Perceived Economic Strain, Subjective Social Status, and Colorectal Cancer Screening Utilization in U.S. Men-A Cross-Sectional Analysis.

Although socioeconomic status (SES) is fundamentally related to underutilization of colorectal cancer (CRC) screening, the role of perceived economic strain and subjective social status with CRC screening is understudied. The aim of this study was to investigate whether greater perceived economic strain or lower subjective social status would decrease the odds of CRC screening uptake and being up-to-date with guideline-recommended CRC screening. We also explored interactions with household income and educational attainment. Cross-sectional survey-based data from men aged 45-75 years living in the United States (N = 499) were collected in February 2022. Study outcomes were ever completing a stool- or exam-based CRC screening test and being up-to-date with CRC screening. Perceived economic strain and subjective social status were the predictors. We conducted logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (CI). Greater perceptions of economic strain decreased odds of being up-to-date with CRC screening. Household income modified the association between perceived economic strain and completing a stool-based test; the association was stronger for men from lower-income households. In unadjusted models, higher subjective social status increased odds of completing an exam-based test and being up-to-date with CRC screening. Our findings suggest that experiencing economic strain may interfere with men's CRC screening decisions and may capture additional information about barriers to CRC screening utilization beyond those captured by income or education.

Social Inequities in the Survival of Liver Cancer: A Nationwide Cohort Study in Korea, 2007-2017.

BACKGROUND: To analyze the effects of socioeconomic status (type of insurance and income level) and cancer stage on the survival of patients with liver cancer in Korea. METHODS: A retrospective cohort study was constructed using data from the Healthcare Big Data Platform project in Korea between January 1, 2007, and December 31, 2017. A total of 143,511 patients in Korea diagnosed with liver cancer (International Classification of Diseases, 10th Revision [ICD-10] codes C22, C220, and C221) were followed for an average of 11 years. Of these, 110,443 died. The patient's insurance type and income level were used as indicators of socioeconomic status. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using a Cox proportional hazards regression model to analyze the relationship between the effects of sex, age, and cancer stage at first diagnosis (Surveillance, Epidemiology, and the End Results; SEER), type of insurance, and income level on the survival of patients with liver cancer. The interactive effects of the type of insurance, income level, and cancer stage on liver cancer death were also analyzed. RESULTS: The lowest income group (medical aid) showed a higher risk for mortality (HR (95% CI); 1.37 (1.27-1.47) for all patients, 1.44 (1.32-1.57) for men, and 1.16 (1.01-1.34) for women) compared to the highest income group (1-6) among liver cancer (ICD-10 code C22) patients. The risk of liver cancer death was also higher in the lowest income group with a distant cancer stage (SEER = 7) diagnosis than for any other group. CONCLUSION: Liver cancer patients with lower socioeconomic status and more severe cancer stages were at greater risk of death. Reducing social inequalities is needed to improve mortality rates among patients in lower social class groups who present with advanced cancer.

Nature, prevalence, and risk factors for self-neglect among older people: a pilot study from Vellore, South India.

Changes in demography in developing countries haves led to new issues among older rural populations, such as self-neglect which is under researched.Self-neglect identified as poor self-care, unsafe living quarters, inadequate medical care and poor utilization of services increase the odds of morbidity and mortality.Methods Our study was conducted in Kaniyambadi, a rural block in Vellore district in the state of Tamil Nadu, India. Ten villages were randomly selected. The study was conducted among people older than 60 years who were selected by random sampling using a computer-generated list. The following assessments were done: (i) A 19-item questionnaire was used to assess self-neglect, (ii) Katz index of daily living to assess functional activity, (iii) Mini Mental State Examination to evaluate cognition, (iv) Geriatric Depression Scale to identify depression, (v) Duke Social Support Index to measure social supports. Clinical data and anthropometric data were also collected. Data were entered into Epidata v3.1. All analyses were performed using SPSS v23.0.Results One hundred fourteen people above 60 years of age participated. The prevalence of self-neglect was 21.1% (95% CI 14.9%-29%); about half of the elderly population (47.38%) refused to seek or follow medical advice. Lower levels of education (OR 3.678, 95% CI 1.017 - 13.301), lower social class (OR 4.455, 95% CI 1.236 - 16.050) and functional impairment (3.643, 95% CI 1.373 - 9.668) were found to be significant factors associated with self-neglect. Though prevalence of comorbidities (70%) and depression (27%) were high, there was no statistical evidence of association with self-neglect.

Associations Between Psychopathological Symptom Severity Amid the Pandemic and the Childhood Sociodemographic Environment.

It is well-documented that childhood socioeconomic status (SES) is associated with various health conditions in adulthood. Here, we examine the extent to which childhood SES is associated with COVID-19 pandemic anxiety and depression. Participants (n = 212), recruited from Amazon Mechanical Turk, were assessed for depression and anxiety in February 2022 for both the current context and retrospective self-perceived early pandemic depression and anxiety (April 2020). Participants also reported childhood SES and current demographics. Consistent with predated findings, we show a strong, positive correlation between depression and anxiety under both conditions. Paternal unemployment in childhood was associated with increased anxiety, while maternal occupation was not. High household education in childhood was generally associated with greater anxiety and depression, similar to past studies examining education levels and depression. However, the shift from high school to post-secondary degrees (trade school and associate's) was associated with decreased anxiety and depression, which may reflect "essential work" careers, therefore indicating a dualism. Growing up in crowded, de-individualized spaces was associated with lower anxiety and depression, suggesting better conditioning for the imposition of COVID-19 quarantines. Pandemic-related unemployment was associated with an increase in anxiety and depression. Strong political views, regardless of ideology, were associated with increased anxiety. Finally, participants in our cohort perceived their mental health to be worse in the early pandemic for anxiety and depression, up 6.6% and 7.9%, respectively. Our work suggests a complex relationship between SES, demographics, and anxiety and depression during the pandemic. These findings emphasize the importance of exploring the dynamics between early SES and mental health in adulthood, particularly during extended societal stressors.

Childhood obesity's influence on socioeconomic disparities in young adolescents' mental health.

PURPOSE: We investigated whether socioeconomic inequalities in young adolescents' mental health are partially due to the unequal distribution of childhood obesity across socioeconomic positions (SEP), i.e. differential exposure, or due to the effect of obesity on mental health being more detrimental among certain SEPs, i.e. differential impact. METHODS: We studied 4660 participants of the Generation R study, a population-based study in the Netherlands. SEP was estimated by mother's education and household income at age five of the child. We estimated the contribution of the mediating and moderating effects of high body fat percentage to the disparity in mental health. This was done through a four-way decomposition using marginal structural models with inverse probability of treatment weighting. RESULTS: Comparing children with the least to most educated mothers and the lowest to highest household income, the total disparity in emotional problems was 0.98 points (95%CI:0.35-1.63) and 1.68 points (95%CI:1.13-2.19), respectively. Of these total disparities in emotional problems, 0.50 points (95%CI:0.15-0.85) and 0.24 points (95%CI:0.09-0.46) were due to the differential exposure to obesity. Obesity did not contribute to disparities in behavioural problems. CONCLUSION: Addressing the heightened obesity prevalence among children in low SEP families may reduce inequalities in emotional problems in early adolescence.

System circumvention: Dishonest-illegal transgressions are perceived as justified in non-meritocratic societies.

Does believing that "effort doesn't pay" in society shape how people view dishonest-illegal transgressions? Across five studies, we show that when people view societal success as non-meritocratic-that is, more dependent on luck and circumstances than on hard work-they are more lenient in their moral judgements of dishonest-illegal transgressions. Perceiving society as non-meritocratic predicted greater justifiability of dishonest-illegal transgressions in the United States (Study 2), and across 42 countries (N = 49,574; Study 1). And inducing participants to view society as non-meritocratic increased justifiability of others' dishonest-illegal transgressions, via greater feelings of sympathy (Studies 3 and 4). Next, we investigated the contours of these effects. Perceiving societal success as non-meritocratic rather than based on hard work causes people to view dishonest-illegal transgressions as more justifiable if they are perpetrated by the poor, but not the rich (Study 4), and if the dishonest-illegal transgressions are related to economic striving, such as money laundering and dealing illegal drugs (Study 5). In sum, when people see a social system as unfair, they show greater tolerance for dishonest-illegal transgressions perpetrated to circumvent the system.

When the Penny Drops: Understanding how social class influences speciality careers in the UK medical profession.

In the UK, the medical profession is socially exclusive and socially stratified as doctors from more advantaged backgrounds are more likely to train for specialities with more competitive entry. However, in research to date the causes and consequences of social stratification have been overlooked. We explore this subject here, drawing on a qualitative study comprising in-depth interviews with 30 medical students and doctors from less advantaged socio-economic backgrounds negotiating medical school and early careers. Using Bourdieu's 'theory of practice' we show how socialisation in the family and at school influences how aspirant medics from less advantaged backgrounds view the world, suggesting some inclination towards more community orientated careers, which may be less competitive. However, these tendencies are encouraged as they lack stocks of social, economic and cultural capital, which are convertible to power and position in the field. While allowing for both choice and constraint our core argument is that speciality outcomes are sometimes inequitable and potentially inefficient, as doctors from more advantaged backgrounds have privileged access to more competitive careers for reasons not solely related to ability or skill. Our main theoretical contribution is to literature in the sociology of medical education where ours is the first study to open-up the 'black box' of causal factors connecting medical students' resources on entering the field of education and training with speciality outcomes, though our findings also have important implications for practitioners, the profession and for patients. We discuss the implications for safe and effective healthcare and how this informs directions for future research.

The Social Inequality of Music: University Students from a Higher Social Class Are More Likely to Build Relationships and Feel Happiness Through Music.

The relationship between young people's music use and well-being has gained extensive interest in recent years. The relationship-building function of music is one of its most important functions. While many studies have documented the positive effects of this function, there is a lack of research discussing this topic from the perspective of social stratification. This study sampled 691(63.8% male, M age = 19.43, SD = 1.42) Chinese university students to examine the social class differences among university students in acquiring well-being through the relationship-building function of music. The results revealed that university students from a higher social class are more likely to acquire well-being through the relationship-building function of music. In addition, interdependent self-construal plays a moderating role in the mediating model. The mediating effect was only significant when university students have a higher level of interdependent self-construal. These results indicated social class differences among university students in the building of relationships with music, underscoring the need for future research and interventions to address social inequality in the context of music's functions.

Protective action in the workplace in the time of COVID-19: The role of worker representation.

BACKGROUND: This study addresses the contribution of worker representation to health and safety in the pandemic context. To do so, we examine whether the self-reported presence of representatives in workplaces is associated with the implementation of anti-COVID-19 protective action and with which type of measures their existence is most strongly associated (individual, collective or organizational). The article also explores how the presence of worker representatives and anti-COVID-19 protective measures are distributed according to workers' socio-professional characteristics and company features. METHODS: This is a cross-sectional study based on an online survey conducted in Spain (n = 19,452 workers). Multiple Correspondence Analysis was used for the multivariate description while the association between worker representation and protective measures was assessed by robust Poisson regressions. RESULTS: The maps resulting from the Multiple Correspondence Analysis allow for the identification of patterns of inequalities in protection, with a clear occupational social class divide. The regression models show that protective measures are applied more frequently where worker representatives exist, this association being particularly strong in relation to organizational measures. CONCLUSIONS: The presence of worker representation is systematically associated with a greater presence of protective measures, which could have implications for the reduction of social inequalities resulting from labor-management practices.

Enhanced chimp hierarchy optimization algorithm with adaptive lens imaging for feature selection in data classification.

Feature selection is a critical component of machine learning and data mining to remove redundant and irrelevant features from a dataset. The Chimp Optimization Algorithm (CHoA) is widely applicable to various optimization problems due to its low number of parameters and fast convergence rate. However, CHoA has a weak exploration capability and tends to fall into local optimal solutions in solving the feature selection process, leading to ineffective removal of irrelevant and redundant features. To solve this problem, this paper proposes the Enhanced Chimp Hierarchy Optimization Algorithm for adaptive lens imaging (ALI-CHoASH) for searching the optimal classification problems for the optimal subset of features. Specifically, to enhance the exploration and exploitation capability of CHoA, we designed a chimp social hierarchy. We employed a novel social class factor to label the class situation of each chimp, enabling effective modelling and optimization of the relationships among chimp individuals. Then, to parse chimps' social and collaborative behaviours with different social classes, we introduce other attacking prey and autonomous search strategies to help chimp individuals approach the optimal solution faster. In addition, considering the poor diversity of chimp groups in the late iteration, we propose an adaptive lens imaging back-learning strategy to avoid the algorithm falling into a local optimum. Finally, we validate the improvement of ALI-CHoASH in exploration and exploitation capabilities using several high-dimensional datasets. We also compare ALI-CHoASH with eight state-of-the-art methods in classification accuracy, feature subset size, and computation time to demonstrate its superiority.

End-of-Life Planning and the Influence of Socioeconomic Status among Black Americans: A Systematic Review.

Purpose: The purpose of this systematic review is to explore end-of-life (EOL) care planning and the impact of socioeconomic status (SES) among people who identify as Black or African American. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were used to guide and inform this systematic review process. The following academic electronic databases with publications that reflected the interdisciplinary fields related to the research objective were searched APA PsycINFO, CINHAL, PubMed, Scopus, and Social Work Abstracts. Results: After the authors conducted the search, 14 articles (from 13 studies) ultimately met the criteria for inclusion. The results substantiated significant concerns highlighted in previous literature regarding SES and its relation to EOL planning, but also revealed an absence of original work and interventions to increase engagement in EOL planning among Black and African American populations. Conclusion: Black individuals deserve an equitable EOL experience. Researchers, practitioners, and policymakers need to move towards advocacy and action to meet this important need.

Intergenerational reproduction and self-assessed mental health in adulthood in China.

Physical and mental health disparities by socioeconomic status in China are well documented but the effects of the intergenerational reproduction in socioeconomic status on adult mental health have received little attention to date. We utilized cross-sectional data from the 2017 Chinese General Social Survey to examine the significance of intergenerational socioeconomic reproduction for differences in self-assessed mental health in a national sample of Chinese adults between the ages of 23 and 65. We documented substantial elasticities between the socioeconomic status of the survey respondents and their parents: father's education, mother's education and childhood social class were all associated with both respondent education and respondent household income. We also found that associations between parental socioeconomic status and their adult children's self-assessed mental health were partly explained by the children's own socioeconomic status. However, these pathways were noticeably moderated by age cohort. Among younger people, associations between parental socioeconomic status and mental health were mostly explained by educational attainment whereas among older people associations between parental socioeconomic status and mental health were mostly explained by household income. In general, parental socioeconomic status appear to have a greater influence on the mental health of people who grew up after the Chinese economic reform of the 1970s.

Healthy aging, self-care, and choice in India: Class-based engagements with globally circulating ideologies.

Euro-American notions of successful and healthy aging are taking root globally, shaped and inflected by local cultural and political contexts. India is one place where globally inflected discourses of healthy, active, and successful aging are on the rise. However, notions about just what constitutes healthy aging and how to achieve such a goal do not play out the same way across the globe. This article explores how older Indians of diverse social classes are thinking about their own lives in relation to broader discourses of healthy aging circulating within India and abroad. Analyses of in-depth interviews with 25 individuals (11 women and 14 men, ages 57 to 81, across a range of social classes) reveal that while many among the urban elite are enjoying participating in a globally informed healthy-aging culture, such trends are not at all widespread among the non-elite. Moreover, Indians across social classes tend to interpret their own "healthy aging" goals in ways at odds with their perceptions of Western paradigms of healthy and successful aging, sometimes incorporating critiques of the West into their own reflections about health and well-being in later life. By examining how healthy-successful aging ideologies play out across divergent national-cultural and social-class contexts, our aim is to challenge universalizing models and heighten understanding of social inequalities while opening up a wider set of possibilities for imagining what it is to live meaningfully in later life.

Social class stigma and poorer health behaviors: Evidence from the eating in America study.

Although the association between objective markers of low socioeconomic status (SES) and poor health is well established, one underexamined possibility is that over and above objective SES, social class stigma-experiences and anticipation of discrimination based on social class-might undermine people's ability to engage in healthy behaviors. Participants (N = 2022) were recruited between December 2019 and January 2020 via a national Qualtrics panel that was census-matched to the U.S. population in age, gender, income, race/ethnicity, and census region. Participants completed measures of class stigma, alcohol use, disordered eating, comfort eating, sleep disturbance, physical activity, and demographics. Controlling for objective SES and demographics, generalized linear regression models indicated that class stigma was associated with significantly greater alcohol use, disordered eating, greater comfort eating, and sleep disturbance but not less physical activity. Class stigma was not associated with health behaviors after full adjustment for weight/racial discrimination and psychological factors. Results from this investigation suggest that beyond one's objective SES, the stigma associated with having low class may also contribute to poorer health behaviors.

Childhood attention-deficit hyperactivity disorder: socioeconomic inequalities in symptoms, impact, diagnosis and medication.

BACKGROUND: Children from disadvantaged backgrounds are at greater risk of attention-deficit hyperactivity disorder (ADHD)-related symptoms, being diagnosed with ADHD, and being prescribed ADHD medications. We aimed to examine how inequalities manifest across the 'patient journey', from perceptions of impacts of ADHD symptoms on daily life, to the propensity to seek and receive a diagnosis and treatment. METHODS: We investigated four 'stages': (1) symptoms, (2) caregiver perception of impact, (3) diagnosis and (4) medication, in two data sets: UK Millennium Cohort Study (MCS, analytic n ~ 9,000), with relevant (parent-reported) information on all four stages (until 14 years); and a population-wide 'administrative cohort', which includes symptoms (child health checks) and prescriptions (dispensing records), born in Scotland, 2010-2012 (analytic n ~ 100,000), until ~6 years. We described inequalities according to maternal occupational status, with percentages and relative indices of inequality (RII). RESULTS: The prevalence of ADHD symptoms and medication receipt was considerably higher in the least compared to the most advantaged children in the administrative cohort (RIIs of 5.9 [5.5-6.4] and 8.1 [4.2-15.6]) and the MCS (3.08 [2.68-3.55], 3.75 [2.21-6.36]). MCS analyses highlighted complexities between these two stages, however, those from least advantaged backgrounds, with ADHD symptoms, were the least likely to perceive impacts on daily life (15.7% vs. average 19.5%) and to progress from diagnosis to medication (44.1% vs. average 72.5%). CONCLUSIONS: Despite large inequalities in ADHD symptoms and medication, parents from the least advantaged backgrounds were less likely to report impacts of ADHD symptoms on daily life, and their children were less likely to have received medication postdiagnosis, highlighting how patient journeys differed according to socioeconomic circumstances.

Debate: Involuntary treatment and detention are a necessary part of mental health care for children and young people - a perspective from an Independent Advocate in England, United Kingdom.

This is a perspective from an Independent Advocate in England, United Kingdom on the importance of equality in the involuntary treatment of children and young people (CYP). The article highlights the need for safeguards when CYP require detention as part of their mental health care. The paper raises concern that CYP and their families who are less empowered to advocate for optimal care plans may be at risk of less satisfactory outcomes from mental health detention. It notes that CYP in the care system may be particularly vulnerable to such outcomes due to their lower levels empowerment. To mitigate this risk, services need to be proactive in reducing inequity arising from differential levels of empowerment among service users. This could be achieved by adopting strong participation and coproduction activities and ensuring access to Advocacy services for all CYP.

Exploring the Influence of Social Class and Sex on Self-Reported Health: Insights from a Representative Population-Based Study.

This study investigates the intricate interplay between social class, sex, and self-reported health (SRH) using data from the European Health Survey of Spain 2020 (EESE2020). Employing a cross-sectional design and a representative sample of 22,072 individuals, the analysis explores the persistence of disparities after adjusting for covariates, focusing on health-related variables. The study employs logistic regression models and directed acyclic graphs (DAGs) to delineate the direct effects of social class and sex on SRH, identifying a minimum adjustment set to control for confounding variables. Results reveal a gradient effect of social class on SRH, emphasizing the enduring impact of socioeconomic factors. Sex-based disparities in SRH diminish after considering additional health-related variables, highlighting the importance of a holistic approach. DAGs serve as transparent tools in disentangling complex relationships, guiding the identification of essential covariates. The study concludes that addressing health inequalities requires comprehensive strategies considering both individual health behaviours and socio-economic contexts. While recognizing limitations, such as the cross-sectional design, the findings contribute to a nuanced understanding of health disparities, informing evidence-based interventions and policies for a more equitable healthcare system.

Deficiencia de ferritina en gestantes colombianas y factores sociodemográficos asociados / Ferritin deficiency in colombian pregnant women and associated sociodemographic factors / Deficiencia de ferritina en gestantes colombianas y factores sociodemográficos asociados

Objetivo: la ferritina es importante en el almacenamiento de hierro intracelular, en una forma soluble no tóxica. Sus niveles en la gestación se la relacionan con la salud de la madre y con su descendencia. El objetivo es escribir los niveles séricos de ferritina y prevalencia de déficit de ferritina, así como los factores sociodemográficos asociados en gestantes de Colombia. Metodología: estudio transversal; análisis secundario de la Encuesta de Situación Nutricional de Colombia, 2015. Se evaluaron en 1.234 embarazadas con edades entre 12 y 48 años: sus características sociodemográficas y antropométricas, la distribución de los niveles séricos y la prevalencia de déficit de ferritina. Para estimar la asociación entre las diferentes variables sociodemográficas y los niveles séricos, o la prevalencia de déficit de ferritina, se utilizaron modelos de regresión multivariables. Resultados: la prevalencia de deficiencia de ferritina fue de 44.5 % (IC 95 % 40.1 % a 49.0 %), los niveles séricos de ferritina oscilaron entre 4 µg/L y 295,7 µg/L, con un promedio de 29.3 µg/L (IC 95 % 26,5 µg/L-32.2 µg/L). Las gestantes del segundo (OR (OR 2.19 IC 95 % 1.50 a 3.19) y tercer trimestre (OR 3.84 IC 95 % 2.68 a 5.50), aquellas que residen en la región Atlántica (OR 2.18 IC 95 % 1.25 a 3.82) y en la región Orinoquia (OR 2.41 IC 95 %1.19 a 4.88), mostraron asociación con el déficit de ferritina. Conclusión: se halló alta prevalencia en el déficit de ferritina en gestantes colombianas.

Introduction: Ferritin is important in the storage of intracellular iron, in a non-toxic soluble form. Its levels during pregnancy are related to the health of the mother and her offspring. Objective: To describe the serum ferritin levels and the prevalence of ferritin deficiency, and the associated sociodemographic factors in pregnant women in Colombia. Methodology: Cross-sectional study; secondary analysis of the Nutritional Situation Survey of Colombia, 2015. The following were evaluated in 1,234 pregnant women aged between 12 and 48 years: their sociodemographic and anthropometric characteristics, the distribution of serum levels, and the prevalence of ferritin deficiency. To estimate the association between the different sociodemographic variables and serum levels, or the prevalence of ferritin deficiency, multivariate regression models were used. Results: The prevalence of ferritin deficiency was 44.5% (95% CI 40.1% to 49.0%), serum ferritin levels ranged from 4 µg/L to 295.7 µg/L, with a average of 29.3 µg/L (95% CI 26.5 µg/L - 32.2 µg/L). Pregnant women in the second (OR (OR 2.19 95% CI 1.50 to 3.19) and third trimester (OR 3.84 95% CI 2.68 to 5.50), those residing in the Atlantic region ( OR 2.18 95% CI 1.25 to 3.82) and in the Orinoquia region (OR 2.41 95% CI 1.19 to 4.88), showed an association with ferritin deficiency. Conclusion: A high prevalence of ferritin deficiency was found in Colombian pregnant women.

University education facilitates uptake of disease-modifying therapies for multiple sclerosis: A community-based study using the UK MS Register.

BACKGROUND: Higher education is associated with better job opportunities and higher income. OBJECTIVES: Herein, the impact of education on the uptake of disease-modifying therapies (DMTs) for multiple sclerosis (MS) in a publicly funded health care system was examined using the UK MS Register. METHODS: All adult participants with relapsing remitting MS diagnosed between 2008 and 2021 were included. Those without data regarding their education levels were excluded. Binary, multinomial and Cox regression models were used to examine the association between education levels and uptake of DMTs. RESULTS: A total of 6317 participants fulfilled all inclusion and exclusion criteria. A total of 1826/2923 (62%) participants with a university education were treated with DMTs, compared to 1788/3394 (53%) participants with school/diploma received DMTs with an odds ratio of 1.318 (1.178-1.473). Participants with a university education were more likely to be treated with both moderate- and high-efficacy DMTs, compared to others, with odds ratios of 1.227 (1.087-1.385) and 1.545 (1.325-1.802), respectively. University education was also a positive predictor for faster initiation of DMTs, and, importantly, higher-efficacy DMTs. CONCLUSION: In a publicly funded health care system, despite intended equality of access, university education was associated with a higher uptake of DMTs.