Socioeconomic Differences Research Articles

Drugs during pregnancy in low-risk prenatal care and associated factors

Objective: To identify the prevalence of the use of legal and illicit drugs by pregnant women who received prenatal care in Primary Health Care and factors associated with their usage. Methods: Cross-sectional study carried out using a structured script, composed of gestational sociodemographic variables and drug use by pregnant women and their families, applied to 270 women undergoing low-risk prenatal care at 15 Basic Health Units, in two municipalities in a metropolitan region of Southern Brazil, where there are negative socioeconomic and demographic differences in relation to the hub city. Data collection took place from December 2019 to February 2020. Data were analyzed using Pearson’s chi-square test, with associations with a value of p<0.05 being considered significant. Results: Young people aged 25 to 35 accounted for 77% of the sample; brown/black were 60.4%; multigravidae accounted for 41.8% (with more than three children). 86.6% had a steady marital partner. The prevalence of current drug use was 46.2%. There was a statistically significant association between alcohol consumption and having had pregnancy complications (odds ratio of 2.5; confidence interval of 1.17-5.22); between marijuana consumption and the age of 15 to 19 years (odds ratio of 2.7; confidence interval of 1.01-7.03); between tobacco consumption and drug use by the husband (odds ratio of 4.1; confidence interval of 1.75-9.55) and between tobacco use and single-parent family classification (odds ratio of 6.6 ; confidence interval 1.55 - 28.43). Conclusion: The prevalence between current usage and lifetime use was high. The multipregnancies in women were undergoing low-risk prenatal care. Drug use, age, drug use by the husband and single-parent family classification were associated with gestational complications.

Justice beliefs for self and others: Associations with positive and negative affectivity in African Americans and White Americans.

Prior research has shown that a belief in personal justice (i.e., justice for self) is associated with better health and well-being, whereas a belief in justice more generally (i.e., justice for others) is unrelated. However, an emerging perspective is that racial differences may overlay the relationships between multidimensional beliefs about justice and indices of well-being. This includes that well-being among African Americans may be additionally supported by rejecting rather than endorsing some forms of believing in justice. In the present study, we consider racial similarities and differences in the links between beliefs about justice for self and others and emotional well-being. African Americans (N = 117) and White Americans (N = 188) completed measures of beliefs about justice for self and others, and also measures of dispositional tendencies towards experiencing positive and negative emotion (i.e., positive and negative affectivity). In both groups, beliefs about justice for the self were associated with greater positive affect and reduced negative affect. However, beliefs about justice for others were additionally associated with greater negative affect only among African Americans. The link between justice for others and negative affect among African Americans was not attributable to measurement or mean differences in justice beliefs across racial groups, or to socioeconomic differences. Results align with an emerging perspective that simultaneously endorsing and rejecting justice beliefs may be vital to preserving well-being for some racial minorities.

Learning loss one year after school closures: evidence from the Basque Country

AbstractWe use census data on external assessments in primary and secondary schools in the Basque Country (Spain) to estimate learning losses due to the COVID-19 pandemic in March 2021, 1 year after school closures, which lasted from March to June 2020. Differences-in-differences with student and school-by-grade fixed effects show an average learning loss of 0.045 standard deviations, an effect that is smaller than short-run effects estimated by previous papers, and estimated after 6 months of one of the most successful school reopening campaigns among OECD countries. The effect is larger in Mathematics, moderate in Basque language, and none in Spanish language. Controlling for socioeconomic differences, learning losses are especially large in public schools, and also in private schools with a high percentage of low-performing students. On the other hand, we find a regression to the mean within schools, possibly due to a compressed curriculum during the whole period. Finally, and more importantly, we use unique novel data on student socio-emotional well-being and show for the first time that students with higher learning losses self-report significantly worse levels of socio-emotional well-being due to the pandemic.

Change in avoidable hospitalizations for low-income elders following quasi-market reform in primary care – Evidence from a natural experiment in Sweden

Quasi-market reforms have been increasingly implemented in tax-funded health care, but their effects in terms of equity, quality and socioeconomic differentials in quality remain sparsely studied.We create a natural experiment setup exploiting the differential timing of a set of quasi-market reforms – including patient choice, free establishment of providers and changes in provider remuneration –, implemented in primary care in the two largest Swedish regions (Stockholm and Västra Götaland) in 2008–2009. Using a database with individual level data from 2005 to 2009, we construct a difference-in-difference-in-differences model that compares pre to post reform changes in avoidable hospitalizations (AHs) for low-income elders and a matched comparison group, in the region exposed to, versus unexposed to, reform (total N ∼ 200 000).The results show that for low-income elders – a group dominated by older women – reform led to higher AH rates, i.e., worse primary health care quality, than what would have been the case in absence of reform. Specifically, low-income elders exposed to reform missed out on improvements in AHs seen simultaneously in the unexposed region. At the same time, the reform had on average no effect for comparable, non-low-income, peers. The fact that this pattern was specific for avoidable hospitalizations – judged as amenable to interventions in primary care –, but not present for total hospitalizations, supports that it was driven by reform implementation rather than other factors.The study contributes with high-quality empirical evidence to a policy relevant but sparsely researched area and highlights the necessity to consider differential effects of organizational changes across socioeconomic groups.

Multilevel effects of urban form and urban functional zones on housing prices: evidence from open-source big data

While the relationship between local housing prices and the urban form and distribution of urban functional zones in a single city is well-discussed, the conclusion is usually sensitive to a particular city context, and cross-city comparative study is limited. This study attempts to examine the influences of urban form and urban functional zone distribution on housing prices within and between cities after controlling the city-wide socio-economic and demographic differences. Based on multiple open-source big data, such as points-of-interest (POI) and historical housing transaction data, the hierarchical linear model is utilized to compare the housing market of 10 extra-large cities in China. Results indicate that the urban form and the urban functional zone distribution significantly influence housing prices after the socio-economic and demographic differences are controlled. For inter-city comparison, an urban form with high compactness, low centrality, low polycentricity, high density, and low dissimilarity in housing development is related to lower city-level housing prices. For intra-city, proximity to work centers, high-quality hospitals, and schools shows positive associations to housing prices.

Transition to grandparenthood and early retirement in midlife

ABSTRACT This paper aims to capture the interrelationship between two life transitions linking the generation of elderly parents and their adult children: early retirement and the transition to (grand)parenthood. A (grand)parents’ early retirement might be driven by the need to care for a grandchild. Conversely, the transition of their adult children into parenthood might be shaped by the availability of flexible, reliable, and affordable childcare provided by retired (grand)parents. Employing an event history approach, we examine the reciprocal influence that the birth of the first grandchild and early retirement have in midlife. Our study focuses on gender and socio-economic differences drawing on the SHARE multi-country dataset. Results show that becoming a grandparent increases the chances of early retirement for both men and women, slightly more among grandmothers than grandfathers. Among new grandfathers, those with higher education are more likely to go into early retirement compared to their less-educated counterparts. Early retirement, on the contrary, does not predict grandparenthood in a significant way, though there is a relatively higher chance of becoming a grandfather if the person who retired is highly educated.

Determinants of drug-resistant tuberculosis in Hunan province, China: a case-control study

BackgroundDrug-resistant tuberculosis (DR-TB) is a major public health threat in Hunan Province, with an increasing clinical burden in recent years. This study aimed to identify socio-demographic and clinical factors associated with DR-TB in Hunan province, China.MethodsA case-control study was conducted in Hunan province. Cases were all DR-TB patients who were confirmed by culture and Drug susceptibility testing (DST) and enrolled at the DR-TB treatment center of Hunan Chest Hospital from 2013 to 2018. Controls were all Drug Susceptible TB (DS-TB) patients confirmed by DST and enrolled at the same hospital during the same period. A multivariable logistic regression model was fitted to identify factors significantly associated with DR-TB.ResultsA total of 17,808 patients (15,534 DS-TB controls and 2274 DR-TB cases) were included in the study, with a mean age of 42.5 years (standard deviation (SD) ± 17.5 years) for cases and 46.1 years (SD ± 19.1 years) for controls. Age 15-64 years (Adjusted odds ratio (AOR = 1.5, 95% CI; 1.4, 1.8)), ethnic minorities (AOR = 1.5; 95% CI; 1.4, 1.8), and a history of previous TB treatment (AOR) = 1.84; 95% CI: 1.57, 2.15) was significantly associated with DR-TB. Being resident in a province outside Hunan was also a significant risk factor (AOR = 1.67; 1.27, 2.21) for DR-TB.Conclusion and recommendationsTo prevent the occurrence of DR-TB in Hunan Province, interventions should be targeted at high-risk demographic groups such as ethnic minorities, individuals of productive age, and residents living outside the province. Interventions must also be targeted to previously treated cases, suggesting the appropriateness of diagnosis, treatment, and follow-up. Understanding the risk factors at the province level helps design strategies for controlling DR-TB due to variations by socioeconomic differences, quality of health care, and healthcare access.

Inpatient outcomes for lung cancer patients presenting with superior vena cava thrombosis

Background A specific cause of superior vena cava (SVC) syndrome, SVC thrombosis, is a rare but known complication in cancer patients. Early identification and management of SVC thrombosis in lung cancer patients may lead to improved patient outcomes and a reduction in healthcare costs. Methods We studied the racial and socioeconomic differences, length of stay, total hospital charges, and all-cause mortality outcomes in patients with lung cancer with and without SVC thrombosis using data from the National Inpatient Sample. Statistical analysis was performed on STATA. Results A total of 480,750 patients were hospitalized for lung cancer; 720 (0.15%) of these patients had SVC thrombosis. The lung cancer with SVC thrombosis cohort had a statistically higher proportion of Black patients. Patients with lung cancer presenting with SVC thrombosis had an increased hospital length of stay (10 vs 6 days, P < 0.001) and cost ($117,320 vs $80,806, P < 0.005) compared to those without SVC thrombosis. All-cause mortality in patients with lung cancer was 7.7% and the presence of SVC thrombosis significantly increased the odds of inpatient mortality (18.0%). Nonwhite races were associated with higher odds of mortality in lung cancer admissions. Conclusion Race, insurance type, and comorbidities impacted the likelihood of developing SVC thrombosis in patients with lung cancer. SVC thrombosis is a poor prognostic factor for patients with lung cancer. Further studies to evaluate these disparities are warranted.

Are cities ready for low‐carbon inclusive strategies? Household energy management under heterogeneous socioeconomic conditions

AbstractEnergy is an indispensable resource for economic development and the well‐being of society. Due to heterogeneity in socioeconomic conditions, households consume direct energy and produce emissions differently. Analysing energy emissions from heterogeneous socioeconomic groups helps to identify foci for intervention and create policies for sustainable cities. This study aimed to measure household emissions in Varanasi city and investigate the impact of heterogeneous socioeconomic variables on household emissions. Varanasi represents a million‐plus rapidly urbanising city. Analysis of variance (ANOVA) and non‐parametric regression revealed the relationship between end‐use energy emissions and socioeconomic variables for five income classes. Biomass‐based fuels constituted a significant proportion of energy (about 16%–20%) in low‐ to middle‐income groups, however, electricity consumption dominated in upper‐middle‐ and high‐income groups. A fuel‐stacking pattern was found, particularly in cooking activities. LPG was critical to replace solid biomass‐based fuels. To meet the present needs and absorb the impact of a growing population, energy policies and infrastructure should focus on accessibility and efficiency. An inclusive low‐carbon policy with a specialised focus on socioeconomic differences is needed for energy sustainability.

Parental ages and the intergenerational transmission of education: evidence from Germany, Norway, and the United States

ABSTRACT The diverging destinies hypothesis predicts that educational inequality increases in contemporary societies because parents with higher levels of education postpone the birth of their children. This hypothesis is supported by empirical evidence demonstrating that advanced parental ages improve children’s educational outcomes. However, the consequences of socioeconomic differences in parental ages for the intergenerational transmission of education also depend on whether the associations between parental ages and child education vary by parental education. To test this hypothesis, we use data from three countries representing different welfare regimes: Germany, Norway, and the United States. In all three countries, children’s educational attainment at the secondary school level increases with higher parental ages more in families with low than in families with highly educated parents. In other words, the intergenerational transmission of education is stronger for younger than for older parents. Consequently, our findings nuance the diverging destinies hypothesis by demonstrating that increasing parental ages in socioeconomically disadvantaged families increases educational mobility more than decreasing parental ages in socioeconomically advantaged families. These findings are qualitatively the same in all three countries, suggesting that diverging destinies also occur in countries outside the United States.

The Diversity in Tobacco Use Among Women of Reproductive Age (15-49 Years) in Pakistan: A Secondary Analysis of a Multiple Indicator Cluster Survey 2016-2018.

Tobacco use in women of reproductive age group (15-9 years) may contribute to poor maternal and child health outcomes. We estimated the prevalence of smokeless tobacco (ST), cigarette, and waterpipe use among these women in Pakistan and explored associations with socio-economic differences and birth weights after recent childbirths (past 2 years). We used the Multiple Indicator Cluster Surveys datasets from three provinces in Pakistan. Prevalence was generated for current use of tobacco among women with recent childbirth (WWRC) and without recent childbirth (WWoRC). We further compared socio-economic status and birth weights between tobacco users and non-users. The prevalence of current ST use was 1.4% and 2.5%, and waterpipe smoking was 1.2% and 1.8%, in WWRC and WWoRC, respectively. ST use varied across Pakistan's provinces by 13 percentage points in WWRC and WWoRC while waterpipe smoking by 10 and 15 percentage points, respectively. The odds of using any form of tobacco were significantly lower with higher levels of education or wealth index. Compared to children born to mothers who did not use tobacco, the birth weight of children born to mothers who smoked waterpipe was on average 0.83 kg (95% CI -1.6 to -0.1) lower whereas it was 0.33 kg (95% CI -0.9 to 0.3) higher for ST users. Tobacco use among women of reproductive age in Pakistan varied significantly based on province and tobacco type. Waterpipe smoking was associated with a reduction in birth weight. Raising awareness of the harms of tobacco use among women of reproductive age and targeting interventions in high-burden regions of Pakistan should be prioritized. The prevalence of current smokeless tobacco use and waterpipe smoking varied significantly in Pakistan (~13 and ~15 percentage points, respectively) among women of reproductive age, and there seems to be little change in tobacco use behavior around pregnancy and early motherhood. The study highlights a need to better understand the prevalence of tobacco use in Pakistan, and further contextual research is warranted to understand the reasons for such high tobacco use in certain areas. This information highlights the need for improving current tobacco control interventions and policies, including measures that could help reduce its use and prevent its uptake. Furthermore, compared to children born to mothers who did not use any form of tobacco, we found a statistically significant difference (830 g) in birth weight for babies born to mothers who at the time of the interview smoked waterpipe and a non-statistically significant difference of about 330 g for children born to mothers who at the time of the interview used smokeless tobacco. In addition to our findings, some literature suggests the association of waterpipe smoking with low birth weight. A possible explanation could be the exposure to smoke that contains toxicants from the tobacco product itself in addition to the burning of charcoal, which is required when using waterpipe. Waterpipe smoking also results in high exposures to carbon monoxide and polycyclic aromatic hydrocarbons, which are known to be carcinogenic and teratogenic. In terms of smokeless tobacco use, further research is warranted to understand its impact on birth outcomes through longitudinal studies accounting for diverse products, its constituents and the amount of consumption.

The age-based digital divides in China: Trends and socioeconomic differentials (2010–2020)

The age-based digital divide is emerging as a major challenge with the integrated development of population aging and digital transformation. This study examines the dynamics of multifaceted age-based digital divides (perceived Internet importance, Internet access, and learning-oriented Internet use) as well as their socioeconomic differentials (urban-rural residence, gender, and education). Using longitudinal data from China Family Panel Survey (CFPS) from 2010 to 2020, the study found that despite increases in perceived importance and physical access, learning-oriented use showed a downward trend. Moreover, the age-based divides regarding importance and access persisted over time while the divides in learning-oriented use by age fluctuated, and these dynamics varied across different social groups. The largest difference was observed between high-educated and low-educated groups: while the age-based divides in perceived importance and access have widened among the low-educated, these gaps have been bridged among the high-educated populations. For the usage gap, this contrasting developmental trend was only observed between middle-aged and young people, but not for the elderly.

Role of Social Support in Screening Colonoscopy/Sigmoidoscopy Uptake among U.S. Adults

Colorectal cancer (CRC) is a major clinical and public health burden. Screening has been shown to be effective in preventing CRC. In 2021, less than 72% of adult Americans had received CRC screening based on the most recent guidelines. This study examined the relationship between social support and screening colonoscopy or sigmoidoscopy uptake among U.S. adults and the socioeconomic factors that impact the relationship. We conducted a cross-sectional study using the 2021 National Health Interview Survey (NHIS) data for 20,008 U.S. adults to assess the weighted rates of screening colonoscopy or sigmoidoscopy among individuals with strong, some, and weak social support. Adjusted binary logistic regression models were utilized to obtain the weighted odds of receiving a screening colonoscopy or sigmoidoscopy among adults with different levels of social support and socioeconomic status. About 58.0% of adults who reported having colonoscopy or sigmoidoscopy had strong social support, compared to 52.0% who had some or weak social support. In addition, compared to adults with weak social support, the weighted adjusted odds of having colonoscopy or sigmoidoscopy were 1.0 (95% C.I. = 0.994, 0.997; p &lt; 0.001) and 1.3 (95% C.I. = 1.260, 1.263; p &lt; 0.001) for adults with some and strong social support, respectively. Socioeconomic differences were observed in the odds of colonoscopy or sigmoidoscopy uptake based on having strong social support. Having strong social support is an important factor in increasing colonoscopy or sigmoidoscopy screening uptake. Policies and interventions that enhance social support among adults for screening colonoscopy or sigmoidoscopy are warranted.

P018 Inequalities in healthcare access, experience and outcomes in adults with Inflammatory Bowel Disease: A scoping review

Abstract Background Inflammatory Bowel Diseases (IBD) are long-term conditions requiring lifelong access to, and interactions with health services. Accumulating evidence of inequalities in health care access, experience and outcomes for individuals with IBD is apparent. However there is no existing review that systematically maps these inequalities.The purpose of this review was to map and describe the inequalities in healthcare access, experiences, and outcomes of care for adults with IBD, to identify research gaps and future research priorities in this area. Methods A scoping review was conducted to retrieve quantitative, qualitative, and mixed methods evidence from three electronic databases (EMBASE, Medline and CINAHL). English written articles published between 2000 and 2023 were systematically searched using a search strategy. The Joanna Briggs Institute protocol for scoping reviews was followed to perform data extraction and analysis. Results 1343 records were identified. 51 studies met the criteria for inclusion. Studies addressed ethnic disparities of healthcare (33/51), inequalities driven by socioeconomic differences (12/51), rurality (7/51), gender (3/51), age (2/51), culture (2/51), literacy (1/51) and sexuality (1/51). The interrelationship of disparities relating to outcome, access and experience is illustrated in Figure 1. Poorer health outcomes (42/51 studies) were described in those from Black, Asian, and Hispanic ethnic groups in relation to hospital admission, readmission, emergency room attendance, length of stay, IBD-related complications, post-operative complications, treatment delay and length of stay. Deprivation, insurance status in US populations, rural location and age also affected outcome. Access inequalities (24/51 studies) were described to services, therapies and surgery but also to educational opportunities. Poor experience of care (8/51 studies) included appointment issues, lack of cultural understanding and fragmented care. A lack of research was found in the LGBTQIA+ community (1/51). No research was found to investigate inequalities in IBD patients with learning disabilities or autism. Conclusion Inequality affecting a wide range of population characteristics affects outcomes, access and experience in IBD care. Services need to be organised and delivered in a way that addresses this. Further research, including qualitative methods, is particularly needed to understand health experiences of underserved patient populations with IBD. The lack of research amongst LGBTQIA+ individuals, and with learning disabilities, poses a risk of creating inequalities within inequalities.

Early mortality in children with cancer in Denmark and Sweden: The role of social background in a setting with universal healthcare.

Socioeconomic differences in overall survival from childhood cancer have been shown previously, but the underlying mechanisms remain unclear. We aimed to investigate if social inequalities were seen already for early mortality in settings with universal healthcare. From national registers, all children diagnosed with cancer at ages 0-19 years, during 1991-2014, in Sweden and Denmark, were identified, and information on parental social characteristics was collected. We estimated odds ratios (OR) and 95% confidence intervals (CI) of early mortality (death within 90 days after cancer diagnosis) by parental education, income, employment, cohabitation, and country of birth using logistic regression. For children with acute lymphoblastic leukaemia (ALL), clinical characteristics were obtained. Among 13,926 included children, 355 (2.5%) died within 90 days after diagnosis. Indications of higher early mortality were seen among the disadvantaged groups, with the most pronounced associations observed for maternal education (ORadj_Low_vs_High 1.65 [95% CI 1.22-2.23]) and income (ORadj_Q1(lowest)_vs_Q4(highest) 1.77 [1.25-2.49]). We found attenuated or null associations between social characteristics and later mortality (deaths occurring 1-5 years after cancer diagnosis). In children with ALL, the associations between social factors and early mortality remained unchanged when adjusting for potential mediation by clinical characteristics. In conclusion, this population-based cohort study indicated differences in early mortality after childhood cancer by social background, also in countries with universal healthcare. Social differences occurring this early in the disease course requires further investigation, also regarding the timing of diagnosis.

Socio-economic status, functioning and cognition in young versus adult patients newly diagnosed with bipolar disorder and their unaffected relatives; results from a cross-sectional study

BackgroundBipolar disorders (BD) figures on top of the World Health Organization classification of disabling disorders. It is unclear if there are socioeconomic, functioning, and cognition differences in young patients newly diagnosed with BD and whether these are different for young and adult patients newly diagnosed with BD. Understanding these differences is important for tailored treatment and support. MethodsParticipant groups included 401 patients newly diagnosed with BD, 145 of their unaffected first-degree relatives (UR) and 209 healthy control individuals (HC). First, we compared socio-economic status, functioning and cognition between young patients newly diagnosed with BD (150), UR (61) and HC (92) (15–25 years) and adult patients newly diagnosed with BD (251), UR (84) and HC (117) (>25 years), respectively.Second, within patients, we compared functioning and cognition between young and adult patients newly diagnosed with BD. ResultsIn both participant groups, patients newly diagnosed with BD, and to a lesser degree UR, had lower socio-economic status and impaired functioning and cognition compared with HC. Further, young patients newly diagnosed with BD were less functionally impaired, than adults newly diagnosed with BD, whereas cognition did not differ between groups. LimitationsApplied tools for assessments of functioning and cognition are not validated below age 18. ConclusionsOverall, lower socio-economic status and impaired functioning and cognition were found both in young and adult patients newly diagnosed with BD and their UR compared with young and adult HC, respectively. Young patients were less functionally impaired than adults, but cognition was similarly impaired.

Age-Friendly Transportation Policies and Practices in the U.S. and China: A Comparative Study

Despite significant political, cultural, and socioeconomic differences, the U.S. and China share some common development issues, including, but not limited to, an aging population, deficient age-friendly transportation systems, and insufficient government funding support to address the issues faced by their transportation-disadvantaged populations (TDP). Through an extensive literature review, this paper first evaluates and compares the major TDP-related laws, regulations, transportation service delivery procedures, and existing age-friendly transportation improvements made in the U.S. and China. Next, it highlights the differences between the U.S. and China in their socioeconomic characteristics and the implications these have on transportation modal shares and age-friendly transportation planning priorities. In the concluding section, it summarizes the research findings and makes preliminary recommendations.

Racial, ethnic, and socioeconomic differences in hepatocellular carcinoma across the United States

Hepatocellular carcinoma (HCC) poses a significant public health challenge within the US, exerting an increasingly substantial influence on cancer-related deaths. However, the HCC burden is not uniformly distributed, with significant disparities related to race, ethnicity, and socioeconomic status. This manuscript comprehensively reviews the multifaceted origins of HCC disparities, exploring their roots in the sociocultural environment, socioeconomics, the physical/built environment, and the healthcare/political systems. The sociocultural environment highlights the unique challenges faced by racial and ethnic minority populations, including language barriers, cultural beliefs, and limited healthcare access. The socioeconomics and the physical/built environment section emphasize the impact of neighborhood poverty, geographic disparities, and healthcare infrastructure on HCC outcomes. The healthcare and political systems play a pivotal role in driving HCC disparities through practice guidelines, healthcare policies, insurance coverage, and access to care. Inconsistent practice guidelines across specialties and variations in insurance coverage contribute to disparities in HCC surveillance and treatment. In conclusion, addressing HCC disparities requires a multifaceted, patient-centered approach that includes cultural competence, infrastructure enhancements, policy changes, and improved access to care. Collaborative efforts among healthcare professionals, researchers, policymakers, and institutions are essential to reducing the burden of HCC on marginalized communities and ensuring equitable care for all individuals affected by this complex disease.

Socioeconomic inequalities in early adulthood disrupt the immune transcriptomic landscape via upstream regulators

Disparities in socio-economic status (SES) predict many immune system-related diseases, and previous research documents relationships between SES and the immune cell transcriptome. Drawing on a bioinformatically-informed network approach, we situate these findings in a broader molecular framework by examining the upstream regulators of SES-associated transcriptional alterations. Data come from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative sample of 4543 adults in the United States. Results reveal a network—of differentially expressed genes, transcription factors, and protein neighbors of transcription factors—that shows widespread SES-related dysregulation of the immune system. Mediational models suggest that body mass index (BMI) plays a key role in accounting for many of these associations. Overall, the results reveal the central role of upstream regulators in socioeconomic differences in the molecular basis of immunity, which propagate to increase risk of chronic health conditions in later-life.

Socioeconomic differences in dietary habits in Italy before and during COVID-19 pandemic: secondary analysis of a nationwide cross-sectional study

BackgroundSeveral socioeconomic conditions may influence subjects’ adherence to healthy eating habits. Food consumption may be influenced by external stress during crisis periods; however, the effects of these events on food habits are difficult to predict. Also, a pandemic crisis like the recent COVID-19 pandemic may have influenced dietary habits and food consumption. The objective of this study was to compare the dietary habits of Italian people before the COVID-19 pandemic with those belonging to the year 2020 in a nationwide population sample.Materials and methodsInformation on dietary habits has been obtained from the multi-purpose survey on families’ “Aspects of daily life”, carried out in Italy by the Italian National Statistics Institute (ISTAT). We analyzed data coming from 2016 and 2020 editions of the survey (43,000 subjects each year). We used population attributable fraction (PAF) adjusted for age, defined as the proportional reduction in unhealthy diet that would occur if all participants had had a higher education, assuming higher educated individuals as more socially advantaged. Prevalence association for each dietary exposition has been calculated through logistic regression.ResultsLooking at aggregated data from 2016 and 2020 both men and women showed a high prevalence of unhealthy dietary habits. Regarding men, excessive consumption of eggs, pork meat, and bovine meat was characterized by a PAF attributable to socioeconomic conditions to an extent greater than 30%. Women showed the same trend. Focusing on different years of investigation, in 2020, during the COVID-19 pandemic, men and women increased their consumption of eggs, cooked fats, snacks, and sweets, and reduced consumption of fruits and vegetables. Additionally, women increased the assumption of dietary products and meat. Both sexes registered an increase in overweight and obese subjects in 2020.ConclusionsTo our knowledge, this study was the first in our country to use a yearly, nationwide sample to analyze dietary habits by examining specific types of various foods on a nationwide scale and establishing a correlation between these habits and the COVID-19 pandemic. Our results showed unbalanced dietary habits of the Italian population with an excess of consumption of several foods like eggs, cooked fats snacks, and sweets with low consumption of fruits and vegetables. Socioeconomic differences influence food choices but in a complex way since they seemed to affect some wrong dietary habits but not others, especially regarding fruits and vegetables assumption where differences were less evident among social classes. Outside stressors like a crisis period such as the COVID-19 pandemic seem to have an important role in both men and women regarding the assumption of so-called “junk food”.