Multiple Measures Of Socioeconomic Status Research Articles

Association of socioeconomic status measures with physical activity and subsequent frailty in older adults

BackgroundDespite increased recognition, frailty remains a significant public health challenge. Objectivewe aimed to assess the role of education and income, as well as neighborhood socioeconomic status, on physical activity and subsequent frailty in older adults. MethodsUsing a population-based cohort of older adults, this study examined the relationship between socioeconomic status (SES) factors, physical activity and frailty. The study included 1,799 participants (mean [SD], 74.6 (6.2), 53.3% female) from the "National Health and Nutrition Survey of Older Adults Aged 65 and Over in Israel", conducted in 2005–2006. A follow-up interview was performed 12–14 years later in a subgroup of 601 subjects (mean [SD], age 84[4]; 56% women). Self-reported leisure-time physical activity (LTPA) was measured at both baseline and follow-up. SES measures were assessed at baseline. Frailty was measured at follow-up, using the Fried's Phenotype Model.ResultsAll SES measures were strongly and positively associated with LTPA (all p < 0.001). Eighty-two participants (14%) were classified as frail at follow-up. After age and sex adjustment and accounting for attrition bias using inverse probability weighting, baseline LTPA (OR = 2.77, 95% CI: 1.57–4.90, for inactivity; OR = 1.41, 95% CI: 0.75–2.68, for insufficient activity, compared with sufficient activity, Ptrend < 0.001) was inversely associated with incident frailty. The association persisted after further adjustment for SES and comorbidity.ConclusionAmong older individuals, multiple SES measures were positively associated with LTPA, which was a strong predictor of lower subsequent frailty risk.

Association of socioeconomic status measures with physical activity and subsequent frailty in older adults

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite increased recognition, frailty remains a significant public health challenge. Methods Using a population-based cohort of older adults, this study examined the relationship between socioeconomic status (SES) factors, physical activity and frailty. The study included 1,799 participants (mean [SD], age 75[6]; 53% women) from the "National Health and Nutrition Survey of Older Adults Aged 65 and Over in Israel", conducted in 2005-2006. A follow-up interview was performed 12-14 years later in a subgroup of 601 subjects (mean [SD], age 84[4]; 56% women). Extensive data including self-reported leisure time physical activity (LTPA) and SES measures were assessed at baseline. Frailty was measured at follow-up. Results All SES measures were strongly and positively associated with LTPA (all p&amp;lt;0.001). Eighty-two participants (14%) were classified as frail at follow-up. After age and sex adjustment and accounting for attrition bias using inverse probability weighting, baseline LTPA (OR=2.77, 95% CI: 1.57-4.90, for inactivity; OR=1.41, 95% CI: 0.75-2.68, for insufficient activity, compared with sufficient activity, Ptrend&amp;lt;0.001) was inversely associated with incident frailty. The association persisted after further adjustment for SES and comorbidity. Conclusion Among older individuals, multiple SES measures were positively associated with LTPA, which was a strong predictor of lower subsequent frailty risk.

Socioeconomic inequalities in pediatric obstructive sleep apnea.

To examine the association between multiple measures of socioeconomic status (SES) and objectively measured obstructive sleep apnea (OSA) in a Canadian pediatric population. This was a cross-sectional study of 188 children (4-17 years, mean age 9.3 ± 3.5 years) prospectively recruited from two hospital sleep clinics in Canada, using multivariable-adjusted linear and logistic regression of five measures of SES including parental education, income, social class, geographic location, and perceived SES based on the MacArthur Scale of Subjective Social Status, assessed in relation to four polysomnographic OSA variables including apnea-hypopnea index, apnea index, mean oxygen saturation level, and oxygen desaturation index. Overall, low household-level SES appeared to be associated with both frequency (apnea index ≥ 1 events/h) and severity (apnea-hypopnea index ≥ 5 events/h) of OSA in children, with maternal education showing the most consistent and significant associations. Specifically, children with mothers reporting less than high school education had nearly three times the odds of having OSA after controlling factors including body mass index (odds ratio 2.96 [95% confidence interval, 1.05-8.37]), compared to university-educated participants. Consistent associations were also observed for geographic location with less frequency and severity of OSA among nonurban children. Perceived SES was minimally inversely associated with our outcomes. This cross-sectional, multicenter study demonstrated that SES factors are linked to the occurrence and severity of OSA in children. Results indicated the need to incorporate the screening of SES in the diagnostic process of pediatric OSA to provide more targeted intervention and patient-centered care. Park JW, Hamoda MM, Almeida FR, etal. Socioeconomic inequalities in pediatric obstructive sleep apnea. J Clin Sleep Med. 2022;18(2):637-645.

The association between influenza vaccination and socioeconomic status in high income countries varies by the measure used: a systematic review

BackgroundThe purpose of this paper is to systematically review the literature on the relationship between socioeconomic status (SES) and influenza immunization and to examine how certain measures of SES may influence interpretations of this relationship.MethodsWe conducted a systematic review of existing peer-reviewed literature to evaluate the above relationship in the general population. Electronic databases (MEDLINE and EMBASE) were searched from January 2012 to May 2017 to identify English-language studies relevant to this review. Studies were included where influenza vaccination was explicitly reported as the dependent variable and SES as the independent variable. We limited our review to measures of SES that focus on education, income, social class, occupation, and deprivation. Studies that measured SES using other variables (e.g., race, ethnicity, geographic location, rural or urban status, or insurance status) were excluded. Studies were also excluded if they did not report on the human population or did not analyze original data. The population of interest included all age groups, levels of health status, and sociodemographic backgrounds. The review was also limited to World Bank high-income countries. Two authors independently screened full-text articles after obtaining a Kappa score of K = 0.867. The methodological quality of manuscripts was assessed using the appraisal tools developed by the Joanna Briggs Institute. Results were qualitatively reported and synthesized.ResultsOf the 42 articles included in this review, 52.4% (n = 22) found that higher levels of SES resulted in higher levels of influenza vaccination; 4.5% (n = 2) reported a negative association; and 14.3% (n = 6) found no association. Just over a quarter (26.2%, n = 12) of articles reported mixed results.ConclusionsThere was consistently a relationship between SES and influenza immunization, which varied according to how SES was measured. It is recommended that authors be explicit in defining the SES concept they are trying to capture and that they utilize multiple measures of SES (e.g., education, income, class).

Relationship between socioeconomic status and risk of sexually transmitted infections in Uganda: Multilevel analysis of a nationally representative survey.

Socioeconomic status (SES) appears to have positive and negative associations with sexually transmitted infection (STI) risk in resource-limited settings, but few studies have evaluated nationally representative data. We assessed multiple SES measures and their effect on STI risk. We conducted a secondary analysis of data from the Uganda Demographic and Health Survey (UDHS 2011). The primary outcome (STI risk) was self-reported STIs and/or symptoms in the prior 12 months. We examined associations between multiple SES measures and STI risk using a mixed-effects Poisson regression model. The results showed that of the 9256 sexually active individuals, 7428 women and 1828 men were included in the analysis. At an individual level, middle wealth quintile and disposable income were associated with STI risk, whereas being in the richest wealth quintile was protective. Residence in wealthier regions (adjusted incidence rate ratio [aIRR] 3.92, 3.62, and 2.75, for Central, Western, and Eastern regions; p < 0.01) was associated with increased STI risk. Regional level analysis revealed stochastic variability of STI risk across geographical region (variance 0.03; p = 0.01). The bilateral association between SES and STI risk underscores the need for multi-sectoral interventions to address the upstream effects of poverty on STI risk and downstream effects of STIs on health and economic productivity.

Socioeconomic gaps in science achievement

BackgroundIn contrast to the extensive research on socioeconomic gaps in reading and math achievement, little attention has been given to socioeconomic disparities in science skills, particularly during the early years of schooling. This emphasis on later years may be problematic because large socioeconomic disparities emerge in the early years, thus it is crucial to document the size of disparities in science achievement and begin unpacking the range of factors that contribute to these disparities. Additionally, it is crucial to know which components of socioeconomic status are more strongly linked to children’s science skills so that resources can be more effectively targeted to address disparities. Using nationally representative data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-99 (N = 9250), this study examines disparities in science achievement across elementary and middle school related to parental income and parental education separating their effects from each other and from a range of confounding factors. Additionally, it considers whether characteristics of children, families, and schools are pathways through which socioeconomic disparities emerge.ResultsResults show moderate gaps in science achievement related to both household income and parental education. The primary pathways through which parental education and family income influenced science achievement was through mathematics and reading achievement. For parental education gaps, smaller indirect effects also operated through access to informal science learning opportunities both inside and outside of the home environment.ConclusionFirst, this study highlights the importance of considering the contributions of multiple measures of socioeconomic status, instead of a composite. Second, it shows that socioeconomic disparities in science achievement emerge early and that programs and policies aimed at addressing these gaps may need to target children during the early elementary and preschool years. Third, our findings suggest that elementary instructional approaches that simultaneously address science instruction with reading and/or mathematics instruction will likely be especially important for improving overall science outcomes.

The age pattern of social inequalities in health at older ages: are common measures of socio-economic status interchangeable?

ObjectivesSocial inequalities in health have been largely documented in social science research. Members of the most disadvantaged groups experience worse health and higher mortality from birth throughout adulthood. However, it is not clear whether this association persists at older ages. Some studies have found a narrowing of the social gradient in health, at least when ‘traditional’ measures of socio-economic status (SES)—income, education, and occupation—are used. The main goal of the article is to highlight similarities and discrepancies in the age trend of social inequalities in health that arise when multiple measures of SES are considered. Study designThe present study uses a longitudinal sample of over 7000 individuals age 50+ from the Survey of Health, Ageing, and Retirement in Europe to examine the age trend of social inequalities in health. MethodsBy using growth curve models, individual trajectories of self-rated health and physical functioning were analyzed. SES is measured through wealth, income, and education. ResultsThe findings show that for both health outcomes, the choice of the indicator of SES is very consequential, as the age trend of social inequalities in health is substantially different for different measures of SES. ConclusionUsing multiple measures of SES is recommended, as using only one measure would give only a partial account of the age trend of social inequalities in health. In particular, wealth seems to better capture individual's socio-economic position, as it is able to detect health gradients even where education and income fail to do so.

Socioeconomic status and alcohol use in low- and lower-middle income countries: A systematic review.

Harmful use of alcohol is a major cause of global morbidity and mortality. The role of alcohol as a driver of the unfolding non-communicable disease crisis has led to high-profile calls for better epidemiological data. Despite causing a disproportionate amount of harm in low-income groups, there is a critical dearth of evidence on the intra-national socioeconomic patterning of alcohol use in low- and lower-middle income countries (LLMICs). This review aims to fill the gap, providing evidence on the association between socioeconomic status (SES) and alcohol use in these low-income settings. We conducted a comprehensive literature search for primary research published between January 1, 1990 and June 30, 2015 using 13 electronic databases, including Embase and Medline. We also hand-searched references and reviewed 'gray literature' - studies that have not been published in peer-reviewed journals. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and alcohol use. No age or language restrictions were applied. Due to high heterogeneity, we used a narrative approach for data synthesis. After reviewing 4242 records and 247 full-text articles, 23 studies met our inclusion criteria, reporting data on 861,295 individuals aged >10 years from 10 countries. Alcohol use was found to be more prevalent in lower socioeconomic groups in the majority of Southeast Asian studies. The association was mixed for African studies, although these tended to have smaller sample sizes and weaker methods. Studies that measured multiple domains of SES found good agreement between different indicators. Definitions of alcohol use and abuse varied widely between studies, as did socioeconomic groupings. The lack of consistency between studies and the abject lack of data from the majority of LLMICs present a major barrier to policymakers tasked with reducing alcohol-related harm in these settings. Adherence to standardized definitions, the publication of WHO survey data on alcohol and SES, and enhanced surveillance is needed to build an accurate picture of the socioeconomic patterning of alcohol use in developing countries.

Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review.

SummaryBackgroundNon-communicable diseases are the leading global cause of death and disproportionately afflict those living in low-income and lower-middle-income countries (LLMICs). The association between socioeconomic status and non-communicable disease behavioural risk factors is well established in high-income countries, but it is not clear how behavioural risk factors are distributed within LLMICs. We aimed to systematically review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within LLMICs.MethodsWe searched 13 electronic databases, including Embase and MEDLINE, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. No age or language restrictions were applied. We excluded studies that did not allow comparison between more or less advantaged groups. We used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Due to high heterogeneity, we used a narrative approach for data synthesis. We used descriptive statistics to assess whether the prevalence of each risk factor varied significantly between members of different socioeconomic groups. The study protocol is registered with PROSPERO, number CRD42015026604.FindingsAfter reviewing 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals older than 10 years from 39 LLMICs. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than did high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of high socioeconomic status. High socioeconomic groups were found to be less physically active and consume more fats, salt, and processed food than individuals of low socioeconomic status. While the included studies presented clear patterns for tobacco use and physical activity, heterogeneity between dietary outcome measures and a paucity of evidence around harmful alcohol use limit the certainty of these findings.InterpretationDespite significant heterogeneity in exposure and outcome measures, clear evidence shows that the burden of behavioural risk factors is affected by socioeconomic position within LLMICs. Governments seeking to meet Sustainable Development Goal (SDG) 3.4—reducing premature non-communicable disease mortality by a third by 2030—should leverage their development budgets to address the poverty-health nexus in these settings. Our findings also have significance for health workers serving these populations and policy makers tasked with preventing and controlling the rise of non-communicable diseases.FundingWHO.

Adoption of a Multidimensional Approach to Assessing the Impact of Socioeconomic Status on Neurocognitive and Behavioral Outcomes in Pediatric Sickle Cell Disease

Introduction: Broad neurocognitive deficits have been documented in children with sickle cell disease (SCD), even in the absence of stroke. These deficits pose significant consequences, as lower cognitive abilities are associated with lower academic achievement. However, there has been limited research examining the relationship between neurocognitive functioning and socioeconomic status (SES) in youth with SCD. Given that children with SCD experience socioeconomic disadvantage at relatively high rates, SES has been posited as one explanation for the high prevalence of neurocognitive issues in SCD; particularly in the case of patients without stroke or those with less severe phenotypes. In order to better understand the role of SES, we sought to evaluate the effects of multiple distinct measures of SES on neurocognitive outcomes in pediatric SCD.Methods: Fifty-nine children with SCD ages 7-16 (M = 10.44, SD = 2.87; 42% male) enrolled in a larger study of the feasibility and efficacy of a computerized cognitive training program. Primary caregivers reported demographic information, including the child's age, gender, and ethnicity, and rated their child's executive functioning difficulties on the Behavior Rating Inventory of Executive Function (BRIEF). Scores on the BRIEF are represented as T scores, where higher scores reflect more problems. Caregivers also reported on multiple measures of SES, including the participant's health insurance type, whether the participant received free-or-reduced lunch at school, and rated the adequacy of household resources (Family Resource Scale; FRS) and their perceived community and national social status (The MacArthur Scale of Subjective Social Status). Children and adolescents completed the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V).Results: Multiple regression analyses were performed to examine the relationship between SES measures and performance-based and caregiver-reported neurocognitive and behavioral functioning. Controlling for age and gender, having public health insurance significantly predicted lower Full Scale IQs on the WISC-V (R2 = .158, b = -8.609, p = .021), as well as greater impairments on the BRIEF Working Memory (R2 = .219, b = -9.556, p = .014), Organization of Materials (R2 = .166, b = -7.498, p = .011), and Monitor (R2 = .137, b = -6.872, p = .038) subscales. Whereas, having private health insurance significantly predicted higher Full Scale IQs (R2 = .187, b = 10.376, p = 0.007) and fewer problems on the BRIEF Working Memory (R2 = .101, b = 7.868, p = .046), Organization of Materials (R2 = 0.209, b = 9.103, p = .003), and Monitor (R2 = .163, b = 8.231, p = .018) subscales. Additionally, receiving free-or-reduced lunch significantly predicted lower scores on a WISC-V task measuring processing speed (R2 = .316, b = -1.976, p = .006) and a composite indicator of processing speed (R2 = .226, b = -9.849, p = .011). In contrast to hypotheses, higher perceived social status within families' communities on the MacArthur Scale of Subjective Social Status was predictive of lower Full Scale IQs (R2 = .089, b = 1.646, p = .049) and higher perceived social status using the United States as a reference predicted greater impairments on the Plan/Organize (R2 = .169, b = 2.287 p = .011) and Initiate subscales of the BRIEF (R2 = .134, b = 1.839, p = .024).Conclusions: It is feasible to measure SES in multiple ways in clinical trials. In our study, SES significantly predicted performance-based and parent-reported neurocognitive functioning; however, each measure of SES appeared to account for a unique component of SES and demonstrated unique associations with neurocognitive outcomes. Public insurance was a significant predictor of more caregiver-rated problems with children's working memory, organizational skills, and executive functioning. Children who qualified for free-or reduced lunch also scored significantly lower on processing speed tasks. Findings support the hypothesis that SES plays an important role in determining neurocognitive and behavioral outcomes and highlights the value of conceptualizing and assessing SES as a multidimensional construct. Researchers and clinicians should routinely assess SES using various measures to enhance detection of neurocognitive difficulties and assist in crafting tailored interventions to mitigate negative consequences of low SES in children with SCD. DisclosuresNo relevant conflicts of interest to declare.

Poverty and risk factors for non-communicable diseases in developing countries: a systematic review

BackgroundThe association between poverty and health is highly context-specific; in high-income countries, low socioeconomic status is associated with use of tobacco and alcohol, physical inactivity, and poor diet. We lack good quality epidemiological evidence from developing countries, especially from low and lower middle-income countries (LLMICs). This systematic review sought to fill this gap. MethodsWe conducted a comprehensive literature search for primary research published between Jan 1, 1990, and June 30, 2015, using 13 electronic databases, including Embase and Medline, as well as a grey literature review and hand searching of references. Two reviewers independently screened papers retrieved from 13 databases with a search devised by an experienced medical librarian combining MeSH terms and synonyms for non-communicable diseases, behavioural risk factors, poverty, and the 84 LLMICs defined by the World Bank. We included studies from LLMICs that presented data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. We performed narrative data synthesis. FindingsAfter review of 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals aged more than 10 years from 39 LLMICs. Most studies found that, compared with high socioeconomic groups, lower status groups had a high prevalence of tobacco and alcohol use (odds ratios up to 18·8 and 3·5, respectively). Most studies also found that lower socioeconomic groups consumed less fruit, vegetables, fish, and fibre (odds ratios negligible to 12·9, depending on context). Higher socioeconomic groups were up to 4·4 times less physically active and consumed more fats, salt, and processed food; however, these dietary studies tended to be smaller with wide confidence intervals. InterpretationDespite variation in exposure and outcome measures, there is clear evidence that the burden of behavioural risk factors is affected by socioeconomic position within LLMICs. Governments seeking to meet Sustainable Development Goal 3.4—reducing premature mortality from non-communicable diseases by a third by 2030—should leverage their development budgets to address the poverty–health nexus in these settings. Our findings are also important for health workers serving these populations, and for policymakers tasked with preventing and controlling the rise of non-communicable diseases. FundingNone.

Race/ethnicity, socioeconomic status, and ALS mortality in the United States.

Objective:To determine whether race/ethnicity and socioeconomic status are associated with amyotrophic lateral sclerosis (ALS) mortality in the United States.Methods:The National Longitudinal Mortality Study (NLMS), a United States–representative, multistage sample, collected race/ethnicity and socioeconomic data prospectively. Mortality information was obtained by matching NLMS records to the National Death Index (1979–2011). More than 2 million persons (n = 1,145,368 women, n = 1,011,172 men) were included, with 33,024,881 person-years of follow-up (1,299 ALS deaths , response rate 96%). Race/ethnicity was by self-report in 4 categories. Hazard ratios (HRs) for ALS mortality were calculated for race/ethnicity and socioeconomic status separately and in mutually adjusted models.Results:Minority vs white race/ethnicity predicted lower ALS mortality in models adjusted for socioeconomic status, type of health insurance, and birthplace (non-Hispanic black, HR 0.61, 95% confidence interval [CI] 0.48–0.78; Hispanic, HR 0.64, 95% CI 0.46–0.88; other races, non-Hispanic, HR 0.52, 95% CI 0.31–0.86). Higher educational attainment compared with < high school was in general associated with higher rate of ALS (high school, HR 1.23, 95% CI 1.07–1.42; some college, HR 1.24, 95% CI 1.04–1.48; college, HR 1.10, 95% CI 0.90–1.36; postgraduate, HR 1.31, 95% CI 1.06–1.62). Income, household poverty, and home ownership were not associated with ALS after adjustment for race/ethnicity. Rates did not differ by sex.Conclusion:Higher rate of ALS among whites vs non-Hispanic blacks, Hispanics, and non-Hispanic other races was not accounted for by multiple measures of socioeconomic status, birthplace, or type of health insurance. Higher rate of ALS among whites likely reflects actual higher risk of ALS rather than ascertainment bias or effects of socioeconomic status on ALS risk.

Deconstructing the Alcohol Harm Paradox: A Population Based Survey of Adults in England

BackgroundThe Alcohol Harm Paradox refers to observations that lower socioeconomic status (SES) groups consume less alcohol but experience more alcohol-related problems. However, SES is a complex concept and its observed relationship to social problems often depends on how it is measured and the demographic groups studied. Thus this study assessed socioeconomic patterning of alcohol consumption and related harm using multiple measures of SES and examined moderation of this patterning by gender and age.MethodData were used from the Alcohol Toolkit Study between March and September 2015 on 31,878 adults (16+) living in England. Participants completed the AUDIT which includes alcohol consumption, harm and dependence modules. SES was measured via qualifications, employment, home and car ownership, income and social-grade, plus a composite of these measures. The composite score was coded such that higher scores reflected greater social-disadvantage.ResultsWe observed the Alcohol Harm Paradox for the composite SES measure, with a linear negative relationship between SES and AUDIT-Consumption scores (β = -0.036, p<0.001) and a positive relationship between lower SES and AUDIT-Harm (β = 0.022, p<0.001) and AUDIT-Dependence (β = 0.024, p<0.001) scores. Individual measures of SES displayed different, and non-linear, relationships with AUDIT modules. For example, social-grade and income had a u-shaped relationship with AUDIT-Consumption scores while education had an inverse u-shaped relationship. Almost all measures displayed an exponential relationship with AUDIT-Dependence and AUDIT-Harm scores. We identified moderating effects from age and gender, with AUDIT-Dependence scores increasing more steeply with lower SES in men and both AUDIT-Harm and AUDIT-Dependence scores increasing more steeply with lower SES in younger age groups.ConclusionDifferent SES measures appear to influence whether the Alcohol Harm Paradox is observed as a linear trend across SES groups or a phenomenon associated particularly with the most disadvantaged. The paradox also appears more concentrated in men and younger age groups.

Cross race comparisons between SES health gradients among African–American and white women at mid-life

This study explored how multiple indicators of socioeconomic status (SES) inform understanding of race differences in the magnitude of health gains associated with higher SES. The study sample, 1268 African–American women and 2066 white women, was drawn from the National Longitudinal Surveys of Youth 1979. The outcome was the Physical Components Summary from the SF-12 assessed at age 40. Ordinary least squares regressions using education, income and net worth fully interacted with race were conducted. Single measure gradients tended to be steeper for whites than African–Americans, partly because “sheepskin” effects of high school and college graduation were higher for whites and low income and low net worth whites had worse health than comparable African–Americans. Conditioning on multiple measures of SES eliminated race disparities in health benefits of education and net worth, but not income. A discussion of current public policies that affect race disparities in levels of education, income and net wealth is provided.

Socioeconomic inequalities and body mass index in Västerbotten County, Sweden: a longitudinal study of life course influences over two decades.

IntroductionLife course socioeconomic inequalities in heart disease, stroke and all-cause mortality are well studied in Sweden. However, few studies have sought to explain the mechanism for such associations mainly due to lack of longitudinal data with multiple measures of socioeconomic status (SES) across the life course. Given the population health concern about how socioeconomic inequality is related to poorer health, we aim to tackle obesity as one of the prime suspects that could explain the association between SES inequality and cardiovascular disease and consequently premature death. The aim of this study is to test which life course model best describes the association between socioeconomic disadvantage and obesity among 60 year old inhabitants of Västerbotten County in Northern Sweden.MethodsA birth cohort consisting of 3340 individuals born between 1930 and 1932 was studied. Body mass index (BMI) at the age of 60 and information on socioeconomic status at three stages of life (ages 40, 50, and 60 years) was collected. Independent samples t-test was used to compare BMI between advantaged and disadvantaged groups and one-way ANOVA was used to compare BMI among eight SES trajectories. We applied a structured modeling approach to examine three different hypothesized life course SES models (accumulation, critical period, and social mobility) in relation to BMI.ResultsWe found sex differences in the way that late adulthood socioeconomic disadvantage is associated with BMI among inhabitants of Northern Sweden. Our study suggests that social adversity in all stages of late adulthood is a particularly important indicator for addressing the social gradients in BMI among women in Northern Sweden and that unhealthy behaviors in terms of smoking and physical inactivity are insufficient to explain the relationships between social and lifestyle inequalities and BMI.ConclusionIn order for local authorities to develop informed preventive efforts, we suggest further research to identify modifiable risk factors across the life course which could explain this health inequality.

Tourette syndrome and chronic tic disorder are associated with lower socio‐economic status: findings from the Avon Longitudinal Study of Parents and Children cohort

Aim Only a few studies have examined the relationship between Tourette syndrome or chronic tic disorder and socio-economic status (SES). Existing studies are primarily cross-sectional, arise from specialty clinics, and use single measures of SES. In this study we examine this relationship in a longitudinal, population-based sample.Method Data are from 7152 children born during 1991 and 1992 in the county of Avon, UK, from the Avon Longitudinal Study of Parents and Children, who were followed up to age 13. After exclusions for intellectual disability* and autism, 6768 participants (3351 males [49.5%]) and 3417 females [50.5%]) remained. Parental SES was assessed using multiple measures during pregnancy and at 33 months of age. Presence of Tourette syndrome or chronic tics was determined from repeated maternal questionnaires up to when the child was 13 years of age.Results Multiple SES measures were associated with an approximately twofold increased risk of Tourette syndrome and chronic tics. A postnatal composite factor score (lowest vs highest tertile odds ratio 2.09, 95% confidence interval 1.38–3.47) provided the best fit to the data.Interpretations As is seen in several childhood conditions, such as cerebral palsy and autism, lower SES is a risk factor for Tourette syndrome/chronic tics. Potential explanations include differential exposure to environmental risk factors or parental psychopathology as a measure of an increased genetic risk leading to decreased parental SES.

Secondhand smoke exposure in preterm infants with bronchopulmonary dysplasia

Preterm infants and children with bronchopulmonary dysplasia (BPD) often experience significant respiratory morbidities during the first two years of life. Second hand smoke (SHS) has been demonstrated to lead to respiratory morbidities in the general population. The objectives of this study were to assess the prevalence/impact of SHS on preterm infants and children with BPD. Subjects (n = 352) were recruited from the Johns Hopkins BPD outpatient clinic between January 2008 and August 2012. Second hand smoke exposure and respiratory morbidities were assessed through questionnaires and chart review. Twenty-eight percent of preterm infants with BPD were exposed to SHS in the home setting, despite having significant lung disease. SHS was associated with multiple measures of socio-economic status, including lower household income (P < 0.001), lower caregiver education level (P = 0.013), and having public versus private insurance (P = 0.002). We found no difference in acute care use or chronic symptoms with SHS exposure. We observed trends that preterm infants who were exposed to SHS were more likely to be prescribed inhaled corticosteroids (P = 0.054) and were weaned off of supplemental oxygen over 2 months later (P = 0.13) than infants not exposed to SHS. SHS exposure in preterm infants with BPD is common, even in those receiving supplemental oxygen and respiratory medications. Although there were no associations between respiratory outcomes and self-reported SHS exposure, trends toward increased use of inhaled steroids and a longer duration of supplemental oxygen use were noted. Further work is needed to determine more accurate means of assessing SHS risk in this vulnerable population.

Income predictors of smoking cessation among Hispanics

Higher socioeconomic status smokers are more successful at smoking cessation. Few studies have investigated the prospective association between multiple measures of socioeconomic status and Hispanic smoking cessation. We assessed four measures to examine which predicted smoking cessation. Hispanics without debt had 18.5 times higher odds of 30-day cessation (odds ratio = 18.47, 95% confidence interval = 3.26-104.66, p < .01) and 11-fold increased odds of 7-day point prevalence abstinence (odds ratio = 11.32, 95% confidence interval = 2.45-52.24, p < .01) at 3-month follow-up. Yearly income, education, work status, money to see a doctor, and money for medications were not predictive of smoking cessation. Debt level may better measure socioeconomic inequities by capturing objective and subjective social status associated with Hispanic smoking cessation.

Social determinants of crime in a welfare state: Do they still matter?

Despite decades of research on the association between socio-economic status (SES) and crime, its strength and nature remain contested. Using a unique dataset combining data from several administrative registers with a nationally representative sample of 28,485 19 to 30-year-old Finnish citizens, we examine SES differences in violent offences, property offences and driving while intoxicated. We use multiple measures of SES in order to see what it is in SES that increases crime risk. We also test the strain accumulation hypothesis to find out whether presence of multiple strains increases crime risk disproportionately. The results indicate that, in addition to male gender, SES is strongly associated with all three types of crime, and the predictors are largely similar for all the offence types in question. Long-term unemployment and having only a basic education, in particular, were the most robust predictors of offending. These associations held after controlling for previous criminal involvement as well as other social characteristics, whereas the effect of low income on crime was primarily attributable to prior involvement in crime. Overall, the results imply that there are both causation and selection mechanisms at play. No interactive effect was found for strain accumulation.

Do socioeconomic differences in tobacco use exist also in developing countries? A study of Ghanaian adolescents

BackgroundIn Western countries, tobacco use is most prevalent among adolescents in lower socioeconomic groups. The association between socioeconomic status (SES) and tobacco use among adolescents in developing countries is unexplored. Using multiple SES measures, we investigated this association among adolescents in Ghana.MethodA school-based survey of a representative sample of 13-18-year-old Ghanaians (N = 1,165, response rate = 89.7%) was conducted in three regions, in 2008. Logistic regression analysis was used to evaluate the relationship of smoking, tawa (smokeless tobacco) use with familial SES (parental occupation and education, material affluence scale, family structure), an adolescent's individual social position (school performance, plans after graduation) and inter-generational social mobility (predicted by the differences of familial and individual positions).ResultsSocioeconomic differences existed in tobacco use whether measured by familial SES or individual social position with higher prevalence in lower socioeconomic groups. Low father's education and living in a non-nuclear family were associated with both forms of tobacco use while low material affluence was associated with tawa use only; individual social position measured by plans after graduation was the strongest predictor of both smoking and tawa use. Inter-generational downward social mobility and particularly staying in low SES was related to both forms of tobacco use.ConclusionsSimilar to Western countries, lower SES is related to an adolescent's tobacco use also in developing countries. Cumulative socioeconomic disadvantage over generations increases the probability of tobacco use.