Socioeconomic Status Categories Research Articles

Sex Difference and Socioeconomic Inequity in Chinese People With Hypertension: National Cross-Sectional Survey Study.

Sex differences in blood pressure (BP) levels and hypertension are important and the role of socioeconomic status (SES) in sex differences in hypertension remains unclear. This study aimed to evaluate the impact of SES on sex differences of hypertension in a nationally representative survey study. A total of 98,658 participants aged ≥18 years who have lived in their current residence for ≥6 months were recruited from 162 study sites across mainland China. Sex was self-reported. Individual-level SES included the highest level of education and annual household income. Area-level SES included economic development status, urban/rural residency, and north/south location. Outcomes included levels of systolic and diastolic BP, and hypertension. Linear and Cox regression models were used to examine the associations between sex (women vs men) and BP characteristics stratified by individual or combined SES indicators. Systolic and diastolic BP levels and the prevalence of hypertension were higher in men than in women. This sex difference was found across categories of SES with widened sex disparities in participants having more favorable SES. Significant multiplicative interaction effects of SES on the association of sex with BP characteristics were found. Women with improving SES were associated with lower BP and hypertension prevalence compared to men. For combined SES, a 9% (prevalence ratio 0.91, 95% CI 0.83-0.98) and a 30% lower probability (prevalence ratio 0.70, 95% CI 0.63-0.78) of having hypertension were found in women with an overall intermediate SES and high SES, respectively, compared to those with low SES, while no significant reduction was found in men. There are significant sex differences in BP characteristics and SES has a potent impact on the disparities. Sex-specific public health policies to alleviate socioeconomic inequalities, especially in women are important for the prevention of hypertension.

Strategies to advance digital health equity: a qualitative study with underserved groups

BackgroundThe World Health Organization encourages the use of digital health technologies (DHTs) to promote efficiency and sustainability of global public health and wellbeing. However, there is a lack of demonstrable health benefits across underserved groups due to digital exclusion. We conducted a qualitative study exploring the perspectives of underserved groups on strategies to advance digital health equity. MethodsParticipants were recruited through community organisations in North-East England. Individuals represented at least two CLEARS (Culture, Limiting conditions, low Educational attainment, older Age, Residence, low Socioeconomic status) categories associated with digital exclusion. We conducted focus groups (n=4) and semi-structured interview (n=11) to explore individual's experiences of accessing and using DHTs and strategies to enhance inclusivity. A reflective thematic analysis approach was used, assisted by N-Vivo (QSR, v14.23.2). Findings29 individuals (20 female, 9 male) participated from a range of different ethnic minority and religious groups. Participants (n=19) lived in deprived areas, and many (n=22) had low income (<£20 000 annual income). 10 participants had visual and/or hearing impairments. Three key themes centred around access to DHTs, use of DHTs, and desired improvements to support inclusion. Participants experienced barriers accessing and using DHTs, particularly the NHS app, as they did not have photographic ID to be able to register. Individuals overcame such barriers by using non-digital routes (eg, visiting GP receptionist) and asking family or friends to assist. Others described fragmented communication with healthcare providers eg, receiving an inaccessible link to confirm appointments. Many participants viewed implementing educational support services and maintaining non-digital access routes to healthcare as key to enhancing inclusivity, but the financial impact of this on healthcare system. InterpretationThese findings can shape strategies to advance digital inclusivity. Further work is required to design tailored strategies to support different underserved groups and assess the feasibility of implementing these strategies. FundingThis work has been supported by the Early Detection of Neurodegenerative diseases (EDoN) research initiative, funded by Alzheimer's Research UK with support from Gates Ventures and the Alzheimer's Drug Discovery Foundation through its Diagnostic Accelerator Project. This project is also funded by the NIHR, (NIHR205190).

Refined selection of individuals for preventive cardiovascular disease treatment with a transformer-based risk model

Abstract Background Although statistical models have been commonly used to identify patients at risk of cardiovascular disease (CVD) for preventive therapy, these models tend to over-recommend therapy [1]. Moreover, in populations with pre-existing diseases, the current approach is to indiscriminately treat all individuals, as modelling in this context is currently inadequate. Aims To develop and validate a novel deep learning model, the Transformer-based Risk assessment survival model (TRisk) model, for prediction of 10-year risk of CVD in both the general population and individuals with diabetes. Methods An open cohort of 3 million adults aged 25 to 84 years free of CVD and statin use was identified using linked primary and secondary electronic health records from 291 and 98 general practices in England, which were used for TRisk model development and external validation, respectively. Comparison against two commonly recommended statistical models (QRISK3 [2] and SCORE2 [3]) and a deep learning derivation of QRISK3 was conducted. Additional analyses compared discriminatory performance in other age groups, by sex, and across categories of socioeconomic status. Similar analyses were conducted in a subgroup of 59 thousand patients with diabetes. Results TRisk demonstrated superior discrimination (C index in the general population: 0.910; 95% confidence interval [CI]: 0.906 to 0.913). TRisk’s performance was found to be less sensitive to population age range than the benchmark models and outperformed other models also in all stratified analyses. All models were overall well-calibrated. In decision curve analyses, TRisk demonstrated greater net benefit than benchmark models across the range of relevant thresholds. In impact analyses, at the widely recommended 10% risk threshold and the higher 15% threshold for the general population, TRisk reduced both the total number of patients classified at high risk (by 27% and 39% respectively) and the number of false negatives as compared with currently recommended strategies. TRisk similarly outperformed other models in patients with diabetes. Compared with the widely recommended treat-all policy approach for patients with diabetes, TRisk at a 10% risk threshold would lead to deselection of 24% of individuals with a small fraction of false negatives (0.2% of cohort). Conclusion TRisk enabled a more targeted selection of individuals at risk of CVD compared to benchmark statistical and deep learning models, in both the general population and patients with diabetes. Incorporation of TRisk into routine clinical care would allow a reduction in the number of treatment-eligible patients in general population and subgroup with diabetes by approximately one-third and one-quarter respectively while preventing at least as many events as with currently adopted approaches.Models' discrimination on both cohortsImpact analyses for both cohorts

Patterns of change in the association between socioeconomic status and body mass index distribution in India, 1999-2021.

Body mass index (BMI) is an important indicator of human health. However, trends in socioeconomic inequalities in BMI over time throughout India are understudied. Filling this gap will elucidate which socioeconomic groups are still at risk for adverse BMI values. This repeated cross-sectional study analysed four rounds of India's National Family Health Surveys (1998-1999, 2005-2006, 2015-2016, and 2019-2021). The outcome was BMI categories, measured in kilogram per metres squared (kg/m2), defined as severely/moderately thin (<17.0 kg/m2), mildly thin (17.0-18.4 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30.0 kg/m2). We examined the prevalence, standardised absolute change, and odds ratios estimated by multivariable regression models by household wealth and levels of education, two important measures of socioeconomic status (SES). The study population consisted of 1 244 149 women and 227 585 men. We found that those in the lowest SES categories were more likely to be severely/moderately thin or mildly thin. Conversely, those in the highest SES groups were more likely to be overweight or obese. The gradients were steepest for wealth, and this was substantiated by the results of regression models for every wave. There has been a decline in the difference in the prevalence of severely/moderately thin or mildly thin between SES groups when comparing the years 1999 and 2021. SES-based inequalities in BMI were smaller in 2021 compared to 1999. However, those in low SES groups were most likely to be severely/moderately thin or mildly thin while those in high SES groups were more likely to be overweight or obese. Future research should explore the pathways that link SES with BMI.

Exploring Diversity of Hispanic Health Outcomes Through Prism of Environmental Justice

In environmental economics studies US Hispanics are frequently depicted as one large homogeneous group, despite diversity in their countries’ cultural traditions, genetic background and socioeconomic status (SES). This study aimed to compare Florida’s very diverse Hispanic population of Caribbean, Mexican, Central, and South American ancestry.Twelve independent variables were selected from environmental pollution, geospatial challenges, and SES categories. Dependent variables included the relative prevalence of three major chronic diseases: asthma, diabetes, and heart disease. Analysis of pairs correlations was supplemented by multi-variable linear regression. Majority-Hispanic areas have higher than average pollution, diabetes, proximity to disadvantaged neighborhoods, and lower SES. Despite lower pollution than in urban areas, Florida’s inland rural areas had higher rates of all major diseases and lower life expectancies. Cuban and Puerto Rican populations of Miami and Orlando metro areas, respectively, have less favorable SES outcomes and higher diabetes. Columbian and Venezuelan communities have significantly higher education levels than other Hispanic cohorts, and they have the best relative outcome among US Hispanics in SES and health, although still lagging US averages. African-American community in Miami-Dade County was by far the most disadvantaged, with significantly lower SES and health outcomes than any other group in the study, including the nearby Cuban-majority community. Our results confirmed the view that Hispanics are environmentally disadvantaged in Florida, with worse outcomes than the US and Florida average in health and economic factors. Furthermore, the study highlighted significant differentiation of SES and health outcomes among various regional Hispanic cohorts.

The trajectories of free sugar intake during childhood, their main sources and its association with socio-economic factors: generation XXI birth cohort.

The study aimed to describe trajectories of free sugar (FS) intake, its main sources and the associations with socio-economic status (SES) in Portuguese children/adolescents evaluated at 4, 7, 10 and 13 years of age from Generation XXI birth-cohort. Dietary intake was assessed through 3-day food diaries (n 5268). Added sugar intake was estimated following a systematic methodology, and FS was based on the WHO definition. A mixed-effects model with linear and quadratic terms for time was used to estimate FS trajectories and its association with SES, adjusting for children's sex, age, BMI and SES. The FS mean intake (g/day) was 37, 47, 51 and 48 at 4, 7, 10 and 13 years, respectively. FS intake increased 4·6 g/year (CI 95 %: 4·20, 5·04), but velocity decreased by 0·3 g/year2 until 13 years. At all ages, the main food source was sweets. Some item's consumption declined (sweets 25-21 % and yoghurts 22-7 %) as children grew older. Inversely, soft drink intake increased (9-18 %). Boys and children from younger mothers had higher FS intake, whereas higher maternal-SES was associated with lower children's FS intake: occupational status (β = -3·5; 95 % CI: -4·97, -1·94), years of education (β = -3·7; 95 % CI: -4·93, -2·40) and household income (β = -4·9; 95 % CI: -6·50, -3·27). The FS trajectories were similar by SES categories but different by obesity status (interaction term β = -1·04; CI 95 % (-1·50, -0·59)). An increasing FS trajectory during childhood is mainly driven by an increasing intake of soft drinks and nectars. The FS trajectory pattern did not change according to SES categories, but children's FS intake was always higher when their mothers had a lower SES.

Early diagnosis of lupus: A possibilty. A multicentric study from SLE Special Interest Group (SIG) of Indian Rheumatology Association (IRA).

Systemic Lupus Erythematosus (SLE) warrants an early diagnosis and prompt management. Delay in diagnosis can result in repeated flares, permanent damage, and even death. There is a large variability in the time taken to diagnose SLE across the world. We undertook this study to determine the time taken for diagnosis of SLE in India and to identify the factors associated. Patients with SLE diagnosed within the previous 1year as per Systemic Lupus Erythematosus International Collaborating Clinics criteria (SLICC) 2012 criteria were included in a cross-sectional multicentre questionnaire-based survey. Demographic profile, self-reported socioeconomic status as per Kuppuswamy classification of socioeconomic status (version 2022) (SES), and several healthcare related parameters including referral pattern were recorded. Median time taken for diagnosis was used to demarcate early or late diagnosis and associated factors were explored. We included 488 patients with SLE from 10 rheumatology centres. The median time to diagnosis was 6months Interquartile Range (IQR 3,14.7) and within 3months in about one third [150(30.7%)]. Very early diagnosis (<1month) was established in 78(16.0%) patients. The mean SLE Disease Activity Index (SLEDAI) at diagnosis was 10.28+7.24. In univariate analysis, an older age, lower SES, non-southern state of residence and larger family size were significantly associated with late diagnosis. In the multivariate analysis, higher SES (AOR 0.95, 95% CI: 0.92-0.98), multiple organ system involvement at initial presentation (AOR1.75 95%CI: 1.08-2.84) and place of residence in south Indian states (AOR1.92 95%CI: 1.24-2.97) had lesser odds of being associated with late diagnosis. Distance from the closest medical centre/professional did not influence the time to diagnosis. Majority of patients had first consulted a medical graduate (42.5%) or postgraduate doctor (48.2%), and referral to rheumatologist was largely done by postgraduate (65%) doctors. More than half of our patients (61%) self-finance their treatment. Median time to diagnosis of SLE was 6months, 1/3rd being diagnosed within 3months and 78(16.0%) with 1month of symptom onset. Delay in diagnosis was noted in those belonging to lower socioeconomic strata and those with single organ disease. Distance to the health care facility did not influence time to diagnosis.

Influence of Socioeconomic Status on Patients' Choice of Thrombolytic Agent and its Outcome in Acute Ischemic Stroke.

Alteplase, a recombinant tissue-type plasminogen activator (rtPA) is the only FDA-approved thrombolytic drug in acute ischemic stroke (AIS). Tenecteplase is a modified rtPA, which is cheaper. We aimed to study influence of socioeconomic status (SES) in patients' preference of thrombolytic agent and its outcome. This prospective observational study conducted in PGIMER, a tertiary care center in India, recruited AIS patients thrombolyzed between July 2017 and September 2018. We studied variables including SES, thrombolytic agent chosen, and outcomes like National Institutes of Health Stroke Scale (NIHSS) scores at 24-h and at discharge; and modified Rankin Scale (mRS) after 3 months. Thirty-nine patients received tenecteplase and 39 patients received alteplase. Seven patients belonged to upper class, all of whom (100%) chose alteplase. Thirty patients belonged to upper middle class, of whom 25 (83.3%) and five (16.7%) patients chose alteplase and tenecteplase, respectively. Twenty-five patients belonged to lower middle class in which seven (28%) and 15 (72%) chose alteplase and Tenecteplase, respectively. Twenty patients were in upper lower class, of whom 4 (20%) and 16 (80%) chose alteplase and Tenecteplase, respectively. The difference in distribution of SES in tenecteplase and alteplase groups was significant (P = 0.000). Median 3 month-mRS scores were 3 and 3.5 in alteplase and tenecteplase groups, respectively (P = 0.608). There were no significant differences in NIHSS score improvement at 24 h postthrombolysis (P = 0.537) or at discharge (P = 0.429) among different SES categories. No correlation between SES and 3 month-mRS score was found (Spearman's ρ = 0.101, P = 0.398). Majority of patients in upper and lower SES chose alteplase and Tenecteplase, respectively. However, there were no significant differences in outcomes among various SES categories.

P49: Sociodemographic and Clinical Insights into Behavioral Variant Frontotemporal Dementia and Early-Onset Alzheimer’s Disease in Colombia: A Comprehensive Study of Patients and Caregivers

Objectives: As life expectancy continues to rise globally, the prevalence of dementia is also increasing. However, there is a lack of studies in Latin American countries that describe the sociodemographic and clinical characteristics of dementia patients and their caregivers, potentially overlooking important differences that could impact diagnosis in a diverse population. This study aims to elucidate the sociodemographic characteristics of patients with Behavioral Variant Frontotemporal Dementia (bvFTD) and Early-Onset Alzheimer’s Disease (AD), as well as their primary caregivers in Colombia, while also examining the clinical presentation ofdementia.Methods: A total of 83 Colombian participants were included in the study, consisting of 40 healthy controls and 43 individuals previously diagnosed with bvFTD (n = 20) and early-onset AD (n = 23). Diagnoses were established based on the current diagnostic criteria for both conditions. Participants underwent sociodemographic assessments, and a clinical evaluation was conducted. Additionally, caregivers were characterized sociodemographically.Results: Most participants were female (67%) with a mean age of 63 years. Educational levels were comparable between the dementia group (12.4 years) and the control group (12.9 years). A higher proportion of dementia cases were observed in lower socioeconomic status categories (1 to 3). Past medical history of hypertension, type 2 diabetes, and traumatic brain injury was more prevalent in the bvFTD group, whereas coronary disease was more common in the AD group. Initial psychiatric misdiagnosis occurred more frequently in bvFTD (50%) compared to AD (26%), with depression being the most common misdiagnosis in both groups (37.5%), followed by bipolar disorder (25%) and anxiety (25%). Most caregivers were female (70%) with a mean age of 50 years. The most common caregiver-patient relationships were daughter (25.6%) and husband (25.6%), followed by wife (23.3%). The mean educational level of bvFTD caregivers (13.95) was higher than that of AD caregivers (12.87).Conclusions: These findings provide valuable insights into the sociodemographic characteristics of dementia patients and their caregivers in Latin America, a population that is often underrepresented in research. Further exploration of diagnostic variations may be warranted, given the high prevalence of misdiagnosis in this region.

DiffErential attainment and Factors AssoCiated with Training applications and Outcomes (DE FACTO) study: Trauma & Orthopaedic surgery in the UK.

The aims of this study were to describe the demographic, socioeconomic, and educational factors associated with core surgical trainees (CSTs) who apply to and receive offers for higher surgical training (ST3) posts in Trauma & Orthopaedics (T&O). Data collected by the UK Medical Education Database (UKMED) between 1 January 2014 and 31 December 2019 were used in this retrospective longitudinal cohort study comprising 1,960 CSTs eligible for ST3. The primary outcome measures were whether CSTs applied for a T&O ST3 post and if they were subsequently offered a post. A directed acyclic graph was used for detecting confounders and adjusting logistic regression models to calculate odds ratios (ORs), which assessed the association between the primary outcomes and relevant exposures of interest, including: age, sex, ethnicity, parental socioeconomic status (SES), domiciliary status, category of medical school, Situational Judgement Test (SJT) scores at medical school, and success in postgraduate examinations. This study followed STROBE guidelines. Compared to the overall cohort of CSTs, females were significantly less likely to apply to T&O (OR 0.37, 95% CI 0.30 to 0.46; n = 155/720 female vs n = 535/1,240 male; p < 0.001). CSTs who were not UK-domiciled prior to university were nearly twice as likely to apply to T&O (OR 1.99, 95% CI 1.39 to 2.85; n = 50/205 vs not UK-domiciled vs n = 585/1,580 UK-domiciled; p < 0.001). Age, ethnicity, SES, and medical school category were not associated with applying to T&O. Applicants who identified as 'black and minority ethnic' (BME) were significantly less likely to be offered a T&O ST3 post (OR 0.70, 95% CI 0.51 to 0.97; n = 165/265 BME vs n = 265/385 white; p = 0.034). Differences in age, sex, SES, medical school category, and SJT scores were not significantly associated with being offered a T&O ST3 post. There is an evident disparity in sex between T&O applicants and an ethnic disparity between those who receive offers on their first attempt. Further high-quality, prospective research in the post-COVID-19 pandemic period is needed to improve equality, diversity, and inclusion in T&O training.

Household food expenditures and socioeconomic status in relation to dietary nutrient intake in Iranian families

PurposeExamining the impact of socioeconomic status (SES) and expenses spent on food preparation on nutritional intake has always been one of the critical concerns for policymakers. This study aims to investigate the association between household food expenditure as well as SES and dietary nutrient intake in Kermanshah, Iran.Design/methodology/approachIn this cross-sectional study, households were randomly selected from different strict in Kermanshah, Iran. Data were collected with an SES questionnaire, a demographic data collection form, a weekly food purchase checklist and a food record. The authors performed the analysis of covariance to determine the relationship of dietary nutrient intake of study participants across quintile categories of SES and total food expenses per day.FindingsOut of 125 households, 119 households including 401 people finished the study. A significant association was observed between higher SES and higher intake of vitamin B2 (p-value = 0.03). Moreover, the household members at the top level of total food expenses per day had significantly greater dietary nutrient intake of energy (p < 0.001), potassium (p < 0.001), magnesium (p < 0.001), calcium (p < 0.001), zinc (p < 0.001), vitamin B2 (p < 0.001), B6 (p < 0.001), B12 (p = 0.002) and vitamin C (p = 0.04).Originality/valueIn our study, higher dietary nutrient intake was observed in the household members at the highest level of total food expenses daily as well as SES. Therefore, governments and policymakers should pay basic attention to optimizing food costs and improving the economic status of people.

Associations between socioeconomic inequalities and progression to psychological and cognitive multimorbidities after onset of a physical condition: a multicohort study

Chronic physical conditions (e.g., heart diseases, diabetes) increase with population ageing, contributing to psychological and cognitive multimorbidities. Yet, little is known about socioeconomic inequalities in this process. We examined the associations between socioeconomic status (SES) and progression to psychological and cognitive multimorbidities after onset of a physical condition. We used harmonized individual-level data from five prospective cohort studies across 24 countries in the US, Europe and Asia, with repeated morbidity measurements between 2002 and 2021. Participants with at least one new-onset physical conditions (hypertension, diabetes, heart diseases, stroke, chronic lung diseases, cancer, or arthritis) were followed up for progression to physical-psychological multimorbidity, physical-cognitive multimorbidity, and physical-psychological-cognitive multimorbidity. SES was determined based on educational level and total household wealth at the onset of a physical condition. Time to and incidence rates of progressing psychological and cognitive multimorbidities were estimated in analyses stratified by SES. Fine-Gray subdistribution hazard models and multi-state models were used to estimate the associations between SES and progression to psychological and cognitive multimorbidities. Among 20,250 participants aged ≥45 years (mean age at a physical condition onset 65.38 years, standard deviation 8.37) with at least one new-onset physical conditions in the analysis, 7928 (39.2%) progressed to psychological and cognitive multimorbidities during a median follow-up of 8.0 years (168,575 person-years). The mean survival time free from physical-psychological-cognitive multimorbidity was 11.96 years (95% confidence interval 11.57-12.34) in low SES individuals, compared to 15.52 years (15.40-15.63) in high SES individuals, with the corresponding incidence rate of 18.44 (16.32-20.82) and 3.15 (2.48-4.01) per 1000 person-years, respectively. The associations of education, household wealth and SES with multimorbidities followed a dose-dependent relation, with subdistribution hazard ratios per decreasing SES category being 1.24 (1.19-1.29) for physical-psychological multimorbidity, 1.47 (1.40-1.54) for physical-cognitive multimorbidity, and 1.84 (1.72-1.97) for physical-psychological-cognitive multimorbidity. The strongest SES-multimorbidities associations were observed in participants with arthritis, hypertension or diabetes. In multi-state models SES was linked to all five transitions from physical condition to physical-psychological multimorbidity, physical-cognitive multimorbidity and physical-psychological-cognitive multimorbidity. Socioeconomic inequalities are associated with the progression of a chronic physical condition, with the lower SES groups had both an earlier time to and a higher incidence of psychological and cognitive multimorbidities. These findings underscore the need for more effective equity-oriented policies and healthcare practices to address reduced psychological wellness and cognitive maintenance among individuals with low SES and physical conditions. Zhejiang University Hundred Talents Program Research Initiation Fund, Fundamental Research Funds for the Central Universities in China, Wellcome Trust, Medical Research Council, National Institute on Aging, Academy of Finland.

HUBUNGAN ANTARA STATUS SOSIAL EKONOMI KELUARGA DENGAN STATUS GIZI ANAK USIA SEKOLAH DI SD NEGERI 14 NAN SABARIS

Nutritional status describes the balance between the body's need for nutrients to maintain life, growth, development, maintenance of normal body functions and for energy production and other nutrient intake. The purpose of this study was to determine the relationship between family socio-economic status and the nutritional status of school-age children at SD Negeri 14 Nan Sabaris. This study used a descriptive analytical research type with a research design using a Cross Sectional approach. The population in this study was The population in this study were students of SD Negeri 14 Nan Sabaris District, Padang Pariaman Regency. Samples were taken using the simple random sampling method, or a simple random design. The sample in this study was 61 respondents. The univariate analysis results are displayed in the form of a frequency distribution of economic and nutritional status. Bivariate analysis using chi square at α = 0.05%. The results of the study obtained a high socio-economic status category of 18 people (29.5%), moderate there were 9 people (14.8%) and low as many as 34 people (55.7%). While the nutritional status of school children in the normal category was 30 people (49.2%) and thin as many as 31 people (50.8%). In conclusion, there is a significant relationship between socioeconomic status and nutritional status of school children at SDN 14, Nan Sabaris District.

Of the importance to reconsider individual variability in infant studies: Family traits do impact turn-taking perception in 6-month-olds.

Turn-taking is a universal pattern of human conversations characterized by a fast exchange of turns between speakers and an avoidance of overlaps. Language is embedded in this conversational skill acquired well before it during infancy, through everyday interactions with caregivers. The earliness of this skill and its link with language allows us to test whether social environment shapes early language development. We therefore study turn-taking perception of 6-month-old infants by measuring their gazes during video presentation of three different conversational situations where the turn is explicitly given, normally taken or taken with an overlap. We studied 51 infants to cover several family and infant characteristics: infants' sex, presence of siblings, and family socioeconomic status (SES). We found that infants looked more at the second speaker when she overlapped the first speaker than in the other situations, but not all infants were equally sensitive. Indeed, infants from high-SES families reacted differently to the three situations, while infants from the two lower SES categories did not. Also, only singletons reacted differently by looking more at the second speaker after the overlapping and turn-giving situations, and not after the turn-taking situation. Our results emphasize the importance of early social experiences on language development.

Temporal trends in population attributable fractions of modifiable risk factors for dementia: a time-series study of the English Longitudinal Study of Ageing (2004–2019)

BackgroundInterest in modifiable risk factors (MRFs) for dementia is high, given the personal, social, and economic impact of the disorder, especially in ageing societies such as the United Kingdom. Exploring the population attributable fraction (PAF) of dementia attributable to MRFs and how this may have changed over time remains unclear. Unravelling the temporal dynamics of MRFs is crucial for informing the development of evidence-based and effective public health policies. This investigation examined the temporal trajectories of MRFs for dementia in England.MethodsWe used data from the English Longitudinal Study of Ageing, a panel study over eight waves collected between 2004 and 2019 (76,904 interviews in total). We calculated the PAFs for twelve MRFs (including six early- to mid-life factors and six late-life factors), as recommended by the Lancet Commission, and the individual weighted PAFs (IW-PAFs) for each risk factor. Temporal trends were analysed to understand the changes in the overall PAF and IW-PAF over the study period. Subgroup analyses were conducted by sex and socioeconomic status (SES).ResultsThe overall PAF for dementia MRFs changed from 46.73% in 2004/2005 to 36.79% in 2018/2019, though this trend was not statistically significant. During 2004–2019, hypertension, with an average IW-PAF of 8.21%, was the primary modifiable determinant of dementia, followed by obesity (6.16%), social isolation (5.61%), hearing loss (4.81%), depression (4.72%), low education (4.63%), physical inactivity (3.26%), diabetes mellitus (2.49%), smoking (2.0%), excessive alcohol consumption (1.16%), air pollution (0.42%), and traumatic brain injury (TBI) (0.26%). During 2004–2019, only IW-PAFs of low education, social isolation, and smoking showed significant decreasing trends, while IW-PAFs of other factors either did not change significantly or increased (including TBI, diabetes mellitus, and air pollution). Upon sex-specific disaggregation, a higher overall PAF for MRFs was found among women, predominantly associated with later-life risk factors, most notably social isolation, depression, and physical inactivity. Additionally, hearing loss, classified as an early- to mid-life factor, played a supplementary role in the identified sex disparity. A comparable discrepancy was evident upon PAF evaluation by SES, with lower income groups experiencing a higher dementia risk, largely tied to later-life factors such as social isolation, physical inactivity, depression, and smoking. Early- to mid-life factors, in particular, low education and obesity, were also observed to contribute to the SES-associated divergence in dementia risk. Temporal PAF and IW-PAF trends, stratified by sex and SES, revealed that MRF PAF gaps across sex or SES categories have persisted or increased.ConclusionsIn England, there was little change over time in the proportion of dementia attributable to known modifiable risk factors. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them.

Socioeconomic differences in use of antiseizure medication in pregnancies with maternal epilepsy: A population-based study from Nordic universal health care systems.

Research points to disparities in disease burden and access to medical care in epilepsy. We studied the association between socioeconomic status (SES) and antiseizure medication (ASM) use in pregnancies with maternal epilepsy. We conducted a cross-sectional study consisting of 21 130 pregnancies with maternal epilepsy identified from Nordic registers during 2006-2017. SES indicators included cohabitation status, migrant background, educational attainment, and household income. Main outcomes were the proportion and patterns of ASM use from 90 days before pregnancy to birth. We applied multiple imputation to handle SES variables with 2%-4% missingness. We estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) using modified Poisson regression with the highest SES category as reference. Mothers with the highest education and the highest income quintile used ASMs least frequently (56% and 53%, respectively). We observed increased risks of ASM discontinuation prior to or during the first trimester for low SES. The risk estimates varied depending on the SES indicator from aRR = 1.27 for low income (95% CI: 1.03-1.57) to aRR = 1.66 for low education (95% CI: 1.30-2.13). Migrant background was associated with ASM initiation after the first trimester (aRR 2.17; 95% CI 1.88-2.52). Low education was associated with the use of valproate during pregnancy in monotherapy (aRR 1.70; 95% CI 1.29-2.24) and in polytherapy (aRR 2.65; 95% CI 1.66-4.21). Low education was also associated with a 37% to 39% increased risk of switching from one ASM to another depending on the ASM used. For the other SES indicators, aRRs of switching varied from 1.16 (foreign origin; 95% CI 1.08-1.26) to 1.26 (not married or cohabiting; 95% CI 1.17-1.36). Low SES was associated with riskier patterns of ASM use: discontinuation, late initiation, and switching during pregnancy. These findings may reflect unplanned pregnancies, disparities in access to preconception counseling, and suboptimal care.

Socio-Economic Status Classification for Poverty Mitigation

The concept of satellite images available from various sources using image processing technique provides an insight to predict or determine the poverty at various levels based on certain features like roads, buildings, schools and other factors. In the present scenario we are making use of Convolutional Neural Networks (CNN) mainly used for image recognition and processing to predict the poverty at various levels. The efficiency and accuracy of the model depends upon the number of pre-processing steps employed, the number of datasets used, the type of welfare indicator targeted and the choice of AI model. Leveraging advanced algorithms together with the ample amount of geographic information which satellites capture offers an appropriate approach for delicate socio-economic indicator evaluation. Leveraging advanced algorithms together with the ample amount of geographic information which satellites capture offers an appropriate approach for delicate socio-economic indicator evaluation. Key Words: Convolutional neural networks, ReLU architecture, Gaussian Blur

Patterns and socioeconomic differences in secondhand exposure to cigarettes, e-cigarettes, and heated tobacco products at home in Hong Kong adolescents.

Smoke or aerosols from cigarettes, e-cigarettes (ECs), or heated tobacco products (HTPs) are harmful. Yet, there is little knowledge about the specific patterns of secondhand tobacco exposure by source within household settings and the socioeconomic status (SES) differences in adolescents. We used territory-representative student data from a cross-sectional school-based survey in 2020-2021 to calculate the weighted prevalence of secondhand exposure to cigarettes, e-cigarettes, and HTPs in the past seven days. Parental education and perceived family affluence were used as indicators of socioeconomic status. Generalized linear mixed models were used to analyze associations. Among 22039 participants, 29.8% reported any secondhand tobacco exposure (SH-Any) at home, primarily from cigarettes (27.4%), followed by e-cigarettes (4.0%) and HTPs (0.9%). Tertiary parental education level was associated with lower SH-Any exposure (Adjusted odds ratio, AOR=0.49; 95% CI: 0.45-0.53, p<0.001), fewer exposure days (β= -0.685, p<0.001), lower exposure to cigarettes (SH-CC) (AOR=0.49; 95% CI: 0.45-0.54, p<0.001) and to e-cigarettes or HTPs (SH-EC/HTP) (AOR=0.57; 95% CI: 0.45-0.71, p<0.001). 'Poor' family affluence was associated with higher exposures [AOR(SH-Any) =1.14; 95% CI: 1.06-1.22, p=0.001; β(days)=0.160, p<0.001; AOR(SH-CC) =1.15; 95% CI: 1.07-1.24, p<0.001], except for SH-EC/HTP exposure, which was higher in students in an affluent family (AOR =1.66; 95% CI: 1.25-2.21, p<0.001). Significant SES differences in SH-EC/HTP exposure were found only in groups with low parental education level. Dose-response relationships were found between lower SH-Any and SH-CC and higher SES categories (p for trend<0.001). Adolescents experienced a high prevalence of tobacco smoke exposure at home, primarily from cigarettes. Higher SES was associated with lower tobacco exposure, except for SH-EC/HTP, which was higher among adolescents from affluent families. Additionally, high parental education level was protective against exposure to SH-EC/HTP. Comprehensive control measures to reduce the use of these tobacco products are needed to protect adolescents of diverse socioeconomic backgrounds.

Analyzing Trends in Mental and Behavioral Health Support for Children: A Comprehensive Study Using National Survey of Children's Health Database.

Objective This study aimed to explore mental and behavioral health support trends for children aged 3-17, analyzing treatment and counseling using United States data from the 2016-2020 National Survey of Children's Health (NSCH) database. Methods Employing a retrospective observational design,we systematically retrieved and analyzed NSCH Database data from 2016 to 2020.The focus was on understanding mental and behavioral health treatment percentages over time, specifically targeting demographic variations such as age groups, gender, race/ethnicity, and the federal poverty level percentage. Graphical representation utilized Excel, summarizing results based on aggregated data for distinct time intervals, highlighting the importance of mental and behavioral health support for children aged 3-17. Results The study identified significant temporal trends in mental and behavioral health treatment, revealing notable fluctuations across demographic and socio-economic variables. Of the 22,812 participants, 51.7% (CI: 50.2-53.1%, n=12,686) received treatment, exposing disparities. Gender differences were evident, with higher treatment rates in females (53.7%, CI: 51.6-55.9%, n=6,166) thanmales(50.1%, CI: 48.2-52.0%, n=6,520). Age-specific patterns indicated lower intervention rates in younger children (33.5%, CI: 28.6-38.8%, n=447, ages 3-5) compared to adolescents (58.1%, CI: 56.2-59.9%, n=8, 222 ages 12-17). Conclusion The conclusion highlights significant temporal fluctuations and pronounced demographic disparities. Findings underscore varying prevalence rates among age groups, genders, racial/ethnic backgrounds, and socio-economic status categories. This study provides valuable insights for policymakers, healthcare professionals, and researchers, informing targeted interventions to enhance mental and behavioral health support for United States children.

Quality of life among institutionalized and non-institutionalized elderly: A comparative study

Ageing is a natural process that causes several changes in social, hormonal, psychological, and physical circumstances. A person’s ageing is influenced by a variety of factors, including physiological, social, psychological, economic, environmental, and cultural factors, all of which have a substantial impact on the elderly’s quality of life. The present study investigated the quality of life among institutionalized and non-institutionalized elderly in Hubli-Dharwad taluk during 2021-22. The sample comprised 180 elderly (ninety from institutionalized setting and ninety from noninstitutionalized setting) aged 65 years and above were drawn through the purposive sampling method. The self-structured questionnaire, Older people’s Quality of life-35 and Agarwal’s socio-economic status scale were used for collecting information. The results revealed that the female population (55.60%) was more among the institutionalized elderly, while the male population (54.90%) was more among the non-institutionalized elderly. As per age of the elderly 75-84 years old were more (43.40%) among institutionalized elderly and 62 years old were more (68.90%) among non-institutionalized elderly. When it comes to education, most of the institutionalized elderly were studied up tothe 10th standard (33.30%) but most of the non-institutionalized elderly were illiterates (32.20%). According to socio-economic status (SES), most of the institutionalized elderly (38.90%) had upper middle SES category and most of the non-institutionalized elderly (51.10%) had lower middle SES category.The quality of life was high (58.90%) among non-institutionalized elderly as compared to the institutionalized elderly (35.60%).