Socioeconomic Variation Research Articles

Trends and inequalities in distance to and use of nearest natural space in the context of the 20-min neighbourhood: A 4-wave national repeat cross-sectional study, 2013 to 2019

The 20-min neighbourhood is a policy priority for governments worldwide; a key feature of this policy is providing access to natural space (NS) within 800 m of home. The study aims were to (1) examine the association between distance to nearest NS and frequent use over time and (2) examine whether frequent use and changes in use were patterned by income and housing tenure over time. Bi-annual Scottish Household Survey data were obtained for 2013 to 2019 (n:42128 aged 16+). Adults were asked the walking distance to their nearest NS, the frequency of visits to this space and their housing tenure, as well as age, sex and income. We examined the association between distance from home of nearest NS, housing tenure, and the likelihood of frequent NS use (visited once a week or more). Two-way interaction terms were further applied to explore variation in the association between tenure and frequent NS use over time. We found that 87% of respondents lived within 10 min walk of a NS, meeting the policy specification for a 20-min neighbourhood. Greater proximity to NS was associated with increased use; individuals living a 6–10 min walk and over 10 min walk were respectively 53% and 78% less likely to report frequent NS use than those living within a 5 min walk. Housing tenure was an important predictor of frequent NS use; private renters and homeowners were more likely to report frequent NS use than social renters. Our findings provide evidence that proximity to NS is a strong predictor of frequent use. Our study provides important evidence that time-based access measures alone do not consider deep-rooted socioeconomic variation in use of NS. Policy makers should ensure a nuanced lens is applied to operationalising and monitoring the 20-min neighbourhood to safeguard against exacerbating existing inequalities.

Survival outcomes in patients with chronic lymphocytic leukemia treated at academic centers.

7544 Background: Chronic lymphocytic leukemia (CLL), the most prevalent leukemia in western countries, is associated with highly variable clinical outcomes. This study aims to evaluate whether patients with CLL treated at Commission on Cancer accredited academic centers (ACs), which offer high clinical volume, clinical trial access, and postgraduate physician education, have improved survival compared to non-academic centers (NACs). Methods: The National Cancer Database (NCDB) was used to identify CLL patients diagnosed between 2004-2018. Demographic and treatment characteristics were compared between center categories with binary logistic regression for odds of receiving CLL treatment at an AC. Survival analysis was completed with Kaplan Meier and multivariate Cox regression, adjusted for the only available disease-related characteristics in the NCDB, age and Charlson-Deyo comorbidity score, to compare overall survival (OS). Results: Of the 98,186 patients identified, 33.3% were treated at ACs. Patients treated at ACs were younger than those treated at NACs (median age 67 vs. 71 years, p<0.001). ACs were more likely to treat Black and other minority patients, with Black patients representing 9.7% vs. 6.3% of AC vs NAC patients (p<0.001). ACs were more likely than NACs to treat privately insured (39.1% vs. 30.3%), uninsured (3.2% vs.2.0%) and patients on Medicaid (4.1% vs. 2.9%) (p<0.001), as well as patients from the highest quartiles of income (OR 1.46), and education (OR 1.12), when referenced to lowest quartiles (p<0.001). ACs were more likely to manage patients with surveillance versus NACs (53.7% vs. 45%, p<0.001). With a median follow up of 4.3 years, median OS at ACs was significantly improved when compared to NACs, with a median OS of 11.0 years (CI 10.5-11.3) vs. 8.2 years (CI 8.1-8.3), respectively (p<0.001). Survival benefit was maintained at both 5-years (73% vs. 66%) and 10-years (53% vs. 43%) (both p<0.001). On multivariate analysis adjusted for age and comorbidity, management of CLL patients at ACs was an independent factor for improved OS (HR 0.87, CI 0.85-0.89, p<0.001). Conclusions: In this study of a large population of CLL patients, there is significant demographic and socioeconomic variation between CLL patients treated at ACs and NACs. While our study is limited by the available disease and treatment level data available, the improved OS benefit of CLL patients managed at ACs suggests possible differences in treatment and clinical trial availability, and supportive care management. Further investigations into the factors contributing to such disparities would be beneficial to help standardize care and improve outcomes. [Table: see text]

Indigenous Women's Perspectives on Contraception in Rural Guatemala.

In rural, Indigenous Guatemala, women's healthcare is fragmented and inadequate. Our interdisciplinary, multinational research team aimed to 1) describe reproductive health in one rural Indigenous community; 2) explore contraceptive use; and 3) learn about and prioritize Indigenous Maya women's reproductive health beliefs and needs. Our study team conducted mixed-methods surveys with 62 women, led focus groups with 20 community health workers, and analyzed data using concurrent mixed methods analysis. We found that 51% of women surveyed reported current family planning, with 33% using a biomedical method. We found high mean fertility, 6.9 live births per woman aged 40-49 (national average 4.7), with significant socioeconomic variation. We also found that poverty correlated with total fertility, while education inversely correlated. Our research found that contraceptive use had a strong association with access to healthcare and with women's reported sexual autonomy (which we instrumentalized based on women's answers to the question "can you refuse to have sex with your husband?"). Many women we spoke to feared contraception, specifically concerned it could cause cancer. Overall, Guatemalan Indigenous women expressed unease seeking reproductive healthcare within health systems that have historically and currently excluded and mistreated Indigenous communities. Our research documented unexplored influences on contraceptive use, including the relationship between sexual autonomy and contraception and widespread concern of cancer with contraceptive use. We conclude, moving forward, that we and other researchers should continue to collaborate with communities to improve Indigenous women's reproductive healthcare.

Health disparities and COVID-19: A retrospective study examining individual and community factors causing disproportionate COVID-19 outcomes in Cook County, Illinois.

Early data from the COVID-19 pandemic suggests that the disease has had a disproportionate impact on communities of color with higher infection and mortality rates within those communities. This study used demographic data from the 2018 US census estimates, mortality data from the Cook County Medical Examiner's office, and testing results from the Illinois Department of Public Health to perform bivariate and multivariate regression analyses to explore the role race plays in COVID-19 outcomes at the individual and community levels. We used the ZCTA Social Deprivation Index (SDI), a measure of ZCTA area level deprivation based on seven demographic characteristics to quantify the socio-economic variation in health outcomes and levels of disadvantage across ZCTAs. Principal findings showed that: 1) while Black individuals make up 22% of Cook County's population, they account for 28% of the county's COVID-19 related deaths; 2) the average age of death from COVID-19 is seven years younger for Non-White compared with White decedents; 3) residents of Minority ZCTA areas were 1.02 times as likely to test positive for COVID-19, (Incidence Rate Ratio (IRR) 1.02, [95% CI 0.95, 1.10]); 1.77 times as likely to die (IRR 1.77, [95% CI 1.17, 2.66]); and were 1.15 times as likely to be tested (IRR 1.15, [95% CI 0.99, 1.33]). There are notable differences in COVID-19 related outcomes between racial and ethnic groups at individual and community levels. This study illustrates the health disparities and underlying systemic inequalities experienced by communities of color.

Socioeconomic Variations in the Frequency of Parent Number Talk: A Meta-Analysis.

Using data from 12 studies, we meta-analyze correlations between parent number talk during interactions with their young children (mean sample age ranging from 22 to 79 months) and two aspects of family socioeconomics, parent education, and family income. Potential variations in correlation sizes as a function of study characteristics were explored. Statistically significant positive correlations were found between the amount of number talk in parent-child interactions and both parent education and family income (i.e., r = 0.12 for education and 0.14 for income). Exploratory moderator analyses provided some preliminary evidence that child age, as well as the average level of and variability in socioeconomic status, may moderate effect sizes. The implications of these findings are discussed with special attention to interpreting the practical importance of the effect sizes in light of family strengths and debate surrounding "word gaps".

Socioeconomic variations in rates of hospitalisation and mortality from COVID-19 in England

Background/Aims As well as age and presence of comorbidities, research has suggested that socioeconomic factors, such as income and ethnicity, may affect an individual's risk of severe COVID-19. This study looked at the geographical variations in rates of hospitalisation and death from COVID-19, exploring whether socioeconomic factors were linked to these variations. Methods A cross-sectional retrospective quantitative study was conducted using data regarding the number of cases of COVID-19 cases during the first wave of the pandemic in England (March–July 2020). A total of 242 624 confirmed cases of COVID-19 from across England were analysed. The extent to which predisposing factors, such as population density, age and comorbities, affected morbidity and mortality rates in the different regions was calculated. The impact of socioeconomic factors, such as employment status and ethnicity, were also analysed. Results There was a significant association between long unemployment and likelihood of death from COVID-19. Areas with higher proportions of individuals from Black, Asian and ethnic minority backgrounds were also more likely to have higher rates of hospitalisations and deaths from COVID-19. Overall, London was the region with the highest standardised rates of hospitalisation (67.73%) and mortality (20%). Conclusions Socioeconomic factors have contributed to the geographical variations in COVID-19 mortality across different areas of England. This implies that these factors should be taken into account when planning healthcare and public health strategies.

Contemporary Evaluation of Gender, Race, and Socioeconomics with Outcomes in Heart Failure

<h3>Purpose</h3> Variation in outcomes by race, ethnicity, and socioeconomics in adults with heart failure (HF) has been previously observed. We evaluated the association of these factors with HF outcome as assessed by frequency of emergency department (ED) visits over the last 2 and 10 years in a contemporary HF cohort in Hawaii. <h3>Methods</h3> A retrospective chart review from 2011 to 2021 was performed to identify all adult patients (≥18 years old) with HF from any cause as defined by a serum BNP >200, NT proBNP >200, or a positive history of HF as defined by ICD codes. Ethnicities were self-reported at time of intake at the ED. Meth use was defined as a positive urine toxicology screen or by ICD codes. MethHF was defined as HF in a patient with meth use. A regression model was made to evaluate the relative risk of patients with HF to present to the ED over the last 2 years and 10 years adjusted for age, gender, ethnicity, presence of methamphetamine associated cardiomyopathy (MethHF). Homelessness was analyzed as a secondary subgroup. <h3>Results</h3> 46,849 patients were included for analysis. Over the last 10 years (Table 1) Filipino and Japanese patients had a lower risk for presentation to the ED: 17% and 34% respectively. Pacific Islanders, patients with MethHF, and homelessness had a higher risk for presentation to the ED: 44%, 152%, and 160% respectively. Over the last 2 years (Table 2) Japanese patients had a 34% lower risk for presentation to the ED. Black and Pacific Islander patients, those with MethHF, and homelessness had a higher risk for presentation to the ED, 66%, 52%, 28%, and 249% respectively. <h3>Conclusion</h3> The relative risk of presentation to the ED in the last 10 years and 2 years differs greatly by ethnicity and presence of MethHF regardless of gender and age. Homelessness had the highest relative risk of ED presentation. Future research is needed to identify explanatory mechanisms underlying racial, ethnic, socioeconomic variations to target potential interventions.

Impact of more variations on in‐hospital mortality among patients with confirmed COVID‐19

Thanks for Aftab and co-authors’ feedback on this systematic review. Three questions were raised in their letter. We tried to respond to the best of our knowledge, in this letter. Question 1. In-hospital mortality rates decreased in the US over 2020. A retrospective analysis during this time period would be strengthened by accounting for the variation. Response: Several factors may influence mortality rate, for example, optimized treatment plan, viral toxicity attenuation and so on. Most of the included studies in our systematic review were carried out in early stage of the global pandemic (i.e., up to June 2020) in hospital setting with inpatients, thus we were unable to make inference across time. Patients in those earlier studies experienced similar level of improvement despite of the status of angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) use. Nevertheless, following Aftab's feedback and example of differential findings across time in US studies, we double checked data from the three US studies included in our review to examine if such trend was present. Those three studies were conducted in April, May, and June 2020, and none showed clear difference between groups. There might have been a change to the above finding in studies conducted beyond this period, with consideration to virus mutation and the use of vaccination, hence we urge future reviews to explore the time factor. Question 2. Socioeconomic and sociocultural variations in mortality should be considered. Response: We suggest to look at the impact of this from the angles of in-hospital mortality and mortality in community settings. We agree with Aftab and co-authors that in-hospital mortality may be impacted by socioeconomic and sociocultural factors. The in-hospital mortality rate varied between 7% and 30%1-5 across different countries. Tereshchenko's study6 published in 2021 indicated unhealth life style, poverty, lack of health insurance, poor education may influence the application of ACEI/ARB. Compared with less-developed nations, patients in developed nations may have higher chance of receiving ACEI/ARB drugs, hospitalization, more aggressive treatment and vaccination. However, earlier Covid-19 studies at the start of the global pandemic lacked reporting or relevant stratification by these socioeconomic factors. In absence of individual data or subgroup data on these domains, we were unable to carry out further analysis. But we agree this is an important issue which should be addressed in further analysis. We appeal to clinical researchers to record and report such information in future clinical studies. While we also agree with Aftab and co-authors that socioeconomic and sociocultural variation may alter the risk of mortality in general (beyond hospital setting), this is an epidemiological investigation which is beyond the scope of our study (which focuses on in-hospital outcomes). Question 3. Continuation or discontinuation of the ACEI/ARB after discharge from the hospital was not controlled. Response: Aftab and co-authors highlighted an important issue. This was taken into account in our protocol design. We planned to do subgroup analysis on continuation versus discontinuation of ACEI/ARB, but we had only a single randomized control trial (NCT04338009) included in the review, hence were unable to carry out subgroup analysis. The single RCT showed that the mortality rate between discontinuation and continuation of ACEI/ARB was 12.99% versus 14.67%, which is higher than the finding from the Brazil study.7 This could be resulted by varied disease severity and existing comorbidities, but we are not sure. In conclusion, we thank Aftab and co-authors for their thought-provoking feedback. In general, we agree that these are important confounding issues which begs for further investigation, should data becomes available in future updates. The authors have no conflict of interest.

The potential of European abandoned agricultural lands to contribute to the Green Deal objectives: Policy perspectives

The European Green Deal sets targets for biodiversity, climate change, sustainable farming, and rural development. For abandoned agricultural lands to contribute to these goals, specific policy measures to support appropriate land management are required. However, information is lacking on what these policies will mean for landowners and managers. This paper reviews the role of abandoned lands in European Union (EU) policies linked to the Green Deal. We interviewed 30 experts to identify the challenges faced by landowners in response to the identified policies and gather suggestions for future policy improvements. We found few explicit mentions of abandoned lands in policies. The potential of abandoned lands for alternative trajectories (beyond farming) was generally implicit. According to experts, landowners perceive the EU Common Agriculture Policy as the most influential to drive abandonment trajectories and support (or hinder) opportunities for re-management. The main challenges for landowners to (re-)use their lands included conflicting policies, lack of financial and technical support, and a feeling of disconnection with policies defined at EU level. To address the gap between objectives and implementation, policies need to secure support for landowners and managers. We provide three recommendations to uncover the potential of abandoned lands to contribute to the Green Deal targets: (1) increase their visibility in policies, (2) rely on an integrating policy approach, and (3) careful spatial planning to account for biophysical, socioeconomic, and cultural variations across regions.

Socioeconomic variations determine the clinical presentation, aetiology, and outcome of infective endocarditis: a prospective cohort study from the ESC-EORP EURO-ENDO (European Infective Endocarditis) registry.

Infective endocarditis (IE) is a life-threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socioeconomic factors might influence its epidemiology, clinical presentation, investigation and management, and outcome, in a large international multicentre registry. The EurObservational Programme (EORP) of the European Society of Cardiology EURO-ENDO (European Infective Endocarditis) registry comprises a prospective cohort of 3113 adult patients admitted for IE in 156 hospitals in 40 countries between January 2016 and March 2018. Patients were separated in three groups, according to World Bank economic stratification [group 1: high income (75.6%); group 2: upper-middle income (15.4%); group 3: lower-middle income (9.1%)]. Group 3 patients were younger [median age (interquartile range, IQR): group 1, 66 (53-75) years; group 2, 57 (41-68) years; group 3, 33 (26-43) years; P < 0.001] with a higher frequency of smokers, intravenous drug use, and human immunodeficiency virus infection (all P < 0.001) and presented later [median (IQR) days since symptom onset: group 1, 12 (3-35); group 2, 19 (6-54); group 3, 31 (12-62); P < 0.001] with a higher likelihood of developing congestive heart failure (13.6%, 11.1%, and 22.6%, respectively; P < 0.001) and persistent fever (9.8%, 14.2%, and 27.9%, respectively; P < 0.001). Among 2157 (69.3%) patients with theoretical indication for cardiac surgery, surgery was performed less frequently in group 3 patients (75.5%, 76.8%, and 51.3%, respectively; P < 0.001), who also demonstrated the highest mortality (15.0%, 23.0%, and 23.7%, respectively; P < 0.001). Socioeconomic factors influence the clinical profile of patients presenting with IE across the world. Despite younger age, patients from the poorest countries presented with more frequent complications and higher mortality associated with delayed diagnosis and lower use of surgery.

Structural and Attitudinal Barriers to Bicycle Ownership and Cycle-Based Transport in Gauteng, South Africa

Policies that aim to facilitate and promote non-motorised transport (NMT), and in particular cycling, have been developed by many high-income countries facing increasingly congested roads and saturated public transport systems. Such policies are also emerging in many low- and middle-income settings where high rates of urbanisation have led to similar problems with motorised transport. The aim of the present study was to better understand the potential structural and attitudinal barriers to cycle-based transport in one such context: South Africa’s Gauteng Province, the industrial powerhouse of sub-Saharan Africa that has recently made a firm commitment to NMT. The study focussed on demographic and socioeconomic variation in bicycle and car ownership, and related this to: (1) the reported use of motorised and non-motorised transport (both private and public); and (2) perceived ‘problems’ with cycling. The analyses drew on interviews with key respondents from n = 27,490 households conducted in 2013 as part of the third Quality of Life survey undertaken by the Gauteng City Regional Observatory. The survey contained items on three outcomes of interest: household vehicle ownership (bicycles and cars); modes of transport used for the “trips” most often made; and respondents’ “single biggest problem with… cycling”. Respondent- and household-level demographic and socioeconomic determinants of these outcomes were examined using descriptive and multivariable statistical analyses, the latter after adjustment for measured potential confounders identified using a theoretical causal path diagram (in the form of a directed acyclic graph). Of the n = 26,469 households providing complete data on all of the variables examined in the present study, only n = 8722 (32.9%) owned a car and fewer still (n = 2244; 8.4%) owned a bicycle. The ownership of these assets was commonest amongst wealthier, economically active households; and those that owned a car had over five times the odds of also owning a bicycle, even after adjustment for potential confounding (OR 5.17; 95% CI 4.58, 5.85). Moreover, of household respondents who reported making ‘trips’ during the preceding month (n = 18,209), over two-thirds of those whose households owned a car (70.1%) reported private car-based transport for such trips, while only 3.2% of those owning a bicycle reported cycling. Amongst the specific responses given to the item requesting the “single biggest problem with… cycling” by far the commonest was “Don’t know how to cycle” (32.2%), less than half as many citing “Vehicle accident risk” (15.9%), and fewer still: “Destination is too far” (13.9%); “Crime” (10.3%); “Too much effort” (9.2%); or “Lack of good paths” (4.6%). While the first of these reasons was commonest amongst poorer households, concerns about risk and effort were both most common amongst better educated, economically active and wealthier/better serviced households. In contrast, concerns over (cycle) paths were only common amongst those owning bicycles. The low prevalence of household bicycle ownership, and the disproportionate number of households owning bicycles that also owned cars, might explain the very small proportion of the ‘the trips most often made’ that involved cycle-based transport (0.3%), and the preferential use of cars amongst households owning both bicycles and cars. Low levels of bicycle ownership might also explain why so many respondents cited “Don’t know how” as the “single biggest problem with… cycling”; although risk and effort were also substantial concerns (presumably for many who did, and some who did not, know how to cycle); the lack of suitable cycle lanes being only primarily a concern for those who actually owned bicycles. Structural and attitudinal barriers to cycle-based transport limit the use of cycle-based transport in Gauteng, not only amongst the vast majority of household respondents who lack the means to cycle (and the means to learn how), but also amongst those dissuaded from learning to cycle, purchasing a bicycle and/or using a bicycle they own by: the risks and effort involved; the lack of suitable cycle paths; and/or because they also own a car and prefer to drive than cycle.

Socio-economic inequalities in child growth: Identifying orientation and forward-looking layout

Socio-economic inequalities in child growth: Identifying orientation and forward-looking layout

Socioeconomic and geographic differences in ablation of atrial fibrillation in Norway - a national cohort study

BackgroundThe aim of this study was to analyse whether there are patient related or geographic differences in the use of catheter ablation among atrial fibrillation patients in Norway.MethodsNational population-based data on individual level of all Norwegians aged 25 to 75 diagnosed with atrial fibrillation from 2008 to 2017 were used to study the proportion treated with catheter ablation. Survival analysis, by Cox regression with attained age as time scale, separately by gender, was applied to examine the associations between ablation probability and educational level, income level, place of residence, and follow-up time.ResultsSubstantial socioeconomic and geographic variation was documented. Atrial fibrillation patients with high level of education and high income were more frequently treated with ablation, and the education effect increased with increasing age. Patients living in the referral area of St. Olavs Hospital Trust had around three times as high ablation rates as patients living in the referral area of Finnmark Hospital Trust.ConclusionsDifferences in health literacy, patient preference and demands are probably important causes of socioeconomic variation, and studies on how socioeconomic status influences the choice of treatment are warranted. Some of the geographic variation may reflect differences in ablation capacity. However, geographic variation related to differences in clinical practice and provider preferences implies a need for clearer guidelines, both at the specialist level and at the referring level.

Horizontal inequity in the utilisation of Continuum of Maternal Health care Services (CMHS) in India: an investigation of ten years of National Rural Health Mission (NRHM)

BackgroundContinuum of Maternal Health Care Services (CMHS) has garnered attention in recent times and reducing socio-economic disparity and geographical variations in its utilisation becomes crucial from an egalitarian perspective. In this study, we estimate inequity in the utilisation of CMHS in India between 2005 and 06 and 2015-16.MethodsWe used two rounds of National Family Health Survey (NFHS) - 2005-06 and 2015-16 encompassing a sample size of 34,560 and 178,857 pregnant women respectively. The magnitude of horizontal inequities (HI) in the utilisation of CMHS was captured by adopting the Erreygers Corrected Concentration indices method. Need-based standardisation was conducted to disentangle the variations in the utilisation of CMHS across different wealth quintiles and state groups. Further, a decomposition analysis was undertaken to enumerate the contribution of legitimate and illegitimate factors towards health inequity.ResultsThe study indicates that the pro-rich inequity in the utilisation of CMHS has increased by around 2 percentage points since the implementation of National Rural Health Mission (NRHM), where illegitimate factors are dominant. Decomposition analysis reveals that the contribution of access related barriers plummeted in the considered period of time. The results also indicate that mother’s education and access to media continue to remain major contributors of pro-rich inequity in India. Considering, regional variations, it is found that the percentage of pro-rich inequity in high focus group states increased by around 3% between 2005 and 06 and 2015-16. The performance of southern states of India is commendable.ConclusionsOur study concludes that there exists a pro-rich inequity in the utilisation of CMHS with marked variations across state boundaries. The pro-rich inequity in India has increased between 2005 and 06 and high focus group states suffered predominantly. Decentralisation of healthcare policies and granting greater power to the states might lead to equitable distribution of CMHS.

Physical inactivity, and its association with hypertension among employees in the district of Colombo

BackgroundPhysical inactivity is a leading cause of morbidity and mortality and is a major public health problem. Insufficient activity is responsible for a large proportion of non-communicable diseases such as hypertension.ObjectivesThe purpose of this study was to assess socioeconomic variations in physical activity and to measure the association between physical inactivity and hypertension among government officials in Sri Lanka.MethodsA cross-sectional study was carried out among 275 senior-officers(SOs) and 760 managerial-assistants(MAs) aged 30–60 years and attached to Public Administration institutions in Colombo District in Sri Lanka. Physical-activity(PA) was gathered using the International Physical Activity Questionnaire(IPAQ) adopted and validated to the Sri Lankan context. Blood pressure(measured and classified using JNC-7 guidelines) and anthropometric indices were recorded. Energy utilization of all vigorous and moderated PA and walking was expressed as metabolic-equivalent-of-task(MET) min per week. A total-MET-score was calculated and categorized based on IPAQ guidelines.ResultsSocioeconomic variations in PA levels were observed as 58.1%(n = 158) SOs and 30.6%(n = 226) MAs were involved in inadequate PA. Among the SOs diagnosed with hypertension, more half(59.1%; n = 52) were physically inactive, while among MAs, 65.9%(n = 143) with hypertension were physically inactive. After adjusting for potential confounding factors being physically inactive was associated with a higher risk of hypertension among SOs[OR 2.08 [95% CI 1.07, 4.6] and MAs[OR 2.8 [95% CI 1.8, 4.6]. The main modality of commuting to work for SOs(59%) was private transport, and MAs(64%) public transport Commuting distance was positively correlated(p < 0.05) with total transport MET among SOs and MAs. After adjusting for confounders, commuting distance of > 20 km was found to lower the odds of hypertension among SOs and MAs(OR = 0.713; 95% CI 0.4 to1.3; and OR = 0.63; 95% CI 0.46 to 0.87).ConclusionDespite the current knowledge that being physically active promotes health, the practice was different. Physical inactivity was associated with hypertension and prevalent among both SOs and MAs. Higher commuting distance is positively correlated with total transport MET and associated with lower odds of hypertension among SOs and MAs. Longitudinal studies are required to provide a causative association between physical inactivity and hypertension among these employees.

Socioeconomic variation of multimorbidity in Colombian older adults

Multimorbidity (MM) prevalence among older adults is increasing worldwide. Variations regarding the socioeconomic characteristics of the individuals and their context have been described, mostly in high-income settings. However, further research is needed to understand the effect of the coexistence of infectious diseases along with socioeconomic factors regarding MM. This study aims to examine the variation of MM regarding infectious diseases mortality after adjusting for socioeconomic factors. A cross-sectional multilevel study with a nationally representative sample of 17,571 Colombian adults of 60 years of age or older was conducted. Individual socioeconomic, demographic, childhood and health related characteristics, as well as group level variables (multidimensional poverty index and infectious diseases mortality rate) were analyzed. A two-level stepwise structural equation model was used to simultaneously adjust for the individual and contextual effects. Multimorbidity prevalence was 62.3% (95% CI 61.7–62.9). In the multilevel adjusted models, age, female sex, having functional limitations, non-white ethnicity, high body mass index, higher income, physical inactivity and living in urban areas were associated with multimorbidity among the sample for this study. The median odds ratio for multidimensional poverty was 1.18 (1.16–1.19; p = 0.008) and for infectious diseases was 1.25 (1.22–1.28; p = 0.014). This paper demonstrates that MM varies regarding the mortality of infectious diseases and shows a strong association between MM and poverty in a low-middle income country. Differences in the factors involved in the etiology of multimorbidity are expected among wealthy and poor countries regarding availability and prioritization of health services.

Validation of an obstetric quality of recovery scoring tool (ObsQoR-11) after elective caesarean delivery in a developing country: a prospective observational study

BackgroundThe obstetric quality of recovery scoring tool (ObsQoR-11) was developed and validated in the United Kingdom for use after elective and emergency caesarean delivery. Quality of recovery scoring tools validated in one country may not be valid in other countries with significant cultural, socio-economic and linguistic variations. The aim of the current study was to validate a Hindi version of the ObsQoR-11. MethodsIn this prospective observational study, 100 parturients who underwent elective caesarean delivery in a tertiary care obstetric referral university hospital in North India were asked to complete a Hindi version of the ObsQoR-11 scoring tool 24 h after surgery. The performance of the Hindi version of ObsQoR-11 was assessed using measures of validity, reliability, and feasibility. ResultsThe Hindi version of ObsQoR-11 correlated moderately with the global health visual analogue scale (r=0.45, 95% CI 0.27 to 0.59; P <0.0001) and discriminated well between good and poor recovery (mean (SD) score 84.6 (9.4) vs 75.0 (11.2); P <0.0001). The reliability and internal consistency were moderate (Cronbach’s alpha=0.66; Spearman-Brown Prophesy Reliability estimate=0.57) with good repeatability (intraclass correlation coefficient 0.85, 95% CI 0.69 to 0.93; P <0.0001) and no floor or ceiling effects. All parturients completed the questionnaire in a (median (IQR) time of completion of 3 (1.5 – 5.5) min). ConclusionThe Hindi version of the ObsQoR-11 questionnaire is a promising scoring tool to evaluate quality of recovery after elective caesarean delivery. Further research is needed to evaluate the Hindi tool in other institutions in India as well as in other languages.

Urban residential energy switching in China between 1980 and 2014 prevents 2.2 million premature deaths

Urban residential energy switching in China between 1980 and 2014 prevents 2.2 million premature deaths

Socio-economic and demographic patterns of mental health complaints among the employed adults in Estonia

BackgroundMental health problems follow a distinct socio-economic gradient and contribute to the health inequalities. The study aims to analyse the socio-economic and demographic factors of self-reported mental health complaints (stress, depressiveness, overtiredness, suicidal thoughts) among employed adult population in Estonia.MethodsData on 4041 employed respondents (2064 men and 1977 women) aged 20–64 years from nationally representative health surveys from years 2016 and 2018 in Estonia were used for the study. Dependent variables included self-reported stress, depressiveness, overtiredness, and suicidal thoughts. Descriptive statistics and both log-binomial and Poisson regression analysis were used to describe the socio-economic and demographic variations in these mental health complaints.ResultsMore than half of the respondents had either stress, depressiveness, overtiredness or suicidal thoughts with 25% reporting two or more of mental health complaints. Lower personal income was associated with higher rates of all mental health complaints (stress, depressiveness, overtiredness, and suicidal thoughts) among employed adults in Estonia. Additionally, lower education was associated with higher prevalence of depressiveness and lower job skills predicted higher prevalence of suicidal thoughts. Higher prevalence ratios for depressiveness and overtiredness were found for women compared to men whereas Estonians had higher prevalence ratios for stress and suicidal thoughts compared to non-Estonians. All mental health complaints were more frequently reported at younger ages (compared to 50-64-year olds) and by not married or cohabiting respondents.ConclusionHigh prevalence of mental health complaints and their socio-economic and demographic patterning refer to considerable inequalities in mental health among employed adults. Policy actions targeting especially younger adults and those with financial difficulties are needed to address these early manifestations of mental health problems.

Geographical, Socioeconomic, and Gender Inequalities in Opioid Use in Catalonia.

Background: In recent years, worldwide opioid use has seen a sharp increase, especially for the treatment of chronic non-cancer pain. Catalonia is no exception to this trend. However, no recent studies have addressed the socioeconomic and gender inequalities in opioid use in the different geographical areas of Catalonia. Methods: We performed an ecological study to analyse the associations between socioeconomic status, gender and the use of opioids in the 372 Health Areas of Catalonia. Robust Poisson models were performed to analyse the data provided from the Central Register of Insured Persons and dispensing data from the Electronic Prescription Database. Results: The results show that socioeconomic status has a major impact on opioid use, with the most deprived areas presenting the highest levels of use. There are major inequalities in the DDD/1,000 inhabitants per areas. Moreover, women have much higher utilization rates than men, especially in more deprived areas. The greatest difference is observed in the use of weak opioids in women: the DDD/1,000 inhabitants per day was 2.34 in the area with the lowest use, compared with 22.18 in the area with the highest use. Conclusions: Our findings suggest that stronger action is needed to promote best practices in prescribing for chronic pain and to reduce socioeconomic and gender variation between geographical areas. This study provides a model for routine monitoring of opioid prescription for targeted interventions aimed at lowering high-dose consumption in specifically identified areas.