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1.
J Ambul Care Manage ; 46(1): 54-62, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36102831

RESUMEN

The socioeconomic status (SES) component of the Social Vulnerability Index ranks US counties based on the SES of county residents and was used to evaluate the impact of SES on the performance of the health care delivery system. Using Medicare fee-for-service data, the performance of the health care delivery system was evaluated based on population measures such as per capita hospital admissions, quality of care measures such as surgical mortality, postacute care measures such as readmissions, and service volume measures such as posthospitalization nursing home and rehabilitation admissions. Substantial differences in delivery system performance across SES populations were observed.


Asunto(s)
Medicare , Clase Social , Estados Unidos , Planes de Aranceles por Servicios
2.
rev.cuid. (Bucaramanga.2010) ; 13(1): 1-14, 20221213.
Artículo en Portugués | LILACS, BDENF - Enfermería, COLNAL | ID: biblio-1369166

RESUMEN

Introdução: O sedentarismo em adolescentes contribui para a ocorrência de diferentes doenças, sendo relevante investigar sobre fatores associados. Objetivo: Analisar a associação entre sedentarismo e nível socioeconômico em adolescentes de escolas públicas. Materiais e métodos: Estudo transversal, realizado com 347 adolescentes matriculados em escolas públicas do ensino médio do município de Divinópolis, Minas Gerais. A coleta de dados ocorreu no ano de 2017. O sedentarismo foi avaliado utilizando-se o International Physical Activity Questionnaire e o nível socioeconômico pelo critério da Associação Brasileira de Empresas de Pesquisa. Foi realizada estatística descritiva e analítica através de modelo de regressão logística multivariada. Resultados: Participaram da investigação 347 adolescentes. A média de idade do grupo foi de 16,4 ± 1,0 anos. Os indivíduos caracterizados como sedentários constituíram 38,9% da amostra, sendo que, destes, 66,7% eram do sexo feminino. Possuir maior nível socioeconômico diminui a probabilidade de ser sedentário (OR=0,235; p=0,021), assim como ser estudante das escolas públicas da região sudoeste aumenta essa chance(OR=2,680; p=0,04). Discussão: Os motivos pelos quais as condições socioeconômicas podem influenciar o sedentarismo são variados. A ausência de espaços públicos pode contribuir para a elevação do sedentarismo em adolescentes com menor nível socioeconômico. Conclusão: Esta investigação sinaliza a importância de investimentos públicos em políticas de estímulo à prática de atividade física para os adolescentes, em especial para os do sexo feminino e de menor nível socioeconômico.


Introduction: A sedentary lifestyle in adolescents contributes to the occurrence of different diseases, making it relevant to investigate associated factors. Objective: To analyze the association between sedentary lifestyle and socioeconomic status in adolescents from public schools. Materials and methods: Cross-sectional study, carried out with 347 adolescents enrolled in public high schools in the city of Divinópolis, Minas Gerais. Data collection took place in 2017. Sedentary lifestyle was assessed using the International Physical Activity Questionnaire and socioeconomic status using the criteria of the Brazilian Association of Research Companies. Descriptive and analytical statistics were performed using a multivariate logistic regression model. Results: 347 adolescents participated in the investigation. The mean age of the group was 16.4 ± 1.0 years. Individuals characterized as sedentary constituted 38.9% of the sample, of which 66.7% were female. Having a higher socioeconomic level decreases the probability of being sedentary (OR = 0,235; p = 0.021), just as being a student in public schools in the southwest region increases this chance (OR = 2,680; p = 0.04). Discussion: The reasons why socioeconomic conditions can influence a sedentary lifestyle are varied. The absence of public spaces can contribute to the increase in sedentary lifestyles in adolescents with lower socioeconomic status. Conclusion: This investigation highlights the importance of public investments in policies to encourage the practice of physical activity for adolescents, especially for females and lower socioeconomic status.


Introducción: El sedentarismo en los adolescentes contribuye a la ocurrencia de diferentes enfermedades, por lo que es relevante investigar los factores asociados. Objetivo: Analizar la asociación entre sedentarismo y nivel socioeconómico en adolescentes de escuelas públicas. Materiales y métodos: Estudio transversal, realizado con 347 adolescentes matriculados en escuelas secundarias públicas de la ciudad de Divinópolis, Minas Gerais. La recolección de datos tuvo lugar en 2017. El estilo de vida sedentario se evaluó mediante el Cuestionario Internacional de Actividad Física y el nivel socioeconómico según los criterios de la Asociación Brasileña de Empresas de Investigación. La estadística descriptiva y analítica se realizó mediante un modelo de regresión logística multivariante. Resultados: 347 adolescentes participaron en la investigación. La edad media del grupo fue de 16,4 ± 1,0 años. Los individuos caracterizados como sedentarios constituyeron el 38,9% de la muestra, de los cuales el 66,7% eran mujeres. Tener un nivel socioeconómico más alto disminuye la probabilidad de ser sedentario (OR = 0,235; p = 0,021), al igual que ser alumno de escuelas públicas de la región suroeste aumenta esta posibilidad (OR = 2,680; p = 0,04). Discusión: Las razones por las que las condiciones socioeconómicas pueden influir en un estilo de vida sedentario son variadas. La ausencia de espacios públicos puede contribuir al aumento de estilos de vida sedentarios en adolescentes de menor nivel socioeconómico. Conclusión: Esta investigación destaca la importancia de la inversión pública en políticas para incentivar la práctica de actividad física en adolescentes, especialmente en mujeres y estrato socioeconómico más bajo.


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Servicios de Salud Escolar , Clase Social , Adolescente , Conducta Sedentaria
3.
BMC Pregnancy Childbirth ; 22(1): 821, 2022 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-36336679

RESUMEN

INTRODUCTION: Caesarean section (C/S) rates have significantly increased across the world over the past decades. In the present population-based study, we sought to evaluate the association between C/S and neonatal mortality rates. MATERIAL AND METHODS: This retrospective ecological study included longitudinal data of 166 countries from 2000 to 2015. We evaluated the association between C/S rates and neonatal mortality rate (NMR), adjusting for total fertility rate, human development index (HDI), gross domestic product (GDP) percentage, and maternal age at first childbearing. The examinations were also performed considering different geographical regions as well as regions with different income levels. RESULTS: The C/S rate and NMR in the 166 included countries were 19.97% ± 10.56% and 10 ± 10.27 per 1000 live birth, respectively. After adjustment for confounding variables, C/S rate and NMR were found correlated (r = -1.1, p < 0.001). Examination of the relationship between C/S rate and NMR in each WHO region resulted in an inverse correlation in Africa (r = -0.75, p = 0.005), Europe (r = -0.12, p < 0.001), South-East Asia (r = -0.41, p = 0.01), and Western Pacific (r = -0.13, p = 0.02), a direct correlation in America (r = 0.06, p = 0.04), and no correlation in Eastern Mediterranean (r = 0.01, p = 0.88). Meanwhile, C/S rate and NMR were inversely associated in regions with upper-middle (r = -0.15, p < 0.001) and lower-middle (r = -0.24, p < 0.001) income levels, directly associated in high-income regions (r = 0.02, p = 0.001), and not associated in low-income regions (p = 0.13). In countries with HDI below the centralized value of 1 (the real value of 0.9), the correlation between C/S rate and NMR was negative while it was found positive in countries with HDI higher than the mentioned cut-off. CONCLUSIONS: This study indicated that NMR associated with C/S is dependent on various socioeconomic factors such as total fertility rate, HDI, GDP percentage, and maternal age at first childbearing. Further attentions to the socioeconomic status are warranted to minimize the NMR by modifying the C/S rate to the optimum cut-off.


Asunto(s)
Cesárea , Mortalidad Infantil , Recién Nacido , Humanos , Embarazo , Femenino , Estudios Retrospectivos , Factores Socioeconómicos , Clase Social , Países en Desarrollo
4.
Acta Orthop ; 93: 837-848, 2022 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-36341544

RESUMEN

BACKGROUND AND PURPOSE: Patients receiving a total hip arthroplasty (THA) are subsequently at an increased risk of cardiovascular disease (CVD). Further, socioeconomic status (SES) has an effect on CVD. We evaluated whether low SES is associated with a higher risk of readmission due to CVD after THA within 90 days in a setting with universal tax-supported healthcare. PATIENTS AND METHODS: We performed a nationwide population-based cohort study using Danish health registries from 1995 to 2017. Individual-based information on SES markers (cohabitation, education, income, and liquid assets) was obtained for all participants. The outcome was any hospital-treated CVD. The data was transformed using the pseudo-observation method to enable an estimation of the adjusted risk ratios (RRs) with 95% confidence intervals (CI) for each marker using generalized linear regression. RESULTS: Among 103,286 THA patients, 452 were hospitalized with CVD within 90 days after surgery. Low SES seemed to be associated with a small increased risk of CVD, as the RRs for any CVD were 1.1 (95% CI 0.7-1.7) for patients living alone vs. cohabiting, 1.3 (CI 0.7- .3) for low education vs. high, 1.4 (CI 0.8-2.6) for low income vs. high, and 1.3 (CI 0.8-2.1) for low liquid assets vs. high. CONCLUSION: Living alone, low education, low income, and low liquid assets seem to be associated with a small increased risk of readmission due to CVD 90 days after THA. Wide confidence intervals in risk should be considered when interpreting the study results.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Enfermedades Cardiovasculares , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Estudios de Cohortes , Factores de Riesgo , Clase Social , Sistema de Registros , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología
5.
BMJ Open ; 12(11): e055853, 2022 11 03.
Artículo en Inglés | MEDLINE | ID: mdl-36328394

RESUMEN

OBJECTIVES: To identify and investigate complex pathways to stunting among children aged 6-24 months to determine the mediating effects of dietary diversity and continued breast feeding on the association between socioeconomic factors and child stunting. DESIGN, SETTING AND PARTICIPANTS: We analysed the most recent cross-sectional Demographic and Health Survey data from Cambodia (2014). We applied structural path analysis on a sample of 1365 children to model the complex and inter-related pathways of factors determining children's height for age. Explanatory variables included a composite indicator of maternal employment, household wealth, maternal education, current breastfeeding status and dietary diversity score. Results are presented both in terms of non-standardised and standardised coefficients. OUTCOME MEASURE: The primary outcome measure was height-for-age Z-scores as a continuous measure. RESULTS: Findings suggest that children's dietary diversity and continued breast feeding mediate the association between socioeconomic status and children's height. While there was no significant direct effect of maternal education on children's height, results suggested significant indirect pathways through which maternal education effects children's height; operating through household wealth, maternal employment, dietary diversity and continued breastfeeding status (p<0.001). Most notably, 41% of the effect of maternal employment on children's height was mediated by either dietary diversity or continued breast feeding. CONCLUSION: We provide evidence to support targeted nutrition interventions which account for the different ways in which underlying socioeconomic factors influence infant and young child feeding practices, and the potential impact on child nutritional status.


Asunto(s)
Trastornos del Crecimiento , Fenómenos Fisiológicos Nutricionales del Lactante , Lactante , Niño , Femenino , Humanos , Estudios Transversales , Cambodia/epidemiología , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/etiología , Lactancia Materna , Factores Socioeconómicos , Clase Social , Estado Nutricional
6.
Transl Psychiatry ; 12(1): 478, 2022 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-36379922

RESUMEN

Differential racial and socioeconomic disparities in dementia incidence across income groups and their underlying mechanisms remain largely unknown. A retrospective cohort study examining all-cause dementia incidence across income groups was conducted linking third National Health and Nutrition Examination Surveys (NHANES III) to Centers for Medicare and Medicaid Services-Medicare data over ≤26 y of follow-up (1988-2014). Cox regression and generalized structural equations models (GSEM) were constructed among adults aged≥60 y at baseline (N = 4,592). Non-Hispanic Black versus White (NHW) adults had higher risk of dementia in age and sex-adjusted Cox regression models (HR = 1.34, 95%CI: 1.15-1.55, P < 0.001), an association that was attenuated in the SES-adjusted model (HR = 1.15, 95%CI: 1.01-1.34, P = 0.092). SES was inversely related to dementia risk overall (per Standard Deviation, HR = 0.80, 95% CI:0.69-0.92, P = 0.002, Model 2), mainly within the middle-income group. Within the lowest and middle-income groups and in socio-economic status (SES)-adjusted models, Mexican American participants were at lower all-cause dementia risk compared with their NHW counterparts. GSEM models further detected 3 pathways explaining >55% of the total effect of SES on dementia risk (Total effect = -0.160 ± 0.067, p = 0.022), namely SES→LIFESTYLE→DEMENTIA (Indirect effect (IE) = -0.041 ± 0.014, p = 0.004), SES→LIFESTYLE→COGN→DEMENTIA (IE = -0.006 ± 0.001, p < 0.001), SES→COGN→DEMENTIA(IE = -0.040 ± 0.008, p < 0.001), with the last two remaining significant or marginally significant in the uppermost income groups. Diet and social support were among key lifestyle factors involved in socio-economic disparities in dementia incidence. We provide evidence for modifiable risk factors that may delay dementia onset differentially across poverty-income ratio groups, underscoring their importance for future observational and intervention studies.


Asunto(s)
Demencia , Medicare , Adulto , Anciano , Humanos , Estados Unidos/epidemiología , Persona de Mediana Edad , Encuestas Nutricionales , Estudios Retrospectivos , Clase Social , Demencia/epidemiología , Demencia/diagnóstico , Factores Socioeconómicos
7.
Arch Osteoporos ; 17(1): 139, 2022 11 09.
Artículo en Inglés | MEDLINE | ID: mdl-36350414

RESUMEN

This study examines the relationship between socioeconomic status, comorbidities, and clinical outcomes of hip fracture patients. Lower socioeconomic status is not only associated with poorer comorbidities but is also independently impacting surgical access and outcomes. This can be considered a "double setback" in the management of hip fractures. PURPOSE: The effect of socioeconomic status on hip fracture outcomes remains controversial. We examine the relationship between SES and patient comorbidity, care access, and clinical outcomes of surgically managed hip fracture patients. METHODS: Using healthcare payor status as a surrogate for SES, patients operated for fragility hip fractures between 2013 and 2016 were dichotomised based on payor status, namely private healthcare (PRIV) versus subsidised healthcare (SUB). PRIV patients were compared with SUB patients in terms of demographic data, ASA scores, co-morbidity burden (Charlson comorbidity index, CCI), time to surgery, length of acute hospitalisation, and 90-day readmission rates. RESULTS: A total of 145 patients in group PRIV and 1146 patients in group SUB were included. SUB patients had a higher mean Charlson Co-morbidity Index (CCI) (p = 0.01), a longer length of hospitalisation (p = 0.001), an increased delay in surgery (p = 0.005), and higher 90-day readmission rates (p = 0.013). Lower SES (p = 0.01), older age (p = 0.01), higher CCI (p < 0.01), and a higher American Society of Anaesthesiologists score (ASA) (p = 0.03) were predictive of time to surgery. Lower SES (p = 0.02) and higher CCI (p < 0.001) were predictive of the length of hospitalisation. Lower SES (p = 0.04) and higher CCI (p < 0.001) were predictive of 90-day readmission rates. CONCLUSIONS: Low SES is associated with higher CCI in surgically treated hip fracture patients. However, it is independently associated with slower access to surgery, a longer hospital stay, and higher readmission rates. Hence, lower SES, with its associated higher CCI and independent impact on surgical access and outcomes, can be considered a "double setback" in the management of fragility hip fractures.


Asunto(s)
Fracturas de Cadera , Readmisión del Paciente , Humanos , Factores de Riesgo , Estudios Retrospectivos , Fracturas de Cadera/epidemiología , Fracturas de Cadera/cirugía , Comorbilidad , Clase Social , Morbilidad
8.
Sci Rep ; 12(1): 19118, 2022 Nov 09.
Artículo en Inglés | MEDLINE | ID: mdl-36352182

RESUMEN

To examine, by gender, the relationship between adverse events in childhood or adolescence and the increased risk of early mortality (before 80 years). The study sample included 941 participants of the English Longitudinal Study of Aging who died between 2007 and 2018. Data on socioeconomic status, infectious diseases, and parental stress in childhood or adolescence were collected at baseline (2006). Logistic regression models were adjusted by socioeconomic, behavioral and clinical variables. Having lived with only one parent (OR 3.79; p = 0.01), overprotection from the father (OR 1.12; p = 0.04) and having had an infectious disease in childhood or adolescence (OR 2.05; p = 0.01) were risk factors for mortality before the age of 80 in men. In women, overprotection from the father (OR 1.22; p < 0.01) was the only risk factor for mortality before the age of 80, whereas a low occupation of the head of the family (OR 0.58; p = 0.04) and greater care from the mother in childhood or adolescence (OR 0.86; p = 0.03) were protective factors. Independently of one's current characteristics, having worse socioeconomic status and health in childhood or adolescence increased the risk of early mortality in men. Parental overprotection increased the risk of early mortality in both sexes, whereas maternal care favored longevity in women.


Asunto(s)
Mortalidad Prematura , Padres , Masculino , Humanos , Adolescente , Femenino , Estudios Longitudinales , Factores Sexuales , Clase Social , Factores de Riesgo
9.
BMC Public Health ; 22(1): 2058, 2022 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-36357862

RESUMEN

BACKGROUND: To investigate environmental and social risk factors for myopia in children and adolescents in Germany. METHODS: 1437 children aged between 3 and 18 inclusive were examined as part of the LIFE Child study based in Leipzig, Germany. Information about leisure time activities and social status was ascertained by parents and children in a questionnaire. Refractive status was attained by measuring noncycloplegic autorefraction. Myopia was defined as spherical equivalent (SE) ≤ - 0.75 D. Risk factors were identified using multiple logistic regression analysis. RESULTS: In multiple logistic regression analysis, myopia was significantly associated with less frequent outdoor activity ("once a week" vs. "twice a week or more": odds ratio (OR) 4.35, 95% confidence interval (CI) 1.89-9.98, p<0.01) and longer near work sessions (1-2 h vs. < 1 h: OR 1.83, CI 1.10-3.04, p=0.02; > 3 h vs. < 1 h: OR 3.71, CI 1.43-9.61, p<0.01) after adjustment for age, sex and socioeconomic status (SES). Duration of outdoor activity, near work frequency and SES showed no significant association with myopia (p > 0.05). Children with a lower SES were involved in longer periods of outdoor and near work activities but on fewer occasions over the course of the week, although this connection was not significant. CONCLUSION: Myopia is associated with environmental factors. The present findings suggest that daily exposure to sunlight and a restriction of long-duration near work activities might protect against pathological eye growth. Prevention strategies should be implemented for children at all ages.


Asunto(s)
Miopía , Niño , Adolescente , Humanos , Preescolar , Miopía/epidemiología , Miopía/etiología , Refracción Ocular , Actividades Recreativas , Pruebas de Visión/efectos adversos , Encuestas y Cuestionarios , Factores de Riesgo , Clase Social
10.
Artículo en Inglés | MEDLINE | ID: mdl-36360833

RESUMEN

The aim of this study is threefold: (1) investigate the impact of subjective socioeconomic status on the health of older people with a further exploration of its extent, (2) explore the relationship between diverse class mobility trajectories and health disparities among older people, and (3) examine the health disparities among older people with different subjective socioeconomic statuses in groups of various class mobility. The data for this study came from the Chinese General Social Survey (CGSS) of 2017, and regression and moderation models are used. The results indicate that for each level of increase in the subjective socioeconomic status of older people, the health score significantly increased by 0.159. The health status of older people who experienced upward class mobility is significantly better than those who did not; therefore, different class mobility trajectories also shape health disparities. The moderation role of class mobility on the impact of subjective socioeconomic status on the health of older people is also confirmed. The results provide further support for the subjective socioeconomic status having a significant impact on the health of older people with different class mobility trajectories. An upward class mobility trajectory somewhat diminishes this influence. Therefore, policy interventions should be provided to enhance the subjective socioeconomic status of older people and increase their opportunities for upward class mobility.


Asunto(s)
Disparidades en el Estado de Salud , Clase Social , Humanos , Anciano , Factores Socioeconómicos , Estado de Salud
11.
Rev Bras Epidemiol ; 25(Supl 2): e220007, 2022.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-36327412

RESUMEN

OBJECTIVE: To describe the situation of food insecurity of families according to the socioeconomic characteristics and dimensions of the food system in Brumadinho, state of Minas Gerais, Brazil, after the dam rupture in Córrego do Feijão mine. METHODS: This is a descriptive study focused on households carried out from the baseline of the Brumadinho Health Project. Food insecurity, the main outcome, was assessed by the short version of the Brazilian Food Insecurity Scale. Other investigated variables were: socioeconomic data; geographic stratum of the households; family's assets; income; expenses; cultivation of food and animal husbandry for consumption. Descriptive analyses were performed comparing the food insecurity of the household according to the other variables by the χ2 test to compare the proportions. RESULTS: Of the investigated households (n=1,441), 35.1% were facing food insecurity. facing food insecurity had: lower prevalence of masonry households with coating (91.4%; 95%CI 87.7%-94.1% vs. 96.7%; 95%CI 94.9%-97.8%); highest proportion of rudimentary cesspit (16.9%; 95%CI 13.3%-21.2% vs. 9.4%; 95%CI 7.4-11.9); lower prevalence of own and paid-off homes (63.9%; 95%CI 56.8-70.5 vs. 77.3%; 95%CI 72.3-81.7); and income reduction after the dam rupture (33.0%; 95%CI 27.1-39.6 vs. 14.1%; 95%CI 11.2-17.6), when compared with those in a food security situation. CONCLUSION: The prevalence of food insecurity was high, with report of a reduction in household income after the dam rupture. Moreover, most of the households had worse structural quality and sewage outfall. These results evidence the vulnerability of families and possible violation of the human right to adequate food, denoting the urgency of continuous reparative actions.


Asunto(s)
Abastecimiento de Alimentos , Estado Nutricional , Humanos , Brasil , Estudios Transversales , Clase Social , Factores Socioeconómicos
12.
BMC Pregnancy Childbirth ; 22(1): 804, 2022 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-36324136

RESUMEN

BACKGROUND: Giving birth in health facilities with skilled birth attendants (SBAs) is one of the key efforts promoted to reduce preventable maternal deaths in sub-Saharan Africa. However, research has revealed large socioeconomic status (SES) disparities in facility-based childbirth. We seek to extend the literature on the factors underlying these SES disparities. Drawing on the Disparities in Skilled Birth Attendance (DiSBA) framework, we examined the contribution of three proximal factors-perceived need, accessibility, and quality of care-that influence the use of SBAs. METHODS: We used data from a survey conducted in Migori County, Kenya in 2016, among women aged 15-49 years who gave birth nine weeks before the survey (N = 1020). The primary outcome is facility-based childbirth. The primary predictors are wealth, measured in quintiles calculated from a wealth index based on principal component analysis of household assets, and highest education level attained. Proposed mediating variables include maternal perceptions of need, accessibility (physical and financial), and quality of care (antenatal services received and experience of care). Logistic regression with mediation analysis was used to investigate the mediating effects. RESULTS: Overall, 85% of women in the sample gave birth in a health facility. Women in the highest wealth quintile were more likely to give birth in a facility than women in the lowest quintile, controlling for demographic factors (adjusted odds ratio [aOR]: 2.97, 95% CI: 1.69-5.22). College-educated women were five times more likely than women with no formal education or primary education to give birth in a health facility (aOR: 4.96; 95% CI: 1.43-17.3). Women who gave birth in health facilities had higher perceived accessibility and quality of care than those who gave birth at home. The five mediators were estimated to account for between 15% and 48% of the differences in facility births between women in the lowest and higher wealth quintiles. CONCLUSION: Our results confirm SES disparities in facility-based childbirth, with the proximal factors accounting for some of these differences. These proximal factors - particularly perceived accessibility and quality of care - warrant attention due to their relationship with facility-birth overall, and their impact on inequities in this care.


Asunto(s)
Accesibilidad a los Servicios de Salud , Servicios de Salud Materna , Femenino , Embarazo , Humanos , Kenia , Parto Obstétrico , Instituciones de Salud , Clase Social , Parto , Encuestas y Cuestionarios , Atención Prenatal , Factores Socioeconómicos
13.
BMJ Open ; 12(11): e058777, 2022 11 07.
Artículo en Inglés | MEDLINE | ID: mdl-36343998

RESUMEN

OBJECTIVE: Examine whether the relationship between the pooled cohort equations (PCE) predicted 10-year risk for atherosclerotic cardiovascular disease (ASCVD) and absolute risk for ASCVD is modified by socioeconomic status (SES). DESIGN: Population-based longitudinal cohort study-Atherosclerosis Risk in Communities (ARIC)-investigating the development of cardiovascular disease across demographic subgroups. SETTING: Four communities in the USA-Forsyth County, North Carolina, Jackson, Mississippi, suburbs of Minneapolis, Minnesota and Washington County, Maryland. PARTICIPANTS: We identified 9782 ARIC men and women aged 54-73 without ASCVD at study visit 4 (1996-1998). PRIMARY OUTCOME MEASURES: Risk ratio (RR) differences in 10-year incident hospitalisations or death for ASCVD by SES and PCE predicted 10-year ASCVD risk categories to assess for risk modification. SES measures included educational attainment and census-tract neighbourhood deprivation using the Area Deprivation Index. PCE risk categories were 0%-5%, >5%-10%, >10%-15% and >15%. SES as a prognostic factor to estimate ASCVD absolute risk categories was further investigated as an interaction term with the PCE. RESULTS: ASCVD RRs for participants without a high school education (referent college educated) increased at higher PCE estimated risk categories and was consistently >1. Results indicate education is both a risk modifier and delineates populations at higher ASCVD risk independent of PCE. Neighbourhood deprivation did modify association but was less consistent in direction of effect. However, for participants residing in the most deprived neighbourhoods (referent least deprived neighbourhoods) with a PCE estimated risk >10%-15%, risk was significantly elevated (RR 1.65, 95% CI 1.05 to 2.59). Education and neighbourhood deprivation inclusion as an interaction term on the PCE risk score was statistically significant (likelihood ratio p≤0.0001). CONCLUSIONS: SES modifies the association between PCE estimated risk and absolute risk of ASCVD. SES added into ASCVD risk prediction models as an interaction term may improve our ability to predict absolute ASCVD risk among socially disadvantaged populations.


Asunto(s)
Aterosclerosis , Enfermedades Cardiovasculares , Masculino , Humanos , Femenino , Enfermedades Cardiovasculares/epidemiología , Medición de Riesgo/métodos , Estudios Longitudinales , Aterosclerosis/epidemiología , Factores de Riesgo , Clase Social
14.
Artículo en Inglés | MEDLINE | ID: mdl-36361206

RESUMEN

Running can improve physical health and psychological wellbeing. However, the characteristics of conducive running environments are relatively unknown. This study determines neighborhood factors that attract running and explores how age and gender mediate built environment preferences. Spatial patterns of runners in Metro Vancouver were identified using crowdsourced fitness data from Strava, a popular application for tracking physical activities. The influence of socio-economic status (SES), green and/or blue space, and urbanicity on route popularity was assessed using a Generalized Linear Model (GLM). The influence of these neighborhood variables was also calculated for runners by age and gender. The results show high neighborhood SES, the presence of green and/or blue space, and high population density are associated with increased running activities in all age and gender groups. This study contributes a novel approach to understanding conducive running environments by demonstrating the utility of crowdsourced data in combination with data about urban environments. The patterns of this large group of runners can be used to inform planning for cities that promote running, as well as seek to encourage equal participation among different ages and genders.


Asunto(s)
Características del Vecindario , Carrera , Humanos , Femenino , Masculino , Características de la Residencia , Ciudades , Clase Social
15.
Circ Heart Fail ; 15(11): e009353, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36378758

RESUMEN

BACKGROUND: Neighborhood socioeconomic status (SES) is associated with worse health outcomes, yet its relationship with in-hospital heart failure (HF) outcomes and quality metrics are underexplored. We examined the association between socioeconomic neighborhood disadvantage and in-hospital HF outcomes for patients from diverse neighborhoods in the Get With The Guidelines-Heart Failure registry. METHODS: SES-disadvantage scores were derived from geocoded US census data using a validated algorithm, which incorporated household income, home value, rent, education, and employment. We examined the association between SES-disadvantage quintiles with all-cause in-hospital mortality, adjusting for demographics and comorbidities. RESULTS: Of 593 053 patients hospitalized for HF between 2017 and 2020, 321 314 (54%) had residential ZIP Codes recorded. Patients from the most compared with least disadvantaged neighborhoods were younger (mean age 67 versus 76 years), more often Black (42% versus 9%) or Hispanic (14% versus 5%), and had higher comorbidity burden. Demographic-adjusted length of stay increased by ≈1.5 hours with each increment in worsening SES-disadvantage quintiles. Adjusted-mortality odds ratios increased with worsening SES-disadvantage quintiles (Ptrend=0.003), and was 28% higher (adjusted OR=1.28 [1.12-1.48]) for the most compared with least disadvantaged neighborhood groups. CONCLUSIONS: Patients hospitalized for HF from disadvantaged neighborhoods were younger and more often Black or Hispanic. SES disadvantage was independently associated with higher in-hospital mortality. Further research is needed to characterize care delivery patterns in disadvantaged neighborhoods and to address social determinants of health among patients hospitalized for HF. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02693509.


Asunto(s)
Insuficiencia Cardíaca , Anciano , Humanos , American Heart Association , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Sistema de Registros , Características de la Residencia , Factores de Riesgo , Clase Social , Factores Socioeconómicos , Estados Unidos/epidemiología
17.
Front Public Health ; 10: 1022790, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36388317

RESUMEN

Introduction: Studies have shown that suicide is closely related to various social factors. However, due to the restriction in the data scale, our understanding of these social factors is still limited. We propose a conceptual framework for understanding social determinants of suicide at the national level and investigate the relationships between structural determinants (i.e., gender, employment statuses, and occupation) and suicide outcomes (i.e., types of suicide, places of suicide, suicide methods, and warning signs) in South Korea. Methods: We linked a national-level suicide registry from the Korea Psychological Autopsy Center with the Social Determinants of Health framework proposed by the World Health Organization's Commission on Social Determinants of Health. Results: First, male and female suicide victims have clear differences in their typical suicide methods (fire vs. drug overdose), primary warning signs (verbal vs. mood), and places of death (suburb vs. home). Second, employees accounted for the largest proportion of murder-suicides (>30%). The proportion of students was much higher for joint suicides than for individual suicides and murder-suicides. Third, among individuals choosing pesticides as their suicide method, over 50% were primary workers. In terms of drug overdoses, professionals and laborers accounted for the largest percentage; the former also constituted the largest proportion in the method of jumping from heights. Conclusion: A clear connection exists between the investigated structural factors and various suicide outcomes, with gender, social class, and occupation all impacting suicide.


Asunto(s)
Suicidio , Humanos , Masculino , Femenino , Suicidio/psicología , Factores Sociales , Determinantes Sociales de la Salud , República de Corea/epidemiología , Clase Social
18.
BMC Public Health ; 22(1): 2036, 2022 11 07.
Artículo en Inglés | MEDLINE | ID: mdl-36344975

RESUMEN

BACKGROUND: Little research has investigated the associations between proximity to physical activity facilities and behavior-related health and the majority have focused on proximity from home address. We add to the literature by examining proximity of these facilities to work and home address and including a wide range of physical activity facilities. We assess the associations for proximity of physical activity facilities from home and work address with self-reported frequency of exercise and obesity. METHODS: Our analytical sample of 7358 participants was from the 2018 wave of the Swedish Longitudinal Occupational Survey of Health. We used logistic binomial regression adjusting for age, sex, education, civil status, individual socioeconomic status, neighborhood socioeconomic status, number of children under 12 years of age, work strain, and chronic disease. RESULTS: Longer distance from home to paid outdoor and paid indoor physical activity facilities was associated with low frequency of exercise (fully adjusted Relative Risk for both 1.01, 95% CI 1.01-1.02). Associations of any or free outdoor facility with low frequency of exercise were not robust. Findings also indicated associations between long distance from workplace to any and paid outdoor facility and low frequency of exercise. Results for obesity were in the similar direction, however, these were not statistically significant. CONCLUSION: Increased distance of paid outdoor and paid indoor physical activity facilities from home and of paid outdoor facilities from work was associated with low frequency of exercise. Longitudinal and larger studies are needed to confirm our findings, particularly regarding obesity.


Asunto(s)
Ejercicio Físico , Obesidad , Niño , Humanos , Estudios Transversales , Obesidad/epidemiología , Obesidad/terapia , Características de la Residencia , Clase Social
19.
Int J Equity Health ; 21(1): 156, 2022 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-36345031

RESUMEN

BACKGROUND: A growing body of research demonstrates that economic conditions and racial and ethnic disparities result in excessive overuse of emergency departments (EDs) by a small group of socioeconomically marginalized residents. Knowledge and understanding of these issues on the part of the healthcare team can promote equality by providing structurally competent care. This study aims to identify the major social and structural factors related to patterns of ED visits by Arab and Jewish patients in Israel, where access to health services is covered by universal national health insurance. METHODS: A cross-sectional study was conducted using questionnaires of ED patients in a tertiary care medical center in Jerusalem. The hospital is the largest of the three EDs in Jerusalem with over 90,000 adult patient visits a year. The sample was stratified by ethnicity, including 257 Jewish patients and 170 Arab patients. The outcome variable was repeat visits for the same reason to the ED within 30 days. RESULTS: There were differences between Jewish and Arab patients' social and structural characteristics, including health status, socioeconomic status, feeling of safety, and social support. There were also significant differences in some of the characteristics of health service utilization patterns, including ED repeat visits, language barriers when seeking healthcare in the community, and seeking information about medical rights. The variables associated with repeat visits were different between the two groups: among the Arab patients, repeat visits to the ED were associated with concerns about personal safety, whereas among the Jewish patients, they were associated with poverty. CONCLUSION: The study illustrates the gaps that exist between the Arab and Jewish population in Israel. The findings demonstrated significant differences between populations in both health status and access to health services. In addition, an association was found in each ethnic group between different structural factors and repeat ED requests. This study supports previous theories and findings of the relationship between structural and social factors and patterns of health services utilization.


Asunto(s)
Árabes , Judíos , Adulto , Humanos , Estudios Transversales , Servicio de Urgencia en Hospital , Clase Social , Israel/epidemiología
20.
Sci Data ; 9(1): 719, 2022 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-36418857

RESUMEN

Data on women's living conditions and socio-economic development are important for understanding and addressing the pronounced challenges and inequalities faced by women worldwide. While such information is increasingly available at the national level, comparable data at the sub-national level are missing. We here present the LivWell global longitudinal dataset, which includes a set of key indicators on women's socio-economic status, health and well-being, access to basic services and demographic outcomes. It covers 447 regions in 52 countries and includes a total of 265 different indicators. The majority of these are based on 199 Demographic and Health Surveys (DHS) for the period 1990-2019 and are complemented by extensive information on socio-economic and climatic conditions in the respective regions. The resulting dataset offers various opportunities for policy-relevant research on gender inequality, inclusive development and demographic trends at the sub-national level.


Asunto(s)
Clase Social , Condiciones Sociales , Humanos , Femenino , Factores Socioeconómicos
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