Socioeconomic status and health in Australia

Urban disadvantage and delayed nephrology referral in Australia

This paper explores the relationship between area level measures of social disadvantage and the late referral of patients with end-stage renal disease (ESRD) to a nephrologist. Patients who were referred late were those who needed to commence dialysis within 3 months of referral to a nephrologist. Late referral has been associated with increased morbidity and mortality. We studied 3334 patients who started ESRD treatment in Australian capital cities between 1 April 1995 and 31 December 1998. The proportion referred late varied between areas, was higher in areas of greater disadvantage and was significantly related to the age- and sex-standardised incidence of ESRD. This may indicate inequitable access to optimal pre-ESRD care.

Socioeconomic differences among Australian adults in consumption of fruit and vegetables and intakes of vitamins A, C and folate

OBJECTIVE

To determine whether socioeconomic groups differ in their food intakes for fruit and vegetables, their consumption of fruit and vegetables dense in vitamin A, folate and vitamin C, and their nutrient intakes of vitamin C, folate and vitamin A.

METHODS

The 1995 Australian National Nutrition Survey collected food intake data from 8883 adults aged 18-64 years using a 24-h dietary recall. Fruit and vegetables were measured as amount (g) consumed. Intakes of nutrients were estimated from the 24-h dietary recall data. Participants were categorized by whether or not they consumed fruit or vegetables high in vitamin A, folate and vitamin C. Gross annual household income was used to measure socioeconomic position.

RESULTS

Participants from low-income households consumed a smaller quantity of fruit and vegetables. They were also less likely to consume fruit and vegetables high in vitamin C, folate and vitamin A. Consistent with these findings, men and women from disadvantaged socioeconomic groups had lower intakes of vitamin C and folate compared with their more affluent counterparts. These differences were small to moderate in magnitude. Vitamin A intakes were not significantly related to income.

CONCLUSION

As well as promoting healthy dietary practices, nutrition-promotion strategies should target the nutrient intakes of lower socioeconomic groups. These programmes should focus on improving the quantity and choice of fruit and vegetables consumed by people from low-income households.

Socio-economic differences in fruit and vegetable consumption among Australian adolescents and adults

OBJECTIVES

To determine whether socio-economic groups differ in their fruit and vegetable consumption, and the variety eaten, and whether socio-economic differences are similar for adolescents and adults. The study also examined whether socio-economic groups vary in their reported desire to increase the amount of fruit and vegetables consumed, and the perceived barriers to achieving this.

DESIGN, SETTING AND SUBJECTS

The 1995 Australian National Nutrition Survey collected fruit and vegetable intake data from adolescents aged 13-17 years and adults 18-64 years using a 24-hour dietary recall. Gross annual household income was used to measure socio-economic position.

RESULTS

Approximately 44% of males and 34% of females did not consume fruit in the 24 hours preceding the survey, and 20% of males and 17% of females did not consume vegetables. Among adolescents and adults, fruit and vegetable consumption was positively related to income. The only exception was vegetable consumption among adolescent males, which did not vary by income. Lower-income adults consumed a smaller variety of fruits and vegetables than their higher-income counterparts. Fruit and vegetable variety did not vary by income among adolescents. Lower-income adults expressed less desire to increase their fruit and vegetable consumption, and were more likely to report that price and storage were barriers to doing so. Socio-economic differences in consumption and variety were more apparent for adults than for adolescents.

CONCLUSIONS

In addition to increasing the consumption of fruits and vegetables among the general population, nutrition interventions, programmes and policy aiming to improve diet should target adolescents and adults from low socio-economic groups. Strategies should address price and storage barriers.

Social disadvantage and variation in the incidence of end-stage renal disease in Australian capital cities

OBJECTIVE

To evaluate variation in the incidence of end-stage renal disease (ESRD) within Australian capital cities. To explore the relation between the incidence of ESRD and socioeconomic disadvantage.

METHODS

We obtained data from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) regarding 5,013 patients from capital cities who started ESRD treatment between 1 April 1993 and 31 December 1998. We used the postcode at the start of treatment to calculate the average annual incidence of ESRD for each of 51 capital city regions using 1996 Census counts based on place of usual residence. We calculated standardised incidence ratios with 95% confidence intervals for each region. The standardised incidence ratios were examined in relation to the SEIFA Index of Relative Socio-economic Disadvantage (IRSD), derived from the 1996 Census. Low IRSD values indicate more disadvantaged areas.

RESULTS

There is significant variation in the standardised incidence of ESRD within capital cities. There was a significant correlation (r=-0.41, p=0.003) between the standardised incidence ratio for ESRD and the SEIFA IRSD.

CONCLUSIONS AND IMPLICATIONS

Capital city areas that are more disadvantaged have a higher incidence of ESRD. Socioeconomic factors may be important determinants of the risk of developing ESRD.

Regional variation in the incidence of end-stage renal disease in Indigenous Australians

OBJECTIVE

To evaluate regional variation in the incidence of end-stage renal disease (ESRD) in Indigenous Australians, and to examine the proximity to ESRD treatment facilities of Indigenous patients.

DESIGN

Secondary data review, with collection of primary data regarding patients' place of residence before beginning ESRD treatment.

PARTICIPANTS

Indigenous ESRD patients who commenced treatment in Australia during 1993-1998.

METHODS

We obtained data from the Australian and New Zealand Dialysis and Transplant Registry regarding 719 Indigenous patients who started ESRD treatment between 1 January 1993 and 31 December 1998. We obtained primary data from the treating renal units to determine the place of residence before beginning renal replacement therapy. We calculated the average annual incidence of ESRD for each of the 36 Aboriginal and Torres Strait Islander Commission regions using population estimates based on the 1996 Census, and calculated standardised incidence ratios with 95% confidence intervals for each region. We compared the number of cases with the treatment facilities available in each region.

MAIN OUTCOME MEASURE

Regional standardised ESRD incidence for Indigenous Australians referenced to the total resident population of Australia.

RESULTS

Standardised ESRD incidence among Indigenous Australians is highest in remote regions, where it is up to 30 times the national incidence for all Australians. In urban regions the standardised incidence is much lower, but remains significantly higher than the national incidence. Forty-eight per cent of Indigenous ESRD patients come from regions without dialysis or transplant facilities and 16.3% from regions with only satellite dialysis facilities.

CONCLUSIONS

There is marked regional variation in the incidence of ESRD among Indigenous Australians. Because of the location of treatment centres, there is inequitable access to ESRD treatment services for a significant proportion of Indigenous patients.

Losing the battle of the bulge: causes and consequences of increasing obesity

Increasing proportions of Australians are overweight or obese, a problem shared by all developed and, increasingly, developing nations. Now as many people in the world are overweight as underweight. Increasing obesity is a serious public health as well as economic problem. Its associated greater risks of high blood pressure, heart disease, osteoarthritis, type 2 diabetes, some cancers and other health problems consume considerable proportions of healthcare budgets. Health inequalities often reflect social inequalities, but with overweight there is also a male-female difference in the relationship between overweight and socioeconomic status. Health promotion campaigns are underestimating the social determinants of health, and "risk fatigue" is affecting attitudes to complying with healthy lifestyle standards. Proposals to reverse the obesity trend, such as taxing or restricting the advertising of unhealthy foods, raise contentious issues of choice and regulation.

Trends in coronary heart disease--has the socio-economic differential changed?

OBJECTIVE

To compare both trends in rates of coronary heart disease and levels of coronary risk factors between different socio-economic groups.

METHODS

Rates of coronary events for men and women aged 25 to 69 years were estimated from a population-based register in the Lower Hunter Region of New South Wales from 1985 to 1993. Risk factor levels were estimated for men and women aged 35 to 64 years from three surveys of risk factors conducted in 1983, 1988/89 and 1994 in the same study population.

RESULTS

There was a decline in major coronary events from 1985 to 1993. The greatest decline was for fatal coronary events, which fell by between 4.3% and 9.1% per year. Trends in event rates were similar for all socio-economic groups, except for trends in non-fatal definite myocardial infarction among women. Women from the areas with high socio-economic status tended to have a greater reduction in non-fatal definite myocardial infarction compared with women from low socio-economic areas. Trends in risk-factor levels were similar except the prevalence of cigarette smoking among women from the lowest quintile of socio-economic status did not decline.

CONCLUSION

Prevention strategies seem to have had a beneficial impact on this population, resulting in similar declines in rates of coronary events for all socio-economic groups. However, event rates are still high, suggesting a further reduction in mortality and morbidity is possible. This could be achieved by further reductions in smoking, cholesterol and blood pressure, especially among people from areas with low socio-economic status.

Socioeconomic determinants of health in Australia: policy responses and intervention options

Tackling socioeconomic health inequalities represents one of Australia's most challenging public health issues. Research has demonstrated that the role of physicians and other health professionals, as advocates for change in the delivery of health services, public health policy and other community-wide initiatives, is extremely important in reducing mortality and improving health outcomes. Multilevel actions to reduce health inequalities should include changes to macrolevel social and economic policies; improving living and working conditions; strengthening communities for health; improving behavioural risk factors; empowering individuals and strengthening their social networks; and improving responses from the healthcare system and associated treatment services. Australia has yet to develop a coordinated and integrated approach to addressing health disparities; however, previously successful public health interventions addressing other health issues are good starting points.