL [OR: 2.30 (95%CI: 1.93-2.74)] and IADL [OR: 2.26 (95%CI: 1.98-2.57)]. The odds of functional limitation were higher among individuals with lower levels of education and income, but there was no interaction between multimorbidity and socioeconomic position measures. Multimorbidity was associated with functional limitation (BADL and IADL) and socioeconomic conditions, and this association was constant across socioeconomic position levels.

Trends in the ability of socioeconomic position to predict individual body mass index: an analysis of repeated cross-sectional data, 1991-2019.

The widening of group-level socioeconomic differences in body mass index (BMI) has received considerable research attention. However, the predictive power of socioeconomic position (SEP) indicators at the individual level remains uncertain, as does the potential temporal variation in their predictive value. Examining this is important given the increasing incorporation of SEP indicators into predictive algorithms and calls to reduce social inequality to tackle the obesity epidemic. We thus investigated SEP differences in BMI over three decades of the obesity epidemic in England, comparing population-wide (SEP group differences in mean BMI) and individual-level (out-of-sample prediction of individuals' BMI) approaches to understanding social inequalities. We used repeated cross-sectional data from the Health Survey for England, 1991-2019. BMI (kg/m2) was measured objectively, and SEP was measured via educational attainment, occupational class, and neighbourhood index of deprivation. We ran random forest models for each survey year and measure of SEP adjusting for age and sex. The mean and variance of BMI increased within each SEP group over the study period. Mean differences in BMI by SEP group also increased: differences between lowest and highest education groups were 1.0kg/m2 (0.4, 1.6) in 1991 and 1.3kg/m2 (0.7, 1.8) in 2019. At the individual level, the predictive capacity of SEP was low, though increased in later years: including education in models improved predictive accuracy (mean absolute error) by 0.14% (- 0.9, 1.08) in 1991 and 1.05% (0.18, 1.82) in 2019. Similar patterns were obtained for occupational class and neighbourhood deprivation and when analysing obesity as an outcome. SEP has become increasingly important at the population (group difference) and individual (prediction) levels. However, predictive ability remains low, suggesting limited utility of including SEP in prediction algorithms. Assuming links are causal, abolishing SEP differences in BMI could have a large effect on population health but would neither reverse the obesity epidemic nor reduce much of the variation in BMI.

Material Need Insecurities among People on Hemodialysis: Burden, Sociodemographic Risk Factors, and Associations with Substance Use.

Despite their relevance to health outcomes, reports of food insecurity and housing instability rates among adults on hemodialysis are limited. Their relation to sociodemographic and behavioral factors are unknown for this population. We enrolled a convenience sample of people receiving hemodialysis at Baltimore and Washington D.C. metropolitan area facilities. Participants completed measures of socioeconomic position, food insecurity, housing instability, and substance use disorder. We cross-referenced participant and facility zip codes with measures of area poverty and residential segregation. We examined associations between individual- and area-level sociodemographic characteristics, food insecurity, and housing instability using multivariable logistic regression models. Of the 305 participants who completed study surveys, 57% were men, 70% were Black, and the mean age was 60 years. Thirty-six percent of the sample reported food insecurity, 18% reported housing instability, and 31% reported moderate or high-risk substance use. People on hemodialysis who were younger, with lower educational attainment, with lower incomes or experiencing financial strain were more likely to have material need insecurities (p<0.05 for all). Among participants living in segregated jurisdictions, men had increased odds of food insecurity compared to women (OR 3.7, 95% CI 1.61 - 8.53); younger participants (age <55 years) had increased odds of food insecurity compared to older participants (OR 3.3, 95% CI 1.49 - 7.32). Associations between gender or younger age category and food insecurity were not statistically significant in less segregated counties (p interaction for residential segregation x gender: p = 0.006; residential segregation x younger age category: p = 0.12). Food insecurity, housing instability, and substance use were common among this sample of adults on hemodialysis. Younger adults on hemodialysis, particularly those living in residentially segregated jurisdictions, were at increased risk for food insecurity. Future research should examine whether material need insecurities perpetuate disparities in dialysis outcomes.

Socioeconomic inequalities in COVID-19 - An analysis of health insurance data

Abstract Background Evidence on socioeconomic inequalities in COVID-19 outcomes largely rests on ecological studies. Only few studies investigated inequalities in different COVID-19 outcomes prospectively on an individual level. We therefore conducted an analysis of German health insurance data to assess socioeconomic inequalities in COVID-19 incidence and hospitalizations within a cohort of insured individuals. Methods We used data of 3.17 million working-aged individuals (18 to 67 years) from various statutory health insurances in Germany. Educational level and occupational position were used as measures of socioeconomic position (SEP). We calculated directly age-standardized incidence rates per 1000 person-weeks (IR) and incidence rate ratios (IRR) among the sample population for COVID-19 incidence and COVID-19 hospitalizations for each exposure during the first four pandemic waves (01.01.2020-31.12.2021). Results Age-standardized IR and IRR of COVID-19 incidence and hospitalizations showed social gradients with higher rates in socioeconomically more disadvantaged groups. Incidence risk was higher among those in a low occupational position (IRR low vs. high: 1.29, 95% CI 1.27-1.31) and with a low level of education (IRR low vs. high: 1.36, 95% CI 1.34-1.38). Inequalities in COVID-19 hospitalizations were more pronounced with an IRR for low vs. high occupational position of 2.29 (95% CI 2.10-2.50) and an IRR for low vs. high level of education of 1.86 (95% CI 1.72-2.03). Conclusions We found socioeconomic inequalities in COVID-19 by education and occupational position, with inequalities in hospitalizations being more pronounced than those in incidence risk. These results show a high potential of prevention to improve population health and health equity in pandemics with novel respiratory pathogens. Further research on the underlying mechanisms of these inequalities in COVID-19 is needed. Key messages • Socioeconomically more disadvantaged individuals have a higher risk of COVID-19 and a severe disease progression. • These inequalities should be addressed in future pandemic preparedness planning in order to minimize the unequal health impacts of pandemics with new emerging diseases.