Socioeconomic Position Research Articles

Socioeconomic inequalities in greenhouse gas emissions from household travel in Aotearoa/New Zealand

BackgroundA just transition to a decarbonised transport system requires understanding current inequity in transport-related greenhouse gas emissions (GHGe). MethodsWe used the population-based nationally representative New Zealand Household Travel Survey (2015–2018 data) to examine inequalities in GHGe from household travel by NZDep (an area measure of socioeconomic position [SEP]). ResultsThere was a broadly linear association between SEP and GHGe from household travel. People resident in the least deprived areas emitted around 79 % more GHGe per week from household travel than those in the most [mean 63.6 CO2eq (95 %CI 58.5–68.6) compared to 35.6 kg CO2eq (95 %CI (32.6–38.6)]. Most of the difference was due to the additional 97 km per week travelled by car by people resident in the least deprived areas. Residents in the least deprived areas travelled further and more frequently for paid and unpaid work and leisure purposes than those in the most. Air travel also showed significant inequities with 2.4 % of residents in the least deprived areas reporting air travel in the last week compared to 0.1 % in the most deprived. Air travel was the second largest source of mean weekly transport emissions in residents living in the least deprived areas. ConclusionThere are large inequities by area deprivation in GHGe from household travel in Aotearoa/New Zealand. Transport policy needs to focus on measures to reduce emissions that are effective and reduce inequities. Significant work on policy processes, design and evaluation need to occur to facilitate this dual transformation.

Employment wages and diseases of despair in early adulthood: Links through subjective socioeconomic status and cumulative stressor exposure

Rising mortality due to suicides, overdoses, and substance-related diseases, also called “deaths of despair,” has attracted significant academic, public, and media attention in recent years. This type of mortality, and key precursor “diseases of despair” like depressive mood and substance-related problems, tend to concentrate in people affected by deindustrialization and the loss of well-paid industrial jobs, that is, working-age adults with less than a BA degree. It is thought that risks build up when young adults with less education struggle to find decent jobs upon entering the labor market, which in turn triggers (1) subjective perceptions of being stuck in lower socioeconomic rungs; and (2) exposure to chronic stressors in various domains (e.g., housing, relationships). This study examined whether wages were related to diseases of despair (i.e., depressive mood and substance-related problems) through these two types of processes in a longitudinal sample (N = 543) overrepresenting young Canadian adults with lower educational attainment followed from their mid-teens to their mid-20s. Psychological processes and outcomes were self-reported, whereas exposure to stressors was assessed with a gold-standard interview-based protocol. After taking into account key potential confounders measured in adolescence (e.g., stressor exposure, mental health symptoms), results show that wages in early adulthood (in the early and mid-20s) were indirectly associated with depressed mood and substance-related problems in the mid-20s, through internal psychological processes and external exposure to chronic stressors. The specific processes in play varied by outcome. For depressive mood, subjective perceptions of one's relative socioeconomic position emerged as particularly relevant, whereas for substance-related problems, significant indirect associations emerged only when both internal psychological processes and external exposures to stressors were considered jointly. Access to decent jobs offering good wages among young adults without university degrees should thus be considered when designing policies aimed at reducing diseases of despair in younger generations.

Exploring the mechanisms underlying increased risk of depressive disorder in ethnic minority populations in Europe: A causal loop diagram

BackgroundMultiple ethnic minority populations in Europe show high risk of major depressive disorder (MDD), with ethnic discrimination and low socioeconomic position (SEP) as established risk factors. How this risk is shaped by the interactions between these, and other social factors, remains to be elucidated. We aimed to develop a causal-loop diagram (CLD) to gain a better understanding of how factors at the intersection of ethnic discrimination and SEP dynamically interact to drive MDD risk. MethodsWe iteratively mapped the interactions and feedback loops between factors at the intersection of ethnic discrimination and SEP, drawing input from (i) a series of two interviews with a range of MDD domain experts, (ii) an existing CLD mapping the onset of MDD across psychological, biological, and social dimensions at the level of the individual, and (iii) other relevant literature. ResultsThrough tracing the feedback loops in the resulting CLD, we identified ten driving mechanisms for MDD onset in ethnic minorities (two related to ethnic discrimination, SEP, social network and support, and acculturation, as well as one relating to the living environment and self-stigma towards MDD); and four factors that modulate these mechanisms (recent migration, religious affiliation, neighborhood social environment, and public stigma towards MDD). The intersecting nature of ethnic discrimination and SEP, combined with the reinforcing dynamics of the identified driving mechanisms across time- and spatial scales, underscores the excess exposure to circumstances that increase MDD risk in ethnic minorities. ConclusionsWhile this CLD requires validation through future studies, the intersecting and reinforcing nature of the identified driving mechanisms highlights that tackling the high risk of MDD in ethnic minorities may require intervening at multiple targets, from the individual (e.g., psychological interventions targeting negative beliefs or reducing stress) to the societal level (e.g., addressing labor market discrimination).

Agreement between audiometric hearing loss and self-reported hearing difficulty on the Revised Hearing Handicap Inventory differs by demographic factors

BackgroundNew standardised measures of self-reported hearing difficulty can be validated against audiometric hearing loss. This study reports the influence of demographic factors (age, sex, race and socioeconomic position (SEP)) on...

Non-parental Childcare During Early Childhood and Problem Behaviour Trajectories from Ages 5 to 14 Years.

Using data from the nationally representative Millennium Cohort Study, this study examined the association between age of starting and weekly hours in formal childcare between birth and 5years with internalising and externalising behaviour trajectories from ages 5 to 14years in England (N = 6194 children). Associations were analysed using multilevel general linear regression models, with adjustment for socio-economic position, maternal mental health, demographics, and child temperament. Later entry was associated with more internalising behaviours at age 14years. Children who spent > 40h per week in childcare between birth and 3years displayed more externalising behaviour at 5years than children who did not attend childcare. Controlling for socio-economic position and parental mental health attenuated findings.

Income disparities in loss in life expectancy after colon and rectal cancers: a Swedish register-based study

BackgroundDifferences in the prognosis after colorectal cancer (CRC) by socioeconomic position (SEP) have been reported previously; however, most studies focused on survival differences at a particular time since diagnosis. We...

Equitable Pedagogical Practices in Learning Mathematics at Secondary Schools in Nepal

The central focus of this study is to explore equitable pedagogical practices in learning mathematics in diversified learners’ mathematics classrooms. This study focused on investigating the challenges faced by mathematics teachers to conduct equitable pedagogical practices in learning mathematics in mathematics classrooms and exploring the possible ways to promote equitable pedagogical practices in learning mathematics. An interpretive critical theory paradigm was employed for collecting, analysing, and interpreting data in an iterative process. Qualitative narratives were collected through in-depth interviews, focus group discussions (FGD), and classroom observations of which five secondary-level mathematics teachers of Dhading were observed. Through multi-layered theme analysis and interpretation, the study produced five emergent challenges: linguistic issues, classroom diversity, the dominance of banking pedagogy, student absenteeism, school environment, and socioeconomic position. Moreover, the study showed eight different ways to promote equitable pedagogical practices in learning mathematics: providing additional support for marginalized students, using multi-methods of mathematics teaching, promoting peer and group work, individual treatment, motivational counseling, teaching mathematics relating to daily life, promoting collaborative learning and cooperative teaching, and promoting culturally responsive teaching.

‘That is because we are alone’: A relational qualitative study of socio-spatial inequities in maternal and newborn health programme coverage in rural Uttar Pradesh, India

ABSTRACT This qualitative study was conducted in Uttar Pradesh state, India to explore how interrelated socio-economic position and spatial characteristics of four diverse villages may have influenced equity in coverage of community-based maternal and newborn health (MNH) services. We conducted social mapping and three focus group discussions in each village, among women of lower and higher socio-economic position who recently gave birth, and with community health workers (n = 134). Data were analysed in NVivo 11.0 using thematic framework analysis. The extent of socio-economic hierarchies and spatial disparateness within the village, combined with distance to larger centers, together shaped villages’ level of socio-spatial remoteness. Disadvantaged socio-economic groups expressed being more often spatially isolated, with less access to infrastructure, resources or services, which was heightened if the village was physically distant from larger centers. In more socio-spatially remote villages, inequities in coverage of MNH services that disadvantaged lower socio-economic position groups were compounded as these groups more often experienced ASHA vacancies, as well as greater distance to and poorer perceived quality of health services nearest the village. The results inform a conceptual framework of ‘socio-spatial remoteness’ that can guide public health research and programmes to more comprehensively address health inequities within India and beyond.

Is there a link between health care utilisation and subjective well-being? An exploratory study among older Danes.

While extensive research has explored the influence of traditional factors such as socioeconomic position on health care utilisation, the independent role of an individual's well-being in their health care seeking behaviour remains largely uncharted territory. In this study, we delve into the role of subjective well-being (SWB) in health care utilisation. We use a unique link between survey data from a representative group of Danish citizens aged 50-80 and administrative register data containing information on health care utilisation and sociodemographics. We explore whether SWB is a predictor of health care utilisation (general practice services) over and above health (as measured by health-related quality of life (HRQoL)). We find that the association between SWB and number of services provided in general practice differs across levels of HRQoL. Among those with lower HRQoL, we find a positive association between health care utilisation and SWB. Results hold true even when controlling for previous health care utilisation, suggesting that the mechanism is not driven by reverse causality. Our findings suggest that, in particular for vulnerable individuals in poor health and with poor SWB, the propensity to seek care is inappropriately low, and there is a need for more proactive supply-driven health care.

Racialization processes and depressive symptoms among pregnant Mexican-origin immigrant women.

This study examines how racialization processes (conceptualized as multilevel and dynamic processes) shape prenatal mental health by testing the association of discrimination and the John Henryism hypothesis on depressive symptoms for pregnant Mexican-origin immigrant women. We analyzed baseline data (n = 218) from a healthy lifestyle intervention for pregnant Latinas in Detroit, Michigan. Using separate multiple linear regression models, we examined the independent and joint associations of discrimination and John Henryism with depressive symptoms and effect modification by socioeconomic position. Discrimination was positively associated with depressive symptoms (β = 2.84; p < .001) when adjusting for covariates. This association did not vary by socioeconomic position. Women primarily attributed discrimination to language use, racial background, and nativity. We did not find support for the John Henryism hypothesis, meaning that the hypothesized association between John Henryism and depressive symptoms did not vary by socioeconomic position. Examinations of joint associations of discrimination and John Henryism on depressive symptoms indicate a positive association between discrimination and depressive symptoms (β = 2.81; p < .001) and no association of John Henryism and depressive symptoms (β = -0.83; p > .05). Results suggest complex pathways by which racialization processes affect health and highlight the importance of considering experiences of race, class, and gender within racialization processes.

Improving the identification of bone-specific physical activity using wrist-worn accelerometry: A cross-sectional study in 11-12-year-old Australian children.

Physical activity (PA) during childhood and adolescence is important for the accrual of maximal peak bone mass. The precise dose that benefits bone remains unclear as methods commonly used to analyze PA data are unsuitable for measuring bone-relevant PA. Using improved accelerometry methods, this study identified the amount and intensity of PA most strongly associated with bone outcomes in 11-12-year-olds. Participants (n=770; 382 boys) underwent tibial peripheral quantitative computed tomography to assess trabecular and cortical density, endosteal and periosteal circumference and polar stress-strain index. Seven-day wrist-worn raw acceleration data averaged over 1-s epochs was used to estimate time accumulated above incremental PA intensities (50 milli-gravitational unit (mg) increments from 200 to 3000mg). Associations between time spent above each 50mg increment and bone outcomes were assessed using multiple linear regression, adjusted for age, sex, height, weight, maturity, socioeconomic position, muscle cross-sectional area and PA below the intensity of interest. There was a gradual increase in mean R2 change across all bone-related outcomes as the intensity increased in 50mg increments from >200 to >700mg. All outcomes became significant at >700mg (R2 change=0.6%-1.3% and p=0.001-0.02). Any further increases in intensity led to a reduction in mean R2 change and associations became non-significant for all outcomes >1500mg. Using more appropriate accelerometry methods (1-s epochs; no a priori application of traditional cut-points) enabled us to identify that ∼10min/day of PA >700mg (equivalent to running ∼10km/h) was positively associated with pQCT-derived measures of bone density, geometry and strength in 11-12-year-olds.

Long-term exposure to transportation noise and diabetes mellitus mortality: a national cohort study and updated meta-analysis

BackgroundLong-term exposure to transportation noise is related to cardio-metabolic diseases, with more recent evidence also showing associations with diabetes mellitus (DM) incidence. This study aimed to evaluate the association between transportation noise and DM mortality within the Swiss National Cohort.MethodsDuring 15 years of follow-up (2001–2015; 4.14 million adults), over 72,000 DM deaths were accrued. Source-specific noise was calculated at residential locations, considering moving history. Multi-exposure, time-varying Cox regression was used to derive hazard ratios (HR, and 95%-confidence intervals). Models included road traffic, railway and aircraft noise, air pollution, and individual and area-level covariates including socio-economic position. Analyses included exposure-response modelling, effect modification, and a subset analysis around airports. The main findings were integrated into meta-analyses with published studies on mortality and incidence (separately and combined).ResultsHRs were 1.06 (1.05, 1.07), 1.02 (1.01, 1.03) and 1.01 (0.99, 1.02) per 10 dB day evening-night level (Lden) road traffic, railway and aircraft noise, respectively (adjusted model, including NO2). Splines suggested a threshold for road traffic noise (~ 46 dB Lden, well below the 53 dB Lden WHO guideline level), but not railway noise. Substituting for PM2.5, or including deaths with type 1 DM hardly changed the associations. HRs were higher for males compared to females, and in younger compared to older adults. Focusing only on type 1 DM showed an independent association with road traffic noise. Meta-analysis was only possible for road traffic noise in relation to mortality (1.08 [0.99, 1.18] per 10 dB, n = 4), with the point estimate broadly similar to that for incidence (1.07 [1.05, 1.09] per 10 dB, n = 10). Combining incidence and mortality studies indicated positive associations for each source, strongest for road traffic noise (1.07 [1.05, 1.08], 1.02 [1.01, 1.03], and 1.02 [1.00, 1.03] per 10 dB road traffic [n = 14], railway [n = 5] and aircraft noise [n = 5], respectively).ConclusionsThis study provides new evidence that transportation noise is associated with diabetes mortality. With the growing evidence and large disease burden, DM should be viewed as an important outcome in the noise and health discussion.

Influence of multimorbidity and socioeconomic position on long-term healthcare utilization and prognosis in patients after cardiac resynchronization therapy implantation.

We aimed to investigate the influence of socioeconomic position (SEP) and multimorbidity on cross-sectional healthcare utilization and prognosis in patients after cardiac resynchronization therapy (CRT) implantation. We included first-time CRT recipients with left ventricular ejection fraction ≤35% implanted between 2000 and 2017. Data on chronic conditions, use of healthcare services, and demographics were obtained from Danish national administrative and health registries. Healthcare utilization (in- and outpatient hospitalizations, activities in general practice) was compared by multimorbidity categories and SEP by using a negative binomial regression model. The association between SEP, multimorbidity, and prognostic outcomes was analysed using Cox proportional hazards regression. We followed 2007 patients (median age of 70 years), 79% were male, 75% were on early retirement or state pension, 37% were living alone, and 41% had low education level for a median of 5.2 [inter-quartile range: 2.2-7.3) years. In adjusted regression models, a higher number of chronic conditions were associated with increased healthcare utilization. Both cardiovascular and non-cardiovascular hospital contacts were increased. Patients with low SEP had a higher number of chronic conditions, but SEP had limited influence on healthcare utilization. Patients living alone and those with low educational level had a trend towards a higher risk of all-cause mortality [adjusted hazard ratio (aHR): 1.17, 95% confidence interval (CI) 1.03-1.33, and aHR 1.09, 95% CI 0.96-1.24). Multimorbidity increased the use of cross-sectional healthcare services, whereas low SEP had minor influence on the utilizations. Living alone and low educational level showed a trend towards a higher risk of mortality after CRT implantation.

Social inequalities in pregnancy metabolic profile: findings from the multi-ethnic Born in Bradford cohort study.

Lower socioeconomic position (SEP) associates with adverse pregnancy and perinatal outcomes and with less favourable metabolic profile in nonpregnant adults. Socioeconomic differences in pregnancy metabolic profile are unknown. We investigated association between a composite measure of SEP and pregnancy metabolic profile in White European (WE) and South Asian (SA) women. We included 3,905 WE and 4,404 SA pregnant women from a population-based UK cohort. Latent class analysis was applied to nineteen individual, household, and area-based SEP indicators (collected by questionnaires or linkage to residential address) to derive a composite SEP latent variable. Targeted nuclear magnetic resonance spectroscopy was used to determine 148 metabolic traits from mid-pregnancy serum samples. Associations between SEP and metabolic traits were examined using linear regressions adjusted for gestational age and weighted by latent class probabilities. Five SEP sub-groups were identified and labelled 'Highest SEP' (48% WE and 52% SA), 'High-Medium SEP' (77% and 23%), 'Medium SEP' (56% and 44%) 'Low-Medium SEP' (21% and 79%), and 'Lowest SEP' (52% and 48%). Lower SEP was associated with more adverse levels of 113 metabolic traits, including lower high-density lipoprotein (HDL) and higher triglycerides and very low-density lipoprotein (VLDL) traits. For example, mean standardized difference (95%CI) in concentration of small VLDL particles (vs. Highest SEP) was 0.12 standard deviation (SD) units (0.05 to 0.20) for 'Medium SEP' and 0.25SD (0.18 to 0.32) for 'Lowest SEP'. There was statistical evidence of ethnic differences in associations of SEP with 31 traits, primarily characterised by stronger associations in WE women e.g., mean difference in HDL cholesterol in WE and SA women respectively (vs. Highest-SEP) was -0.30SD (-0.41 to -0.20) and -0.16SD (-0.27 to -0.05) for 'Medium SEP', and -0.62SD (-0.72 to -0.52) and -0.29SD (-0.40 to -0.20) for 'Lowest SEP'. We found widespread socioeconomic differences in metabolic traits in pregnant WE and SA women residing in the UK. Further research is needed to understand whether the socioeconomic differences we observe here reflect pre-conception differences or differences in the metabolic pregnancy response. If replicated, it would be important to explore if these differences contribute to socioeconomic differences in pregnancy outcomes.

Design, Methods, and Participation in Riksmaten Young Children—A Swedish National Dietary Survey

BackgroundNational dietary surveys provide essential data for risk benefit assessments of foods and nutrients, for management and policy development. Physical activity measurement and biomonitoring can provide important complementary data but are less commonly included. ObjectivesThis study aimed to describe the study design and methods of the cross-sectional Swedish national dietary survey Riksmaten Young Children (Riksmaten småbarn), of children aged 9 mo, 18 mo, and 4 y. Participation/dropout rates for the 2 older age groups are also presented. The impact of different recruitment strategies is discussed. MethodsChildren (N = 16,655) were randomly selected from the population register; invitations to guardians were sent by post and where possible, followed up by telephone. Food intake was assessed by a 2-d food diary and/or questionnaire. Height and weight were reported after measurement. Physical activity (accelerometery, 7 d) and stool, blood, and urine samples were assessed in subgroups. ResultsFood consumption data were collected in 1828 children (11% of the invited; 18 mo: n = 1078, and 4 y: n = 750). Of participants also in subgroups, 71% provided physical activity data (n = 1307), 60% stool samples (n = 630), and 51% blood and/or urine samples (n = 593). The study population represented all geographic regions and types of municipalities in Sweden, but participating households had both higher education level and higher income than the target population. Only minor differences were seen in participation rates between recruitment via post and telephone compared with those through post only (12% compared with 10%). Repeated contact attempts were needed for the majority of participants (65%). Despite the low-participation rate, 99% of the participants completed the study once started. ConclusionsAlthough it was a challenge to recruit participants, Riksmaten Young Children provides a substantial amount of information at national level, representative in terms of sex, geography, and family structure. The underrepresentation of households with lower socioeconomic position must be considered when generalizing results.

Pregnancy complications and childhood mental health: is the association modified by sex or adverse social circumstances? Findings from the ‘growing up in Ireland’ national infant cohort study

Specific pregnancy complications, socioeconomic position and sex have all been independently associated with child mental health outcomes, but their combined effects remain unclear. We examined whether total number of complications experienced in the pregnancy associated with mental health at 5 and 9-years, and whether this varied by sex or adverse social circumstances. Pregnancy complications were self-reported at 9-months post-natally from a list of 16 complications. Parents completed the Strengths and Difficulties Questionnaire (SDQ) when their child was 5 and 9-years. The primary outcome was the SDQ-total and scoring in the clinical range (> 16) was a secondary outcome. We applied generalized linear mixed models to a large nationally representative Irish cohort (GUI; n = 11,134). Analyses were adjusted for sex, adverse social circumstances (at 9-months), and gestational smoking. We included an interaction term between pregnancy complications and each variable respectively in separate models to examine if associations varied by sex or adverse circumstances.After controlling for covariates, total complications associated with mental health at 5 and 9-years. Each additional pregnancy complication conferred a 10% higher total-SDQ score (exponentiated co-efficient 1.10 [95%CI 1.06–1.14], 1.20 [1.15–1.26], 1.20 [1.12–1.29] and 1.34 [1.21–1.48] for 1, 2, 3 and 4 + complications respectively). For the dichotomised outcome, generally increasing odds for clinical levels of mental health difficulties were observed (OR 1complication = 1.89, 95%CI [1.37–2.59]; OR 2complications = 2.31, 95%CI [1.53–3.50]; OR 3complications = 1.77, 95%CI [0.89–3.52]; OR 4 + complications = 6.88, 95%CI [3.29–14.40]). Females had significantly lower odds of exhibiting clinically significant mental health difficulties than males (OR = 0.43, 95%CI[0.32–0.57]).There was no evidence that the association between pregnancy complications and child’s mental health varied by sex or social circumstances at 5 or 9-years. Males exposed to numerous pregnancy complications in the context of adverse social circumstances had the highest predicted probability of having mental health difficulties in middle childhood.

Lifestyle and incident dementia: A COSMIC individual participant data meta‐analysis

The LIfestyle for BRAin Health (LIBRA) index yields a dementia risk score based on modifiable lifestyle factors and is validated in Western samples. We investigated whether the association between LIBRA scores and incident dementia is moderated by geographical location or sociodemographic characteristics. We combined data from 21 prospective cohorts across six continents (N=31,680) and conducted cohort-specific Cox proportional hazard regression analyses in a two-step individual participant data meta-analysis. A one-standard-deviation increase in LIBRA score was associated with a 21% higher risk for dementia. The association was stronger for Asian cohorts compared to European cohorts, and for individuals aged ≤75 years (vs older), though only within the first 5 years of follow-up. No interactions with sex, education, or socioeconomic position were observed. Modifiable risk and protective factors appear relevant for dementia risk reduction across diverse geographical and sociodemographic groups. A two-step individual participant data meta-analysis was conducted. This was done at a global scale using data from 21 ethno-regionally diverse cohorts. The association between a modifiable dementia risk score and dementia was examined. The association was modified by geographical region and age at baseline. Yet, modifiable dementia risk and protective factors appear relevant in all investigated groups and regions.

Socio-economic inequities in mental health problems and wellbeing among women working in the apparel and floriculture sectors: testing the mediating role of psychological capital, social support and tangible assets

BackgroundIt is still unknown whether the mechanisms proposed by the Reserve Capacity Model (RCM) explaining socio-economic health and wellbeing inequities in high income countries can be applied to low-income countries. This study investigates whether different reserve capacities (intra-, inter-personal, and tangible) can explain the association between relative socio-economic position (SEP) and wellbeing outcome measures among Ethiopian women working in Foreign Direct Investment (FDI).MethodUsing a cross-sectional design, we collected quantitative survey data among 2,515 women working in the apparel and floriculture sectors in Ethiopia, measuring GHQ-12 mental health problems, multi-dimensional wellbeing, relative SEP, psychological capital (PsyCap), social support (emotional and financial social support network), and tangible assets (e.g., owning mobile phone, having access to toilet facilities). We used cluster-adjusted structural equation modelling to test whether PsyCap, social support, and/or tangible assets mediate the association between relative SEP (IV) and GHQ-12 mental health problems and multi-dimensional wellbeing (DVs).ResultsPsyCap and the size of the financial support network significantly mediate the socio-economic gradient in both wellbeing outcomes. The size of the emotional social support network shows no association with multi-dimensional wellbeing and shows an unexpected negative association with GHQ-12 mental health problems scores, including a significant mediation effect. Tangible assets show no association with the wellbeing outcome measures and do not mediate socio-economic mental health problems and wellbeing inequities.ConclusionsThe RCM can be applied in low-income countries, although in unexpected ways. Similar to findings from high-income countries, PsyCap and size of the financial social support network show significant mediation effects in explaining mental health problems and wellbeing inequities in Ethiopia. These reserves could therefore serve as a buffer for socio-economic inequities in mental health and wellbeing and can therefore assist in decreasing these inequities for women working in FDI sectors in Ethiopia.

Demographic Representation in Clinical Research Relative to a Cochlear Implant Patient Population.

Research samples that are representative of patient populations are needed to ensure the generalizability of study findings. The primary aim was to assess the efficacy of a study design and recruitment strategy in obtaining a participant sample that was representative of the broader cochlear implant (CI) patient population at the CI center. A secondary aim was to review whether the CI recipient population was representative of the state population. Demographic variables were compared for a research participant sample (n = 79) and the CI patient population (n = 338). The participant sample was recruited from the CI patient population. The study design included visits that were at the same location and frequency as the recommended clinical follow-up intervals. The demographics for the combined group (participant sample and patient population) were then compared to the reported demographics for the population in North Carolina. There were no significant differences between the participant sample and patient population for biological sex, age at implantation, racial distribution, socioeconomic position, degree of urbanization, or drive time to the CI center (p ≥ 0.086). The combined CI recipient population was significantly different from the North Carolina population for the distributions of race, ethnicity, and degree of urbanization (p < 0.001). The study design and recruitment strategy allowed for recruitment of a participant sample that was representative of the CI patient population. Disparities in access to cochlear implantation persist, as supported by the significant differences in the combined CI recipient population and the population for our state. 3 Laryngoscope, 134:4101-4110, 2024.

Understanding oral cancer disparities in India: Exploring socioeconomic and demographic factors impacting access to care and outcomes

The high prevalence rates, inequalities in treatment outcomes and access to care and other factors make oral cancer a major public health concern in India. The diverse aspects of oral cancer disparities in India are examined in this article, with a particular emphasis on the socioeconomic and demographic variables that affect outcomes and access to care. Disparities still exist even with improvements in treatment modalities. These are caused by low socioeconomic position, low health literacy, cultural customs, and gender variations in risk behaviors. A comprehensive strategy that includes investments in healthcare infrastructure, health education programs, and tobacco control measures is needed to reduce the disparities in oral cancer. India may strive toward providing equal access to oral cancer care for all its population by eliminating systemic injustices and encouraging preventative measures.