Socioeconomic Differences In Incidence Research Articles

Racial, ethnic and neighborhood socioeconomic differences in incidence of dementia: A regional retrospective cohort study.

Evidence on the effects of neighborhood socioeconomic disadvantage on dementia risk in racially and ethically diverse populations is limited. Our objective was to evaluate the relative extent to which neighborhood disadvantage accounts for racial/ethnic variation in dementia incidence rates. Secondarily, we evaluated the spatial relationship between neighborhood disadvantage and dementia risk. In this retrospective study using electronic health records (EHR) at two regional health systems in Northeast Ohio, participants included 253,421 patients aged >60 years who had an outpatient primary care visit between January 1, 2005 and December 31, 2015. The date of the first qualifying visit served as the study baseline. Cumulative incidence of composite dementia outcome, defined as EHR-documented dementia diagnosis or dementia-related death, stratified by neighborhood socioeconomic deprivation (as measured by Area Deprivation Index) was determined by competing-risk regression analysis, with non-dementia-related death as the competing risk. Fine-Gray sub-distribution hazard ratios were determined for neighborhood socioeconomic deprivation, race/ethnicity, and clinical risk factors. The degree to which neighborhood socioeconomic position accounted for racial/ethnic disparities in the incidence of composite dementia outcome was evaluated via mediation analysis with Poisson rate models. Increasing neighborhood disadvantage was associated with increased risk of EHR-documented dementia diagnosis or dementia-related death (most vs. least disadvantaged ADI quintile HR=1.76, 95% confidence interval=1.69-1.84) after adjusting for age and sex. The effect of neighborhood disadvantage on this composite dementia outcome remained after accounting for known medical risk factors of dementia. Mediation analysis indicated that neighborhood disadvantage accounted for 34% and 29% of the elevated risk for composite dementia outcome in Hispanic and Black patients compared to White patients, respectively. Neighborhood disadvantage is related to the risk of EHR-documented dementia diagnosis or dementia-related death and accounts for a portion of racial/ethnic differences in dementia burden, even after adjustment for clinically important confounders.

Race, ethnicity, and socioeconomic differences in incidence of pediatric embryonal tumors in the United States.

The etiology of childhood cancers and its social patterning remains largely unknown. Accounting for socioeconomic status (SES) when exploring the association between race/ethnicity and cancer incidence is necessary to better understand such etiology. We aimed to investigate differences in the incidence of embryonal tumors (ETs) by SES and race/ethnicity in the United States using population-based registries of the Surveillance, Epidemiology, and End Results (SEER) Program. Children with ETs aged 0-19 years diagnosed between 2000 and 2015 were ascertained from the census tract-level SEER database. SES was measured using a tract-level composite index. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) by SES quintile and race/ethnicity were estimated using multivariable Poisson regression models. The majority of tumors had lower incidence among nonwhite children compared with non-Hispanic (NH) white children, after controlling for SES. NH blacks had a higher incidence of Wilms tumor than NH whites (IRR: 1.26; 95% CI, 1.13-1.39). There was an increasing linear trend (P=0.0001) across increasing SES quintile for embryonal rhabdomyosarcoma after controlling for race/ethnicity. Effect modification by race/ethnicity of the relationship between SES and tumor incidence was observed for several groups. Hispanics had a significant, linear trend (P=0.0005) in the incidence of Wilms tumor, while Asian/Pacific Islanders experienced a significant inverse trend (P=0.0002). Results from this study suggest differences in the incidence of several ETs by race/ethnicity and that these differences may be modified by SES. Investigation of potential risk factors that are socially patterned is warranted.

Socio-economic differences in incidence, bystander cardiopulmonary resuscitation and survival from out-of-hospital cardiac arrest: A systematic review

Socio-economic differences in incidence, bystander cardiopulmonary resuscitation and survival from out-of-hospital cardiac arrest: A systematic review

Ethnic and Neighborhood Socioeconomic Differences In Incidence and Survival From Out-Of-Hospital Cardiac Arrest In Singapore

Objective: We aimed to examine the association of ethnicity and socioeconomic status (SES) with Out-of-Hospital Cardiac Arrest (OHCA) incidence and 30-day survival in Singapore. Methods: We analyzed the Singapore cohort of Pan-Asia Resuscitation Outcome Study (PAROS), a multi-center, prospective OHCA registry between 2010 and 2015. The Singapore Socioeconomic Disadvantage Index (SEDI) score, obtained according to zip code, was used as surrogate for neighborhood SES. Age-adjusted OHCA incidence and Utstein survival were calculated by ethnicity and SES. Utstein survival was defined as the number of cardiac OHCA cases with initial rhythm of ventricular fibrillation witnessed by a bystander who survived 30-days or until hospital discharge. Logistic regression was used to investigate association of ethnicity with 30-day and Utstein survivals. Results: Our study population comprised 8,900 patients: 6,453 Chinese, 1,472 Malays, and 975 Indians. The overall age-adjusted incidence ratios (95% CI) for Malay/Chinese and Indian/Chinese were 1.93 (1.83–2.04) and 1.95 (1.83–2.08), respectively. The overall age-adjusted incidence ratios (95% CI) for average/low and high/low SEDI group were 1.12 (0.95–1.33) and 1.29 (1.08–1.53), respectively. Malay showed lesser Utstein survival of 8.1% compared to Chinese (14.6%) and Indian (20.4%) [p = 0.018]. Ethnicity did not reach statistical significance (p = 0.072) in forward selection model of Utstein survival, while SEDI score and category were not significant (p > 0.2 and p = 0.349). Conclusions: We found Malay and Indian communities to be at higher risks of OHCA compared to Chinese, and additionally, the Malay community is at higher risk of subsequent mortality than the Chinese and Indian communities. These disparities were not explained by neighborhood SES.

Cutaneous malignant melanoma show geographic and socioeconomic disparities in stage at diagnosis and excess mortality

Background Preventive measures are needed to counteract the increasing burden of cutaneous malignant melanoma (CMM). As a basis for rational melanoma prevention, we investigated geographic differences and impact from socioeconomic factors related to incidence, clinical stage at diagnosis and outcome.Material and methods All patients with primary invasive CMM diagnosed in 2004–2013 in the southern and the western Swedish health care regions with a population of 2.9 million adults were eligible for the study. Population-based data were obtained from the national Cancer Register and the national Melanoma Quality Register. Geographic and socioeconomic differences in incidence per stage at diagnosis were mapped and correlated to excess mortality.Results Disease mapping based on 9743 cases in 99 municipalities and 20 metropolitan districts showed marked, regional disparities in stage-specific incidence of CMM. The incidence of stage I–II tumors was higher in the western health care region, whereas the incidence of stage III–IV CMMs was higher in the southern region. The divergent incidence patterns per stage at diagnosis were consistent across population strata based on educational level. The geographic disparities in CMM stage influenced relative survival with an excess five-year mortality ratio in the southern region versus the western region of 1.49 (95% confidence interval 1.22–1.82). The excess mortality ratio for patients with low versus high educational level was 1.81 (1.37–2.40).Conclusion Residential region and educational level influenced CMM stage and, thereby, excess mortality. These observations suggest that geographic as well as socioeconomic data should be considered in prevention of CMM.

Abstract 13165: Median Household Income and Rural Location Associated With Sudden Unexpected Death in Wake County, NC

Introduction: The incidence of sudden unexpected death (SUD) in a racially and socioeconomically diverse population has been inadequately studied. We collated all SUDs among the 18 to 64 year population over a 12-month period in Wake County, North Carolina, a racially and socioeconomically diverse predominantly urban county, population c1 million. We investigated the socioeconomic differences in incidence of SUD to assist in future development of targeted interventions. Methods: Cases of possible SUD were identified from the Wake County EMS. Expected deaths were excluded and determination for cohort inclusion was made by independent cardiologists from review of medical records and medical examiner’s reports. SUD cases were geocoded to the level of census tract using death certificate residence address and the U.S Census Geocoder. Wake County includes 185 census tracts, population 5022 ± 2285 (M±SD). Median household income and other demographic data were obtained from the 2013 American Community Survey and 2010 U.S Census. Univariate and multivariable analysis were used to identify associates of SUD. Results: The 2013 incidence of SUD in Wake County was 19.5/100,000. A majority (107 of 185) of census tracts had at least one SUD, with 190 total. Census tracts with ≥1 SUD had a higher population of African Americans, a greater proportion unmarried, and a lower median household income than those with no SUDs (figure, p≤.001). After multivariable analysis, only median household income and rural tract location remained significantly associated with sudden death. Conclusion: This examination exemplifies the importance of studying sudden unexpected death in a racially and socioeconomically diverse population. Multivariable analysis suggests that low household income and rural location are important potential contributing factors to sudden death. Educational interventions to reduce the incidence of sudden death should be developed with these populations in mind.

Temporal trends in case-fatality of myocardial infarction and stroke by socioeconomic position in Sweden 1987-2010

Background There are substantial socioeconomic inequalities in cardiovascular diseases (CVD). There are concerns about the persistent significant socioeconomic differences in incidence and case-fatality of CVD in Sweden. Is the gap between different socioeconomic positions widening or narrowing. In this study we analyze temporal trends in survival after myocardial infarction (MI) and stroke for different socioeconomic position in Sweden among men and women aged 30 to 75 years, 1987 to 2010. Methods We used a national …

The development of socioeconomic inequalities in anxiety and depression symptoms over the lifecourse

PurposeSocioeconomic inequalities in anxiety and depression widen with increasing age. This may be due to differences in the incidence or persistence of symptoms. This paper investigates the widening of inequalities in anxiety and depression over the lifecourse.MethodsData were from the West of Scotland Twenty-07 Study, constituting three cohorts aged approximately 16, 36 and 56 years at baseline and re-visited at 5-yearly intervals for 20 years. Symptoms were measured using the Hospital Anxiety and Depression Scale. Adjusting for age and sex, multilevel models with pairs of interviews (n = 6,878) nested within individuals (n = 3,165) were used for each cohort to estimate associations between current symptoms and education or household social class for both those with and without earlier symptoms, approximating socioeconomic differences in incidence and persistence.ResultsInequalities in current symptom levels were present for both those with and without earlier symptoms. In the youngest cohort, those with less education were more likely to experience persistent depression and to progress from anxiety to depression. At older ages there were educational and social class differences in both the persistence and incidence of symptoms, though there was more evidence of differential persistence than incidence in the middle cohort and more evidence of differential incidence than persistence in the oldest cohort.ConclusionsDifferential persistence and symptom progression indicate that intervening to prevent or treat symptoms earlier in life is likely to reduce socioeconomic inequalities later, but attention also needs to be given to late adulthood where differential incidence emerges more strongly than differential persistence.

Socioeconomic differences in incidence and relative survival after a first acute myocardial infarction in the Basque Country, Spain

ObjectiveTo estimate the incidence and 28-day and 5-year survival rates after a first acute myocardial infarction (AMI) in relation to socioeconomic status in the Basque Country (Spain) between 1999 and 2000. MethodsData from a population-based registry of AMI were used. The study included 3,619 patients to calculate age-standardized incidence by the direct method and 2,003 patients (out-of-hospital deaths were excluded) to calculate observed and relative survival using the Kaplan-Meier and Hakulinen methods, respectively. Socioeconomic status was quantified using a deprivation index ecologically assigned to each patient according to the census tract of residence at diagnosis of AMI and was categorized into quintiles. ResultsAmong men, the risk of AMI was higher in the lowest socioeconomic group than in the highest socioeconomic group (RR=1.17; 95%CI: 1.02-1.34). In men, a higher risk of death was observed in the middle (Q3; HR=1.60; 95%CI: 1.02-2.51) and low (Q5; HR=1.65; 95%CI: 1.02-2.69) quintiles compared with the least deprived group for age-adjusted survival during the acute phase. In the fully adjusted model, this effect was attenuated and no significant differences were observed in long-term survival. Among women, no significant differences were observed either in incidence or in short- and long-term survival. ConclusionsSocioeconomic inequalities were only observed in men in incidence and in survival during the acute phase after an AMI.

Differences in breast cancer incidence in Australia and England by age, extent of disease and deprivation status: women diagnosed 1980–2002

To compare breast cancer incidence in England and Australia by age, extent of disease and deprivation. We analysed data for women aged 15-99 years diagnosed with breast cancer in England or Australia during the period 1990 to 1994, and in West Midlands or New South Wales during the period 1980 to 2002. We calculated three-year rolling average incidence rates and incidence rate ratios (IRR) between West Midlands and New South Wales by age, extent of disease and category of deprivation. Breast cancer incidence was higher in England than in Australia, and in West Midlands than in New South Wales but became more similar over time. Socio-economic differences in incidence were greater in New South Wales than in West Midlands. The most deprived women in West Midlands were diagnosed at a later stage of disease than the most deprived women in New South Wales. Incidence among elderly women was higher in West Midlands than in New South Wales. There were also high proportions of tumours with unknown stage among elderly women in West Midlands. Although the overall incidence of breast cancer is similar, differences by age, extent of disease and deprivation exist. The underlying reasons for these patterns require further examination.

Socioeconomic differences in incidence of cervical cancer in Finland by cell type

Introduction. We studied variation in incidence of cervix cancer during 1971–1995 among Finnish women born in 1906 to 1945 by social class and cell type. Material and methods. The Finnish Cancer Registry data were linked to the 1970 Population Census, which included social class data. There were 0.8 million individuals in the cohort under follow-up, with 5 102 squamous cell cancers and 573 cases of cervical adenocarcinoma diagnosed after the census date. Results. Incidence of squamous cell cancer was more than two-fold in the lowest social class (standardized incidence ratio (SIR) 1.29, 95% CI 1.21–1.36) as compared with the highest one (SIR 0.59, 0.51–0.66), while there was no association between social class and risk on adenocarcinoma (SIR 1.07, 0.87–1.28 and 1.08, 0.79–1.45, respectively). Discussion. Oncogenic HPV is regarded as the necessary cause of all types of cervix cancer. Sexually transmitted diseases and social status are correlated. Lack of association between adenocarcinoma and social class makes the HPV-etiology of this cell type less credible than that of squamous cell cancer.

Are there geographic and socio-economic differences in incidence, burden and prevention of malaria? A study in southeast Nigeria

RationaleIt is not clearly evident whether malaria affects the poor more although it has been argued that the poor bear a very high burden of the disease. This study explored the socioeconomic and geographic differences in incidence and burden of malaria as well as ownership of mosquito nets.MethodsStructured questionnaires were used to collect information from 1657 respondents from rural and urban communities in southeast Nigeria on: incidence of malaria, number of days lost to malaria; actions to treat malaria and household ownership of insecticide treated and untreated mosquito nets. Data was compared across socio-economic status (SES) quartiles and between urban and rural dwellers.ResultsThere was statistically significant urban-rural difference in malaria occurrence with malaria occurring more amongst urban dwellers. There was more reported occurrence of malaria amongst children and other adult household members in better-off SES groups compared to worse-off SES groups, but not amongst respondents. The average number of days that people delayed before seeking treatment was two days, and both adults and children were ill with malaria for about six days. Better-off SES quartile and urban dwellers owned more mosquito nets (p < 0.05) (treated and untreated).ConclusionMalaria occurs more amongst better-off SES groups and urban dwellers in southeast Nigeria. Deployment of malaria control interventions should ensure universal access since targeting the poor and other supposedly vulnerable groups may exclude people that really require malaria control services.

Coronary heart disease among diabetic and nondiabetic people — socioeconomic differences in incidence, prognosis and mortality

Objective To investigate coronary heart disease (CHD) morbidity and mortality and their patterning by socioeconomic status among diabetic and nondiabetic individuals in Finland. Methods All diabetic persons aged 35–74 years entitled to free anti-diabetic medication were drawn from the 1991–1996 national health insurance files along with nondiabetic referents. Outcome events for up to 6 years of follow-up, corresponding to 418 987 and 867 813 person-years in diabetic and nondiabetic people, respectively, were identified from national health insurance, hospital discharge and causes of death registers using personal identification codes. Results The annual CHD incidence for diabetic women and men was 2.7% and 3.7%, respectively, corresponding to relative risks of 3.55 (95% CI: 3.43–3.67) and 2.64 (95% CI: 2.56–2.72) compared to nondiabetic persons. The impact of diabetes on CHD mortality was greater, with relative death rates of 6.04 and 3.42 for women and men, respectively. CHD mortality and incidence displayed systematic socioeconomic trends with higher rates among worse-off diabetic and nondiabetic people, although gradients were generally steeper for nondiabetics. In the diabetic population, socioeconomic differences were rather similar for sudden CHD deaths and nonfatal CHD incident cases. For both genders, socioeconomic differences in mortality after CHD diagnosis were small in both diabetic and nondiabetic persons, except for the lowest compared to the highest income quintile. Conclusions Socioeconomic CHD mortality differences among diabetic people in Finland were mainly explained by higher CHD incidence and particularly sudden deaths without prior CHD diagnosis. No systematic socioeconomic differences were found in long-term prognosis after CHD diagnosis.

Urban/rural and deprivational differences in incidence and clustering of childhood diabetes in Scotland.

Scottish hospital discharges were monitored during the period 1977-1983 for new cases of diabetes in children aged 18 years or under. An estimated ascertainment rate of 94% was obtained by validation against an independent register of cases. The postcode sector at the time of admission was available for 2125 (97%) of the 2183 cases, and was used as the basis for a small-area analysis of urban/rural and socioeconomic differences in incidence and to test for clustering. Incidence rates standardized for age and sex showed important differences between the 16 Scottish postcode areas. At the sector level, the standardized rate was 20% lower in urban sectors compared to rural sectors, but this could be explained by area to area differences and by socioeconomic effects within areas. In contrast, significant socioeconomic differences in incidence were evident within areas which could not be explained by urban/rural effects, the children in deprived sectors having 80% of the risk of those in other sectors. Rates were particularly low among children in deprived urban sectors. Nevertheless, significant variations in incidence remained between the 16 areas which could not be explained by either urban/rural or socioeconomic differences, indicating the existence of other important factors. Tests for clustering of cases both within postcodes sectors and across adjacent postcode sectors were also performed. Although clusters could be identified, they were no more common than would be expected by chance. Tests for space-time clustering were also negative.

Biology and schizophrenia.

Huxley, Mayr, Osmond and Hoffer1 have recently discussed transmission of what they consider the schizophrenic genotype. They have advanced the explanation of a simple, single-locus, Mendelian basis for what they regard as ‘schizophrenia’. Moran2, more recently, has combined such a hypothesis with the observations of socio-economic differences in incidence of schizophrenic diagnosis and concluded a socio-economic class-related genetic polymorphism. None of these authors, however, discussed the inconsistent observations regarding distributions of psychiatric diagnoses by different diagnosticians. The studies of Mehlman3, as well as those of other writers4–8, have supported doubts regarding the objectivity of recent systems of psychiatric classification and their reliability for the construction of simple, general biological concepts. Psychiatric taxonomy is essentially a symptom-oriented classification scheme, which groups patients according to symptoms rather than according to the disorders underlying the symptoms9,10, A simple hypothesis regarding the aetiology of ‘schizophrenia’, which is based on particular groups of diagnostic data, may partially reflect the concepts of the particular diagnosticians. The inconsistencies in diagnostic distributions and the biological irrelevance of the diagnostic systems may indicate that ‘schizophrenia’ represents a heterogeneity of disorder constellations rather than a single, universally- and reliably-diagnosed entity, A simple biological theory designed to explain the aetiology of such a category, or class differences in incidence, may be somewhat premature in this context.