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1.
BMC Cancer ; 24(1): 467, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38622568

RESUMO

BACKGROUND: The incidence of thyroid cancer as the most common type of endocrine gland malignancy has risen more significantly than any malignancies in recent years. Estimated new cases of thyroid cancer in the United States in 2024 were 12,500 and 31,520 for men and women, respectively, and estimated deaths were 1,180 for women and 990 for men. Indices of socio-economic have been commonly used to measure the development of countries. Therefore, this study aimed to examine the correlation between indices of socioeconomic status and epidemiological indices of thyroid cancer throughout the world. In addition, this study has compared two indices of human development and a socio-demographic index. METHOD: This worldwide ecological study used data on thyroid cancer incidence, mortality, human development index (HDI), and sociodemographic index (SDI) between 1990 and 2019 from the Global Burden of Disease (GBD). We evaluated the correlation between incidence and mortality rates with socioeconomic indices by using Pearson's correlation coefficient. Furthermore, for the first time, the generalized additive model (GAM) was employed for modeling. The statistical software R, version 4.2.2, was used to conduct all statistical analyses. RESULTS: The correlation between the incidence of thyroid cancer and the HDI was significant and positive (r = 0.47, p-value < 0.001). While the correlation between thyroid cancer mortality and HDI was not statistically significant (r = 0.01, p-value = 0.076). Besides, the incidence of thyroid cancer was significantly positively correlated with SDI (r = 0.48, p-value < 0.001). The multiple GAM showed that for one unit increase in HDI, the risk of thyroid cancer was increased by 2.1 times (RR = 2.1, 95%CI = 2.04 to 2.19), and for one unit increase in SDI, the risk of thyroid cancer was shown to increase by 2.2 times. (RR = 2.2, 95%CI = 2.19 to 2.35). CONCLUSION: It has been evident that countries with higher incidence of thyroid cancer display higher socioeconomic indices. While, countries with higher socioeconomic indices, report lower mortality rates. However, based on the modeling results, it can be concluded that the SDI is slightly more useful in this regard. Therefore, examining the epidemiological indices of thyroid cancer by socio-economic indices can be useful to reflect a clear image of the distribution of this cancer in each country, and can be used for planning cancer prevention strategies.


Assuntos
Carga Global da Doença , Neoplasias da Glândula Tireoide , Masculino , Humanos , Feminino , Fatores Socioeconômicos , Neoplasias da Glândula Tireoide/epidemiologia , Classe Social , Incidência , Saúde Global , Anos de Vida Ajustados por Qualidade de Vida
2.
Int J Equity Health ; 23(1): 75, 2024 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-38627768

RESUMO

BACKGROUND: Considering that dementia is an international public health priority, several countries have developed national dementia strategies outlining initiatives to address challenges posed by the disease. These strategies aim to improve the care, support, and resources available to meet the needs of persons living with dementia and their care partners and communities. Despite the known impact of social determinants of health on dementia risk, care, and outcomes, it is unclear whether dementia strategies adequately address related inequities. This study aimed to describe whether and how national dementia strategies considered inequities associated with social determinants of health. METHODS: We conducted an environmental scan of the national dementia strategies of countries that are part of the Organisation for Economic Cooperation and Development (OECD). Included strategies had to be accessible in English or French. Sub-national or provincial plans were excluded. We synthesised information on strategies' considerations of inequity through a thematic analysis. RESULTS: Of the 15 dementia strategies that met inclusion criteria, 13 mentioned at least one inequity (M = 2.4, median = 2, range:0-7) related to Race/Ethnicity; Religion; Age; Disability; Sexual Orientation/Gender Identity; Social Class; or Rurality. Age and disability were mentioned most frequently, and religion most infrequently. Eleven strategies included general inequity-focused objectives, while only 5 had specific inequity-focused objectives in the form of tangible percentage changes, deadlines, or allocated budgets for achieving equity-related goals outlined in their strategies. CONCLUSIONS: Understanding if and how countries consider inequities in their dementia strategies enables the development of future strategies that adequately target inequities of concern. While most of the strategies mentioned inequities, few included tangible objectives to reduce them. Countries must not only consider inequities at a surface-level; rather, they must put forth actionable objectives that intend to lessen the impact of inequities in the care of all persons living with dementia.


Assuntos
Demência , Pessoas com Deficiência , Humanos , Feminino , Masculino , Identidade de Gênero , Classe Social , Etnicidade , Demência/terapia
3.
Circ Cardiovasc Qual Outcomes ; 17(4): e010090, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38597091

RESUMO

BACKGROUND: Socioeconomically disadvantaged communities in the United States disproportionately experience poor cardiovascular outcomes. Little is known about how hospitalizations and mortality for acute cardiovascular conditions have changed among Medicare beneficiaries in socioeconomically disadvantaged and nondisadvantaged communities over the past 2 decades. METHODS: Medicare files were linked with the Centers for Disease Control and Prevention's social vulnerability index to examine age-sex standardized hospitalizations for myocardial infarction, heart failure, ischemic stroke, and pulmonary embolism among Medicare fee-for-service beneficiaries ≥65 years of age residing in socioeconomically disadvantaged communities (highest social vulnerability index quintile nationally) and nondisadvantaged communities (all other quintiles) from 2003 to 2019, as well as risk-adjusted 30-day mortality among hospitalized beneficiaries. RESULTS: A total of 10 942 483 Medicare beneficiaries ≥65 years of age were hospitalized for myocardial infarction, heart failure, stroke, or pulmonary embolism (mean age, 79.2 [SD, 8.7] years; 53.9% female). Although age-sex standardized myocardial infarction hospitalizations declined in socioeconomically disadvantaged (990-650 per 100 000) and nondisadvantaged communities (950-570 per 100 000) from 2003 to 2019, the gap in hospitalizations between these groups significantly widened (adjusted odds ratio 2003, 1.03 [95% CI, 1.02-1.04]; adjusted odds ratio 2019, 1.14 [95% CI, 1.13-1.16]). There was a similar decline in hospitalizations for heart failure in socioeconomically disadvantaged (2063-1559 per 100 000) and nondisadvantaged communities (1767-1385 per 100 000), as well as for ischemic stroke, but the relative gap did not change for both conditions. In contrast, pulmonary embolism hospitalizations increased in both disadvantaged (146-184 per 100 000) and nondisadvantaged communities (153-184 per 100 000). By 2019, risk-adjusted 30-day mortality was similar between hospitalized beneficiaries from socioeconomically disadvantaged and nondisadvantaged communities for myocardial infarction, heart failure, and ischemic stroke but was higher for pulmonary embolism (odds ratio, 1.10 [95% CI, 1.01-1.20]). CONCLUSIONS: Over the past 2 decades, hospitalizations for most acute cardiovascular conditions decreased in both socioeconomically disadvantaged and nondisadvantaged communities, although significant disparities remain, while 30-day mortality is now similar across most conditions.


Assuntos
Insuficiência Cardíaca , AVC Isquêmico , Infarto do Miocárdio , Embolia Pulmonar , Humanos , Feminino , Idoso , Estados Unidos/epidemiologia , Masculino , Medicare , Hospitalização , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Classe Social
4.
Int J Equity Health ; 23(1): 72, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38622678

RESUMO

BACKGROUND: Social and geographical inequity in access to primary healthcare is an ongoing concern in Sweden. Digital care can potentially decrease geographical inequity. This study aimed to evaluate how urbanicity affects the utilization of a public digital primary healthcare service - PHC Online. METHODS: We performed an ecological cross-sectional study of 4,482 PHC Online visits grouped by 83 public primary healthcare centers. Multiple linear regression analysis was performed with PHC Online visits per 1,000 registered patients as the dependent variable and urbanicity (municipalities grouped by number of inhabitants), socioeconomic status (Care Need Index), and morbidity (Adjusted Clinical Groups) per primary healthcare center as independent variables. RESULTS: Utilization of PHC Online was more common among those of a younger age (median 32 years) and among women (65%). Urbanicity did not affect utilization. Lower socioeconomic status and higher morbidity had negative effects on utilization (B -3.289, p = 0.001, B -7.728, p = 0.045). CONCLUSIONS: Geographical differences based on urbanicity do not seem to affect the utilization of PHC Online. Further studies are needed to clarify a possible association to geographical barriers in access to primary healthcare, specifically accounting for factors associated with urbanicity and distance to physical clinics, and how age and sex affect such an association. Lower utilization of PHC Online in low socioeconomic status and high morbidity populations raises questions on the effect of digital primary care on equitable access to primary healthcare.


Assuntos
Disparidades em Assistência à Saúde , Classe Social , Humanos , Feminino , Adulto , Estudos Transversais , Suécia , Atenção Primária à Saúde
5.
Front Public Health ; 12: 1345866, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38596511

RESUMO

Background: Socioeconomic status inequality is an important variable in the emergence of urological diseases in humans. This study set out to investigate the association between the prevalence of overactive bladder (OAB) and the poverty income ratio (PIR) that served as a more influential indicator of socioeconomic status compared to education and occupation. Method: Data from the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2020 were used in this cross-sectional study. The association between the PIR and OAB was examined using weighted multivariate logistic regression and weighted restricted cubic splines (RCS). Additionally, interaction analysis was used for investigation to the connections between PIR and OAB in various covariate groups in order to confirm the stability of the results. Results: We observed a noteworthy inverse association between PIR and OAB after adjusting for potential confounding variables (OR = 0.87, 95% CI, 0.84-0.90, p < 0.0001). PIR was transformed into categorical variables, and the association held steady after that (1.0 < PIR <4.0 vs. PIR ≤ 1.0, OR = 0.70, 95% CI =0.63-0.77, p < 0.0001; PIR ≥ 4.0 vs. PIR ≤ 1.0, OR = 0.56, 95% CI =0.48-0.65, p < 0.0001). Additionally, RCS analysis showed that PIR and OAB had a negative nonlinear response relationship. Subgroup analyses showed that the inverse association between PIR and prevalence of OAB was stronger in obese than in nonobese individuals (P for interaction < 0.05). Conclusion: In our study, we observed a significant negative association between the PIR and the prevalence of OAB. In the future, PIR could be used as a reference standard to develop strategies to prevent and treat OAB.


Assuntos
Bexiga Urinária Hiperativa , Adulto , Humanos , Estudos Transversais , Bexiga Urinária Hiperativa/epidemiologia , Inquéritos Nutricionais , Classe Social , Renda
6.
BMC Med ; 22(1): 162, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38616257

RESUMO

BACKGROUND: The COVID-19 pandemic resulted in major inequalities in infection and disease burden between areas of varying socioeconomic deprivation in many countries, including England. Areas of higher deprivation tend to have a different population structure-generally younger-which can increase viral transmission due to higher contact rates in school-going children and working-age adults. Higher deprivation is also associated with a higher presence of chronic comorbidities, which were convincingly demonstrated to be risk factors for severe COVID-19 disease. These two major factors need to be combined to better understand and quantify their relative importance in the observed COVID-19 inequalities. METHODS: We used UK Census data on health status and demography stratified by decile of the Index of Multiple Deprivation (IMD), which is a measure of socioeconomic deprivation. We calculated epidemiological impact using an age-stratified COVID-19 transmission model, which incorporated different contact patterns and clinical health profiles by decile. To separate the contribution of each factor, we considered a scenario where the clinical health profile of all deciles was at the level of the least deprived. We also considered the effectiveness of school closures and vaccination of over 65-year-olds in each decile. RESULTS: In the modelled epidemics in urban areas, the most deprived decile experienced 9% more infections, 13% more clinical cases, and a 97% larger peak clinical size than the least deprived; we found similar inequalities in rural areas. Twenty-one per cent of clinical cases and 16% of deaths in England observed under the model assumptions would not occur if all deciles experienced the clinical health profile of the least deprived decile. We found that more deaths were prevented in more affluent areas during school closures and vaccination rollouts. CONCLUSIONS: This study demonstrates that both clinical and demographic factors synergise to generate health inequalities in COVID-19, that improving the clinical health profile of populations would increase health equity, and that some interventions can increase health inequalities.


Assuntos
COVID-19 , Adulto , Criança , Humanos , COVID-19/epidemiologia , Pandemias , Inglaterra/epidemiologia , Classe Social , Efeitos Psicossociais da Doença
7.
BMC Public Health ; 24(1): 1008, 2024 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-38605335

RESUMO

BACKGROUND: This study examined the prospective association between financial-related discrimination and psychological well-being related measures and assessed the role of financial-related discrimination in explaining socioeconomic inequalities in psychological well-being related measures. METHODS: Data of UK older adults (≥ 50 years) from the English Longitudinal Study of Ageing were used (baseline: Wave 5, 2010/2011; n = 8,988). The baseline total non-pension wealth (in tertiles: poorest, middle, richest) was used as a socioeconomic status (SES) measure. Financial-related discrimination at baseline was defined as participants who reported they had been discriminated against due to their financial status. Five psychological well-being related measures (depressive symptoms, enjoyment of life, eudemonic well-being, life satisfaction and loneliness) were examined prospectively across different follow-up periods (Waves 6, 2012/2013, 2-year follow-up; and 7, 2014/2015, 4-year follow-up). Regression models assessed associations between wealth, financial-related discrimination, and follow-up psychological measures, controlling for sociodemographic covariates and baseline psychological measures (for longitudinal associations). Mediation analysis informed how much (%) the association between wealth and psychological well-being related measures was explained by financial-related discrimination. RESULTS: Participants from the poorest, but not middle, (vs. richest) wealth groups were more likely to experience financial-related discrimination (OR = 1.97; 95%CI = 1.49, 2.59). The poorest (vs. richest) wealth was also longitudinally associated with increased depressive symptoms and decreased enjoyment of life, eudemonic well-being and life satisfaction in both 2-year and 4-year follow-ups, and increased loneliness at 4-year follow-up. Experiencing financial-related discrimination was longitudinally associated with greater depressive symptoms and loneliness, and lower enjoyment of life across follow-up periods. Findings from mediation analysis indicated that financial-related discrimination explained 3-8% of the longitudinal associations between wealth (poorest vs. richest) and psychological well-being related measures. CONCLUSIONS: Financial-related discrimination is associated with worse psychological well-being and explains a small proportion of socioeconomic inequalities in psychological well-being.


Assuntos
Envelhecimento , Bem-Estar Psicológico , Humanos , Idoso , Estudos Longitudinais , Classe Social , Pobreza , Fatores Socioeconômicos
8.
BMC Public Health ; 24(1): 1007, 2024 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-38605383

RESUMO

INTRODUCTION: Post-stroke depression (PSD) is a common neuropsychiatric complication that affects approximately one-third of stroke patients. The treatment and prognosis of this disease are poor. Socioeconomic status (SES) is closely related to health outcomes; however, only a few previous studies have focused on the association between SES and PSD. Given the substantial population of stroke patients in China, it is crucial to examine the potential risk factors associated with PSD. Conducting studies on this population and investigating the influence of economic conditions can provide valuable guiding theoretical insights into PSD prevention and management. METHODS: We used data from the 2018 China Health and Retirement Longitudinal Study and selected appropriate samples for analysis. Depression was estimated using the Center of Epidemiologic Studies Depression Scale-10, a validated tool for assessing depression in the general population. Multiple logistic regression analysis was employed to assess the association between SES and PSD and to evaluate any urban-rural differences. RESULTS: Of the 749 respondents, 370 (49.4%) had depression. Stroke patients with a middle school education demonstrated a greater risk of developing depression than those with a primary school education or below after adjusting for all control variables (odds ratio (OR) = 1.60, 95% confidence interval (CI): 1.03-2.51, P = 0.036). However, stroke patients with a high school education or above had a lower risk of developing depression than those with a primary school education or below (OR = 0.50, 95% CI: 0.28-0.88, P = 0.016). In rural areas, stroke patients with a high school or above education level had lower rates of depression than those with a primary school education or below (OR = 0.44, 95% CI: 0.21-0.91, P = 0.027). This difference was not significant in urban areas. CONCLUSIONS: SES significantly influences the occurrence of PSD, which is reflected by education attainment and annual household expenditures. Education attainment was an independent influence on PSD, with a more pronounced effect in rural versus urban areas. We hope to reduce the prevalence of PSD and enhance the comprehensive management of this disease by modifying the influencing factors. Sex, self-reported health status, activities of daily living, night-time sleep duration, and life satisfaction also influenced the occurrence of PSD.


Assuntos
Aposentadoria , Acidente Vascular Cerebral , Pessoa de Meia-Idade , Humanos , Idoso , Estudos Longitudinais , Depressão/epidemiologia , Depressão/etiologia , Atividades Cotidianas , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia , Classe Social , China/epidemiologia
9.
Beijing Da Xue Xue Bao Yi Xue Ban ; 56(2): 230-238, 2024 Apr 18.
Artigo em Chinês | MEDLINE | ID: mdl-38595238

RESUMO

OBJECTIVE: To explore the potential mechanisms of the relationship between socioeconomic status (SES) and depression of Chinese older adults through the mediating role of digital participation and health lifestyle. METHODS: Using the nationally representative data from the China Family Panel Studies in 2020, 4 846 participants aged 60 years and older were analyzed in our study. We explored the potential mechanisms of the relationship between SES and depression of Chinese older adults in the digital era through a chain multiple mediating effects model. The KHB (The Karlson, Holm, and Breen) method was used to analyze the mediating role of digital participation and health lifestyle and the proportion of mediating effect between the two was also calculated. A series of robustness tests were further conducted and the fit of the model was checked by structural equation modeling. RESULTS: The mean age of the 4 846 older adults included in this study was (68.20±5.07) years, 48.06% of whom were female and 51.94% were male. The KHB results showed that both digital participation and health lifestyle could mediate the relationship between SES and depression of older adults (P < 0.000 1) and the mediating role of health lifestyle accounted for a greater proportion than digital participation. And our study mainly found three potential pathways of SES and depression of older adults, including: (1) SES → digital participation → health lifestyle → depression, (2) SES → health lifestyle → depression, and (3) SES → depression. Structural equation modeling tests proved the overall fit of the model in this study. CONCLUSION: Our findings showed that in the digital age, in addition to the direct relationship between SES and depression of older adults, and the health lifestyle as a mediator between the relationship, there is also a sequential mediating role of digital participation and health lifestyle to reduce the risk of depression. The findings suggest that we should pay more attention to the probability of the digital divide exacerbating health inequalities and socioeconomic inequalities accumulation in the digital age and promote the co-progress of digital literacy and health literacy among older adults.


Assuntos
Estilo de Vida , Classe Social , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , China/epidemiologia
10.
Front Public Health ; 12: 1365105, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38562255

RESUMO

Introduction: Low socioeconomic status (SES) has been linked to chronic pain (CP); however, the mechanisms by which SES over the life course influences downstream CP outcomes remain unclear. Methods: This study utilizes data from the Midlife in the United States (MIDUS) survey, a prospective sample of community-dwelling individuals (N=781), to investigate the chain of risk additive model of SES in relation to CP. Additionally, the study examines the mediating role of allostatic load (AL) in the relationship between life course SES and CP. Confirmatory factor analysis was employed to capture the multidimensionality of life course SES and path analysis was used to examine the direct and indirect effects on CP. AL was computed by quartile-based summation and by latent class analysis. Results: Results indicated lower SES in MIDUS 2 was associated with greater high-interference CP odds in MIDUS 3 (OR=1.069, 95% CI=1.006-1.136, P < 0.05) and no association was found between distal SES and levels of CP interference. Similarly, no significant relationship was observed between SES and the number of CP locations. Additionally, no additive effects of SES were found, and AL did not present mediation effects on the association between life course SES and CP. Discussion: The present study emphasizes the importance of directly proximal effects of SES on CP, underscoring the need for equitable distribution of health resources and the implementation of policies focused on diminishing socioeconomic inequalities. Further research is needed to examine alternative pathways by which proximal SES impact CP.


Assuntos
Alostase , Dor Crônica , Humanos , Estados Unidos , Acontecimentos que Mudam a Vida , Estudos Prospectivos , Classe Social
11.
Int J Geriatr Psychiatry ; 39(4): e6082, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38563601

RESUMO

BACKGROUND: Stroke survivors are at high risk of coping with cognitive problems after stroke. In recent decades, the relationship between socioeconomic status (SES) and health-related outcomes has been a topic of considerable interest. Learning more about the potential impact of SES on poststroke cognitive dysfunction is of great importance. OBJECTIVE: The purpose of this systematic review and meta-analysis was to summarize the association between SES and poststroke cognitive function by quantifying the effect sizes of the existing studies. METHOD: We searched studies from PubMed, Ovid, Embase, Cochrane, Scopus, and PsychINFO up to January 30th 2024 and the references of relevant reviews. Studies reporting the risk of poststroke cognitive dysfunction as assessed by categorized SES indicators were included. The Newcastle-Ottawa scale and the Agency for Healthcare Research and Quality were used to evaluate the study quality. Meta-analyses using fixed-effect models or random-effect models based on study heterogeneity were performed to estimate the influence of SES on cognitive function after stroke, followed by subgroup analyses stratified by study characteristics. RESULTS: Thirty-four studies were eligible for this systematic review and meta-analysis. Of which, 19 studies reported poststroke cognitive impairment (PSCI) as the outcome, 13 reported poststroke dementia (PSD), one reported both PSCI and PSD, and one reported vascular cognitive impairment no dementia. The findings showed that individuals with lower SES levels had a higher risk of combined poststroke cognitive dysfunction (odds ratio (OR) = 1.91, 95% confidence interval (CI) = 1.59-2.29), PSCI (OR = 2.09, 95% CI = 1.57-2.78), and PSD (OR = 1.95, 95% CI = 1.48-2.57). Subgroup analyses stratified by SES indicators demonstrated the protective effects of education and occupation against the diagnoses of combined poststroke cognitive dysfunction, PSCI, and PSD. CONCLUSIONS: Stroke survivors belonging to a low SES are at high risk of poststroke cognitive dysfunction. Our findings add evidence for public health strategies to reduce the risk of poststroke cognitive dysfunction by reducing SES inequalities.


Assuntos
Disfunção Cognitiva , Acidente Vascular Cerebral , Humanos , Cognição , Disfunção Cognitiva/etiologia , Acidente Vascular Cerebral/complicações , Aprendizagem , Classe Social
12.
Int J Public Health ; 69: 1606784, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38586473

RESUMO

Objectives: This study aims to compare selected early childhood health risks and health outcomes of children from marginalized Roma communities (MRCs) in Slovakia with those of the majority. Methods: We obtained cross-sectional data from mother-child dyads from the majority (N = 109) and MRCs (N = 143) via questionnaires and from medical records. Socioeconomic status, health risks and health outcomes were compared using chi-square and Mann-Whitney U tests in SPSS. Results: Mothers from MRCs reported significantly worse socioeconomic status. Air quality in the households in MRCs was significantly worse, affected by heating with stoves, burning fresh wood and indoor smoking. The diet composition of children from MRCs was characterized by shorter breastfeeding and unhealthy diet composition less fresh fruits and vegetables, more processed meat products, and sweet and salty snacks. Children from MRCs more often suffered from respiratory and diarrheal diseases, used antibiotics and were hospitalized. Conclusion: The health and healthy development of children living in MRCs is endangered by various poverty-related factors. Persistent differences in exposures and health in early childhood should be a priority goal of the state's social and health policies.


Assuntos
Roma (Grupo Étnico) , Humanos , Pré-Escolar , Estudos Transversais , Classe Social , Dieta , Avaliação de Resultados em Cuidados de Saúde
13.
BMC Psychol ; 12(1): 196, 2024 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-38600603

RESUMO

Discrimination is harmful action taken against individuals or groups to protect customary relations of power and privilege. Older adults are particularly vulnerable to experiences of discrimination that adversely affect their quality of life. We use data from the Longitudinal Ageing Study of India (LASI; Wave 1; 2017-2018) to examine different contextual forces that shape the experiences of discrimination in older adults in India, specifically gender, caste, and economic condition. We used the theory of intersectionality to hypothesize that economic condition, caste, and gender combine uniquely to engender perceived discrimination in older adults. We first used a concentration index to determine the sample's pre-existing inequality levels. The concentration curve evidenced a disproportionate concentration of discrimination among people with low income. Next, we used a three-way ANCOVA to examine the effects of caste, gender, and economic condition on individuals' experiences of discrimination. A significant interaction effect of caste, gender, and economic condition [F(1, 30,394) = 8.91 p = 0.003] evidenced the compounding effects of inequalities on experiences of discrimination. Finally, we ran a moderation model to test the ameliorating effects of education on experiences of discrimination experienced by marginalized castes. The model was significant (ß= -0.192; p < 0.001), thereby supporting the proposition that increased education level can lead to an increased sense of belonging and perceptions of equal treatment, which relate negatively to perceived discrimination. Results are discussed considering intersectionality in peoples' struggles and resilience in India.


Assuntos
Discriminação Percebida , Qualidade de Vida , Humanos , Idoso , Enquadramento Interseccional , Classe Social , Índia
14.
BMC Womens Health ; 24(1): 231, 2024 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-38600481

RESUMO

BACKGROUND: Early childbearing disrupts girls' otherwise healthy growth into adulthood and adversely affects their education, livelihood, and health. Individual, sociocultural, economic, environmental, and health service-related factors contribute to childbearing among young females. In India, caste affects health outcomes despite several affirmative policies aimed at improving the health and welfare of the backward castes/tribes. However, there is a dearth of empirical evidence about the impact of caste on early childbearing, more specifically, regarding the trajectory of inter-caste disparities in early childbearing. METHOD: This study used data from all five rounds of the National Family Health Survey (NFHS) in India to assess the association between caste and early childbearing over the last three decades. All women aged 20-24 [NFHS-1 (n = 17,218), NFHS-2 (n = 15,973), NFHS-3 (n = 22,807), NFHS-4 (n = 122,955) and NFHS-5 (n = 118,700)] were considered to create a pooled data set (n = 297,653) for analysis. Bivariate analysis and binary logistic regression were conducted using Stata (v17). ArcMap (v10.8) presented the caste-wise prevalence of early childbearing among the states and Union Territories (UTs). RESULTS: Many women continue to have early childbearing despite a considerable reduction over the last three decades from 47% in 1992-93 to 15% in 2019-21. Compared to NFHS-1, the odds of early childbearing increased by 15% in NFHS-2 and, after that, declined by 42% in NFHS-3 and 64% in NFHS-4 and NFHS-5. The inter-caste disparity in early childbearing persists, albeit with a narrowing gap, with the Scheduled castes (SC) remaining the most vulnerable group. Adjusting the effects of socio-demographic and economic characteristics, SC women had significantly higher odds of early childbearing (OR = 1.07, CI = 1.04-1.11) than those from the General caste. CONCLUSION: To decrease early childbirth, a focus on adolescent marriage prevention and increasing contraceptive use among young SC women is necessary. Strengthening ongoing programs and policies targeting educational and economic empowerment of the socially weaker castes/tribes will help in reducing early childbearing. Efforts to prevent early childbearing will accelerate the achievement of the Sustainable Development Goals (SDGs)-especially those related to health, poverty, nutrition, education, and general wellbeing, in addition to protecting women's reproductive rights.


Assuntos
Pobreza , Classe Social , Adolescente , Feminino , Humanos , Escolaridade , Nível de Saúde , Índia/epidemiologia , Fatores Socioeconômicos
15.
PLoS One ; 19(4): e0301578, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38626125

RESUMO

BACKGROUND: Although most of the livelihood programmes target women, those that involve women and men have been evaluated as though men and women were a single homogenous population, with a mere inclusion of gender as an explanatory variable. This study evaluated the impact of WORTH Yetu (an economic empowerment intervention to improve livelihood outcomes) on household hunger, and household socioeconomic status (SES) among caregivers (both women and men) of orphaned and vulnerable children (OVC) in Tanzania. The study hypothesized that women and men respond to livelihood interventions differently, hence a need for gender-disaggregated impact evaluation of such interventions. METHODS: This is a secondary analysis of longitudinal data, involving caregivers' baseline (2016-2019) and follow-up (2019-2020) data from the USAID Kizazi Kipya project in 25 regions of Tanzania. Two dependent variables (ie, outcomes) were assessed; household hunger which was measured using the Household Hunger Scale (HHS), and Socioeconomic Status (SES) using the Principal Component Analysis (PCA). WORTH Yetu, a livelihood intervention implemented by the USAID Kizazi Kipya project was the main independent variable whose impact on the two outcomes was evaluated using multivariate analysis with a multilevel mixed-effects, ordinal logistic regression model with difference-in-differences (DiD) estimator for impact estimation. RESULTS: The analysis was based on 497,293 observations from 249,655 caregivers of OVC at baseline, and 247,638 of them at the follow-up survey. In both surveys, 70% were women and 30% were men. Their mean age was 49.3 (±14.5) years at baseline and 52.7 (±14.8) years at the follow-up survey. Caregivers' membership in WORTH Yetu was 10.1% at the follow-up. After adjusting for important confounders there was a significant decline in the severity of household hunger by 46.4% among WORTH Yetu members at the follow-up compared to the situation at the baseline (adjusted Odds Ratio (aOR) = 0.536, 95% Confidence Interval (CI) [0.521, 0.553]). The decline was 45.7% among women (aOR = 0.543 [0.524, 0.563]) and 47.5% among men (aOR = 0.525 [0.497, 0.556]). Regarding SES, WORTH Yetu members were 15.9% more likely to be in higher wealth quintiles at the follow-up compared to the situation at the baseline (aOR = 1.159 [1.128, 1.190]). This impact was 20.8% among women (aOR = 1.208 [1.170, 1.247]) and 4.6% among men (aOR = 1.046 [0.995, 1.101]). CONCLUSION: WORTH Yetu was associated with a significant reduction in household hunger, and a significant increase in household SES among OVC caregivers in Tanzania within an average follow-up period of 1.6 years. The estimated impacts differed significantly by gender, suggesting that women and men responded to the WORTH Yetu intervention differently. This implied that the design, delivery, and evaluation of such programmes should happen in a gender responsive manner, recognising that women and men are not the same with respect to the programmes.


Assuntos
Cuidadores , Fome , Criança , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Modelos Logísticos , Tanzânia/epidemiologia , Classe Social , Inquéritos e Questionários
16.
PLoS One ; 19(4): e0300433, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38564613

RESUMO

The current study seeks to investigate digital inequality among older adults in China, specifically examining two socially defined age groups: young-old adults (aged 60-74) and old-old adults (aged 75+). Descriptive statistics and multiple regression were used to examine the prevalence of and identify the factors associated with Internet access, usage (frequency and breadth containing 11 activities), skills, and social support. The study used data from the 2018 China Longitudinal Ageing Social Survey (CLASS) which consisted of 11,419 respondents aged 60 years and older. We found that 40.22% of older adults had access to the Internet, and 18.27% used it regularly. Socioeconomic factors played a crucial role in determining Internet access and usage, with young-old adults with higher education using the Internet more frequently, deliberately, and competently. Those with higher economic status had greater social support to use it, and the old-old adults with higher socioeconomic status were more likely to have Internet access. This study has implications for prioritizing targeted policies and interventions aimed at supporting socioeconomically disadvantaged older adults and ensuring equal opportunities for all to access and benefit from the digital world.


Assuntos
Acesso à Internet , Classe Social , Idoso , Humanos , Pessoa de Meia-Idade , China/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários , População do Leste Asiático
17.
J Korean Med Sci ; 39(12): e130, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38565179

RESUMO

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.


Assuntos
Neoplasias Hepáticas , Classe Social , Masculino , Humanos , Feminino , Estudos de Coortes , Estudos Retrospectivos , Fatores Socioeconômicos , República da Coreia/epidemiologia
18.
BMC Public Health ; 24(1): 953, 2024 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-38570765

RESUMO

OBJECTIVE: The diagnosis of hidden hearing loss (HHL) in calm state has not yet been determined, while the nutritional status is not involved in its pathogenic risk factors. In utero iron deficiency (ID) may delay auditory neural maturation in infants. We evaluated the association between ID and HHL as well as the modification effect of socioeconomic status (SES) on this association in newborns. STUDY DESIGN: We included 859 mother-newborns from the baseline of this observational northeast cohort. Data on exposure assessment included iron status [maternal hemoglobin (Hb) and neonatal heel prick serum ferritin (SF)] and SES (occupation, education and income). Auditory neural maturation was reflected by auditory brainstem response (ABR) testing and electrocochleography (ECochG). RESULTS: Iron status and SES were independently and jointly associated with the prediction of neonatal HHL by logistic and linear regression model. The mediation effects were performed by Process. ID increased absolute latency wave V, interpeak latency (IPL) III-V, and summting potentials (SP) /action potentials (AP), which were combined as HHL. Low SES showed the highest risk of HHL and the highest levels of related parameters in ID newborns. Moreover, after Corona Virus Disease 2019 (COVID-19) were positive, preschool children who experience ID in neonatal period were more likely to suffer from otitis media with effusion (OME). High SES also showed similar risk effects. CONCLUSION: Both low and high SES may strengthen the risk of ID on neonatal HHL in Northeast China.


Assuntos
Deficiências de Ferro , Mães , Lactente , Feminino , Pré-Escolar , Humanos , Recém-Nascido , 60707 , Ferro , Classe Social
19.
Eur J Gen Pract ; 30(1): 2322996, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38477291

RESUMO

Public engagement in health research is vital for addressing health disparities and promoting inclusivity among minoritised communities who often face barriers to accessing healthcare. Minoritised communities are groups, which have been made minorities by a dominant culture, race, ethnic group and/or social class and may experience health inequalities as a result. By incorporating diverse perspectives and lived experiences of minoritised communities, this approach aims to achieve contextually relevant research outcomes that reduce health inequalities and improve overall well-being. However, underrepresentation and lack of inclusivity challenges persist, necessitating the establishment of inclusive partnerships and grassroots participatory methodologies.To foster inclusive public engagement, it is important to overcome structural and cultural barriers, address socioeconomic challenges, and build trust with minoritised communities. This can be achieved by promoting a cultural shift that values inclusivity, providing comprehensive training to researchers, and collecting rigorous data on engagement demographics for transparency and accountability. Involving minoritised communities in decision-making through participatory research approaches enhances trust and yields successful outcomes. Additionally, allocating sufficient resources, collaborating in co-production, and prioritising the diverse needs and perspectives of stakeholders contribute to fostering inclusive public engagement in research.Overall, inclusive engagement practices particularly in primary care research have the potential to reduce health inequalities and cater to the unique requirements of minoritised communities, thereby creating more impactful outcomes and promoting equitable healthcare access.


There is an important need to engage with minoritised communities in primary care researchEngaging diverse communities in research helps produce relevant research to address health inequalities.The exclusion of minoritised communities from research can be addressed by taking action towards more inclusive engagement.


Assuntos
Atenção Primária à Saúde , Classe Social , Humanos
20.
World J Urol ; 42(1): 166, 2024 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-38492172

RESUMO

BACKGROUND: To investigate the influence of socioeconomic status (SES) and gender on the incidence and survival of patients with bladder cancer on a small scale within the city of Hamburg, Germany. METHODS: Patients documented in the Hamburg Cancer Registry aged ≥ 18 years with primary bladder carcinoma (ICD-10: C67, D09.0), diagnosed in the period 2004-2020 (follow-up until 31.12.2021), and residing in Hamburg were included. The patients were divided into three groups (low, intermediate, and high SES) based on the socioeconomic situation at the district level, defined by the proportion of unemployed individuals, social housing, benefit recipients according to law, etc. Relative survival in the years 2004-2020 was calculated using a period approach. RESULTS: Among the 10,659 patients included, age-standardized 5-year relative survival (5YRS) in 2004-2020 correlated with SES. The age-standardized 5YRS differed significantly between patients with high and intermediate SES vs low SES. Women with low SES had the worst 5YRS at 58.2%, while men with high SES presented the best relative 5YRS at 73.5%. This effect remained after stratification by UICC stages. Concerning incidence, there is an indication that women with low SES were more often diagnosed in higher UICC stages III or IV than women with high SES (18.3% versus 12.6%). CONCLUSIONS: The socioeconomic situation at the time of diagnosis, as well as gender, has a substantial impact on the incidence and cancer survival rates in patients with bladder cancer. Further research, including the study of patient care, is needed to better understand and address these inequalities.


Assuntos
Classe Social , Neoplasias da Bexiga Urinária , Masculino , Humanos , Feminino , Estudos Longitudinais , Incidência , Sistema de Registros , Neoplasias da Bexiga Urinária/patologia , Fatores Socioeconômicos
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