People Of Higher Socioeconomic Status Research Articles

The future burden of type 2 diabetes in Belgium: a microsimulation model

ObjectiveTo forecast the annual burden of type 2 diabetes and related socio-demographic disparities in Belgium until 2030.MethodsThis study utilized a discrete-event transition microsimulation model. A synthetic population was created using 2018 national register data of the Belgian population aged 0–80 years, along with the national representative prevalence of diabetes risk factors obtained from the latest (2018) Belgian Health Interview and Examination Surveys using Multiple Imputation by Chained Equations (MICE) as inputs to the Simulation of Synthetic Complex Data (simPop) model. Mortality information was obtained from the Belgian vital statistics and used to calculate annual death probabilities. From 2018 to 2030, synthetic individuals transitioned annually from health to death, with or without developing type 2 diabetes, as predicted by the Finnish Diabetes Risk Score, and risk factors were updated via strata-specific transition probabilities.ResultsA total of 6722 [95% UI 3421, 11,583] new cases of type 2 diabetes per 100,000 inhabitants are expected between 2018 and 2030 in Belgium, representing a 32.8% and 19.3% increase in T2D prevalence rate and DALYs rate, respectively. While T2D burden remained highest for lower-education subgroups across all three Belgian regions, the highest increases in incidence and prevalence rates by 2030 are observed for women in general, and particularly among Flemish women reporting higher-education levels with a 114.5% and 44.6% increase in prevalence and DALYs rates, respectively. Existing age- and education-related inequalities will remain apparent in 2030 across all three regions.ConclusionsThe projected increase in the burden of T2D in Belgium highlights the urgent need for primary and secondary preventive strategies. While emphasis should be placed on the lower-education groups, it is also crucial to reinforce strategies for people of higher socioeconomic status as the burden of T2D is expected to increase significantly in this population segment.

Associations of socioeconomic status and obesity with hypertension in tibetan adults in a Chinese plateau area

BackgroundPrevious studies have identified that socioeconomic status (SES) and obesity are associated with hypertension. However, their interaction on hypertension risk has not yet been assessed.MethodsThe study used data from 6,069 Tibetan residents in Chengguan District in Lhasa, the Chinese Tibetan autonomous region’s capital, based on a cohort study conducted from May 2018 to September 2019 in five provinces in southwest China. We used logistic regression models to assess the complex relations of SES and obesity with hypertension.ResultsCompared with individuals of high SES, low and moderate SES were positively associated with high risk of hypertension. SES and obesity have significant additive interaction on hypertension (general obesity by BMI: RERI = 1.33, P < 0.001; abdominal obesity by WC: RERI = 0.76, P < 0.001; abdominal obesity by WHtR: RERI = 0.96, P < 0.001). In people from the low and moderate SES segments, obesity was linked to an increased risk of hypertension, but the correlations were stronger in people from the moderate SES category. Compared with people of high SES and non obese, those with moderate SES and obesity had a higher risk of hypertension, and ORs were 4.38 (2.80, 6.84) for general obesity by BMI, 3.38 (2.05, 5.57) for abdominal obesity by WC, and 3.18 (1.57, 6.42) for abdominal obesity by WHtR.ConclusionThere is an independent and additive interaction effect of obesity and SES on the risk of hypertension. People with obesity, especially those of moderate and low SES, should reduce weight and waist circumference, and pay more attention to blood pressure. Moreover, the government, health administration departments, and society should prioritize improving the socioeconomic status of the Tibetan population and addressing risk factors like obesity.

Social status and unethical behavior: Two replications of the field studies in Piff et al. (2012).

Prominent social psychologists and major media outlets have put forward the notion that people of high socioeconomic status (SES) are more selfish and behave more unethically than people of low SES. In contrast, other research in economics and sociology has hypothesized and found a positive relationship between SES and prosocial and ethical behavior. We review the empirical evidence for these contradictory findings and conduct two direct, well-powered, and preregistered replications of the field studies by Piff and colleagues (2012) to test the relationship between SES and unethical/selfish behavior. Unlike the original findings, we find no evidence of a positive relationship between SES and unethical/selfish behavior in the two field replication studies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Out-of-pocket fees for health care in Australia: implications for equity.

Out-of-pocket fees for health care in Australia: implications for equity.

Moving the Needle in Gout Management: The Role of Culture, Diet, Genetics, and Personalized Patient Care Practices.

Gout is a metabolic disorder, and one of the most common inflammatory arthritic conditions, caused by elevated serum urate (SU). Gout is globally rising, partly due to global dietary changes and the growing older adult population. Gout was known to affect people of high socioeconomic status. Currently, gout disproportionately affects specific population subgroups that share distinct racial and ethnic backgrounds. While genetics may predict SU levels, nongenetic factors, including diet, cultural traditions, and social determinants of health (SDOH), need to be evaluated to optimize patient treatment outcomes. This approach would allow clinicians to assess whether certain cultural norms, or some SDOH, could be contributing to their patient’s risk of developing gout or recurrent gout flares. A cultural assessment may inform the development of culturally tailored dietary recommendations for patients with gout. Causal and association studies investigating the interaction between diet, genetics, and gout, should be cautiously interpreted due to the lack of reproducibility in different racial groups. Optimal gout management could benefit from a multidisciplinary approach, involving pharmacists and nurses. While data on the effect of specific dietary recommendations on managing hyperuricemia and gout may be limited, counseling patients with gout on the role of a healthy diet to optimally control their gout flares and other comorbidities should be part of patient education. Future research investigating the role of a gene–diet interaction in the context of hyperuricemia and gout is needed. Optimal care for patients with gout needs to include a holistic assessment for gout and gout-related comorbidities. Additionally, addressing health beliefs and culture-specific lifestyle factors among patients with gout may reduce their risk of gout flare, improve adherence to urate-lowering therapy (ULT), and achieve health equity in gout management.

Step up to health, Nigeria! utilizing information from abuja's world cancer day walks for equity-based cancer prevention interventions.

e22508 Background: Abuja, Nigeria’s annual World Cancer Day Walk (WCDW) is a tool for promoting public awareness of cancer risk factors, preventative lifestyle strategies, and the importance of early screening as critical elements of prevention and control. The day includes physical activities (walk, race, ride, skate, cycle, marathon), as well as health education and free breast cancer, cervical, and prostate screenings. The effectiveness of the event to attract the most vulnerable Nigerian populations has not been studied. Aim: To determine the social-demographic characteristics of participants and evaluate the impact of outreach campaigns. Methods: Approximately 2,000 Nigerians attended Abuja WCDW on February 1, 2020. A similar number attended Abuja WCDW on February 5, 2022. Trained research assistants recruited participants to complete a one-sheet questionnaire that assessed basic demographic, social, and lifestyle information. Participants were given informed consent. In 2020, 237 (11%) participants, aged 18-68 years voluntarily completed survey (ClinicalTrials #NCT04248881). In 2022, 111 (6%), aged 17-74 years voluntarily completed survey (ClinicalTrials #NCT05239325). Note: In 2021, Abuja WCDW was canceled due to COVID. Results: In 2020, the mean age for participants was 28; SD 7.71. Sixty-eight percent were women. Eighty-seven percent had at least an undergraduate education. Of the 237 participants, 65% reported that they attended to obtain free cancer screening. More than 50% reported they had no health insurance. Of those insured, more had National Health Insurance Scheme (NHIS) than private insurance. The average body mass index (BMI) was between 24-28; BMI was highest among the mid-20 age group. Lifestyle data revealed more men than women were concerned with their health; those with health worries were more likely to have had cancer screening at the event. The 2022 WCDW data were being analyzed at the time of abstract submission; findings will be presented at the meeting. Analysis: Data from 2020 revealed participants are predominately associated with a lower risk of developing cancer. They have higher levels of knowledge about cancer and lifestyle/health-related behaviors beneficial for early detection and prevention. WCDW is a great avenue for cancer awareness/lifestyle prevention interventions yet there is an urgent need to evaluate efficacy of current outreach to target underserved members of Nigerian population: those with lower levels of education, unemployed, lower income, and without insurance. Conclusions: Attendees in 2020 are younger people of higher socioeconomic status with lifestyle practices that could reduce cancer risk. If our 2022 data are similar, we must elaborate better strategies to reach populations at greater risk and encourage them to attend future events to have more impactful lifestyle/prevention outcomes. Clinical trial information: NCT05239325.

Changes Among Mexican Adults in Physical Activity and Screen Time During the COVID-19 Lockdown Period and Association With Symptoms of Depression, Anxiety, and Stress, May 29-July 31, 2020.

We examined the association between changes in physical activity and leisure screen time and mental health outcomes during the early stages of the recommended COVID-19 stay-at-home period in a national sample of Mexican adults aged 18 years or older. A cross-sectional online survey conducted from May 29 through July 31, 2020, among 1,148 participants, reported time spent in physical activity and leisure screen time during a typical week before (retrospectively) and a week during the COVID-19 stay-at-home period. Mental health outcomes during this period were measured with the Depression, Anxiety and Stress Scale (DASS-21). Linear regression models were used to estimate the associations between changes in physical activity and leisure screen time and mental health outcomes by socioeconomic status (SES), adjusting for potential confounders. Compared with maintaining high levels of physical activity or increasing them, decreasing physical activity was associated with higher stress scores overall, and among people of high SES, with higher scores for DASS-21, depression, and anxiety. Among participants of low and medium SES only, increasing screen time was associated with higher DASS-21, depression, anxiety, and stress scores compared with maintaining low or decreasing leisure screen time. Results highlight the potential protective effect of physical activity and limited leisure screen time on mental health in the context of COVID-19 stay-at-home restrictions.

Commentary on Di Castelnuovo et al.: The internal and external validity of cohort studies that measure J-shaped curves for all-cause mortality.

As with cohort studies, Di Castelnuovo et al. found that alcohol consumption of 0–10 g/day led to significant reductions in all-cause mortality. However, there is a need to consider factors which affect internal and external validity, as these factors may lead to the observed protective J-shaped curve. The article by Di Castelnuovo et al. outlines the alcohol relative risks (RRs) for all-cause and cause-specific mortality based on a collective re-analysis of data from 16 cohort studies [1]. Like other similar cohort studies, Di Castelnuovo et al. found that consumption of between 0 and 10 g of alcohol per day (g/day) led to significant reductions in all-cause mortality and cardiovascular deaths. As it is currently under debate if a J-shaped curve for alcohol and health exists [2, 3] this study's findings, as well as the results of other cohort studies with similar methods examining public health and clinical practices, should be analyzed within the context of each study's internal and external validity. The sample size (n = 142 960) of the Di Castelnuovo et al. study is unique, as it provides power to detect small effect sizes. However, despite its sample size, there was insufficient power to reach conclusions regarding the RR of 0.98 for people who consumed 10 to < 20 g/day. Therefore, larger cohort studies are required to determine the significance of these RRs. The internal validity of studies which measure RRs close to the null (RR = 1) is particularly important, as small biases can affect the directionality of the results. As with numerous other cohort studies, Di Castelnuovo et al.'s findings are subject to measurement and design limitations. These limitations, mentioned in the article, include a lack of information on drinking patterns, using cross-sectional measurements for alcohol use, inconsistent life-time abstention, using broad measurements for confounders (e.g. daily cigarette use), survivor bias (i.e. unhealthy drinkers dying before cohort recruitment), former drinker bias (drinkers who experience negative health affects abstaining from alcohol and healthy drinkers continuing to drink) and the cardio-effects of alcohol differing for people with different ALDH2 genotypes [4-6]. Such limitations should be addressed when designing future cohort studies. The external validity of the study by Di Castelnuovo et al. is important to consider. Di Castelnuovo et al. examine the impact of alcohol on deaths, and did not examine the impact of alcohol on premature mortality, morbidity or total health loss. The scope of the analysis should be considered when comparing the results of this study to other studies. For example, the Global Burden of Disease study modelled total health loss and found that no level of alcohol consumption provides a health benefit [3]. While data on mortality are easier to communicate than is the total health loss, such as via disability-adjusted life years (DALYs) lost, the DALYs lost provide more comprehensive estimates of the health burden [7]. As with other similar cohort studies, Di Castelnuovo et al.'s results are affected by representivity bias (caused by design and response biases). For example, the southern Finland/alpha-tocopherol, beta-carotene cancer prevention (ATBC) study restricted recruitment to men aged 50–69 years. Additionally, women, people who drink less, are older in age and have higher socio-economic status are often more likely to agree to participate in studies [8, 9]. These factors bias the representation of cohort deaths (upon which all-cause mortality RRs are based) towards those which are more common in people of older ages, women and people of higher socio-economic status. This is particularly important, as alcohol is the leading risk factor for death among people aged 15–49 years (due mainly to injuries) [3, 10], and there is emerging evidence that socio-economic status may be an effect modifier with RRs being higher for people of lower socio-economic status [11]. Therefore, efforts should be made in future cohort studies to achieve population representation, either through design or weighting. Lastly, different approaches are used to model the impact of alcohol consumption on health (i.e. using all-cause mortality or summing cause-specific mortality). The use of all-cause mortality probably accounts for causes of death which are causally related to alcohol consumption, but where evidence of causality has not yet been established (versus the Global Burden of Disease study, which would exclude these causes of death [3]). However, all-cause mortality estimates are also more susceptible to biases due to the inclusion of causes of death which have a spurious association with alcohol. The study by Di Castelnuovo et al., as well as other cohort studies which examine the effect of alcohol on all-cause mortality, provide data which are critical to public health. However, efforts should be made to avoid potential biases when designing future cohort studies, especially in studies which examine the effects of low-dose alcohol consumption on health. None. None Kevin Shield: Conceptualization. Jurgen Rehm: Conceptualization.

Subjective Economic Inequality Decreases Emotional Intelligence, Especially for People of High Social Class

Across five studies (three preregistered; N = 2,481), we investigated two effects as follows: (1) Is higher subjective economic inequality associated with a decreased ability to accurately identify emotions (emotional intelligence)? When inequality is high, people are less focused on others and may thus be less motivated to correctly identify their emotions. (2) Is this main effect of subjective inequality qualified by an interaction with socioeconomic status (SES)? Past research suggests that high SES leads to lower emotional intelligence because people of higher SES are less dependent on others and thus less motivated to identify their emotions. When perceiving higher inequality, high SES individuals should feel even more self-reliant, thereby exacerbating the difference in emotional intelligence between people of low and high SES. We provide empirical support in three out of five studies for the first and in four out of five studies for the second hypothesis. An internal meta-analysis supported both hypotheses.

The effect of education, income inequality and merit on inequality acceptance

Abstract A large number of observational and experimental studies have explored the determinants of individual preferences for redistribution. In general, inequalities are more likely to be accepted by people of higher socioeconomic status, in richer societies and when inequalities are perceived as justifiable owing to differences in productivity. Almas et al. (2020) show that in a relatively unequal society (the United States), the highly educated accept inequality significantly more than the less educated, whereas, in a relatively equal society (Norway), the less educated accept inequality more, but not significantly more, than the highly educated. Here, we replicate this finding using data from experiments conducted in four locations across three countries all distinct from the ones studied by Almas et al. However, a closer look at the data indicates that the origin of the interaction effect varies depending on which societies one compares. Data for Norway and the United States indicate that meritocratic values among the highly educated are less prevalent in more equal societies and that this is the driver of the triple interaction effect. In contrast, in our data the interaction effects have multiple drivers.

The association of smoking and socioeconomic status on melanoma skin cancer

Skin cancer is the most common cancer type in Western populations and melanoma is the most dangerous form of the disease. In recent years, a link between ‘social determinants’ and melanoma has emerged. Social determinants encompass both socioeconomic factors (including income, education, poverty level, area of residence, occupation and social status) and lifestyle factors (including exposure to UV light, marital status, hobbies, smoking, obesity). This study carried out by a team of investigators based in Swansea and London in the UK was designed to re‐examine the relationship between people's smoking habits, as well as socioeconomic status, and the occurrence and progression of melanoma. In order to achieve this, the team used a population database that held details of patients diagnosed and treated in Wales. The investigators were able to analyse data from more than 9,000 patients diagnosed with melanoma over the five years included in this study, and in addition they reviewed information on 26,000 people without melanoma. They found that smoking was associated with a decreased occurrence of melanoma and that it had no effect on death rates caused by melanoma itself, although death rates due to other causes were higher amongst smokers than non‐smokers. There was also a higher rate of melanoma in people of higher socioeconomic status, but these individuals also had a higher chance of survival from melanoma than those of lower socioeconomic status. The explanation for these findings needs to be clarified, as the differences may be due to a direct effect of smoking on the development and progress of melanoma, or may be related to other factors such as sun exposure rates amongst smokers and non‐smokers. This is a summary of the study: The association of smoking and socioeconomic status on cutaneous melanoma: a population‐based, data‐linkage, case‐control study.

Qualitative Research on the Real-Time Decision Making of WIC Participants While Food Shopping: Use of Think-Aloud Methodology

BackgroundPeople of lower socioeconomic status often experience disparities related to dietary intake as compared with People of higher socioeconomic status. Foods purchased influence the availability of foods in the home environment, and availability of foods in the home environment is associated with dietary intake. ObjectiveTo identify what factors influence food purchasing decisions of low-income parents while food shopping. DesignA qualitative study using think-aloud methodology, the processing of information through verbalization concurrent with task performance, was used to verbally capture real-time decision making. Participants and settingTwenty-eight parents with a preschool-aged child enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Study visits took place at the WIC clinic office and local grocery stores. Main outcomesReasons for making decisions while food shopping. AnalysisAudio recordings were transcribed, and thematic analysis was used to analyze the data. Descriptive statistics were used to characterize demographics and shopping behaviors. ResultsA parent’s decision in a food purchase was based on child preference, value, need of an item, or the parent choice for a product. In addition, themes emerged related to participant shopping behavior included the influence of participation in WIC on food and beverage purchases, multiple trips to the store, and a frequent focus on purchasing bottled water and juice. The average shopping trip was 31.5±15.7 minutes, and the median amount spent was $38.61. ConclusionUnderstanding the influences of parent decisions while making food purchases can better help inform the nutrition education provided as part of WIC.

Is the link between socioeconomic status and resilience mediated by reserve-building activities: mediation analysis of web-based cross-sectional data from chronic medical illness patient panels

ObjectivesThe purpose of this study is to test the hypothesis that the link between socioeconomic status (SES) and resilience is mediated by reserve-building activities.DesignCross-sectional observational study. Structural equation modelling (SEM)...

Interactions between race/ethnicity, poverty status, and pregnancy cardio-metabolic diseases in prediction of postpartum cardio-metabolic health

ABSTRACT Background: Prenatal health disparities exist for African Americans and low socioeconomic status (SES) individuals when compared to non-Hispanic Whites and people of higher SES, particularly in cardio-metabolic diseases. Furthermore, having had a pregnancy-specific cardio-metabolic disease, e.g. preeclampsia, increases risk for future cardio-metabolic disease. Although these factors (race, SES and pregnancy cardio-metabolic disease) are interrelated, studies have rarely considered their combined effect on postpartum cardio-metabolic risk. The purpose of this study was to assess whether SES, race/ethnicity, and prenatal cardio-metabolic disease interact in the prediction of postpartum cardio-metabolic risk. Methods: A sample of 1,753 low-income women of African American, Latina, non-Hispanic White race/ethnicity was recruited after a birth in 5 US sites. Household income was used to categorize poverty status as Poor (< Federal Poverty Level; FPL), near poor (100–200% FPL), or low/middle income (> 200% FPL). Three prenatal cardio-metabolic disease diagnoses (preeclampsia, gestational hypertension, gestational diabetes) were identified from medical records. Four biomarkers (mean arterial pressure, glycosylated haemoglobin, total cholesterol:HDL ratio, and waist-hip ratio) were collected at 6 and 12 months postpartum, and combined into an average postpartum cardio-metabolic risk index. Maternal age, pre-pregnancy body mass index, parity, health behaviors and employment status were covariates. Results: Analyses revealed interactions of race/ethnicity, poverty status, and prenatal cardio-metabolic diseases in the prediction of postpartum cardio-metabolic risk. African American women had higher postpartum cardio-metabolic risk, which was exacerbated following a prenatal cardio-metabolic disease. Low/middle income African American women had higher cardio-metabolic risk compared to poor African American, and all Latina and White women. Conclusions: African American women, and especially those who experienced pregnancy complications, emerged as vulnerable, and greater household income did not appear to confer protection against worse postpartum cardio-metabolic risk for this group. These results highlight the complex interplay between socioeconomic status and race/ethnicity with respect to understanding health disparities.

Socio‐economic status and HbA1c in type 2 diabetes: A systematic review and meta‐analysis

Up until now, differences in HbA1c levels by socio-economic status (SES) have been identified, but not yet quantified in people with type 2 diabetes. The aim of this study was therefore to assess the difference in HbA1c levels between people with type 2 diabetes of different SES in a systematic review and meta-analysis. A systematic literature search was conducted in MEDLINE, Embase, Ebsco, and the Cochrane Library until January 14, 2018. Included studies described adults with type 2 diabetes in whom the association between SES and HbA1c levels was studied. Studies were rated for methodological quality and data were synthesized quantitatively (meta-analysis) and qualitatively (levels of evidence), stratified for type of SES variable, i.e., education, income, deprivation, and employment. Fifty-one studies were included: 15 high, 27 moderate, and 9 of low methodological quality. Strong evidence was provided that people of low SES have higher HbA1c levels than people of high SES, for deprivation, education, and employment status. The pooled mean difference in HbA1c levels between people of low and high SES was 0.26% (95% CI, 0.09-0.43) or 3.12mmol/mol (95% CI, 1.21-5.04) for education and 0.20% (95% CI, -0.05 to 0.46) or 2.36mmol/mol (95%CI, -0.61 to 5.33) for income. In conclusion, our systematic review and meta-analysis showed that there was an inverse association between SES and HbA1c levels in people with type 2 diabetes. Future research should focus on finding SES-sensitive strategies to reduce HbA1c levels in people with type 2 diabetes.

Economía naranja colombiana en tiempos modernos

El presente artículo tiene como protagonista al concepto de economía creativa, como un sector que se ha abordado muy poco en Colombia. La industria creativa a lo largo de los años ha presentado altos niveles de crecimiento, teniendo en cuenta que no cuenta con un apoyo real por parte del gobierno, sin embargo, cabe destacar que, si se apoyara esta industria naciente en Colombia, se generaría una participación económica significativa, que resultaría en un ingreso de diferente proveniencia para el país y en general para la región, hablando específicamente de producción de materias primas. Se pretende, por tanto, dar a conocer los posibles cambios que tendrían que darse en Colombia, de índole tanto económica como cultural, para comprender que los bienes y servicios culturales no están exclusivamente dirigidos a grupos de personas de alto nivel socioeconómico, noción que favorecería el incentivo directo a este concepto y con ello traería beneficios en diferentes aspectos para el país.

Infusing fundamental cause theory with features of Pierre Bourdieu's theory of symbolic power.

The theory of fundamental causes is one of the more influential attempts to provide a theoretical infrastructure for the strong associations between indicators of socioeconomic status (education, income, occupation) and health. It maintains that people of higher socioeconomic status have greater access to flexible resources such as money, knowledge, prestige, power, and beneficial social connections that they can use to reduce their risks of morbidity and mortality and minimize the consequences of disease once it occurs. However, several key aspects of the theory remain underspecified, compromising its ability to provide truly compelling explanations for socioeconomic health inequalities. In particular, socioeconomic status is an assembly of indicators that do not necessarily cohere in a straightforward way, the flexible resources that disproportionately accrue to higher status people are not clearly defined, and the distinction between socioeconomic status and resources is ambiguous. I attempt to address these definitional issues by infusing fundamental cause theory with features of a well-known theory of socioeconomic stratification in the sociological literature-Pierre Bourdieu's theory of symbolic power.

Socioeconomic Determinants of Sodium Intake in Adult Populations of High-Income Countries: A Systematic Review and Meta-Analysis

Background. A poorer quality diet among individuals with low socioeconomic status (SES) may partly explain the higher burden of noncommunicable disease among disadvantaged populations. Because there is a link between sodium intake and noncommunicable diseases, we systematically reviewed the current evidence on the social patterning of sodium intake. Objectives. To conduct a systematic review and a meta-analysis of the evidence on the association between SES and sodium intake in healthy adult populations of high-income countries. Search Methods. We followed the PRISMA-Equity guidelines in conducting a literature search that ended June 3, 2016, via MEDLINE, Embase, and SciELO. We imposed no publication date limits. Selection Criteria. We considered only peer-reviewed articles meeting the following inclusion criteria: (1) reported a measure of sodium intake disaggregated by at least 1 measure of SES (education, income, occupation, or any other socioeconomic indicator); (2) were written in English, Spanish, Portuguese, French, or Italian; and (3) were conducted in a high-income country as defined by the World Bank (i.e., per capita national gross income was higher than $12 746). We also excluded articles that exclusively sampled low-SES individuals, pregnant women, children, adolescents, elderly participants, or diseased patients or that reported results from a trial or intervention. Data Collection and Analysis. As summary measures, we extracted (1) the direction (positive, negative, or neutral) and the magnitude of the association between each SES indicator and sodium intake, and (2) the estimated sodium intake according to SES level. When possible and if previously unreported, we calculated the magnitude of the relative difference in sodium intake between high- and low-SES groups for each article, applying this formula: ([value for high-SES group – value for low-SES group]/[value for high-SES group]) × 100. We considered an association significant if reported as such, and we set an arbitrary 10% relative difference as clinically relevant and significant. We conducted a meta-analysis of the relative difference in sodium intake between high- and low-SES groups. We included articles in the meta-analysis if they reported urine-based sodium estimates and provided the total participant numbers in the low- and high-SES groups, the estimated sodium intake means for each group (in mg/day or convertible units), and the SDs (or transformable measures). We chose a random-effects model to account for both within-study and between-study variance. Main Results. Fifty-one articles covering 19 high-income countries met our inclusion criteria. Of these, 22 used urine-based methods to assess sodium intake, and 30 used dietary surveys. These articles assessed 171 associations between SES and sodium intake. Among urine-based estimates, 67% were negative (higher sodium intake in people of low SES), 3% positive, and 30% neutral. Among diet-based estimates, 41% were negative, 21% positive, and 38% neutral. The random-effects model indicated a 14% relative difference between low- and high-SES groups (95% confidence interval [CI] = –18, –9), corresponding to a global 503 milligrams per day (95% CI = 461, 545) of higher sodium intake among people of low SES. Conclusions. People of low SES consume more sodium than do people of high SES, confirming the current evidence on socioeconomic disparities in diet, which may influence the disproportionate noncommunicable disease burden among disadvantaged socioeconomic groups. Public Health Implications. It is necessary to focus on disadvantaged populations to achieve an equitable reduction in sodium intake to a population mean of 2 grams per day as part of the World Health Organization’s target to achieve a 25% relative reduction in noncommunicable disease mortality by 2025.

Socioeconomic Determinants of Sodium Intake in Adult Populations of High-Income Countries: A Systematic Review and Meta-Analysis.

A poorer quality diet among individuals with low socioeconomic status (SES) may partly explain the higher burden of noncommunicable disease among disadvantaged populations. Because there is a link between sodium intake and noncommunicable diseases, we systematically reviewed the current evidence on the social patterning of sodium intake. To conduct a systematic review and a meta-analysis of the evidence on the association between SES and sodium intake in healthy adult populations of high-income countries. We followed the PRISMA-Equity guidelines in conducting a literature search that ended June 3, 2016, via MEDLINE, Embase, and SciELO. We imposed no publication date limits. We considered only peer-reviewed articles meeting the following inclusion criteria: (1) reported a measure of sodium intake disaggregated by at least 1 measure of SES (education, income, occupation, or any other socioeconomic indicator); (2) were written in English, Spanish, Portuguese, French, or Italian; and (3) were conducted in a high-income country as defined by the World Bank (i.e., per capita national gross income was higher than $12 746). We also excluded articles that exclusively sampled low-SES individuals, pregnant women, children, adolescents, elderly participants, or diseased patients or that reported results from a trial or intervention. As summary measures, we extracted (1) the direction (positive, negative, or neutral) and the magnitude of the association between each SES indicator and sodium intake, and (2) the estimated sodium intake according to SES level. When possible and if previously unreported, we calculated the magnitude of the relative difference in sodium intake between high- and low-SES groups for each article, applying this formula: ([value for high-SES group - value for low-SES group]/[value for high-SES group]) × 100. We considered an association significant if reported as such, and we set an arbitrary 10% relative difference as clinically relevant and significant. We conducted a meta-analysis of the relative difference in sodium intake between high- and low-SES groups. We included articles in the meta-analysis if they reported urine-based sodium estimates and provided the total participant numbers in the low- and high-SES groups, the estimated sodium intake means for each group (in mg/day or convertible units), and the SDs (or transformable measures). We chose a random-effects model to account for both within-study and between-study variance. Fifty-one articles covering 19 high-income countries met our inclusion criteria. Of these, 22 used urine-based methods to assess sodium intake, and 30 used dietary surveys. These articles assessed 171 associations between SES and sodium intake. Among urine-based estimates, 67% were negative (higher sodium intake in people of low SES), 3% positive, and 30% neutral. Among diet-based estimates, 41% were negative, 21% positive, and 38% neutral. The random-effects model indicated a 14% relative difference between low- and high-SES groups (95% confidence interval [CI] = -18, -9), corresponding to a global 503 milligrams per day (95% CI = 461, 545) of higher sodium intake among people of low SES. People of low SES consume more sodium than do people of high SES, confirming the current evidence on socioeconomic disparities in diet, which may influence the disproportionate noncommunicable disease burden among disadvantaged socioeconomic groups. Public Health Implications. It is necessary to focus on disadvantaged populations to achieve an equitable reduction in sodium intake to a population mean of 2 grams per day as part of the World Health Organization's target to achieve a 25% relative reduction in noncommunicable disease mortality by 2025.

Mortality, greenhouse gas emissions and consumer cost impacts of combined diet and physical activity scenarios: a health impact assessment study

ObjectiveTo quantify changes in mortality, greenhouse gas (GHG) emissions and consumer costs for physical activity and diet scenarios.DesignFor the physical activity scenarios, all car trips from <1 to <8 miles...