Regional Deprivation Research Articles

Neighborhood Socioeconomic Status Independently Predicts Outcomes After Mitral Valve Surgery

BackgroundSocioeconomic status has increasingly recognized influence on outcomes after cardiac surgery. However, singular metrics fail to fully capture the socioeconomic context within which patients live, which vary greatly between neighborhoods. We sought to explore the impact of neighborhood-level socioeconomic status on patients undergoing mitral valve surgery in the United States. MethodsAdults undergoing first-time, isolated mitral valve surgery were queried from The Society of Thoracic Surgeons Adult Cardiac Surgery Database between 2012 and 2018. Socioeconomic status was quantified using the Area Deprivation Index, a weighted composite including average housing prices, household incomes, education, and employment levels. The associations between regional deprivation, access to mitral surgery, valve repair rates, and outcomes were evaluated using logistic regression. ResultsAmong 137,100 patients included, patients with socioeconomic deprivation had fewer elective presentations, more comorbidity burden, and more urgent/emergent surgery. Patients from less disadvantaged areas received operations from higher volume surgeons and had higher repair rates (highest vs lowest quintile: 72% vs 51%, P < .001, more minimally-invasive approach (33% vs 20%, P < .001), lower composite complication rate (42% vs 50%, P < .001), and lower 30-day mortality (1.8% vs 3.9%, P < .001). After hierarchical multivariable adjustment, the Area Deprivation Index significantly predicted 30-day mortality and repair rate (P < .001). ConclusionsIn a risk-adjusted national analysis of mitral surgery, patients from more deprived areas were less likely to undergo mitral repair and more likely to have complications. Further work at targeting neighborhood-level disparity is important to improving mitral surgical outcomes in the United States.

Regional deprivation and risk of developing cardiovascular diseases (Framingham Risk Score): data from ESSE-RF

<h3></h3> Сердечно-сосудистые заболевания (ССЗ) являются одной из ведущих причин смерти в Российской Федерации. По данным исследования «Глобальное бремя болезней, травм и факторов риска 2016», ишемическая болезнь сердца и цереброваскулярная болезнь являлись основными причинами потерянных лет жизни в России в 2016 г. Во многих российских исследованиях изучали связь между индивидуальными показателями (например, уровень дохода, образования) и риском развития сердечно-сосудистых заболеваний. Ассоциация между территориальными показателями депривации и риском развития ССЗ в России остается малоизученной. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Проанализировать связь между региональной депривацией и риском развития ССЗ у взрослого населения России. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Текущее исследование основано на данных исследования «Эпидемиология сердечно-сосудистых заболеваний в различных регионах России» (ЭССЕ-РФ).<b></b> Всего в наше исследование включено 15 264 респондентов, из них 6304 мужчин и 8960 женщин в возрасте 25—64 года без ССЗ. Фрамингемская шкала учитывает возраст, пол, уровень систолического артериального давления, общего холестерина и липопротеинов высокой плотности, статус курения и наличие сахарного диабета. Региональная депривация измерена с помощью индекса депривации. Показатели для построения индекса взяты из данных Федеральной службы государственной статистики за 2010 г. Индекс включает 17 показателей, отражающих социально-экономическую и экологическую депривацию на региональном уровне. С помощью индекса можно измерить общую депривацию, а с помощью его компонентов — социальную, экономическую и экологическую депривацию регионов. Для установления ассоциации депривации с риском развития ССЗ применили обобщенные оценочные уравнения с независимой корреляционной структурой. <h3>РЕЗУЛЬТАТЫ</h3> В нашем исследовании отсутствует статистически значимая связь между общей депривацией и 10-летним риском развития ССЗ. У населения, проживающего в наиболее экономически депривированных регионах, по сравнению с наименее экономически депривированными регионами шансы наличия риска ССЗ ≥7,5% и риска ССЗ ≥10% были выше. <h3>ЗАКЛЮЧЕНИЕ</h3> Необходимо провести дополнительные исследования, используя проспектовые данные ЭССЕ-РФ.

Small-Area Geographic and Socioeconomic Inequalities in Colorectal Cancer in Cyprus.

Colorectal cancer (CRC) is one of the leading causes of death and morbidity worldwide. To date, the relationship between regional deprivation and CRC incidence or mortality has not been studied in the population of Cyprus. The objective of this study was to analyse the geographical variation of CRC incidence and mortality and its possible association with socioeconomic inequalities in Cyprus for the time period of 2000-2015. This is a small-area ecological study in Cyprus, with census tracts as units of spatial analysis. The incidence date, sex, age, postcode, primary site, death date in case of death, or last contact date of all alive CRC cases from 2000-2015 were obtained from the Cyprus Ministry of Health's Health Monitoring Unit. Indirect standardisation was used to calculate the sex and age Standardise Incidence Ratios (SIRs) and Standardised Mortality Ratios (SMRs) of CRC while the smoothed values of SIRs, SMRs, and Mortality to Incidence ratio (M/I ratio) were estimated using the univariate Bayesian Poisson log-linear spatial model. To evaluate the association of CRC incidence and mortality rate with socioeconomic deprivation, we included the national socioeconomic deprivation index as a covariate variable entering in the model either as a continuous variable or as a categorical variable representing quartiles of areas with increasing levels of socioeconomic deprivation. The results showed that there are geographical areas having 15% higher SIR and SMR, with most of those areas located on the east coast of the island. We found higher M/I ratio values in the rural, remote, and less dense areas of the island, while lower rates were observed in the metropolitan areas. We also discovered an inverted U-shape pattern in CRC incidence and mortality with higher rates in the areas classified in the second quartile (Q2-areas) of the socioeconomic deprivation index and lower rates in rural, remote, and less dense areas (Q4-areas). These findings provide useful information at local and national levels and inform decisions about resource allocation to geographically targeted prevention and control plans to increase CRC screening and management.

German Index of Socioeconomic Deprivation (GISD): Revision, update and applications.

Regional deprivation indices enable researchers to analyse associations between socioeconomic disadvantages and health outcomes even if the health data of interest does not include information on the individuals' socioeconomic position. This article introduces the recent revision of the German Index of Socioeconomic Deprivation (GISD) and presents associations with life expectancy as well as age-standardised cardiovascular mortality rates and cancer incidences as applications. The GISD measures the level of socioeconomic deprivation using administrative data of education, employment, and income situations at the district and municipality level from the INKAR database. The indicators are weighted via principal component analyses. The regional distribution is depicted cartographically, regional level associations with health outcomes are presented. The principal component analysis indicates medium to high correlations of the indicators with the index subdimensions. Correlation analyses show that in districts with the lowest deprivation, the average life expectancy of men is approximately six years longer (up to three years longer for women) than for those from districts with the highest deprivation. A similar social gradient is observed for cardiovascular mortality and lung cancer incidence. The GISD provides a valuable tool to analyse socioeconomic inequalities in health conditions, diseases, and their determinants at the regional level.

DISP-07. SURVIVAL ANALYSIS OF GLIOBLASTOMA PATIENTS IN PENNSYLVANIA ACCORDING TO AREA DEPRIVATION INDEX AND IDH STATUS

Abstract INTRODUCTION Glioblastoma (GBM) is the most aggressive primary brain tumor with a universally poor prognosis. Living in disadvantaged neighborhoods is associated with poor health outcomes, including increased cancer incidence. This study was designed to elucidate the relationship between GBM patients’ survival, isocitrate dehydrogenase (IDH) mutation status, and residential areas of deprivation in the state of Pennsylvania. METHODS Patients from Pennsylvania with a pathological diagnosis of GBM WHO Grade IV between January 2007 and December 2018 were retrospectively reviewed in the Penn State Health database. Demographic variables and molecular features were assessed. Area Deprivation Index (ADI) is a validated measure of regional socioeconomic deprivation that indexes neighborhoods by percentile, with low ADI scores representing less deprivation. Patients were assigned to low ( &amp;lt; 50) or high ( ≥ 51) ADI groups. Survival was measured against IDH status and ADI score; log-rank tests were performed. RESULTS 121 GBM WHO Grade IV patients were identified (median age at diagnosis: 63, 39.7% female, 60.3% male, 93.4% of white race). Among those, 64 (52.9%) had low ADI, and 57 (47.1%) had high ADI. Patients with high ADI had similar overall survival (OS) rates and progression free survival (PFS) at 18 months (56% OS, 95% confidence interval [CI]: 48-64%; 37.4% PFS, 95%CI: 30-44%; P=0.27) compared to patients with low ADI (50% OS, 95%CI: 43-57%; 32.4% PFS, 95%CI: 26-39%; P = 0.27). Further classification by IDH status resulted in 17 (14%) IDH mutant (IDHm) and 104 (86%) IDH wildtype (IDHwt) patients. Survival analysis demonstrated no significant difference in OS between IDHwt and IDHm patients, regardless of ADI score. CONCLUSION The aggressive nature of GBM requires early diagnostic approaches to impact survival. Living in socioeconomic disadvantaged areas may diminish survival outcomes; however, our data indicate that GBM may be too aggressive for ADI to have a significant impact on prognosis.

Socioeconomic and geographic inequalities in colorectal cancer in Cyprus: An ecological study

Abstract Background Colorectal cancer (CRC) is one of the main causes of mortality and morbidity worldwide. To date, the relationship between regional deprivation and CRC incidence or mortality has not been studied in the population of Cyprus. The aim of this study was to analyse the geographical variation of CRC incidence and mortality and its possible association with socio-economic inequalities in Cyprus for the periods between 2000 and 2015. Methods A small area ecological study in Cyprus, with census tracts as units of spatial analysis, for the period between 2000 and 2015. The incidence date, sex, age, post code, primary site, death date in case of death or last contact date in case of alive for all cases of CRC from 2000-2015 were obtained from the Cyprus Ministry of Health. Indirect standardization was used to calculate the sex and age Standardize Incidence Ratios (SIRs) and Standardized Mortality Ratios (SMRs) of CRC while the smoothed values of SIRs, SMRs and Mortality to Incidence ratio (M/I ratio) were estimated using the univariate Bayesian Poisson log-linear spatial model. Results There are geographical areas having 15% higher SIR and SMR, with most of those areas located at the east coast of the island. Higher M/I ratio values were found in the rural, remote, and less dense areas of the island while lower rates were observed in the metropolitan areas. An inverted U-shape pattern in CRC incidence and mortality was observed with higher rates in the areas classified in the second quartile of the socio-economic deprivation index and lower rates in rural, remote, and less dense areas. A different pattern emerged in the M/I ratio indicating a stepwise increase across increasing levels of socioeconomic deprivation. Conclusions These findings can potentially provide useful information at local and national levels and can inform public health authorities to appropriately allocate resources for geographically targeted prevention and control plans to increase CRC screening. Key messages • M/I ratio of CRC was positively associated with regional deprivation since a stepwise increase was found across increasing levels of rural-related socioeconomic deprivation. • Interventions aimed at reducing the risks of CRC should primarily focus on socially deprived communities in Cyprus.

Do regional characteristics predict developmental delay? Analyses of German school entry examination

Abstract Background Children's health and development are strongly linked to their living situation, including their family's socioeconomic position (SEP) and living region. However, research on the impact of the living region on children's development beyond family SEP is scarce. This study evaluated whether rurality and regional socioeconomic deprivation (DEP) are associated with children's development independently of family SEP. Methods The study used population-based data of 5-6.5 years old children (n = 22,801) from mandatory school entry examinations (SEE) in the German federal state of Brandenburg, which were examined in 2018/2019. The SEE data have been linked with data on i. rurality that was defined by an inverted population density and ii. regional DEP that were provided by the German Index of Socioeconomic Deprivation. By binary multilevel models, the predictive values of rurality and regional DEP for global developmental delay (GDD) were evaluated, while adjusting for family SEP. Results Children with high family SEP showed reduced odds for GDD compared to medium family SEP (female: OR = 4.26, CI95=3.14-5.79, male: OR = 3.46, CI95=2.83-4.22) and low family SEP (female: OR = 16.58, CI95=11.90-23.09, male: OR = 12.79, CI95=10.13-16.16). Regional DEP additionally predicted GDD, with higher odds for children from more deprived regions (female: OR = 1.35, CI95=1.13-1.62, male: OR = 1.20, CI95=1.05-1.39). Rurality did not predict GDD beyond family SEP and regional DEP. Conclusions In addition to family SEP, the regional DEP has an effect on children's developmental delay. Hence, Public Health should take into account regional socioeconomic conditions as determinant of health over the life course in addition to family SEP. Key messages • Regional socioeconomic deprivation contributes to inequalities in children's development and health. • Besides family SEP, regional socioeconomic circumstances are of particular interest to promote health over the life course.

Who Is Able to Resist What Is Forbidden?-The Relationship between Health Literacy and Risk Behaviours in Secondary School Students in the Broader Social and Educational Context.

In the last Health Behaviour in School-Aged Children (HBSC) survey conducted in Poland in 2018, a group of 17-year-old adolescents (n = 1663; mean age 17.63 ± 0.36 years) was included outside the international protocol. This allowed an assessment to be made of their level of health literacy (HL) using the 10-point HBSC research tool. The aim of the study was to investigate the relationship between HL and risk behaviours (RB). A standardised index of RB in the last 30 days was considered as an outcome measure. This index was significantly higher in the group with low HL (0.318 ± 1.269) in comparison with the group with high HL (−0.083 ± 0.962). In a multivariate linear regression model, the strongest predictors of RB were gender, academic performance and level of regional deprivation, but the association with HL remained significant. This significant association persisted in general schools and in girls but disappeared in vocational schools and in boys. It was also shown that in rural areas, good academic performance has a less significant impact on RB if the HL level is low. The analyses led to the conclusion that when examining the relationship between HL and RB in older adolescents, it is advisable to take into account gender, the educational track and neighbourhood characteristics.

Frequency of Ketoacidosis at Diagnosis of Pediatric Type 1 Diabetes Associated With Socioeconomic Deprivation and Urbanization: Results From the German Multicenter DPV Registry.

To investigate whether socioeconomic deprivation and urbanization are associated with the frequency of diabetic ketoacidosis (DKA) at diagnosis of pediatric type 1 diabetes. Children and adolescents aged ≤18 years, living in Germany, with newly diagnosed type 1 diabetes documented between 2016 and 2019 in the Diabetes Prospective Follow-up Registry (DPV; Diabetes-Patienten-Verlaufsdokumentation), were assigned to a quintile of regional socioeconomic deprivation (German Index of Socioeconomic Deprivation) and to a degree of urbanization (Eurostat) by using their residence postal code. With multiple logistic regression models, we investigated whether the frequency of DKA at diagnosis was associated with socioeconomic deprivation or urbanization and whether associations differed by age-group, sex, or migration status. In 10,598 children and adolescents with newly diagnosed type 1 diabetes, the frequency of DKA was lowest in the least deprived regions (Q1: 20.6% [95% CI 19.0-22.4], and increased with growing socioeconomic deprivation to 26.9% [25.0-28.8] in the most deprived regions [Q5]; P for trend <0.001). In rural areas, the frequency of DKA at diagnosis was significantly higher than in towns and suburbs (intermediate areas) or in cities (27.6% [95% CI 26.0-29.3] vs. 22.7% [21.4-24.0], P < 0.001, or vs. 24.3% [22.9-25.7], P = 0.007, respectively). The results did not significantly differ by age-group, sex, or migration background or after additional adjustment for socioeconomic deprivation or urbanization. This study provides evidence that prevention of DKA at diagnosis by means of awareness campaigns and screening for presymptomatic type 1 diabetes should particularly target socioeconomically disadvantaged regions and rural areas.

Pattern of Regional Disparities in the Level of Household Deprivation among the Scheduled Tribes of Eastern India: A District-level Analysis

This study attempted to show regional disparities in the level of deprivation among the Scheduled Tribe population in eastern Indian states (Bihar, Jharkhand, Odisha and West Bengal). This work is based on house listing and housing table of Census of India, 2011 and Socio-Economic Cast Census data. The Wroclaw Taxonomic method was employed for measuring the deprivation index. The results show that, out of 110 districts, 55 districts are in a middle-deprived stage and 13 districts are in a highly deprived stage. Among the states, the level of deprivation is very high in Odisha, followed by West Bengal. The situation is quite better in Jharkhand. The study also shows that the districts with little better condition are either situated in agricultural plain, mining centres, power plants or tourism centres. The study also reveals that the areas with the better conditions are either in agricultural plains, mining centres, power plants or tourism centres. As a result, the research recommends enhancing previously existing tribal development programmes as well as regional general development programmes in order to reduce concerns such as tribal, rural and regional deprivation.

Continuing inequalities in COVID-19 mortality in England and Wales, and the changing importance of regional, over local, deprivation.

BackgroundObservational studies have highlighted that where individuals live is far more important for risk of dying with COVID-19, than for dying of other causes. Deprivation is commonly proposed as explaining such differences. During the period of localised restrictions in late 2020, areas with higher restrictions tended to be more deprived. We explore how this impacted the relationship between deprivation and mortality and see whether local or regional deprivation matters more for inequalities in COVID-19 mortality.MethodsWe use publicly available population data on deaths due to COVID-19 and all-cause mortality between March 2020 and April 2021 to investigate the scale of spatial inequalities. We use a multiscale approach to simultaneously consider three spatial scales through which processes driving inequalities may act. We go on to explore whether deprivation explains such inequalities.ResultsAdjusting for population age structure and number of care homes, we find highest regional inequality in October 2020, with a COVID-19 mortality rate ratio of 5.86 (95% CI 3.31 to 19.00) for the median between-region comparison. We find spatial context is most important, and spatial inequalities higher, during periods of low mortality. Almost all unexplained spatial inequality in October 2020 is removed by adjusting for deprivation. During October 2020, one standard deviation increase in regional deprivation was associated with 20% higher local mortality (95% CI, 1.10 to 1.30).ConclusionsSpatial inequalities are greatest in periods of lowest overall mortality, implying that as mortality declines it does not do so equally. During the prolonged period of low restrictions and low mortality in summer 2020, spatial inequalities strongly increased. Contrary to previous months, we show that the strong spatial patterning during autumn 2020 is almost entirely explained by deprivation. As overall mortality declines, policymakers must be proactive in detecting areas where this is not happening, or risk worsening already strong health inequalities.

The cost- effectiveness of early dental visit in infants and toddlers focused on regional deprivation in South Korea: A retrospective cohort study.

The aims of this study are to evaluate the cost-effectiveness of early dental visits (EDVs) and to investigate how regional deprivation impacts the economic evaluation. This study used the South Korea National Health Insurance database, which included medical claim data and voluntary-based oral examination data. The subjects of this study included whole participants for oral examinations for infants and toddlers of the National Health Insurance Corporation. A retrospective cohort study was designed and measured all oral treatments, costs, and number of visits for 208,969 children (experimental group, 101,768; non- experimental group, 107,201) who underwent oral examination for infants and toddlers from 2007 to 2014. The cost-effectiveness was measured using the incremental cost-effectiveness ratio, and the T-health index was used as the measurement for effectiveness. In addition, the difference in the effect according to the level of regional deprivation was confirmed. The findings of this study showed that EDVs were cost-effective and that children who participated in EDVs had better oral health (T-health-2 index difference 0.32 point in most deprived regions) and needed 5 USD less costly dental treatments than those who did not have EDVs. The cost-effectiveness of EDVs varied according to the level of regional deprivation and was the highest in the most deprived regions. The study findings suggested that the provision of oral examination for infants and toddlers was a cost-effective dental policy. Additionally, EDVs were more effective in children who resided in the most deprived regions, a finding that will lead to the development of policy intervention to improve dental care despite spatial inequality for disadvantaged population groups. Regarding the distribution of dental hospitals/clinics, incentive based dental polices for either dental providers or patients are needed that will assure the delivery of dental care despite spatial inequality.

Association of regional socioeconomic deprivation and rurality with global developmental delay in early childhood: Data from mandatory school entry examinations in Germany

From birth to young adulthood, health and development of young people are strongly linked to their living situation, including their family's socioeconomic position (SEP) and living environment. The impact of regional characteristics on development in early childhood beyond family SEP has been rarely investigated. This study aimed to identify regional predictors of global developmental delay at school entry taking family SEP into consideration.We used representative, population-based data from mandatory school entry examinations of the German federal state of Brandenburg in 2018/2019 with n=22,801 preschool children. By applying binary multilevel models, we hierarchically analyzed the effect of regional deprivation defined by the German Index of Socioeconomic Deprivation (GISD) and rurality operationalized as inverted population density of the children's school district on global developmental delay (GDD) while adjusting for family SEP (low, medium and high).Family SEP was significantly and strongly linked to GDD. Children with the highest family SEP showed a lower odds for GDD compared to a medium SEP (female: OR=4.26, male: OR=3.46) and low SEP (female: OR=16.58, male: OR=12.79). Furthermore, we discovered a smaller, but additional and independent effect of regional socioeconomic deprivation on GDD, with a higher odds for children from a more deprived school district (female: OR=1.35, male: OR=1.20). However, rurality did not show a significant link to GDD in preschool children beyond family SEP and regional deprivation.Family SEP and regional deprivation are risk factors for child development and of particular interest to promote health of children in early childhood and over the life course.

The impact of regional socioeconomic deprivation on the timing of HIV diagnosis: a cross-sectional study in Germany

BackgroundHIV infections which are diagnosed at advanced stages are associated with significantly poorer health outcomes. In Germany, the proportion of persons living with HIV who are diagnosed at later stages has remained continuously high. This study examined the impact of regional socioeconomic deprivation on the timing of HIV diagnosis.MethodsWe used data from the national statutory notification of newly diagnosed HIV infections between 2011 and 2018 with further information on the timing of diagnosis determined by the BED-Capture-ELISA test (BED-CEIA) and diagnosing physicians. Data on regional socioeconomic deprivation were derived from the German Index of Socioeconomic Deprivation (GISD). Outcome measures were a non-recent infection based on the BED-CEIA result or an infection at the stage of AIDS. The effect of socioeconomic deprivation on the timing of diagnosis was analysed using multivariable Poisson regression models with cluster-robust error variance.ResultsOverall, 67.5% (n = 10,810) of the persons were diagnosed with a non-recent infection and 15.2% (n = 2746) with AIDS. The proportions were higher among persons with heterosexual contact compared to men who have sex with men (MSM) (76.8% non-recent and 14.9% AIDS vs. 61.7% non-recent and 11.4% AIDS). MSM living in highly deprived regions in the countryside (< 100 k residents) were more likely to have a non-recent infection (aPR: 1.16, 95% CI: 1.05–1.28) as well as AIDS (aPR: 1.41, 95% CI: 1.08–1.85) at the time of diagnosis compared to MSM in less deprived regions in the countryside. No differences were observed among MSM from towns (100 k ≤ 1 million residents) or major cities (≥ 1 million residents), and no differences overall in the heterosexual transmission group.ConclusionsAn effect of socioeconomic deprivation on the timing of HIV diagnosis was found only in MSM from countryside regions. We suggest that efforts in promoting HIV awareness and regular HIV testing are increased for heterosexual persons irrespective of socioeconomic background, and for MSM with a focus on those living in deprived regions in the countryside.

Local iron deficiency in the substantia nigra directly contributes to hyperlocomotion phenotypes

Brain iron is precisely regulated, and disrupted brain iron homeostasis is implicated in neuropsychological disease. Mounting evidence connects the iron status of the substantia nigra (SN) with locomotion-related neural symptomatology. Researchers in this field have long speculated that iron deficiency in the SN directly causes the high-locomotion symptoms observed in neuropsychiatric disorders. However, no direct experimental evidence of a causal relationship has been presented. To explore the relationship between iron deficiency in the SN and locomotion-related phenotypes, we stereotaxically injected the well-documented iron chelator, deferiprone (DFP) into the SN of mice to induce regional brain iron deprivation and subsequently performed behavioral tests. Altered expression of iron metabolism-related molecules was detected in the brain regions with interventions, and behavioral changes were observed. Targeted iron chelation effectively decreased the local iron content of the SN. Among the brain regions examined, only DFP injected into the SN resulted in the hyperlocomotion phenotype. Upon SN iron chelation, transferrin receptor (Tfr) expression was found to be upregulated. Conversely, viral vector-mediated SN-Tfr knockdown was sufficient to induce SN iron deficiency and mimic the hyperlocomotion phenotype. All locomotion changes had a significant negative correlation with iron alteration in the SN. Furthermore, SN iron disturbance also contributed to poor sleep efficiency. Thus, SN iron deficiency directly contributed to triggering both hyperlocomotion and sleep disturbances. This study offers a promising research and therapeutic direction for iron-linked neuropsychiatric diseases.

지역사회 노인의 신체활동에 영향을 미치는 다수준 요인

This study was attempted to provide basic data for the development of intervention programs by identifying the factors influencing physical activity for the elderly in the S city community through multiple-level analysis. A part of the 2019 Community Health Survey data, e- region index and public portal data were used for analysis. The subject this study were 5,939 peoples aged 65 years or older living in S city. Individual factors included sex, age, economic activity status, income, marital status, educational attainment, hypertension, diabetes, depression, smoking status, self-assessment of stress and self-assessment of health. Regional factors included regional deprivation index, the number of cultural facilities, residential environment satisfaction and social networking. The analysis was conducted using a multi-level model to identify the factors related to physical activity in the elderly by considering both individual and regional levels. As a results, individual factors affecting physical activity were gender, age, smoking status and self-assessment of health. Regional level factors affecting physical activity was identified as social networking. Based on these results, it is suggested that an efficient program be developed to increase the physical activity of the elderly in the community.

Regional variation in coronary angiography rates: the association with supply factors and the role of indication: a spatial analysis

BackgroundCoronary angiographies (CAs) are among the most common diagnostic procedures carried out in German hospitals, and substantial regional differences in their frequency of use have been documented. Given the heterogeneity with regard to the expected benefits and the varying scope for discretion depending on the indication for the procedure, we hypothesized that the observed variation and the association of need and supply factors differs by indication for CA.MethodsWe investigated the correlation between supply factors and the regional rates of CAs in Germany while controlling for need using spatial‐autoregressive error models (SARE) and spatial cross-regressive models with autoregressive errors (SCRARE). The overall rates of CAs and the rates in specific patient subgroups, namely, patients with and without myocardial infarction (MI), were calculated based on a comprehensive set of nationwide routine data from three statutory health insurances at the district level.ResultsAlthough little variation was found in cases with MI, considerable variation was seen in the overall cases and cases without MI. The SARE models revealed a positive association between the number of hospitals with a cardiac catheterization laboratory per 10,000 population and the rates of overall cases and cases without MI, whereas no such relationship existed in cases with MI. Additionally, an association between regional deprivation and the rates of CAs was found in cases with MI, but no such association was seen in cases without MI.ConclusionsThe results supported the hypothesis that the relative association of need and supply factors differed by the indication for CA. Although the regional differences in the frequency of use of CAs can only be explained in part by the factors examined in our study, it offers insight into patient access to and the provision of CA services and can provide a platform for further local research.

Association of regional deprivation and metabolic syndrome in Russian adults

<h3></h3> Известно, что метаболический синдром (МС) способствует увеличению заболеваемости и смертности от сердечно-сосудистых заболеваний. При этом не только МС в целом, но и его отдельные компоненты, такие как абдоминальное ожирение, гипергликемия, дислипидемия и высокий уровень артериального давления, увеличивают риск развития сердечно-сосудистых осложнений. В многочисленных исследованиях установлена связь между депривацией и МС с использованием как отдельных переменных депривации (например, уровня дохода, образования), так и комплексных моделей (индексов), включающих несколько переменных. Вместе с тем на сегодняшний день ассоциация экологической и социально-экономической депривации с МС среди взрослого населения России остается малоизученной. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Проанализировать связь между региональной депривацией и МС у взрослого населения России. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Для анализа использованы данные исследования «Эпидемиология сердечно-сосудистых заболеваний и их факторов риска в регионах Российской Федерации». В исследовании приняли участие мужчины и женщины в возрасте 25—64 лет (всего 21 921 человек). МС определяли по критериям, предложенным Международной диабетической федерацией (2009). Показатели для построения индекса депривации взяты из данных Федеральной службы государственной статистики за 2010 г. Индекс включает 17 показателей, отражающих социальную, экономическую и экологическую депривацию на региональном уровне. Индекс предназначен для измерения общей депривации, а его элементы — для измерения социальной, экономической и экологической депривации регионов. Для изучения ассоциации региональной депривации с МС и его компонентами использованы обобщенные оценочные уравнения. <h3>РЕЗУЛЬТАТЫ</h3> Частота МС и отдельных его компонентов увеличивается в регионах с высоким уровнем общей депривации и, наоборот, уменьшается в наиболее социально депривированных регионах. <h3>ЗАКЛЮЧЕНИЕ</h3> Разработку и реализацию профилактических программ, направленных на снижение заболеваемости и смертности от сердечно-сосудистых заболеваний, следует осуществлять с учетом показателей благополучия регионов.

Survival of colorectal cancer: the role of contextual, individual and tumour-specific characteristics

Abstract Background Colorectal cancer (CRC) is the second most common cancer in women and the third most common cancer in men in Germany. One in two people suffering from CRC dies within five years after diagnosis. The aim of our ongoing research project is to investigate the interaction of contextual, individual and tumour-specific characteristics and their effect on CRC survival in Bavaria. Methods A total of 124,958 incident cases of CRC (ICD-10 C18-C20) from the Bavarian Cancer Registry are linked with data on area deprivation based on the Bavarian Index of Multiple Deprivation (BIMD). We include all years with a CRC-specific case completeness of 90% or more, i.e. 2004 to 2018. We calculate Kaplan-Meier curves as well as mixed proportional hazards models including non-linear effects. Our modelling strategy starts from a baseline model with random effects at district, municipality, and individual level, which we continuously extend to include regional (deprivation), individual (age at diagnosis, sex) as well as tumour-specific variables (tumour site, grading, cancer stage, histological subtype, diagnosis of multiple primary tumours). Results Preliminary results show significant random effects at district and municipality level as well as a negative impact of deprivation on CRC survival for all sites. Individual as well as tumour-specific characteristics, such as age, grading, and cancer stage, demonstrate the strongest effects on CRC survival and partly explain survival differences according to area level (districts, municipalities), and level of deprivation. The effects of individual as well as tumour-specific characteristics vary between districts and municipalities in Bavaria depending on their level of area deprivation. Conclusions Contextual, individual and tumour-specific characteristics have an impact on CRC survival. Future studies may also include health services characteristics in CRC survival analysis. Key messages CRC survival is inversely associated with area deprivation in Bavaria. The effects of individual and tumour-specific characteristics, e.g. age and cancer stage, increase with the level of deprivation.

Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany \u2013 an ecological study

BackgroundSepsis is a substantial health care burden. Data on regional variation in sepsis incidence in Germany and any possible associations with regional socioeconomic deprivation and health care capacity is lacking.MethodsEcological study based on the nationwide hospital Diagnosis-related Groups (DRG) statistics data of 2016. We identified sepsis by ICD-10-codes and calculated crude and age-standardized incidence proportions in the 401 administrative German districts. Associations between socioeconomic and health care capacity indicators and crude and age-adjusted sepsis incidence were investigated by simple and multiple negative binomial (NB) regressions.ResultsIn 2016, sepsis incidence was 178 per 100,000 inhabitants and varied 10-fold between districts. We found that the rate of students leaving school without certificate was significantly associated with crude and age-standardized explicit sepsis incidence in the simple and multiple NB regressions. While we observed no evidence for an association to the capacity of hospital beds and general practitioners, the distance to the nearest pharmacy was associated with crude- and age-standardized sepsis incidence. In the multiple regression analyses, an increase of the mean distance + 1000 m was associated with an expected increase by 21.6 [95% CI, 10.1, 33.0] (p < 0.001), and 11.1 [95% CI, 1.0, 21.2]/100,000 population (p = .026) after adjusting for age differences between districts.ConclusionsResidence in districts with lower socioeconomic status (e.g., less education) and further distance to pharmacies are both associated with an increased sepsis incidence. This warrants further research with individual-level patient data to better model and understand such dependencies and to ultimately design public health interventions to address the burden of sepsis in Germany.